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Jun. 26. 2020 3:39PM Donlee Pump Co No. 4053 P. 3 <br /> UNDERGROUND STORAGE TANK <br /> I� MONITORING SYSTEM CERTIFICATION FORM (Page tot s) <br /> V!: INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monlforfng system control panel. <br /> Make of Monitoring System Control Panel Madel of Monitoring System Control Panel Software Version Installed <br /> Check the appropriate boxes to ladleate speolflc agullornonf ins ectedfserviced. <br /> Monitoring Device Used Device Model tJ MonitorIng Device Used JDevice Model# <br /> Tank ID: 6 9 Tank ID: 9 1 <br /> (84 tank number,stored product,e fBy lank number,stored roducf,etc. <br /> In-lank Gauging(SW Tonk) ry p h—rN;s c In-lank Gauging(SW Tank) /"'o f.e'R <br /> Annular Space or Vault Sensor 4d Annular Space or Vault Sensor YO'7 <br /> ❑VPH Sensor ❑VPH Sensor <br /> Product PIpIng Product PI In <br /> ❑Mechanical LLD [I Mechanical LLD <br /> Elewonle LLD ?zl> 5'I�G Electronic LLD p SPGY f <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> —jySump Sensor U�tump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Fill Piping Fill PI In <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Vent Piping Vent Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping ~uW <br /> ❑VPH Sensor(Plping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Monitoring Device Used Device Model# Monitoring Device Used F Device Moder# <br /> Tank ID: p TGSi';L Tank 1D: <br /> B tank number stored roducf,etc.. _ 8 tank number,stored product,etc. <br /> In-tank Gauging(SW Tank) t"c t Y4$E El In tank Gauging(SW Tank) <br /> ❑Annular Space or Vault Sensor ❑Annular Space or Vault Sensor <br /> n VPH Sensor ❑VPH Sensor <br /> I Product Piping Product Piping <br /> ❑Mechanical LLD I ❑Mechanical LLD <br /> j0 Electronic LLD ❑Electronlc LLD <br /> I ❑YPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> Sump Sensor Z Aa ❑Sump Sensor <br /> j! []VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Fill Piping Fill Piping <br /> ;r❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> . ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> ir Vent Piping Vent Piping <br /> ❑VPH Sensor(Plping) ❑VPH Sensor(PIPing) <br /> ❑Sump Sensor 1 ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> .i Vapor Recovaq Piping Vapor Recovery Piping <br /> Cl VPH Sensor(Piping) ❑VPH Sensor(Piping) J <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPN Sensor(Sump) <br /> ID=Iden dllcalton.SW=Singie-walled.VPH Vac uurnPressurdlivdrostatic,LLD=Une leap detects' <br />