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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 lD Sensor Model Component(s) Monitored Pass Fail <br /> L - 1 2 0 8 / 3 0 4 REGULAR UNLEADED S T P SUMP / BRINE 0 ❑ <br /> L - 2 2 0 8 / 3 0 4 REGULAR UNLEADED FILL SUMP / BRINE 0 ❑ <br /> L - 3 3 0 3 REGULAR UNLEADED ANNULAR SPACE 0 ❑ <br /> L - 4 2 0 8 / 3 0 4 PREMIUM UNLEADED S T P SUMP / BRINE 0 ❑ <br /> L - 5 2 0 8 / 3 0 4 PREMIUM UNLEADED FILL SUMP / BRINE 0 ❑ <br /> L - 6 3 0 3 PREMIUM UNLEADED ANNULAR SPACE 0 ❑ <br /> L - 7 2 0 8 / 3 0 4 DISPENSER 1 / 2 0 ❑ <br /> L - 8 2 0 8 / 3 0 4 DISPENSER 3 / 4 0 ❑ <br /> L - 9 2 0 8 / 3 0 4 DISPENSER 5 / 6 0 ❑ <br /> L - 10 2 0 8 / 3 0 4 DISPENSER 7 / 8 0 ❑ <br /> L - 11 2 0 8 / 3 0 4 DISPENSER 9 / 10 0 ❑ <br /> L - 12 2 0 8 / 3 0 4 DISPENSER 11 / 12 0 ❑ <br /> L - 16 2 0 8 / 3 0 4 VENT BOX SUMP / BRINE 0 ❑ <br /> SMART SENSORS ❑ ❑ <br /> S - 9 0 0 1 REGULAR UNLEADED PRODUCT LINE 0 ❑ <br /> S - 10 0 0 1 VENT LINES 0 ❑ <br /> S - 11 0 0 1 VAPOR RETURN LINE 0 ❑ <br /> S - 12 0 0 1 PREMIUM UNLEADED PRODUCT LINE 0 ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ji <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 />