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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 2 of 6) VI. INVENTORY OF EQUIPMENT CERTIFIED ID =Identification, SW= Single -Wailed, VPH = Vacuum/Pressure/H A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. Make of Monitoring System Control Panel RONAN Model of Monitoring System Control Panel X76S Version Installed =NA Check the appropriate boxes to indicatespecific equipment ins ected/serviced. Monitoring Device Used Device Model # Monitorin Device Used Device Model # TANK ID: B tank number, stored product, etc. Slop Tank ❑ In -Tank Gauging (SW Tank) TANK ID: B tank number, stored product, etc. ❑ In -Tank Gauging (SW Tank) ® Annular Space or Vault Sensor LS -7 ❑ Annular Space or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping ❑ Mechanical LLD ❑ Mechanical LLD ❑ Electronic LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ® Sump Sensor LS -3 ❑ Sump Sensor ❑ VPH Sensor (Sump) LF ❑ VPH Sensor (Sump) PF Fill Piping Fill 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 ❑ VPH Sensor (Sump) ❑ Sump Sensor ❑ 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) MonitoringDevice Used Device Model # Monitoring Device Used Device Model # TANK ID: B tank number, stored product, etc. ❑ In -Tank Gauging (SW Tank) TANK ID: B tank number, stored product,_ etc. ❑ In -Tank Gauging (SW Tank) ❑ Annular Space or Vault Sensor ❑ Annular Space or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping ❑ Mechanical LLD ❑ Mechanical LLD ❑ Electronic LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Fill Piping Fill 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 ❑ VPH Sensor (Sump) ❑ Sump Sensor ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recovery Piping ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ VPH Sensor (Piping) ❑ Sump Sensor El Sensor (Sump) El VPH Sensor (Sump) ydrostatic, LLD =Line Leak Detector