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Underground Storage Tank Monitoring System Certification Form Dispenser 21/22 Sump Sensor 16. SENSOR TESTING RESULTS List only sensors tested on date of this certification. List "Sensor ID" as labeled in system programming. Additional copies of this page may be attached to accommodate all sensors tested. Sensor lD Sensor Model Component(s) Monitored Pass Fail L28 794380-323 Dispenser 23/24 Sump Sensor 0 ❑ L29 794380-323 Unleaded Additive Fill/STP Sump Sensor El ❑ L30 794380-323 All Tanks Vent Sump Sensor M ❑ L31 794380-323 T5 Unleaded 91 Remote Fill Sump Sensor 0 ❑ L32 794380-323 Additive Piping Trans. Sump Sensor 0✓ ❑ L33 794380-304 Dispenser 1/2 Sump Brine Sensor 0 ❑ L34 794380-304 Dispenser 3/4 Sump Brine Sensor E ❑ L35 794380-304 Dispenser 5/6 Sump Brine Sensor 0 ❑ L36 794380-304 Dispenser 7/8 Sump Brine Sensor 0✓ ❑ L37 794380-304 Dispenser 9/10 Sump Brine Sensor 0 ❑ L38 794380-304 Dispenser 11/12 Sump Brine Sensor r ❑ L39 794380-304 Dispenser 13/14 Sump Brine Sensor 0 ❑ L40 794380-304 Dispenser 15/16 Sump Brine Sensor 0✓ ❑ L41 794380-304 Dispenser 17/18 Sump Brine Sensor 0 ❑ L42 794380-304 Dispenser 19/20 Sump Brine Sensor 0 ❑ L43 794380-304 Dispenser 21/22 Sump Brine Sensor M r] L44 794380-304 Dispenser 23/24 Sump Brine Sensor M✓ ❑ L45 794380-304 Unleaded Additive Fill/STP Sump Brine Sensor M✓ ❑ L46 794380-304 All Tanks Vent Sump Brine Sensor 0 ❑ L47 794380-304 T5 Unleaded 91 Remote Fill Sump Brine Sensor 0 ❑ L48 794380-304 Additive Piping Trans. Sump Brine Sensor 0 ❑ L49 794380-304 T1 Unleaded 87A Fill Sump Brine Sensor 0 ❑ L50 794380-304 T1 Unleaded 87A Turbine Sump Brine Sensor 0 ❑ L51 794380-304 T2 Unleaded 87B Fill Sump Brine Sensor 0 ❑ Describe all answers marked "No" or "Fail" and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 3of6