HomeMy WebLinkAboutVac. Sensor Results (Diesel) 3-17-16Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors
I. Results of VacuumlPressure Monitoring Equipment Testing
This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of
this form must be included with the Monitoring System Certification Form, which must be provided to the tank
system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the
local agency regulating UST systems within 30 days of test date.
J. Comments:
LG 163-1, Enc. II
Manufacturer:
-yEEDER-ROOT
! lVrooet:
-33!g2g4sa
{ System Type: I Pressure; [lvacuum
_1 Component(s) Monitored by this Sensor:
-DIESEL
PRODUCT LINE
Sensor Functionality Test Result: X Pass; f] fal Interstitial Communication Test Result: [l fass; I pait
,Component(s) Monitored by this Sensor:
--!jESELJEN]1!NESensor Functionality Test Result ffi fass; E fal hterstitial Communication Test Result: [l Pass; E pait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result fl pass; f] fal Interstitial Commrmication Test Result fl Pass; n fait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: fl Pass; n fal Interstitial Communication Test Result I lass; E fait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: fl pass; n fail Interstitial Communication Test Result: n Pass; I fait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result fl fass; n fal Interstitial Communication Test Resuh I Pass; n fait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result I fass; n nal Interstitial Communication Test Result n pass; n pait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: E pass; fl faU Interstitial Communication Test Result f] fass; I fait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result I fass; I fal Interstitial Communication Test Result I tass; n pait
Component(s) Monitored by this Sensor:
Sensor Functionality Test Resuk f] pass; fl fal Interstitial Communication Test Result n pass; I fait
How was interstitial communication verified?
ffi Leak Introduced at Far End of Interstitial Space;r I Gauge; I Visual Inspection; I Otner @escribe in Sec. J, below.
Vacuum was restored to operating levels in all interstitial spaces: [t Yes n No (f no, describe in Sec. J, below)
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lf the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the
sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice.