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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 Cerdfication Form must be prepared for each monitoring system control panel. <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed <br /> Veeder Root TLS-350 334.00 <br /> Check the appropriate boxes to Indicate specific equipment In ected(serviced. <br /> Monitorin Device Used Device Model# Monitorin Device Used Device Model# <br /> Tank ID: T1: 87 Slave Tank ID:T2: 87 Master <br /> (By tank number,stored product,elC.) (Bv tank number stored product,elc <br /> ❑In-tank Gauging(SW Tank) ❑ In-tank Gauging(SW Tank) <br /> ®Annular Space or Vault Sensor 794390-409 ®Annular Space or Vault Sensor 794390-409 <br /> ❑VPH Sensor ❑VPH Sensor <br /> Product Piping Product Piping <br /> ❑Mechanical LLD ❑Mechanical LLD <br /> ❑Electronic LLD ®Electronic LLD 8484 <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor 794380-208 ®Sump Sensor 794380-208 <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Fill Piping Fill Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor 794380-208 ®Sump Sensor 794380-208 <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 /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Monitoring Device Used Device Model# Monitoring Device Used Device Model# <br /> Tank ID:T3: Diesel Tank ID:T4: 91 <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 794390-409 ®Annular Space or vault Sensor 794390-409 <br /> ❑VPH Sensor ❑VPH Sensor <br /> Product Piping Product Piping <br /> ®Mechanical LLD VMI 99LD-2000 ❑Mechanical LLD <br /> ❑Electronic LLD ®Electronic LLD 8484 <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor 794380-208 ®Sump Sensor 794380-208 <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> Fill PIpInA Fill Piping <br /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ®Sump Sensor 794380-208 ®Sump Sensor 794380-208 <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 /> ❑VPH Sensor(Piping) ❑VPH Sensor(Piping) <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor(Sump) ❑VPH Sensor(Sump) <br /> in c 1rkwdifr--Wm RW a Simk-AA= M VPH c Vara 13 vyvl2m a rrr"rin-wfatir. i i n a i Ino tmk rbharhv <br />