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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 <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <br />L- 1 <br />2 <br />0 <br />8 <br />DISPENSER 3/ <br />4 <br />D <br />❑ <br />L- 2 <br />2 <br />0 <br />8 <br />DISPENSER 5/ <br />6 <br />D <br />❑ <br />L- 3 <br />2 <br />0 <br />8 <br />DISPENSER 7/ <br />8 <br />D <br />❑ <br />L- 4 <br />2 <br />0 <br />8 <br />DISPENSER 9/ <br />10 <br />D <br />❑ <br />L- 5 <br />2 <br />0 <br />8 <br />REGULAR UNLEADED <br />S T P <br />SUMP <br />D <br />❑ <br />L-6 <br />2 <br />0 <br />8 <br />REGULAR UNLEADED <br />FILL <br />SUMP <br />D <br />❑ <br />L-7 <br />2 <br />0 <br />8 <br />PREMIUM UNLEADED <br />S T P <br />SUMP <br />D <br />❑ <br />L-8 <br />2 <br />0 <br />8 <br />PREMIUM UNLEADED <br />FILL <br />SUMP <br />D <br />❑ <br />L-9 <br />4 <br />2 <br />0 <br />WHOLE VESSEL ANNULAR <br />SPACE <br />D <br />❑ <br />L-10 <br />2 <br />0 <br />8 <br />DISPENSER 1/ <br />2 <br />D <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <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 6 <br />