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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) <br /> Monitoring Device Used Device Model # Monttoen Device Used Device Model # <br /> VENT I TRANSITION SUMP ID: VENT I TRANSITION SUMP ID: <br /> D Sump Sensor ❑ Sump Sensor <br /> D VPH Sensor ❑ VPH Sensor <br /> UDC ID: UDC ID: <br /> D Electronic Sensor D Electronic Sensor <br /> ® Mechanical Device Bravo F I M ® Mechanical Device Bravo <br /> D VPH Sensor ❑ VPH Sensor <br /> UDC ID : 1111011013 UDC ID: <br /> D Electronic Sensor D Electronic Sensor <br /> 10 Mechanical DeviceBravo low I M D Mechanical Device <br /> D VPN Sensor D VPH Sensor <br /> UDC ID: UDC ID: <br /> D Electronic Sensor D Electronic Sensor <br /> D Mechanical Device D Mechanical Device <br /> D VPH Sensor D VPH Sensor <br /> UDC ID: UDC ID: <br /> D Electronic Sensor D Electronic Sensor <br /> D Mechanical Device D Mechanical Device <br /> D VPH Sensor D VPH Sensor <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> D Other (Specify in section V11) D Other (Specify in section Vll.) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> D Other (Specify in section VU.) D Other (Specify in section VIL) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> D Other (Specify in section Vll.) D Other (Specify in section Vll.) <br /> Include information for every underground storage tank componentmonitored by this monitoring system control panel. /fthe monitoring system <br /> control panel monitors more components than this form accommodates additional copies of these pages may be attached. <br /> Vile COMMENTS <br /> Use this section to provide additional comments about the inventory of the equipment certified. <br /> This tank has audible / visual overfill alarm and overfill drop tubes installed on both product tanks. The Unleaded is a <br /> pressure system with positive shutdown on sump alarms. The Diesel is a "Safe Suction System" verified for SJC HazMat <br /> during monitor cert on 8-5-2014. This system has a remote annunciator mounted outside and above the UST's. <br /> The audible / visual overfill alarm was demonstrated during inspection . <br /> 4 <br /> [D = Identification, VPH = Vawum Pressureh•tydrostatic, UDC = Under-Dispenser Contaiunent <br /> UN407 www.unidoes.org 316 - Rev. 10101118 <br />