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Urtderground Storage Tank <br /> Monitoring System Certification Form <br /> . MONITORING SYSTEM AND PROGRAMMING <br /> A separate Monitoring Sys(am Certification Form must be prepared for each control panel. <br /> Make of tonitoring System Model of Monitoring System Software Version Instai1ed <br /> Control Panel Control Panel <br /> Attach the post certrficatton reports if the monitoring systern is capable of generating Yes Na NA <br /> either; 50onitoring System et-up K Aiarm History Report <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 0 CJ <br /> buildup on floats; and ) 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 0 ❑ <br /> tested, and confirmed operational? <br /> Does the flow of fuel stop at the dispenser if a release is detected in the under- 0 ❑ <br /> dispenser containment? <br /> Does the turbine automatically strut 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? 5� 0 a <br /> (Check all that apply) p Sump ❑ UDC <br /> If monitoring system alarms are relayed to a remote monitoring center, is all ❑ 0 <br /> communication equipment operational? <br /> Descfibe aff answers marked "No"or "Fail"and proposed remedy in Section 9. <br /> List al/monitoring equip ent either replaced or repairer}in SecHon g <br /> Page 2 of 6 <br />