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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) Monitoring Device Used Device Model# Monitoring Device Used Device Model# UDC ID: UDC ID: ❑Electronic Sensor ❑Electronic Sensor ❑Mechanical Device ❑Mechanical Device ❑VPH Sensor ❑VPH Sensor UDC ID: UDC ID: ❑Electronic Sensor ❑Electronic Sensor ❑Mechanical Device ❑Mechanical Device ❑VPH Sensor ❑VPH Sensor UDC ID: UDC ID: Electronic Sensor Lj Electronic Sensor ❑Mechanical Device ❑Mechanical Device ❑VPH Sensor ❑VPH Sensor UDC ID: UDC ID: ❑Electronic Sensor ❑Electronic Sensor ❑Mechanical Device ❑Mechanical Device ❑VPH Sensor ❑VPH Sensor UDC ID: UDC ID: ❑Electronic Sensor ❑Electronic Sensor ❑Mechanical Device ❑Mechanical Device ❑VPH Sensor ❑VPH Sensor UDC ID: UDC ID: ❑Electronic Sensor ❑Electronic Sensor ❑Mechanical Device ❑Mechanical Device ❑VPH Sensor ❑VPH Sensor Vent/Transition Sump ID: VentiTransition Sump ID: ❑Sump Sensor ❑Sump Sensor ❑VPH Sensor ❑VPH Sensor Other Device ID: L1 600kw Gen. Other Device ID FOR Box Sump Sw ❑J Sump Sensor 794380-208 k Sump Sensor 794380-208 ❑VPH Sensor ❑VPH Sensor Other Device ID: 60OKW Gen.Day T Other Device ID: Boiler Day Tank ❑d Sump Sensor 794380-208 ❑d Sump Sensor 794380-208 ❑VPH Sensor ❑VPH Sensor Other Device ID: AST Main Fill Sum Other Device ID: Fuel Purifier Sump ❑,/ Sump Sensor 794380-208 J❑Sump Sensor 794380-208 ❑VPH Sensor ❑VPH Sensor Other Device ID: Fill Pen Sump Box Other Device ID: Filter Cabinet W Sump Sensor 794380-208 ./❑Sump Sensor 794380-420 ❑VPH Sensor I I ❑VPH Sensor Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring system control panel monitors more components than this form accommodates,additional copies of these pages may be attached. VII. COMMENTS Use this section to provide any additional comments about the inventory of the equipment certified.