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Underground Storage Tank <br />Monitoring System Certification Form <br />Tank ID: 87 <br />Sensor ID <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <br />L1 <br />208 <br />sump <br />® <br />❑ <br />L2 <br />420 <br />annular <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Tank ID: <br />Sensor ID <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <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" andproposed remedy in Section 9. <br />List all Monitoring equipment either replaced or repaired in Section 9. <br />Page 4 of 9 <br />