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Underground Storage Tank <br />Monitoring System Certification Form <br />16. 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 />Sensor lD <br />Sensor Model Component(s) Monitored <br />Pass <br />Fail <br />s22 <br />330020-464 <br />Premium Prod VAC 4 <br />❑✓ <br />❑ <br />s23 <br />330020-464 <br />Premium Vent VAC <br />M <br />❑ <br />s24 <br />330020-464 <br />Gas Addi. Prod VAC <br />0✓ <br />❑ <br />s25 <br />330020-464 <br />Gas Addi. VENT VAC <br />0✓ <br />❑ <br />s28 <br />330020-464 <br />91 Remote Fill VAC <br />0 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />0 <br />❑ <br />0 <br />❑ <br />0 <br />❑ <br />❑r— <br />❑ <br />❑ <br />F. <br />❑ <br />ri <br />0 <br />❑ <br />0 <br />❑ <br />0 <br />❑ <br />0 <br />❑ <br />0 <br />❑ <br />0 <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 />