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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 /> UDCs: <br /> Sensor ID Sensor Model Component(s) Monitored Pass Fail <br /> L1 208 1/2 ® ❑ <br /> L2 304 1/2 brine ® ❑ <br /> L3 208 3/4 ® ❑ <br /> L4 304 3/4 brine ® ❑ <br /> L5 208 5/6 ® ❑ <br /> L6 304 5/6 brine ® ❑ <br /> 0 208 7/8 ® ❑ <br /> L8 304 7/8 brine ® ❑ <br /> L9 208 9/10 ® ❑ <br /> L10 304 9/10 brine ® ❑ <br /> L11 208 11/12 ® ❑ <br /> L12 304 11/12 brine ® ❑ <br /> L13 208 vent box ® ❑ <br /> L14 304 vent box brine ® ❑ <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 />