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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM <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 /> Gilbarco EMC 14 . 04 <br /> Check the appropriate boxes to indicate specific equipment inspected/serviced. <br /> Monitoring Device Used I Device Model # Monitoring Device Used Device Model # <br /> Tank ID : Tank ID : <br /> B tank number, stored roduct, etc. T1 : DIGS@I By tank number, stored product, etc.) <br /> 0 In-tank Gauging (SW Tank) Mag-1 -Probe ❑ In-tank Gauging (SW Tank) <br /> • Annular Space or Vault Sensor 420 ❑ Annular Space or Vault Sensor <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> (RI Mechanical LLD North sump LD 2000 South Sump LD 2000 ❑ Mechanical LLD <br /> ❑ Electronic LLD ❑ Electronic LLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> Sump Sensor 208 ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vent Piping Vent Piping <br /> F1VPH Sensor (Piping) El VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> i <br />� ❑ VPH Sensor (Piping) [I VPH Sensor (Piping) <br />' <br /> El Sensor El Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> TanklD : TanklD : <br /> By tank number, stored product, etc. By tank number, storedproduct, etc. <br /> ❑ In-tank Gauging (SW Tank) ❑ In-tank Gauging (SW Tank) <br /> ❑ Annular Space or Vault Sensor ❑ Annular Space or Vault Sensor <br /> El Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> El LLD El Mechanical LLD <br /> El LLD El Electronic LLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> I ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vent Piping Vent Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vapor Recovery Piping PH Vapor Recovery Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> ID = Identification, SW = Single-walled, VPH = Vacuum/PressureMydrostatic, LLD = Line leak detector <br />