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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 3 of s) <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> Vent/Transition Sump ID : Additive Vent Sump Vent/Transition Sump ID : <br /> ® Sump Sensor 794380-323 ❑ Sump Sensor <br /> ® VPH Sensor 794380-304 ❑ VPH Sensor <br /> uoc ID : 1 & 2 rUDC ID : 3 & 4 <br /> ® Electronic Sensor 794380-208 Electronic Sensor 794380 -208 <br /> ® Mechanical Device OPW Shear Valve Mechanical Device OPW Shear Valve <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 5 & 6 UDC ID : 7 & 8 <br /> M Electronic Sensor 794380-208 ® Electronic Sensor 794380-208 <br /> ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 9 & 10 UDC ID : 11 & 12 <br /> ® Electronic Sensor 794380-208 ® Electronic Sensor 794380-208 <br /> ® Mechanical Device OPW Shear Valve N Mechanical Device OPW Shear Valve <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : UDC ID : <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : UDC ID : <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <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 VII.) ❑ Other (Specify in section VII.) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section VII.) ❑ Other (Specify in section Vll.) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section VII.) ❑ Other (specify in section VII.) <br /> Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring <br /> system control panel monitors more components than this form accommodates, additional copies of these pages may be attached. <br /> VII . COMMENTS <br /> Use this section to provide any additional comments about the inventory of the equipment certified. <br /> T4 Additive has a shared Fill and STP sump . Fill sump sensors are covered in Piping sump listing . <br /> ID = Identification, VPH = Vacuum/Pressure/Hydrostatic, UDC = Underydispenser containment <br />