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Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors <br />LG 163-1, Enc. lI <br />I. Results of Vacuum/Pressure Monitoring Equipment Testing <br />This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of <br />this form must be included with the Monitoring System Certification Form, which must be provided to the tank <br />system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the <br />local agency regulating UST systems within 30 days of test date. <br />Manufacturer: veeder root Model: vph <br />System Type: r Pressure P Vacuum <br />Sensor ID <br />" r <br />Component(s) Monitored by this Sensor:r--� <br />87- roduct <br />1 <br />Sensor Functionality Test Result: r Pass t_._? Fail <br />Interstitial Communication Test Result: ri Pass <br />.....i Fail <br />2 <br />Component(s) Monitored by this Sensor: <br />87 vent <br />Sensor Functionality Test Result: r.. Pass R Fail <br />Interstitial Communication Test Result: r Pass <br />ai I <br />3 <br />Component(s) Monitored by this Sensor: <br />vapor recovery <br />�r�--! <br />Sensor Functionality Test Result: P� Pass t....= Fail <br />Interstitial Communication Test Result: Pass <br />F Fail <br />Component(s) Monitored by this Sensor: <br />91 product <br />4 <br />Sensor Functionality Test Result: r Pass r Fail <br />Interstitial Communication Test Result: Fe Pass <br />._.' Fail <br />Component(s) Monitored by this Sensor:tt----tt <br />91 vent <br />5 <br />Sensor Functionality Test Result: !!! Pass rJ Fail <br />Interstitial Communication Test Result: Y7 Pass <br />«l Fail <br />Component(s) Monitored by this Sensor: <br />dsl product <br />6 <br />Sensor Functionality Test Result: r Pass RF" <br />Interstitial Communication Test Result: el Pass <br />....1 Fail <br />Component(s) Monitored by this Sensor:t--� <br />dsl vent <br />7 <br />Sensor Functionality Test Result: r Pass 1.....! Fail <br />Interstitial Communication Test Result: Pass <br />.....' Fail <br />Component(s) Monitored by this Sensor: <br />Sensor Functionality Test Result: r Pass r Fail <br />Interstitial Communication Test Result: ; Pass <br />w Fail <br />Component(s) Monitored by this Sensor: <br />Sensor Functionality Test Result: r Pass r Fail <br />Interstitial Communication Test Result: 1771 Pass <br />_ Fail <br />Component(s) Monitored by this Sensor: <br />Sensor Functionality Test Result: L Pass FJ Fail <br />Interstitial Communication Test Result: 171 Pass <br />Fail <br />How was interstitial communication verified? <br />!F Leak Introduced at Far End of Interstitial Space' F Gauge r 1sLu7I I n,action <br />r Other Describe in Sec. J, below <br />Vacuum was restored to operating levels in all interstitial spaces: <br />Yes r No (If no, describe in Sec. 3, below) <br />P. %,ommenis Avv enaracters max. use auuruuuar sucum a nccucu <br />S-2 AND s-6 failed because they would not see high liquid. <br />Page 4 of 4 <br />1 If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the <br />sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. <br />W0: 2302101 <br />