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UST System Affirmative Statement of Compatibility - Page 3 of 4 Manufacturer Model or Part Year Compatibility With the Specific Product Name Number Manufactured Stored Has Been Demonstrated B Transition Sum E)Third-partyapproval (e.g., UL listing) for use with P this specific fuel. NA NA NA ElManufacturer's Affirmative Statement of Compati- bility posted on SWRCB website. ❑ Manufacturer's Affirmative Statement of Compati- bility submitted with this form. Penetration Fitting LI Third -party approval (e.g., UL listing) for use with this specific fuel. x❑ Manufacturer's Affirmative Statement of Compati- bility posted on SWRCB website. ❑ Manufacturer's Affirmative Statement of Compati- bility submitted with this form. Penetration Fitting❑ Thud -part' approval (e.g., UL listing) for use with this specific fuel. Environ (2 Auto UDC) 2000 ❑ Manufacturer's Affirmative Statement of Compati- bility posted on SWRCB website. ❑ Manufacturer's Affirmative Statement of Compati- bility submitted with this form. Penetration Fitting Lj Third -parry approval (e.g., UL listing) for use with this specific fuel. ❑ Manufacturer's Affirmative Statement of Compati- bility posted on SWRCB website. ❑ Manufacturers Affirmative Statement of Compati- bility submitted with this form. Penetration Fitting Third -party approval (e.g., UL listing) for use with this specific fuel. ❑ Manufacturers Affirmative Statement of Compati- bility posted on SWRCB website - Manufactures Affirmative Statement of Compati- bility submitted with this form. Other Component(s) That May Contact Stored Product El Third -party approval (e.g.,ULlisting) for use with this specific fuel. Emergency Shut Off Valve 10 Series Various ❑ ManuOPW 1postedonSWRCBwebsiitYementofCompati- bty ❑ Manufacturers Affirmative Statement of Compati- bility submitted with this form. Other Component(s) That May Contact Stored Product 91 this r peed -pal c fuel rovval (e.g., UL listing) for use with FE Petro Turbine STP -5-166-51 Various ❑ Manufacturers Affirmative Statement of Compati- bility posted on SWRCB website. ❑ Manufacturers Affirmative Statement of Compati- bility submitted with this form. Other Component(s) That May Contact Stored Product this specifid-partyc approval (e.g., UL listing) for use with this specific fuel. ❑ Manufacturers Affirmative Statement of Compati- bility posted on SWRCB website. ❑ Manufacturers Affirmative Statement of Compati- bility submitted with this form. Attach additional page(s) if necessary.] 1'N-1011 www.unidocs.org 3/4 - 11/16/15