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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) <br /> Moniti Device Used Device Model # Monitoring Device Used Device Model # <br /> VENT I TRANSITION SUMP ID: Vent box VENT t TRANSITION SUMP ID : <br /> ® Sump Sensor VR 794380-208 ❑ Sump Sensor <br /> ® VPH Sensor VR 7943801111304 ❑ VPH Sensor <br /> UDC ID : 111112 UDC ID : 34 <br /> ® Electronic Sensor VR 794380-208 ® Electronic Sensor VR 794380-208 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ® VPH Sensor VR 794380111,304 ® VPH Sensor VR 7943801111304 <br /> UDC ID : 5-6 UDC ID : 7-8 <br /> ® Electronic Sensor VR 7943801111208 ® Electronic Sensor VR 794380-208 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ® VPH Sensor VR 794380111,304 ® VPH Sensor VR 794380-304 <br /> UDC ID : 9- 10 UDC ID : 11 - 12 <br /> ® Electronic Sensor VR 794380-208 ® Electronic Sensor VR 794380-208 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ® VPH Sensor VR 794380-304 ® VPH Sensor VR 794380-304 <br /> UDC ID : UDC ID : <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Other Monitored Component ID: Other Monitored Component ID : <br /> ❑ Other (Specify in section Vtl.) ❑ Other (Specify in section VII.) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> C � <br /> [I Other (Specify in section It') " ❑ Other (Specify in section V11.) <br /> Other Monitored Component ID : Other Monitored Component ID: <br /> ❑ Other (Specify in section Vll.) ❑ Other (Specify in section Vll.) <br /> include information for every underground storage tank component monitored by this monitoring system control panel, if the monitoring system <br /> controlipanel monitors more components than this form accommodates additional copies of these pages may be attached. <br /> VII . COMMENTS <br /> Use this section to provide additional comments about the inventory of the equipment certified. <br /> Estops - Tested & Passed . <br /> Shear Valves - Tested & Passed . <br /> 91 & Diesel are Split Tanks and Share Annular. <br /> i <br /> 4 <br /> ID = Identification, VPH = VacuuntPressureHydrostatic, UDC = Under-Dispenser Containmerit <br />