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UNDERGROUND STORAGE TANFC MONITORING SYSTEMA CERTIFICATION FORM (Page 3 of 6) Monitorin Device Used Device Model # MonitoringDevice Used Device Model # VENT / TRANSITION SUMP ID : VENT / TRANSITION SUMP ID : ❑ Sump Sensor 9 _ E] Sump Sensor ❑ VPH Sensor ❑ VPH Sensor UDC ID : 1 -2 111 10: 34 ® Electronic Sensor 794380-208 ® Electronic Sensor 794380-208 ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID : 5-6 UDC ID : 7-8 ® Electronic Sensor 79438011,208 ® Electronic Sensor 794380-208 ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID : 9- 10 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 Other Monitored Component ID: Other Monitored Component ID: ❑ Other (Specify in section V11) ❑ Other (Specify in section Vll.) Other Monitored Component ID: Other Monitored Component ID : ❑ Other (Specify in section V11) ❑ Other (Specify in section V1/.) Other Monitored Component ID : Other Monitored Component ID: ❑ Other (Specify in section V11.) ❑ Other (Specify in section Vit.) Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring system contro! anel monitors more com onents Phan this form accommodates additJonal co tes of these pages maybe attached. VII . COMMENTS Use this section to provide additional comments about the inventory of the equipment certified. Estop - Tested & Passed . Shear Valves - Tested & Passed . Premium and Diesel Share Annular Sensor. E t ID = Identification, VPH = VacuunVIPressurefHWrostatic, UDC = Under-0isperuer Contalnment i