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RECEIVED BY EHD: <br /> UNDERGROUND STORAGE TANK 7/27/2021 <br /> MONITORING SYSTEM CERTIFICATION FORM (Page (received via Crompco Vault Portal) <br /> VI. INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed <br /> Veeder Root I TLS-350 1134.00 <br /> Check the appropriate boxes to indicate specific equipment inspected/serviced. <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> Tank ID: DIESEL 1 NORTH Diesel Tank ID: DIESEL 2 MIDDLE Diesel <br /> (By tank number, stored product, etc.) (By tank number, stored product, etc.) <br /> P In-tank Gauging (SW Tank) MAG W In-tank Gauging (SW Tank) MAG <br /> P Annular Space or Vault Sensor 794380-303 r Annular Space or Vault Sensor 794380-303 <br /> r VPH Sensor r VPH Sensor <br /> Product Piping Product Pi in <br /> r Mechanical LLD r Mechanical LLD <br /> P Electronic LLD PLLD r Electronic LLD <br /> r VPH Sensor(Piping) 464/463 r,—/ VPH Sensor(Piping) 464/463 <br /> r Sump Sensor 847990-002 r Sump Sensor 794380-208 <br /> r VPH Sensor(Sump) r VPH Sensor(Sump) <br /> Fill Piping Fill Piping <br /> r VPH Sensor(Piping) r VPH Sensor(Piping) <br /> W Sump Sensor 794380-208 P_Sump Sensor 794380-208 <br /> f VPH Sensor(Sump) r VPH Sensor(Sump) <br /> Vent Piping Vent Pi in <br /> r VPH Sensor(Piping) r VPH Sensor(Piping) <br /> f Sump Sensor r Sump Sensor <br /> r VPH Sensor(Sump) r VPH Sensor(Sump) <br /> Vapor RecoveryPiping Va or Recovery Piping <br /> r VPH Sensor(Piping) r VPH Sensor(Piping) <br /> f Sump Sensor r Sump Sensor <br /> f VPH Sensor(Sump) r VPH Sensor(Sump) <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> Tank ID: 1310 Diesel Tank ID: <br /> (By tank number, stored product, etc.) (By tank number, stored product, etc.) <br /> W In-tank Gauging (SW Tank) MAG r In-tank Gauging (SW Tank) <br /> r Annular Space or Vault Sensor 794380-303 r Annular Space or Vault Sensor <br /> f VPH Sensor r VPH Sensor <br /> Product Piping Product Piping <br /> r Mechanical LLD r Mechanical LLD <br /> f Electronic LLD r Electronic LLD <br /> r VPH Sensor(Piping) r VPH Sensor(Piping) <br /> W Sump Sensor 794380-208 F Sump Sensor <br /> r VPH Sensor(Sump) r VPH Sensor(Sump) <br /> Fill Piping Fill Piping <br /> r VPH Sensor(Piping) r VPH Sensor(Piping) <br /> W Sump Sensor 794380-208 r Sump Sensor <br /> r— VPH Sensor(Sump) r VPH Sensor(Sump) <br /> Vent Piping Vent Piping <br /> r VPH Sensor(Piping) r VPH Sensor(Piping) <br /> f Sump Sensor r Sump Sensor <br /> f VPH Sensor(Sump) r VPH Sensor(Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> r VPH Sensor(Piping) f VPH Sensor(Piping) <br /> f Sump Sensor r Sump Sensor <br /> f VPH Sensor(Sump) r VPH Sensor(Sump) <br /> CERS=California Environmental Reporting System,ID=Identification,UST=Underground storage tank,ICC=International Code Council <br />