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Underground Storage Tank <br />Monitoring System Certification Form <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 />L29 <br />794380-304 <br />UDC 15/16 Hydro <br />® <br />❑ <br />L30 <br />794380-304 <br />UDC 17/18 Hydro <br />® <br />❑ <br />L31 <br />794380-304 <br />UDC 19/20 Hydro <br />® <br />❑ <br />L32 <br />794380-304 <br />UDC 21/22 Hydro <br />® <br />❑ <br />L33 <br />794380-304 <br />UDC 23/24 Hydro <br />® <br />❑ <br />L34 <br />794380-304 <br />87A Fill Hydro <br />® <br />❑ <br />L35 <br />794380-304 <br />87A STP Hydro <br />® <br />❑ <br />L36 <br />794380-304 <br />87B Fill Hydro <br />® <br />❑ <br />L37 <br />794380-304 <br />87B STP Hydro <br />® <br />❑ <br />L38 <br />794380-304 <br />91 Fill Hydro <br />® <br />❑ <br />L39 <br />794380-304 <br />91 STP Hydro <br />® <br />❑ <br />L40 <br />794380-304 <br />Additive Fill/STP Hydro <br />® <br />❑ <br />L41 <br />794380-304 <br />Additive Vent Hydro <br />® <br />❑ <br />L42 <br />794380-304 <br />Gas Vent Box Hydro <br />® <br />❑ <br />L43 <br />794380-323 <br />Gas Vent Box Sump <br />® <br />❑ <br />L44 <br />794380-323 <br />Additive Fill/STP Sump <br />® <br />❑ <br />L45 <br />794380-323 <br />87A Fill Sump <br />® <br />❑ <br />L46 <br />794380-323 <br />87B Fill Sump <br />® <br />❑ <br />L47 <br />794380-323 <br />91 Fill Sump <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 4 of 6 <br />