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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 5. MONITORING SYSTEM AND PROGRAMMING <br /> A segarafe Monitoring System Certification Form musf be prepared for each control panel. <br /> Wke of Monitoring System Model of Monitoring System Software Version Installed <br /> Control Panel Control Panel <br /> Ve ed er-Root TLS-350 <br /> Attach the post- erf ficatron reports if the monitoring system is capable of generating Yes No NA <br /> either, 0 Monitoring System Set-up M Alarm History Report <br /> All monitoring equipment is operational per rnanufacturers specifications? <br /> Secondary containment systems are free of damage, debris, or liquid? ❑I�' E] <br /> Are the audible and visual alarms operational? ® E) <br /> All sensors have #peen: 1} visually inspected for wiring kinks, breaks and residual on El El <br /> buildup on floats; and ) tested for functionaIityr 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 ® D El <br /> bested, 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 secencdaryr 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) Ej Sump M UDC <br /> if monitoring system alarms are relayed to a remote monitoring center, is all <br /> communication equipment operational? <br /> Describe all answer's marked nNo"or"Farb"and proposed remedy in S ecfion 9_ <br /> List all monitoring equipment either replaced or repaired in ,Section 9 <br /> Page 2 of <br />