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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page s of 6) <br /> Monitorin Device Used Device Model # Monitorin Device Used Device Model # <br /> VENT / TRANSITION SUMP ID : VENT / TRANSITION SUMP ID : <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 1 -2 UDC ID : &6 <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> ❑x Mechanical Device FLOATS ❑x Mechanical Device FLOATS <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : <br /> 34 UDC ID : 7-8 <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> x❑ Mechanical Device FLOATS ❑X Mechanical Device FLOATS <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 9 = 10 UDC ID : 11 -12 <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> Z Mechanical Device FLOATS 0 Mechanical Device FLOATS <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 13 - 14 UDC ID : 15 - 16 <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> p Mechanical Device FLOATS 9 Mechanical Device FLOATS <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section Vll.) ❑ Other (Specify in section Vll) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section VIL) ❑ Other (Specify in section VIL) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section VIL) ❑ Other (Specify in section VIL) <br /> Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring system <br /> 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 additional comments about the inventory of the equipment certified. <br /> HAD TO TEST 5-6 87 FLOAT 2 TIMES THEN PASSED <br /> ID = identification, VPH = VacuumlPressure/ rostalic, UDC = Under-Dispenser Containment <br />