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Aug . 30 . 2019 8128AM 6onl ee Pump Co No . 2568 P . 4 <br /> UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM JP2983 of 6) <br /> Monitoring Device Used Devlco Model # Monitoring Device Used Device Model # <br /> Ventrrransition Sump ID: Vent/Transition Sum ID: <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor © VPH Sensor <br /> UDC ID : UDC ID: <br /> lectronic Sensor ieclronic Sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID. ^ UDC ID . <br /> lectronlo Sensorleclronio sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC IN UDC ID; <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID . UDC IDU <br /> ❑ Eleclroni0 Sensor Electronic Sensor <br /> © Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPN Sensor <br /> other Monitored Component ID : Other Monitored Component ID: <br /> ❑ Other (Specify in section VII.) ❑ Other (Spocfty in section VII.) <br /> other Monitored Component ID, other Monitored Component ID. <br /> ❑ Other (Specify in section VII.) ❑ Other (Specify in section VN.) <br /> Other Monitored Component ICI : Other Monitored Component ID : <br /> ❑ Other (Specify in section VN.) ❑ Other (Specify in section V11.) <br /> Include information for every underground storage tank component monitored by this monitoring system control panaL if the monitoring <br /> system control panel monitors snore components than (his form accommodates, additional copies of these pages maybe attached. <br /> Vill COMMENTS <br /> Use this section to provide any additional comments about the inventory of the equipment certifisd. <br /> 1 <br /> i <br /> .� . . ... . . • n.. . . • .+ . . . . . .. /1 � . . __ _ a_as _ llly — II..J.,O .JIrw ....nn. <br />