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JUL-24-2008 16:37 Service Station Systems 488 938 8888 P.06 Monitoring System Certification Farm:Addendum for Vacuum/Pressure Interstitial Sensors i LG 163.1,Enc,YY 1. Results of VacuunVPressure Monitoring Equipment Testing This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this forth must be included with the Monitoring System Certification Form, which trust be provided to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer: itilaclel:2� -1 System Type: ❑Pressure; ❑Vacuum Sensor ID e p FCOM onent(s)Monitored by this Sensor; Sensor Functionality Test Result: ZPass; ❑ Fatl Interstitial Communication'Gest Result: Pass; ❑ Fail Cotnponent(s)Monitored by this Sensor;Sensor FunctionalityTest Result: ass; ❑ ail interstitial Communication Test Remult: Pass; ❑ Fail Components)Monitored by this Sensor: Sensor Functionality Test Result: Q Pass; ❑ aiI Interstitial Communication Test Result: Pass; ❑ Fail r� Component(s)Monitored by this Sensor: r Sensor Functionality Test Result: L�"J�,/Pass; El Fail Interstitial Communication Text Result: �asa; ❑ Fail Component(s)Monitored by this Sensor: 14,, Sensor Functionality Test Result: 2fass; ❑ Fail Interstitial Couunuttieation Test Result: [Pass; ❑ FaiI Component(s)Monitored by this Sensor: q Sensor Functionality Test Result: [Pass; ❑ Fail interstitial Cotntnutucation Test Result: Pass; ❑ Fail Component(s)Monitored by this Sensor:'D 5- 721.5-.04 kAz Sensor Functionality Test Result: Pass; t3' El Fail Interstitial Coznrnuuication Test Result: Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: 0 Pass; ❑ Fail interstitial Conununication Test result: ❑Dass; ❑ Fail I�owas interstitial communication verified`' ❑'L ale Introduced at Far End of Interstitial Space;' ❑ Gauge; © Visual nspecdon; ❑ Other(Describe in Sec.J, below) Vacuum was restored to operating levels in all interstitial spaces: 04es ❑No(If no, describe in Sec..7,below) J. Comments: Page J _of t If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuatn/pressure has been demonstrated to be communicating throughout the interstice.