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Underground Storage Tank <br />Monitoring System Certification Form <br />16. SENSOR TESTING RESULTS <br />List only sensors tested on date of this certification. List "Sensor ID" as labeled in system <br />programming. Additional copies of this page may be attached to accommodate all sensors tested. <br />Sensor lD <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <br />L- <br />1 <br />4 <br />2 <br />0 <br />US T ANNULAR SPACE <br />0 <br />❑ <br />L-2 <br />2 <br />0 <br />8 <br />UST STP SUMP <br />0 <br />❑ <br />L- <br />3 <br />2 <br />0 <br />8 <br />PIPE TRANSITION SUMP <br />0 <br />❑ <br />L- <br />4 <br />2 <br />0 <br />8 <br />U D C PUMP REEL <br />0 <br />❑ <br />L- <br />5 <br />4 <br />2 <br />0 <br />A S T ANNULAR SPACE <br />0 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Describe all answers marked "No" or "Fail' and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 3 of 6 <br />