COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

ID = Identification, SW = Single -Waled, VPH = Vacuum(Pressure"Orost-&, LLD = Line Leak Detector UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 2 of s) A. INVENTORY OF EQUIPMENT CERTIFIED A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. Make of Monitoring System Control Panel Gilbarco/Veeder Root Model of Monitoring System Control Panel EMC Software Version Installed 121.00 Check the aro riate boxes to indicate s ecitic equipment ins ected/serviced. Monitoring Device Used Device Model # Monitoring Device Used Device Model TANK ID: 01 Reg TANK ID: 02 Prem (By tank number, stored product. etc.) (Bv tank number, stoned product, etc. ❑ In -Tank Gauging (SW Tank) I ❑ In -Tank Gauging (SW Tank) 0 Annular Space or Vault Sensor VR 794390-420 0 Annular Space or Vault Sensor VR 794390-420 ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping m Mechanical LLD RJ 116-056-5 0 Mechanical LLD Vaporless LD2000 ❑ Electronic LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) Sump Sensor VR 794380-208 0 Sump Sensor VR 794390-205 ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Fill Piping FIII Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) Vent Piping ❑ VPH Sensor (Sump) Vent Piping El Sensor (Piping) [I VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recovery Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Monitoring Device Used Device Model # Monitoring Device Used Device Model # TANK ID: 03 Diesel TANK ID: (Bv tank number, stored product, etc.) (By tank number, stored product, etc. ❑ In -Tank Gauging (SW Tank) ❑ In -Tank Gauging (SW Tank) 0 Annular Space or Vault Sensor VR 794390-420 ❑ Annular Space or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping Z Mechanical LLD Vaporless LD2000 ❑ Mechanical LLD ❑ Electronic LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) Sump Sensor VR 794380-208 ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) FIII Piping FIII Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vent Piping Vent Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recovery Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) ID = Identification, SW = Single -Waled, VPH = Vacuum(Pressure"Orost-&, LLD = Line Leak Detector