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ECEIVED <br /> UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 3of6 <br /> Monitorins Device Used Device Model# Monitoring Device Used <br /> VENT/TRANSITION SUMP ID: VENT/TRANSITION SUMP ID: r1f-[)L P T, A( <br /> ❑Sump Sensor ❑Sump Sensor <br /> ❑VPH Sensor ❑VPH Sensor <br /> UDC ID: UDC ID: <br /> ®Electronic Sensor FFS DC-400 ®Electronic Sensor FFS DC-400 <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑VPH Sensor ❑VPH Sensor <br /> UDC ID: Diesel 3 UDC ID: <br /> ®Electronic Sensor FFS DC-400 ❑Electronic Sensor <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑VPH Sensor ❑VPH Sensor <br /> UDC ID: UDC ID: <br /> ❑Electronic Sensor ❑Electronic Sensor <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑VPH Sensor ❑VPH Sensor <br /> UDC ID: UDC ID: <br /> ❑Electronic Sensor ❑Electronic Sensor <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑VPN Sensor ❑VPH Sensor <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> ❑Other(Specify in section VII.) ❑Other(Specify in section VII.) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> ❑Other(Specify in section Vll.) ❑Other(Specify in section VII.) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> ❑Other(Specify in section VII.) []Other(Specify in section V11.) <br /> Include Information for every underground storage tank component monitored by this monitoring system control panel If the monitoring system <br /> control panel monitors more components than this form accommodates additional copies of these pages may be attached. <br /> VII. COMMENTS <br /> Use this section to provide additional comments about the inventory of the equipment certified. <br /> This tank has audible/visual overfill alarm and overfill drop tubes installed on both product tanks. The Unleaded is a <br /> pressure system with positive shutdown on sump alarms. The Diesel is a"Safe Suction System"verified for SJC HazMat <br /> during monitor cert on 8-5-2014. This system has a remote annunciator with audible and visual mounted outside above <br /> and facing the tanks. UDC's had Bravo floats and chains removed and Franklin Fueling Systems DC-400 stand alone <br /> sensors installed for dispenser shutdown on alarm conditions. <br /> ID=klertification,VPH=VacuumiPressure/Hydrostatic,UDC=Under-Dispenser Cortahment <br /> UN-107 www.unidocs.org 316-Rev.10/01/18 <br />