COMPLIANCE INFO_2018-2019 - Laserfiche WebLink

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I. Results of Vacuum/Pressure Monitoring Equipment Testing This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the Monitoring System Certification Form, which must be provided to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Model:TLS-350 System Type: ❑Pressure;❑✓ Vacuum ;< S1 Component(s)Monitored by this Sensor: Bio-Diesel B-99 Sensor Functionality Test Result:®Pass; ❑ Fail Interstitial Communication Test Result: ❑x Pass; ❑ Fail S^ Component(s)Monitored by this Sensor: 19-20 Product L Sensor Functionality Test Result:®Pass; ❑ Fail Interstitial Communication Test Result: ®Pass; ❑ Fail 3 Component(s)Monitored by this Sensor: 21-30 Product Sensor Functionality Test Result: ®Pass; ❑ Fail Interstitial Communication Test Result: ❑x Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: E3 Pass; El Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail How was interstitial communication verified? ❑x Leak Introduced at Far End of Interstitial Space;' ❑ Gauge; ❑ Visual Inspection; ❑ Other(Describe in Sec.J, LW below as vacuum/pressure restored to operating levels in all interstitial spaces? ®Yes E]No(If no, describe in Sec.J, below) J. Comments(500 characters max.use additional sheets if needed): ' If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor,vacuum/pressure has been demonstrated to be communicating throughout the interstice. Page 4 of