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<br />Underground Storage Tank <br />Monitoring System Certification Form <br /> <br /> <br />Page 3 of 6 <br />6. SENSOR TESTING RESULTS <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 /> <br />Sensor ID Sensor Model Component(s) Monitored Pass Fail <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 /> <br /> <br />L1 420 87 ANNULAR <br />L2 205 87 STP <br />L3 205 91 STP <br />L4 420 DSL- 91 ANNULAR <br />L5 205 DSL STP <br />FLOATS 1-2 <br />FLOATS 3-4 <br />FLOATS 5-6 <br />FLOATS 7-8 <br />✔ <br />✔ <br />✔ <br />✔ <br />✔ <br />✔ <br />✔ <br />✔ <br />✔