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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model# <br /> Vent/Transition Sump ID: Vent/Transition Sump ID: <br /> r Sump Sensor r Sump Sensor <br /> r VPH Sensor r VPH Sensor <br /> UDC ID: 1/2 UDC ID: 7/8 <br /> W Electronic Sensor 794380-208 17 Electronic Sensor 794380-208 <br /> r Mechanical Device r Mechanical Device <br /> I—VPH Sensor r VPH Sensor <br /> UDC ID: 5/6 UDC ID: 11/12 <br /> r Electronic Sensor 794380-208 I✓Electronic Sensor 794380-208 <br /> I—Mechanical Device r Mechanical Device <br /> r VPH Sensor r VPH Sensor <br /> UDC ID: 9/10 UDC ID: <br /> 17 Electronic Sensor 794380-208 r Electronic Sensor <br /> r Mechanical Device r Mechanical Device <br /> r VPH Sensor r VPH Sensor <br /> UDC ID: 3/4 UDC ID: <br /> W Electronic Sensor 794380-208 r Electronic Sensor <br /> r Mechanical Device r Mechanical Device <br /> r VPH Sensor r VPH Sensor <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> r Other(Specify in section VII) r Other(Specify in section VII) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> rOther(Specify in section VII) rOther(Specify in section VII) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> rOther(Specify in section VII) rOther(Specify in section VII) <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 additoinal copies of these pages may be attached. <br /> Al. COMMENTS <br /> Use this section to provide any additional comments about the inventory of the equipment certified. <br /> CERS=California Environmental Reporting System,ID=Identification,UST=Underground storage tank,ICC=International Code Council <br />