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Underground Storage Tank <br />Monitoring System Certification Form <br />6. SENSOR TESTING RESULTS <br />List only sensors tested on date of this certification. List "Sensor I D" as labeled in system <br />programming <br />VPH site: ❑ Yes ®No <br />Tank ID: 91 <br />Sensor lD <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <br />L3 <br />208 <br />sump <br />® <br />❑ <br />L5 <br />420 <br />91/DSL annular <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ A <br />❑ <br />❑ <br />I ❑ <br />Tank ID: DSL <br />Sensor ID <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <br />L4 <br />208 <br />sump <br />® <br />❑ <br />L5 <br />420 <br />91/DSL annular <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 9 <br />