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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 ID"as labeled in system <br /> programming. Additional copies of this page may be attached to accommodate all sensors tested. <br /> Sensor lD Sensor Model Component(s) Monitored Pass Fail <br /> S 11 VAC VAPOR RETURN 0 ❑ <br /> S12 VAC 87 PRODUCT VENT 0 ❑ <br /> S13 VAC 91 PRODUCT LINE 0 ❑ <br /> S14 VAC DIESEL PRODUCT LINE VENT 0 ❑ <br /> S15 VAC 87 PRODUCT LINE 0 ❑ <br /> S16 VAC 91 VENT 0 ❑ <br /> L 1 208 DISPENSR 11-12 0 ❑ <br /> L 2 304 DISPENSER 3-4 BRINE 0 ❑ <br /> L 3 304 DIPSENSER 13-14 BRINE 0 ❑ <br /> L 4 323 DISPENSER 1-2 0 ❑ <br /> L 5 323 DISPENSER 3-4 0 0 <br /> L 6 304 DISPENSER 5-6 BRINE 0 ❑ <br /> L 7 323 DISPENSER 13-14 0 ❑ <br /> L 8 304 DISPENSER 11-12 BRINE 0 ❑ <br /> L 9 323 DIPSENSER 7-8 0 ❑ <br /> L 10 304 DISPESNER 9-10 BRINE 0 ❑ <br /> L11 304 DISPENSER 15-16 BRINE 0 ❑ <br /> L 12 323 DISPENSER 15-16 0 ❑ <br /> L 13 304 DISPENSER 7-8 BRINE 0 ❑ <br /> L 14 323 DISPENSER 5-6 0 ❑ <br /> L 15 304 DISPERNSER 1-2 BRINE 0 ❑ <br /> L 16 323 DISPENSER 9-10 0 ❑ <br /> L 17 303 DIESEL ANNULAR SPACE 0 ❑ <br /> L 18 303 87 ANNULAR SPACE 0 ❑ <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 6 <br />