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MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) Monitoring Device Used Device Model # Monitoring Device Used Device Model # Vent/Transition Sump ID : Additive Trans Sump Vent/Transition Sump ID : Unleaded Vent Sump ® Sump Sensor 794380 - 323 ® Sump sensor 794380 -323 ® VPH Sensor 794380 -304 ® VPH Sensor 794380 -304 UDC ID : 1 & 2 UDC ID : 3 & 4 ® Electronic Sensor 794380 -323 ® Electronic Sensor 794380 - 323 ® Mechanical Device OPW Shear Valve M Mechanical Device OPW Shear Valve ® VPH Sensor 794380 -304 ® VPH Sensor 794380 -304 UDC ID : 5 & 6 UDC ID : 7 & 8 ® Electronic Sensor 794380 -323 ® Electronic Sensor 794380- 323 ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve ® VPH Sensor 794380 - 304 ® VPH Sensor 794380 -304 UDC ID : 9 & 10 UDC ID : 11 & 12 ® Electronic Sensor 794380 -323 ® Electronic Sensor 794380 -323 ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve ® VPH Sensor 794380- 304 ® VPH Sensor 794380 - 304 UDC ID : 13 & 14 UDC ID : 15 & 16 ® Electronic Sensor 794380 -323 M Electronic Sensor 794380 -323 ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve ® VPH Sensor 794380 - 304 ® VPH Sensor 794380 - 304 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 : El (Specify in section Vll.) El Other (Specify in section Vll.) I Other Monitored Component ID : Other Monitored Component ID : ElOther (Specify in section VII.) El Other (Specify in section Vll.) Other Monitored Component ID : Other Monitored Component ID : 1 ElOther (Specify in section Vll.) El Other (Specify in section Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring I system control panel monitors more components than this form accommodates, additional copies of these pages may be attached. VIII . COMMENTS Use this section to provide any additional comments about the inventory of the equipment certified. T4 Unleaded Additive has a shared Fill and STP sump . All sensors are covered in Piping sump listing .