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~ <br />~ _ <br />Monitoring System Certification <br />- ca� <br />6070'VVESTLANE <br />Dn�v/T,nXng/�e*��� —06/262Y0(��.___ <br />Results of Test it) glServici ng <br />hVA <br />,.uu.0following checklist: <br />� Comynents� <br />iVHEN!ARRK/GDATS)TE.TANKGALRDMONITOR WAS )NOP.FOUND FUSEVVASR£K4OVEDHBQ3[�/��FD/.�c�` <br />��J.TUSENS|lh/!TY. <br />-ES'[EDSENSORS BOTH PASS. <br />v*.36 2 of 3 " <br />-- <br />'x [] <br />� <br />NiA <br />NO <br />NIA <br />For pressurized piping systerns, does Vie twb;'ne autornatiuilly shut down if the pipwig se��jndiwy conUinmenl <br />fails, <br />A <br />monitoring systern detects a leak, to operate, or is elecincallydisixrinected? If yes. wll.icll sell -'ors mifiat"-. 'a <br />shut -down? (check all that apply) Sumpffrench Sensiors; Dispen�.(,� Cor�tainrrwnl Sonsijf�. <br />--- <br />' | <br />L1prevenione <br />For tank systems that utili2-, t!ie monitoring system as the primary tank ovurfill w-arning � <br />� <br />ak jil <br />�rfg <br />i <br />^ <br />_ <br />w_mn_nm_mo_p�_co_Ja*/�mm !` <br />- <br />bor below. <br />manufac.tureir name and model for all replacement parts in Sec 1 E <br />No <br />Was liquid found inside any secomdary containment systems c1csigni-,1 as di Y sy� <br />IF Water. if yes, dmxibe causes In Section E, below. <br />'~ <br />/ ! � <br />!------' <br />--- ' — / <br />Lj <br />--!_�-__|_-__-['__—___—_.___-__-______---__--______-------------'^'--____ <br />--_E <br />b6o,,i cle scribe how arid wher. these deficiem.es were or will be corrected. <br />� Comynents� <br />iVHEN!ARRK/GDATS)TE.TANKGALRDMONITOR WAS )NOP.FOUND FUSEVVASR£K4OVEDHBQ3[�/��FD/.�c�` <br />��J.TUSENS|lh/!TY. <br />-ES'[EDSENSORS BOTH PASS. <br />v*.36 2 of 3 " <br />