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Underground Storage Tank <br /> Monitoring System Certification Form <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 /> Sensor ID Sensor Model Component(s) Monitored Pass Fail <br /> L - 1 3 0 - 3 2 2 1 - 1 A 87ANNULAR SPACE 0 ❑ <br /> L - 2 30 - 3221 - 1 87 OCTANE S T P SUMP 0 ❑ <br /> L - 3 3 0 - 3 2 2 1 - 1 A DIESEL ANNULAR SPACE 0 ❑ <br /> L - 4 30 - 3221 - 1 DIESEL # 2 S T P SUMP 0 ❑ <br /> L - 5 30 - 3221 - 1 DISPENSER 1 / 2 0 ❑ <br /> L - 6 30 - 3221 - 1 DISPENSER 3 / 4 0 ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> El ❑ <br /> El ❑ <br /> El ❑ <br /> El El] <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 3 of 6 <br />