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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) <br /> Monitoring Device Used 7 Device Model# Monitorin Device Used Device Model# <br /> VENT/TRANSITION SUMP ID: VENT SUMP VENT/TRANSITION SUMP ID: <br /> ❑Sump Sensor 208 ❑Sump Sensor <br /> ❑VPH Sensor 304 ❑VPH Sensor <br /> UDC ID: 13-14 A UDC ID: 1413-15A <br /> Z Electronic Sensor 208 ❑x Electronic Sensor 208 <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑x VPH Sensor 304 ❑x VPH Sensor 304 <br /> UDC ID: 1513-16A UDC ID: 16B-17A <br /> ❑x Electronic Sensor 208 ❑x Electronic Sensor 208 <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑x VPH Sensor 304 ❑x VPH Sensor 304 <br /> UDC ID: 17B-18A UDC ID: 1813-19 <br /> ❑x Electronic Sensor 208 x❑Electronic Sensor 208 <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑x VPH Sensor 304 x❑VPH Sensor 304 <br /> UDC ID: UDC ID: <br /> ❑Electronic Sensor ❑Electronic Sensor <br /> ❑Mechanical Device ❑Mechanical Device <br /> ❑VPH Sensor ❑VPH Sensor <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> ❑Other(Specify in section Vll.) ❑Other(specify in section Vll.) <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 Vll.) <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 /> RECEIVED <br /> SEP 14 2020 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> 10=Identification,VPH=Vacuum/PressureiHydrostatic,UDC=Under-Dispenser Containment <br />