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^ L13/22/2012 07:31 0000000000 O�E<�����i`F`�E<�E ON PAGE 06/07 <br />Secondary Containment Testing Report Form - Page 5 of 5 <br />Pass/Fail Threshold or Criteria: <br />Test Result: Pass; );Ail Pass; Pass; ❑ Fail Paas; 1+ail. ❑ Fai] <br />Was leak detection sensor __.. <br />, F1d and verified as ❑ YesNo; El Yes; 0 No; ❑ Yes; ❑ No; ❑ Yes; No; <br />properly replace <br />Functional after d an 7 F1 N/A (Not Rcmoved) El N/A (Nat Removcd) ❑ N/A (Not Removed) F-1 N/A (Not Rcmoved) <br />I. 'Testing of Spill Buckets <br />❑ N/A (No spill buckets installed) <br />❑ Spill bucket(s) not tested <br />Test Method Developed .By: ❑ Bucket Manufacturer; ❑ Industry Standard; ❑ PE; ❑ Other (Specify): <br />Test Method Used: ❑ Pressure; ❑ Vacuum; ❑ hydrostatic; ❑ Other (Specify): <br />Test Equipment Used: Equipment Resolution: <br />Bucket #: <br />Bucket #: <br />Bucket #: <br />Bucket #: <br />Bucket Diameter: <br />Bucket Taepth: <br />Wait time between applying <br />pressure/vacitum/water and <br />starting test: <br />Test Start Time: <br />Initial Reading (RT): <br />-- <br />Test End Time: <br />Final Reading (Rr): <br />Change in Reading (RF — RT): <br />Pass/Fail Threshold or Criteria: <br />_ <br />Test result: <br />❑Pass; ❑ FAiI <br />❑ .E'ass; ❑Fail <br />❑ Pass; ❑ Fail <br />❑ Pass; ❑ Fail <br />J. Additional Information <br />Were any repairs made to secondaty containment systems prior to testing? ❑ Yes (describe in "Comments"); ©< No <br />Were any secondary containment systems unable to be tested? ❑ Yes (describe in "Comments"); IMC No <br />Ts any follow-up action recommended? ® Yes (describe in "Comments"); ❑ No <br />Was any cleaning of secondary containment systems done? ❑ Yes (describe management of wastewater in "Comments" ); ® No <br />Tf hydrostatic testing was perfonned, describe in "Comments" what was done with the water after completion oftesting. <br />Comments: Pumped water into tank for reuse <br />M-954.5/5 rvimimidocv.org, If2/UM <br />