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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 2 of 6) <br /> VI . INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monitoring system control panel <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed <br /> GILBARCO EMC 334 . 00 <br /> Check thea roriate boxes to indicate specific equipment ins ected/serviced. <br /> Monitoring Device Used Device Model # Monitoring. Device Used Device Model # <br /> TANK ID : TANK ID : 91 <br /> 8 tank number, stored product, etc. 87 (By tank number, stored product, etc. <br /> ❑x In-Tank Gauging (SW Tank) MAG 1 9 In-Tank Gauging (SW Tank) MAG 1 <br /> ❑x Annular Space or Vault Sensor 4.07 x❑ Annular Space or Vault Sensor 407 <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> ❑x Mechanical LLD 99LD 2000 Mechanical LLD 99LD 2000 <br /> ❑ Electronic LLD ❑ Electronic LLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑x Sump Sensor 208 � 1 0 Sump Sensor 208 <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vent Piping Vent Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> f Vapor Recovery Piping Vapor Recovery Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor <br /> ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> TANK ID; TANK ID : <br /> 8 tank number, stored product, etc. DSL (By tank number, stored product, etc. <br /> ❑x In-Tank Gauging (SW Tank) MAG 1 ❑ In-Tank Gauging (SW Tank) <br /> Annular Space or Vault Sensor 407 SPLIT WITH 91 ❑ Annular Space or vault Sensor <br /> ❑ VPH Sensor ❑ VPN Sensor <br /> I Product Piping Product Piping <br /> ❑x Mechanical LLD 99LD 2000 El Mechanical LLD <br /> ❑ Electronic LLD ❑ Electronic LLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑x Sump Sensor 208 ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> El VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> El Sensor E] Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> i Vent Piping Vent Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> ID = Identification, SW = Single-Walled, VPH = VacuumlPressureMydrostatc, LLD = Line Leak Detector <br />