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Underground Storage Tank <br />Monitoring System Certification Form <br />6. SENSOR TESTING RESULTS <br />List only sensors tested on date of this certification. List "Sensor /D" as labeled in system <br />programming. Additional copies of this page may be attached to accommodate all sensors tested. <br />Sensor ID <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />LFail <br />SenSor-3 <br />LS -600 <br />Turbin Sump <br />0 <br />❑ <br />Sensor -1 <br />LS -610 <br />Annular Space <br />❑ <br />Sensor -2 <br />LS -600 <br />Piping Sump <br />Q <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑i <br />❑ <br />❑ <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 3 of 16 <br />