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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 2 of 6) <br /> VI . INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monitoring system control panel <br /> ftware rsion Installed <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Panel SoVe <br /> RONAN X 7 6 S <br /> Check the appropriate boxes to indicate specific equipment ins ected/serviced. <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> TANK ID : 89 OCTANE TANK ID : RED DIESEL # 2 <br /> 8 tank number, storedproduct, e (By tank number, stored product, etc. <br /> ❑ In-Tank Gauging (SW Tank) N / A ❑ In-Tank Gauging (SW Tank) N / A <br /> 9 Annular Space or Vault Sensor L S - 3 Z Annular Space or vault Sensor L S - 3 <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> Z Mechanical LLD F . E . PETRO - STP - MLD Z Mechanical LLD V M 1 - 99 LD 2000 <br /> ❑ Electronic LLD ❑ Electronic LLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑x Sump Sensor L S - 3 0 Sump Sensor L S - 3 <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vent Piping Vent Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑x Sump Sensor L S - 3 ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Monitoring Device Used Device Model # M.o. nitoring Device Used Device Model # <br /> TANK ID : TANK ID : <br /> (By tank number, stored product, e (By tank number, stored product, etc. <br /> ❑ In-Tank Gauging (SW Tank) ❑ In-Tank Gauging (SW Tank) <br /> ❑ Annular Space or Vault Sensor ❑ Annular Space or Vault Sensor <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> E] Mechanical LLD El Mechanical LLD <br /> j ❑ Electronic LLD ❑ Electronic LLD <br /> El Sensor (Piping) EJ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> [ISump Sensor El Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vent Piping Vent Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> El Sensor (Piping) El VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> El Sensor (Sump) El VPH Sensor (Sump) <br /> ID = Identification, SW = Single-Walled, VPH = VacuumlPressureMydrostatic, LLD = Line Leak Detector <br /> i <br />