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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FOR ( Page 3 of 6) Monitoring Device Used Device Model # Monitoring Device Used Device Model VENT 1 TRANSITION SUMP ID : VENT f TRANSITION SUMP ID : ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor ❑ VPH Sensor UDC ID : 01 / 02 UDC ID : 03104 ® Electronic Sensor 794380-208 ® Electronic Sensor 794380-208 ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID : 05106 UDC ID : ® Electronic Sensor 794380-208 ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID : UDC ID : ❑ Electronic Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID : UDC ID : ❑ Electronic Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor Other Monitored Component ID : Other Monitored Component ID : ❑ Other (Specify in section Vll.) ❑ Other (Specify in section Vll.) Other Monitored Component ID : Other Monitored Component ID : ❑ Other (Specify in section Vll.) ❑ Other (Specify in section Vll.) Other Monitored Component ID : Other Monitored Component ID : ❑ Other (Specify in section Vll.) ❑ Other (Specify in section Vll.) Include information for every underground storage tank componentmonitored by this monitoring system control panel. If the monitoring system control eanel monitors more components than this form accommodates additional copies of these 2ages may be attached. VII. COMMENTS Use this section to provide additional comments about the inventory of the equipment certified. E - Stop - Tested & Passed . Shear Valves - Tested & Passed . 87 & 91 are Split Tank and Share Annular Space & Sensor (794390420) ID = Ider0cation, VPH = VacuunvPresSum+"rostatic. UDC = Under-DispenserContainment