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Underground Storage Tank <br />Monitoring System Certification Form <br />Page 2 of 6 <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 <br />Control Panel <br />Model of Monitoring System <br />Control Panel <br />Software Version Installed <br />Attach the post-certification reports if the monitoring system is capable of generating <br />either; Monitoring System Set-up Alarm History Report Yes No NA <br />All monitoring equipment is operational per manufacturer’s specifications? <br />Secondary containment systems are free of damage, debris, or liquid? <br />Are the audible and visual alarms operational? <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? <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? <br />Does the flow of fuel stop at the dispenser if a release is detected in the under- <br />dispenser containment? <br />Does the turbine automatically shut down if the piping secondary containment <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? <br />(Check all that apply) Sump UDC <br />If monitoring system alarms are relayed to a remote monitoring center, is all <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 />Veeder-Root TLS-350 <br />133.06