COMPLIANCE INFO_2017 - 2018 - Laserfiche WebLink

Home Browse Search

�t niturin� „(elll ( edification Form: Addendum for Vacuum/Pressure Inter,titial tien,ors L(: 163-I. Enc. II I. I t•sults of Vacuum/1'ressure 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. 'rhe owner/operator must submit a copy of the Monitoring Svstem Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer: Veeder Root Model: - - -463 System Type: ❑ Pressure:®Vacuum Sensor II) S Component(s)Monitored b) this Sensor: Sensor Functionality Test Result: Pass: ❑ Fail Interstitial Communication Test Result:® Pass. ❑ Fail Component(s) Monitored by this Sensor: .- !;,L_ 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: t,�t `,e✓�'y' Sensor Functionality 'test Result: Pass: ❑ Fail Interstitial Com mat ion 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'rest Result:E]Pass. L] Fail Component(s)Monitored b) this Sensor: _ Sensor I unctionalit) I est Rc,ulr{Pass: ❑ Fail _ Interstitial Communication I est Result-❑Pa,,: ❑ Fail Component(s) Monitored by this Sensor: _ Sensor I-unctionality lest Result: Pass: ❑ Fail interstitial Communication I est Result:❑Pass: ❑ Fail Component(s)Monitored by this Sensor: \ � • Sensor Functionality Fest Resull 4 Pass. ❑ Fail I tentnial Communication lest Result:❑Pass: ❑ Fail __ Component(s)Monitored by this Sensor. OS 1, 11••,1•, \ 1, , 0 _ �1 (� Sensur Functionality 'I est Result:tS Pass: ❑ Fail Interstitial Communication Test Result:❑Pass: ❑ Fail How was interstitial communication verified? ❑ Leak Introduced at Far End of Interstitial Space:' ❑ Gauge. ® Visual Inspection: ❑ Other(Describe lit Sec-..1, helms Vacuum was restored to operating,levels in all interstitial spaces: ®Yes ❑No Olin), describe in Sec..1. he/on-) .I. Comments: n -- - - MAY 2018 - — -- — - VI RONMENTAL r��E-A-TH nCN Dn2TRA1_ T _ �._-rry Pale of ZS- I If the sensor successfully detects a simulated vacuum-'pressure Icak introduced in the interstitial space at the furthest point from the sensor,vacuum;pressure has been demonstrated to he communicating throue;hout the interstice.