Laserfiche WebLink
RECEIVED <br />JUL 28 2014 <br />S WRCB, January 2002 Page= of _ <br />ENVIRONMENTAL HEALTH <br />A 'rArvrr AVWTr.AP TF.4T1N nPPARTMFNT <br />Test Method Developed By: ❑ Tank Manufacturer ❑ Industry Standard X Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: ❑ Pressure ❑ Vacuum X Ifydrostatic <br />❑ Other (Spec#yj) _ <br />Test Equipment Used: Vacuum Gauge <br />Tank # Tank # <br />Is Tank Exempt From Testing?' ❑ Yes ❑ No ❑ Yes ❑ No <br />Equipment Resolution <br />Tank fl Tank # <br />❑ Yes []No <br />❑ Yes O No <br />Tank Capacity: <br />_ <br />Tank Material: <br />Tank Manufacturer: <br />_ <br />Product Stored: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />- <br />Test Start Time: <br />Initial Reading (R,):— <br />Test End Time: <br />Final Reading (RF): <br />I hr. <br />Test Duration: <br />I hr, <br />1 hr. <br />Change in Reading (RF-RI).'— <br />RFRt):Pass/Fail <br />Pass/FailThreshold or Criteria: <br />2" <br />2" <br />2" <br />2" <br />Test Result: <br />❑'Pass ❑ rail <br />❑ Pass ❑ Fall <br />❑ Pass ❑ Fnil <br />0 pass 0Fail <br />Was sensor removed for testing? <br />n Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No DNA <br />❑ Yes ❑ No UNA <br />Was sensor properly replaced and <br />verified functional after testingl <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ DIo ❑ NA <br />❑ Yes ❑ No DNA <br />❑ Yes ❑ No DNA <br />Comments (include infor'mration on repairs grade prior to leslnrg acrd r'eco»nnerrdedjolloitr-rrp forfailed rests) <br />1 Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br />colttanunent, such as systerns that are hydrostatically monitored or under constant vacutun, are exempt from periodic containment <br />testing. {California Code of Regulations, Title 23, Section 2637(x)(6)} <br />