COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 2 of s) 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 Model of Monitoring System Control Panel Software Version Installed TLS -350 T02256961105001 334 . 01 Check the appropriate boxes to indicatespecific a ui ment ins ected/serviced. Monitoring Device Used Device Model # Monitoring Device Used Device Model # TANK ID : 87 TANK ID : 91 (By tank number, stored product, etcj (By tank number, stored product, etc. ❑ In-Tank Gauging (SW Tank) ❑ In-Tank Gauging (SW Tank) ❑x Annular Space or vault Sensor 0794380-303 Z Annular Space or Vault Sensor , 0794380- 303 ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping ❑ Mechanical LLD ❑ Mechanical LLD • Electronic LLD VM1990 -200 ❑x Electronic LLD VM199LD -200 • VPH Sensor (Piping) 0794380 -301 N VPH Sensor (Piping) 0794380 -301 p Sump Sensor 304- 10208 Z Sump Sensor 304- 10208 ❑p VPH Sensor (Sump) 0794380 -301 Z VPH Sensor (Sump) 0794380-301 Fill Piping Fill Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑x Sump Sensor 304- 10208 Z Sump Sensor 304- 10208 ❑x VPH Sensor (Sump) 0794380-30121 VPH Sensor (Sump) 0794380 -301 Vent Piping Vent Piping Z VPH Sensor (Piping) 0794380-301 0 VPH Sensor (Piping) 0794380-301 ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ 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) Monitoring Device Used Device Model # Monitoring Device Used Device Model # TANK ID : Die TANK ID : (By tank number, stored product, e (By tank number, stored product, etc. ❑ In-Tank Gauging (SW Tank) ❑ In-Tank Gauging (SW Tank) ZAnnular Space or vault Sensor 0794380-303 ❑ Annular Space or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor j Product Piping Product Piping ❑ Mechanical LLD ❑ Mechanical LLD j x❑ Electronic LLD VM1990-200 ❑ Electronic LLD I( ❑x VPH Sensor (Piping) 0794380- 301 ❑ VPH Sensor (Piping) (€ ❑x Sump Sensor 304- 10208 ❑ Sump Sensor ❑x VPH Sensor (Sump) 0794380 -301 ❑ VPH Sensor (Sump) Fill Piping Fill Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑x Sump Sensor 304- 10208 ❑ Sump Sensor ZVPH Sensor (Sump) 0794380-301 ❑ VPH Sensor (Sump) Vent Piping Vent Piping 9 VPH Sensor (Piping) 0794380-301 ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recovery Piping El Sensor (Piping) El VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) ID = Identification, SW = Single-Walled, VPH = VacuumlPiessureMydrostatic, LLD = Line Leak Detector i