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AFORDA-TETT 2O'P 79 1 t_, 1 1 2 <br /> PO E3 36 20115 N SACI"O. DL. Continuous Monitoring <br /> 'r•}-f0RN•i•oN. CA. 95686 <br /> Device Certification <br /> 209 794-0102 800524-9097 <br /> 'PEST UA'I'E (o -a(� - 3"� <br /> SITE: Y�. r� <br /> OPERATOR �, }. O, �dDt , SlAtlonll OWNER <br /> l9M ADDR M t /� t AUDIRLSS <br /> PLIOI49 PRONE <br /> MAKE AND MODEL OF MONITORING SYSTEM ���� - Jc9f r i0 <br /> r j <br /> Contents of Tank rj/`p r,,"- <br /> Capacity of Tank D/z'/ <br /> Type of Product Line: (Gravity, Suction, Pressure). <br /> INDICATE LOCATION OF THE MONFTORING SENSORS TESTED BY PLACING A YES O-R NO IN APPLICABLE 80X: <br /> Annular Space Sensor <br /> Sump Sensor r it� s <br /> Dispenser Containment Sensor j'j 0 "1 <br /> Electronic Overfill/Level ���� �Ufa- o":-J '0° <br /> Electronic In-Line Leek Detector 1)6 )0 L) <br /> Mechanical Line Leak Detector <br /> in Tank Gauging Device t o o 7 6 D <br /> INDICATE THE FOLLOYNNG BY PLACING A YES OR NO IN APPLICABLE BOX: <br /> Does the monfioring system have audible and viauai alarms? Y �, <br /> Does the turbine automatically shut-down If the system detects <br /> a leek, fails to operate or Is electronically disconnected? <br /> Is the monitoring system Installed to prevent unauthorized tampering? <br /> Is the monitoring system operabie as per the manufacturer's specifications? <br /> Which continuous monitoring devices Initiate positive shut-down of the turbine? <br /> i7_7_- 1F, T-ctr, tC Or+ I { <br /> F_�'.a(VC t3lr_�-1- h �7 - oP.' � <. C'CIH�'*'Ol}{i Y_. fXp� _, ( � �� . . =.•?'' i <br /> CERMED TESTER'S ia# <br /> SIGNATURE Of CEATIFIF-0 7ECHNICUAN <br /> PRINTED NAME OF CERTIFIED TECHNICIAN <br />