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Underground Storage Tank <br /> Monitoring System Certification Form <br /> Tank ID: <br /> Sensor ID Sensor Model Component(s) Monitored Pass Fail <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> U DCs: <br /> Sensor ID Sensor Model Component(s)Monitored Pass Fail <br /> 1/2 float and chain 1/2 ® ❑ <br /> 3/4 float and chain 3/4 ® ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> Describe all answers marked "No"or "Fail"and proposed remedy in Section 9. <br /> List all Monitoring equipment either replaced or repaired in Section 9. <br /> Page 5 of 9 <br />