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Ur"CIETILER-RYAN INC. IR Job # 20-600050 Monitoring System Certification Form:Addendum for Vacuum/Pressure Interstitial Sensors LG 163-1.Enc.II 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: 332117-001 System Type: Pressure; ®Vacuum Sensor ID Component(s)Monitored by this Sensor: 87 Product 57 Sensor Functionality Test Result: ®Pass; Fail Interstitial Communication Test Result: ®Pass; Fail Component(s)Monitored by this Sensor: 87 Vent S9 Sensor Functionality Test Result: ®Pass; Fail Interstitial Communication Test Result: ®Pass; Fail Component(s)Monitored by this Sensor: Vapor Lines S10 Sensor Functionality Test Result: ®Pass; Fail Interstitial Communication Test Result: ®Pass; Fail Component(s)Monitored by this Sensor: 91 Product S11 Sensor Functionality Test Result: ®Pass; []Fail Interstitial Communication Test Result: ®Pass; Fail Component(s)Monitored by this Sensor: 91 Vent S12 Sensor Functionality Test Result: ®Pass; Fail Interstitial Communication Test Result: ®Pass; Fail Component(s)Monitored by this Sensor: Diesel Product S13 Sensor Functionality Test Result: ®Pass; Fail Interstitial Communication Test Result: ®Pass; Fail Component(s)Monitored by this Sensor: Diesel Vent S14 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? ® Leak Introduced at Far end of Interstitial;Space;(1) Gauge; []Visual Inspection; Other(Describe in Sec.J, below) Vacuum was restored to operating levels in all interstitial spaces: ®Yes []No(If no,describe in Sec.J, below) J. Comments: Page of (1) 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.