COMPLIANCE INFO 2014 - 2016 - Laserfiche WebLink

Home Browse Search

Monitoring System Certification Form:Addendum for Vacuum/Pressure Interstitial Sensors APR 11 20116 I. Results of Vacuum/Pressure Monitoring Equipment Testing !?-;: This page should be used to document testing and servicing of vacuum and pressure interstitial sensors."A copy of this form must be included with the Monitoring System Certification Form, which must be provided to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer:VEEDER ROOT Model: TLS-350 System Type: ❑Pressure;®Vacuum Sensor Ill Component(s) Nlonitored by this Sensor: 87 line s1 Sensor Functionality Test Result: ®Pass; ❑ Fail Interstitial Communication Test Result: M Pass; ❑ Fail Component(s)Monitored by this Sensor: vapor line s2 Sensor Functionality Test Result: ®Pass; ❑ Fail Interstitial Communication Test Result: M Pass; ❑ Fail Component(s)Monitored by this Sensor: 91 line s3 Sensor Functionality Test Result:M Pass; ❑ Fail Interstitial Communication Test Result: M Pass; ❑ Fail Component(s)Monitored by this Sensor: vents s4 Sensor Functionality Test Result: M Pass; ❑ Fail Interstitial Communication Test Result: M Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail How was interstitial communication verified? M Leak Introduced at Far End of Interstitial Space;' ❑ Gauge; ❑ Visual Inspection; M Other(Describe in Sec.J, below) Was vacuum/pressure restored to operating levels in all interstitial spaces? M Yes ❑No(If no, describe in Sec.J, below) J. Comments: 4-6-2016 ALL PASSED Wat��Faad Ma�4��E Watterinod Rd Sta_.Ic�ktnn Page 4 of 4 ' If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor,vacuum/pressure has been demonstrated to be communicating throughout the interstice. UN-036A-1/1 www.unidocs.org Rev.01/26/06