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Underground Storage Tank <br />Monitoring System Certification Form <br />16. 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 <br />Sensor Model Component(s) Monitored <br />Pass <br />Fail <br />L25 <br />208 <br />DISP 9-10 <br />® <br />0 <br />L26 <br />304 <br />DISP 9-10 BRINE <br />® <br />El <br />L27 <br />208 <br />DISP 11-12 <br />® <br />0 <br />L28 <br />304 <br />DISP 11-12 BRINE <br />® <br />0 <br />� <br />0 <br />� <br />0 <br />In <br />0 <br />© <br />0 <br />El <br />0 <br />E <br />0 <br />� <br />0 <br />� <br />0 <br />0 <br />0 <br />rl <br />0 <br />In <br />0 <br />Irl <br />r <br />r] <br />in <br />El <br />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 />