COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page z of 6) VI. INVENTORY OF EQUIPMENT CERTIFIED A separate Monitoring System Certification ,Form must be prepared for each monitoring system control panel. Make of Monitoring System Control Panel OPW Model of Monitoring System Control Panel TANK MONITOR Software Version Installed NA Check the appropriate boxes to indicate specific eouioment inspected/serviced. Monitoring Device Used Device Model # Monitorinp Device Used Device Model # TANK ID: (By tank number, stored oraduct etc.) 87 TANK 1D: (By tank numberstored product, etc.) DIESEL x❑ In -Tank Gauging (SW Tank) MAG ❑x In -Tank Gauging (SW Tank) MAG ❑x Annular Space or Vault Sensor 30-3221-1 A ❑x Annular Space or Vault Sensor L 30-3221-1 A ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping ❑x Mechanical LLD 99 LD 200_0 Z Mechanical LLD RJ FX -IV -D ❑ Electronic LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑x Sump Sensor 30-3221-1 M Sump Sensor EtE 30-3321-1 ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) I FIII Piping I Fill Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vent Piping Vent Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recovery Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) I n Sump Sensor n Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Monitoring Devlce Used Device Model # Monitoring Device Used Device Model # TANK ID: (By tank number, stored product etcA TANK ID: (By tank number, stored product, etc.) ❑ In -Tank Gauging (SW Tank) ❑ In -Tank Gauging (SW Tank) ❑ Annular Space or Vault Sensor ❑ Annular Space or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping ❑ Mechanical LLD ❑ Mechanical LLD ❑ Electronic LLD ❑ Eleclronic LLD -- ------ -- ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) I ❑ VPH Sensor (Sump) Fill Piping Fill Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vent Piping I Vent Piping I I ❑ VPH Sensor (Piping) I I ❑ VPH Sensor (Piping) I f I ❑ Sump Sensor 1 ❑ Sump Sensor I ❑ VPH Sensor (Sump) I ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recovery Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) ID = IdeftkSbW, SW= Single -W", VPH = V LLD = Line Leak Detector