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Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> v. MONITORING SYSTEM AND PROGRAMMING <br /> A separate Release Detection Equipment Testing Report Form must be prepared for each <br /> monitoring system. <br /> Manufacturer of Monitoring Model of Monitoring Systern Software Version Installed <br /> System Control Panel Control Panel <br /> Bleeder-Root TL - 50 <br /> Attach the post-testing reporls if the monitoring system is capable of generating Yes No NA <br /> either: ❑ Monitoring System Set-up Report ❑ Alarm History Deport <br /> Is all release detection equipment that was tested operational per manufacturer's ❑ <br /> specifications? <br /> Is the secondary containment free of darnage, debris, or liquid? U <br /> Are the release detection audlbfe and visual alarms operational? ❑ <br /> Have all sensors been: 1) visually Inspected for wiring kinks, breaks and residual ❑ ❑ <br /> buildup on floats; and ) tested for functionality and confirmed operational? <br /> Are a]I sensors instalied to detect a release at the earliest opportunity? ❑ ❑ <br /> Was the monitoring system set-up reviewed, and proper settings confirmed? ❑ ❑ 1 <br /> Was the monitoring system's backup battery visually inspected. functionally tested. ❑ l❑ <br /> and confirmed operational? <br /> Was it confirmed that the flow of hazardous substance stops at the dispenser if a ❑ ❑ <br /> release is detected in the under-dispenser containment? <br /> Does the pressure supply pump automatically shut down if the piping secondary Q ❑ <br /> cortain men t monitoring system fails to operate or is disconnected? <br /> Does the pressure supply pump automatically shut down if the piping secondary <br /> containment monitoring system detects a release? Which sensors initiate positive 0 ❑ <br /> shut down? (Check all that apply) ❑ Containment Sump ❑ UDC <br /> If release detection alarms are relayed to a remote monitoring center, is all ❑ D <br /> communication equipment operational? <br /> If there is a ny buried single-wa 11 suction hazardous substance piping. was it <br /> confirmed using the inspection method approved by the Unified Program Agency, ❑ ❑ <br /> that the pipe contents drain tuck into the UST if the suction is released? <br /> Desciibe all answers marked " o" or 'Fail"and the proposed remedy in Section 8_ <br /> t_ist all equipment either replaced or repaired (including cleaning or adjustment) in Section 8. <br /> Page 2 of 6 <br />