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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 6, SIENSC R TESTING RESLI .TS <br /> _ :..: . <br /> List only sensors tested on date of this certification. List "Sensor !D " as labeled in system programming. <br /> Additional copies of this page may be attached to accommodate all sensors tested. <br /> Sensor lD Sensor Model Component(s) Monitored Pass Fail <br /> L1 794380-323 87 Syphon Sump x ❑ <br /> L2 794380 -323 91 STP Sump x ❑ <br /> L3 794390409 91 / 87 Syphon Annular Split Tank x ❑ <br /> L4 794390409 87 Annular Tank x ❑ <br /> L5 794380-323 87 STP Sump x ❑ <br /> L6 794380-208 87 Fill Sump 1 x ❑ <br /> L7 794380-323 91 Fill Sump x p <br /> L8 794380-208 87 Fill Sump 2 x ❑ <br /> L9 794380-323 Dispenser 1 &2 x ❑ <br /> 1. 10 794380-323 Dispenser 3&4 x ❑ <br /> 1. 11 794380-323 Dispenser 5&6 x ❑ <br /> L12 794380-323 Dispenser 7 &8 x ❑ <br /> L13 794380-323 Dispenser 9 & 10 x ❑ <br /> L14 794380-323 Dispenser 11 & 12 x ❑ <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 RECEIVED <br /> OCT 1 8 2022 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT Page 3 of 6 <br />