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RECEIVED VIA EMAIL ON 04-11-2022 <br /> UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM! CERTIFICATION FORM(Page 2 of 6) <br /> VI. INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed <br /> Veeder Root 11 TLS 350 333.05 <br /> Check the appMprlate boxes to indicate specific equipment ins ected/serviced. <br /> Monitoring Device Used Device Model# Monitoring Device Used Device Model# <br /> TANK ID: 1-Unleaded TANK ID: 2-Plus <br /> (By tank number,stored product,etc. By tank number,stored product,etc. <br /> ®In-Tank Gauging(SW Tank) VR 847390-107 ®In-Tank Gauging(SW Tank) VR 847390-107 <br /> ®Annular Space or Vault Sensor Ronan LS-3 ®Annular Space or Vault Sensor VR 794390-420 <br /> ❑VPH Sensor ❑VPH Sensor <br /> Product Piping Product Piping <br /> ❑Mechanical LLD ®Mechanical LLD RJ 116-057-5 <br /> ®Electronic LLD 8484 ❑Electronic LLD <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor VR 794380-208 ®Sump Sensor VR 794380-208 <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Fill Piping Fill Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor VR 794380-208 ®Sump Sensor VR 794380-208 <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Vent Piping Vent Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Monitorin Device Used Device Model# Monitoring Device Used Device Model# <br /> TANK ID: -Premium TANK ID: rt 4-Diesel <br /> B tank number,stored product,etc. (@Z tank number,stored product,etc. <br /> ®In-Tank Gauging(SW Tank) VR 847390-107 ®In-Tank Gauging(SW Tank) VR 847390-107 <br /> ®Annular Space or Vault Sensor Ronan LS-3 ®Annular Space or Vault Sensor Ronan LS-3 <br /> ❑VPH Sensor ❑VPH Sensor <br /> Product Piping Product Piping <br /> ❑Mechanical LLD ®Mechanical LLD VMI LD2000 <br /> ®Electronic LLD 8484 ❑Electronic LLD <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor VR 794380-208 ®Sump Sensor VR 794380-208 <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Fill Piping Fill Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor VR 794380-208 ®Sump Sensor VR 794380-208 <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Vent Piping Vent Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> ID=Identification,SW=Single-Walled,VPH=Vacuim tPressureMydrostatic,LLD=Line Leak Detector <br />