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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 5. MONITORING SYSTEM AND PROGRAMMING <br /> A separate Monitoring System Certification Form must be prepared for each control panel. <br /> Make of Monitoring System Model of Monitoring System Software Version Installed <br /> Control Panel Control Panel <br /> Veeder Root TLS-350 335 <br /> Attach the post-certification reports if the monitoring system is capable of generating F Yes No NA <br /> either; L7 Monitoring System Set-up L7 Alarm History Report <br /> t <br /> All monitoring equipment is operational per manufacturer's specifications? <br /> Secondary containment systems are free of damage, debris, or liquid? <br /> Fr <br /> Are the audible and visual alarms operational? <br /> All sensors have been: 1 visuals ms ected for wirin kinks; breaks and residual � <br /> buildup an floats; and 2} tested for functionality and confirmed operational? 1 ; j <br /> Are all sensors installed to detect a release at the earliest opportunity in the <br /> Q i <br /> j ® <br /> secondary containment? <br /> The monitoring system set-up was reviewed, and proper settings confirmed? ' <br /> i <br /> Was the monitoring control panel's backup battery visually inspected, functionallyr Ll <br /> - tested, and confirmed operational? <br /> j Does the flow of fuel stop at the dispenser if a release is detected in the under11 T7 <br /> - <br /> ; dispenser containment? <br /> Does the turbine automatically shut down if the piping secondary containment E r ® [ <br /> monitoring system fails to operate or is electrically disconnected? I <br /> Does the turbine automatically shut down if the piping secondary containment j <br /> i monitoring system detects a release? Which sensors initiate positive shut down? <br /> Check all that a I Sump V1 UDC <br /> If monitoring system alarms are relayed to a remote monitoring center, is all I <br /> communication equipment operational? I <br /> Describe ail answers marked "No"or "Fail"and proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 2 of 6 <br />