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Underground Storage Tank <br />Release Detection Equipment Testing Report Form <br />TEST RESULTS <br />k this box if Appendix 5.1 continuation page is attached. <br />FSOR <br />y sensors tested. List "Sensor !D" as labeled in system programming. For VPN monitoring, <br />ity must be confirmed between the most distant points in the interstitial space to the extent <br />al as approved by the Unified Program Agency and the sensor that monitors the zone, <br />Sensor Sensor <br />ID Model Component(s) Monitored <br />Function <br />Continuity <br />Pass <br />Fail <br />Pass <br />Fait <br />NA <br />sersy �aH Soh so r <br />4 <br />❑ <br />)9 <br />❑ <br />❑ <br />LS69p rA Sim <br />❑ <br />K <br />❑ <br />❑ <br />3 cs6oat D 9U <br />❑ <br />❑ <br />❑ <br />st oat D �• �,,I <br />❑ <br />;N <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 />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Cl <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 />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />j ❑ <br />j ❑ <br />j❑ <br />❑ <br />Describe all answers marked "No" or 'Fail" and the proposed remedy in Section 8. <br />List all equipment either replaced or repaired (including cleaning or adjustment) in Section 8. <br />Page 3 of 6 <br />_— <br />