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Underground Storage Tank <br />Monitoring Systern,Certification Form <br />6. SENSOR TESTING RESULTS <br />List only sensors tested on date of this certification. List "Senear ID" as labeled in system <br />programming. Additional copies of this page may be Wtached to accommodate all sensors tested. <br />Sensor lD <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <br />Y- L- <br />yrs a13 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />El <br />0 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <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' and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 3of6 <br />