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.... .. ............._... <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> [_ MONITORING SYSTEM AND PROGRAMMING <br /> LA separate Monitoring System Certification Form must be prepared for each control panel. — <br /> Make of Monitoring System I Model of Monitoring System software Version Installed <br /> Control Panel <br /> Control Panel i <br /> EVeeder Root TLS-350 336 <br /> Attach the post-certification reports if the monitoring system is capaEb/e of generating <br /> =T- <br /> either: Monitorin S stem Set-u Yes {€ NA <br /> g Y_ p [[fix Alarm History Report <br /> All monitoring equipment is operational per manufacturer's specifications? � �x <br /> Secondary containment systems are free of damage, debris, or liquid? <br /> Are the audible and visual alarms operational? <br /> El r <br /> All sensors have been: 1) visually inspected for wiring kinks, breaks and residual <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 <br /> secondary containment? ® r <br /> The monitoring system set-up was reviewed, and proper settings confirmed? <br /> Was the monitoring control panel's backup battery visually inspected, functionally <br /> tested, and confirmed operational? ® E <br /> Does the flow of fuel stop at the dispenser if a release is detected in the under- ! <br /> dispenser containment? ® ® r <br /> i Does the turbine automatically shut down if the piping secondary containment <br /> monitoring system fails to operate or is electrically disconnected? ' <br /> - - _ <br /> oes the turbine- automatically shut down if the piping secondary containment <br /> monitoring system detects a release? Which sensors initiate positive shut down? ®x ® <br /> Check all that apply <br /> RR Y�. ® Sump E UDC _ <br /> Zonitoring system alarms are relayed to a remote monitoring center, is all <br /> munication equipment operational? x <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 2 of 6 <br />