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UNDERGROUNDSTORAGETANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 2 of s) <br /> VI. INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed <br /> VEEDER ROOT I TLS - 350 PLUS! 334 . 01 <br /> Check the ro riate boxes to indicatespecific equipment ins ected(serviced. <br /> MonitoringDevice Used Device Model# Monitoring Device Used Device Model# <br /> TANK ID: 87 OCTANE TANK ID: 91 OCTANE <br /> B tank number,storedproduct,e (B.y tank number,stored product,etc. <br /> ❑x In-Tank Gauging(SW Tank) M A G 7 Z In-Tank Gauging(SW Tank) M A G 7 <br /> ❑x Annular Space or Vault Sensor 3 0 3 ❑x Annular Space or Vault Sensor 3 0 3 <br /> ❑VPH Sensor ❑VPH Sensor <br /> Product Piping Product Piping <br /> ❑Mechanical LLD ❑Mechanical LLD <br /> ❑x Electronic LLD P L L D - 8 4 8 4 9 Electronic LLD P L L D - 8 4 8 4 <br /> ❑x VPH Sensor(Piping) 0 0 1 ❑x VPH Sensor(Piping) 0 0 1 <br /> ❑p Sump Sensor 2 0 8 p Sump Sensor 2 0 8 <br /> ❑x VPH Sensor(Sump) 3 0 4 ❑x VPH Sensor(Sump) 3 0 4 <br /> Fill Piping Fill Piping <br /> ❑x VPH Sensor(Piping) 0 0 1 ❑x VPH Sensor(Piping) 0 0 1 <br /> ❑p Sump Sensor 2 0 8 p Sump Sensor 2 0 8 _ <br /> 0 VPH Sensor(Sump) 3 0 4 0 VPH Sensor(Sump) 3 0 4 <br /> Vent Piping Vent Piping <br /> 0 VPH Sensor(Piping) 0 0 1 0 VPH Sensor(Piping) 0 0 1 <br /> ❑x Sump Sensor 2 0 8 ❑x Sump Sensor 2 0 8 <br /> ❑x VPH Sensor(Sump) 3 0 4 ❑x VPH Sensor(Sump) 3 0 4 <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑x VPH Sensor(Piping) 0 0 1 ❑x VPH Sensor(Piping) 0 0 1 <br /> ❑x Sump Sensor 2 0 8 ❑p Sump Sensor 2 0 8 <br /> ❑x VPH Sensor(Sump) 3 0 4 11 ❑x VPH Sensor(Sump) 3 0 4 <br /> Monitoring Device Used Device Model# monitoring Device Used Device Model# <br /> TANK ID: TANK ID: DIESEL # 2 <br /> (By tank number,stored product,e (Bv tank number,stored product,etc. _ _ <br /> ❑In-Tank Gauging(SW Tank) ❑x In-Tank Gauging(SW Tank) M A G 7 <br /> ❑Annular Space or vault Sensor ❑x Annular Space or vault Sensor SHARED W/ 91 OCT <br /> ❑VPH Sensor ❑VPH Sensor <br /> Product Piping Product Piping <br /> ❑Mechanical LLD ❑Mechanical LLD <br /> ❑Electronic LLD 9 Electronic LLD P L L D - 8 4 8 4 <br /> ❑VPH Sensor(Piping) M VPH Sensor(Piping) 0 0 1 <br /> ❑Sump Sensor 9 Sump Sensor 2 0 8 <br /> ❑VPH Sensor(Sump) Z VPH Sensor(Sump) 3 0 4 <br /> Fill Piping Fill Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑x Sump Sensor 2 0 8 <br /> ❑VPH Sensor(Sump) 0 VPH Sensor(Sump) 3 0 4 <br /> Vent Piping Vent Piping <br /> ❑VPH Sensor(Piping) ❑x VPH Sensor(Piping) 0 0 1 <br /> ❑Sump Sensor ❑x Sump Sensor 2 0 8 <br /> ❑VPH Sensor(Sump) Z VPH Sensor(Sump) 3 0 4 <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> ID=Identification,SW=Single-Waged,VPH=Vacuum/Pressure/Hydrostatic,LLD=Line Leak Detector <br />