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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 5. MONITORING SYSTEM AND PROGRAMMING <br /> A separate Monitoring System Certiflcation Form must be prepared for each control panel. <br /> Make of Monitoring System Model Of Monitoring System Software.Version Installed <br /> Control Panel Contraf Panel <br /> Veeder Root TLS-350R 333.04 <br /> Attach the post-certification reports if the monitoring system is capable of generating Yes No NA <br /> either, 01 Monitoring System Set-up RI Alarm History Report <br /> All monitoring equipment is operational per manufacturer's specifications? 0 ll <br /> Secondary containment systems are free of damage, debris, or liquid? 0 L) <br /> Are the audible and visual alarms operational? 0 L) <br /> All sensors have been: 1) visually inspected for wiring kinks, breaks and residual 0 Lj L, <br /> buildup on Floats; and 2)tested for functionality and confirmed operational? <br /> Are all sensors installed to detect a release at the earliest opportunity in the A L) l) <br /> secondary containment? <br /> The monitoring system set-up was reviewed, and proper settings confirmed? A Lj lj <br /> Was the monitoring control panel's backup battery visually inspected,functionally A Lj Ll <br /> tested, and confirmed operational? <br /> Does the flow of fuel stop at the dispenser if a release is detected in the under- 0 L) 11 <br /> dispenser containment? <br /> Does the turbine automatically shut down if the piping secondary containment 0 Lj Lj <br /> monitoring system fails to operate or is electrically disconnected? <br /> Does the turbine automatically shut down if the piping secondary containment <br /> monitoring system detects a release? Which sensors initiate positive shut down? 0 Lj Lj <br /> (Check all that apply) ®Sump 21 IJDG <br /> If monitoring system alarms are relayed to a remote monitoring center, is all J Lj 0 <br /> communication equipment operational? <br /> Describe all 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 2of6 <br />