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Liquid -Phase Product Detector Solid -State Dispenser Pan/Containment Sump Sensors; <br />Piping Sump Sensors; Micro Sensor <br />Version number TLS -350/300/3001 Series Consoles with Sensor Models: 794380-321; <br />794380.-351; 794380-208; 794380-209; 794380-340 <br />> Safety disclaimer: This test procedure only addresses the issue of the interstitial <br />monitors ability to detect leaks. It does not test the equipment for safety hazards. <br />Certification of Results <br />I certify that the interstitial monitor was installed and operated according to the vendor's instructions <br />and that the results presented on this form are those obtained during the evaluation. I also certify that <br />the evaluation was performed using the procedures described in the modified test protocol. <br />I1. Kendall Wilcox, Ph.D., President <br />(printed name) <br />(signature) <br />November 20, 1994 (Revision Dates: <br />April 20, 1998; June 23, 1997) <br />(date) <br />Ken Wilcox Associates. Inc. <br />(organization performing evaluation) <br />Grain Valley, Missouri 64029 <br />(city, state, zip) <br />(816) 443-2494 <br />(phone number) <br />RECE'Ve'D <br />Jul. 1 0 2017 <br />ENVIRONS ONITAL HEALTH <br />DEPARTMENT <br />Liquid -Phase Product Detector - Modified Results Form Page 3 of 3 <br />