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L I. Results of Vacuum/Pressure Monitoring Equipment Testing JUN 0 3 2016 This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy o ft i -t e be included with the Monitoring System Certification Form, which must be provided to the tank system ownprgper�tor�, e owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Model: TLS 350 System Type: ❑✓ Pressure; ❑ Vacuum S-1 Component(s) Monitored by this Sensor: Bio Product Sensor Functionality Test Result: 0 Pass; ❑ Fail Interstitial Communication Test Result: ❑x Pass; ❑ Fail S-2 Component(s) Monitored by this Sensor: 19-20 Product Sensor Functionality Test Result: 0 Pass; ❑ Fail Interstitial Communication Test Result: El Pass; ❑ Fail S-3 Component(s) Monitored by this Sensor: 21-30 Product Sensor Functionality Test Result: El Pass; ❑ Fail Interstitial Communication Test Result: 0 Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail How was interstitial communication verified? 0 Leak Introduced at Far End of Interstitial Space;' ❑ Gauge; ❑ Visual Inspection; ❑ Other (Describe in Sec. J, below) Was vacuum/pressure restored to operating levels in all interstitial spaces? 0 Yes ❑ No (If no, describe in Sec. J, below) J. Comments (500 characters max. use additional sheets if needed): ' If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. Page 4 of