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Secondary Containment Testing Report Form - Page 2 of 5 <br />D. Testing of Tank Annular SpacesNaults <br />R N/A (No tanks have secondary containment) <br />'rest Method Developed By: ElTank Manufacturer; E] Industry Standard; [I PE;E] Other (Specifiv: <br />Test Method Used: El Pressure; ❑ Vacuum; ❑ Hydrostatic; El Other (Specify): <br />Test Equipment Used: <br />Tank 4: Tank <br />I"ClUipment ROS011.160n: <br />Tank 4: <br />Tank <br />. . .............. <br />Is Tank Exempt From Testing. <br />El Yes: E No <br />F-1 Yes: ❑ No <br />F1 Yes; E) No <br />El Yes; El N c) <br />. ..... . . . . .............................. <br />Tank Capacity (gallons): <br />Product/Grade Stored in Tank: <br />Product/Grade in Line: <br />Diesel <br />Tank Manufacturer, <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />30 Min. <br />Tank Model: <br />Wait time between applying <br />pressure/vacuum/water and <br />I starting test (minutes): <br />Test Start Date/Time: <br />1:40 <br />Test Start Time: <br />Initial Reading (RI): <br />5.2 PSI <br />initial Reading (R,): <br />Test End Date/Time: <br />2:40 <br />`rest End Time: <br />Final Reading (Rr): <br />5.2 PSI <br />Final Reading (RO: <br />Change in Reading (RF — RI): <br />0.0 PSI <br />Change in Reading (RF — RI): <br />Pass/Fail Threshold or Criteria: <br />........... . . <br />Pass/Fail Threshold or Criteria: <br />Test Result: <br />Z Pass; El Fail <br />El Pass; 0 Fail <br />Test Result: <br />EJ Pass; El Fail <br />0 Pass; ElFail <br />F-1 Pass; [I Fail <br />El Pass; El Fail <br />Was leak detection sensor <br />11 properly replaced and verified <br />as functional after testing? <br />I❑j Yes; M No'F1 <br />L El N ! A (Not Removed) <br />Yes; M No, <br />❑ NI/A (?got Removed) <br />-1 Yes; [:]No; <br />Ej N/A (Not Removed) <br />I <br />❑Yes; [] No; <br />❑ N/A (Not Remove)) <br />E. Testing of Secondary Piping or Containment Trenches El N/A (No piping 2' containment) <br />'Test Method Developed By: L] Pipe/Trench Manufacturer; Z Industry Standard; 0 PE; El Other (Specify), <br />,rest Method Used: ®Pressure; F] Vacuum; [I Hydrostatic; 0 Other (Specify): <br />Test Equipment Used: gauge Equipment Resolution: 0.2 PSI <br />Pipe Run #: Sat. #2 i Pipe Run 4: Pipe Run #: Pipe Run =#: <br />Pipe/Trench Manufacturer: <br />Environ <br />i. <br />. . ....... . <br />Pipe/Trench Model: <br />Enviroflex <br />Product/Grade in Line: <br />Diesel <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />30 Min. <br />Test Start Date/Time: <br />1:40 <br />Initial Reading (RI): <br />5.2 PSI <br />Test End Date/Time: <br />2:40 <br />Final Reading (Rr): <br />5.2 PSI <br />. ..... <br />Change in Reading (RF — RI): <br />0.0 PSI <br />Pass/Fail Threshold or Criteria: <br />0.0 PSI <br />' <br />Test Result: <br />Z Pass; El Fail <br />El Pass; 0 Fail <br />0 Pass; [:TFail <br />Fail <br />UN -054 - 1,55, www.tmidoc%.or(,, 02/26;02 <br />