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03/22/2012 07:31 0000000000 <br />Secondary Containment Testing Report Form - Page,2 of 5 <br />D. Testing of Tank Annular Spaces/Vaults <br />PAGE 03/07 <br />❑ N/A (No tanks have secondary containment) <br />eveloped By: ❑ Tank.Manufacturer; ❑ Industry Standard; [] PE; ❑ Other (Specif}�): <br />Methodsed: ❑ Pressure; [] Vacuum; © Hydrostatic; ❑ Otlier (,Spec fv); <br />Equipment Used: Equipment Resolution: <br />FfankCapacit <br />Enviroflea <br />ProductlGrade in Line: <br />Diesel <br />Tank #: <br />Tank 4: <br />Tank #: <br />T sink #: <br />pt From Tcsting7 <br />[� Yes; ❑ No <br />❑ Yes; [] No <br />❑Yes ❑ No <br />C] Yes; No <br />(gallons): <br />Inityal Reading (R1): <br />Product/Grade Stored in Tank: <br />Test End Date/Time: <br />Tank Manufacturer: <br />Final Reading (Rr): <br />nk 11'ode1:ait <br />Changc in Reading (R,: , Rr) <br />Pass/.Fail Threshold or Criteria: <br />0.0 PST <br />0.0 PSI <br />tithe between applying <br />L <br />Teat Result: <br />® Pass; 0 Pail <br />e,sure/vacuum/water and <br />❑ Pass; O .Fail 0 Pass; [� Fail I <br />rtin test minutes <br />Test Start'rime: <br />Initial Peading (R,): <br />Test Encs Time: <br />Final Reading (RF) - <br />Change in Reading (its — R,): <br />Pass/rail Threshold or Criteria: <br />_ <br />Teat Re�i(lt: <br />❑ Pass; [� 1i'ail <br />❑ Pass; ❑Fail <br />❑ T'ass; ❑ .Fail <br />Pass; ❑Fail <br />Was leak detection sensor <br />properly replaced and verified <br />rr0--II Yes; <br />Ne <br />[� yes; ❑ No; <br />Yes; El No; <br />�] Yes; No; <br />as functional after testinQ7 <br />No <br />I� N/A (Not Removed) <br />❑ N/A {Not Removed) <br />(j N/A (Not Removed) <br />[� N/A (Not Removed) <br />E. Testing of Secondary Piping or Containment Trenches ❑ N/A (No piping 20 containment) <br />Test Metltod Developed By: ❑ Pipe/Trench Manufacturer; ® Industry Standard; ❑ PE; © Other (.5'peci�): <br />Test Method Used: ® Pressure; ❑ Vacuum; ❑ FTydrostatic; [] Other (Specify): <br />Test Equipment Used: garage Equipment Resolution: 0.2 PSI <br />Pipe Run #i: Sat. 42 Tpipe Run #: Pipe Run #: Pipe Run #: <br />I Pipe/Trench Manufacturer: Environ <br />Pipe/Trench Model: <br />Enviroflea <br />ProductlGrade in Line: <br />Diesel <br />Wait time between applying <br />pressure,/vacuum/water and <br />starting test minutes): <br />30 1Nlin. <br />Test Start Date/Time: <br />1:40 <br />Inityal Reading (R1): <br />$,2 FSI <br />Test End Date/Time: <br />2:40 <br />Final Reading (Rr): <br />5.2 .PST <br />Changc in Reading (R,: , Rr) <br />Pass/.Fail Threshold or Criteria: <br />0.0 PST <br />0.0 PSI <br />Teat Result: <br />® Pass; 0 Pail <br />© Pass; 0 fail <br />❑ Pass; O .Fail 0 Pass; [� Fail I <br />UN -054.2/5 www•nnidocs.org <br />02/26/02 <br />