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JUL-04-2008 12:01 Service Station Systems 408 938 8886 P.06 • 0 Monitoring System Certification Form:Addendum for Vucuuni/Pressure Interstitial Sensors LG 163-1,Enc.II I. Results of"'4''acumn/Pressure Monitoring Equipment Testing This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the Monitoring System Certification Form, which must be provided to the tank system ownerloperator. The ownerloperator must submit a copy of the Monitoring System Certification Forma to the local agency regulating'UST systems within 30 days of test date. Manufacturer: Veer Model: rL 6 System Type; ❑Pressure;MVacuum Sensor ID i. //s Component(s)Monitored by this Sensor: Sensor Functionality Test Result: Pass; ❑ Fail Interstitial Conununication Test Result: Pass; ❑ Fail Components)Monitored by this Sensor: oAk Sensor Functionality Test Result: ffl sass; ❑ Fail Interstitial Communication Test Result: Pass; ❑ Fail Component(s)Monitored by this Sensor; Ae l'gw A 45 Sensor Functionality Test Result:Wpass; ❑ Fail Interstitial Communication Test Result: ass; ❑ Fail 1 Component(s)Monitored by this Sensor: rL/,/j,�rfrrjrJ / 454 Sensor Functionality Test Result: ass; ❑ Fail Interstitial Communication Test Result Pass; ❑ Fail Component(s)Monitored by this Sensor: 04 45� Sensor Functionality Test Result:a pass; ❑ Fail Interstitial Communication Test Result: ass; ❑ Fail GjComponent(s)Monitored by this Sensor: ✓ d, Sensor Functionality Test Result:lvlpass; ❑ Fail Interstitial Communication Test Result: Ugla'ss; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result Pass; ❑ Fail Interstitial Communication Test Result: ass; ❑ 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 RcR ltt❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Has interstitial communication verified? Er Leak Introduced at Far End of Interstitial Space;' [] Gauge; Q Visual Inspec[iotl; ❑ Other(Describe in Sec.A below) Vacuum was restored to operating levels in all interstitial spaces: Q�Yes ❑No(If no, describe in Sec. 1, below) I comments: Page_ of ` If the sensor successfully detect., a simulated vacuunVpressure leak introduced in the interstitial space at the furthest point from the sensor,vacuum/pressure has been demonstrated to be conununicating throughout the interstice.