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ACDEH,August 2003 Page of <br /> 4. TANK ANNULAR TESTING <br /> Test Method Developed By: ❑Tank Manufacturer x Industry Standard ❑Professional Engineer <br /> ❑Other(Specify) <br /> Test Method Used: ❑Pressure xVacuum Hydrostatic <br /> ❑Other(Sped) <br /> imbiwe <br /> auge Equipment Resolution: ''/z" <br /> F Z Tank# 9 <br /> 4Tank# Tank# <br /> Is Tank Exempt From Testing?' 7— �Yes o ❑Yes ,> ❑Yes n No El Yes No <br /> Tank Capacity: <br /> Tank Material: <br /> Tank Manufacturer: <br /> Product Stored: <br /> Wait time between applying <br /> pressure/vacuum/water and �— <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(IQ: <br /> Test End Time: <br /> Final Reading(RF): <br /> Test Duration: 2— ,- <br /> Change in Reading(RF-Ra): — �— <br /> Pass/Fail Threshold or Criteria: T Z <br /> Test Result: ❑Fail ass ❑Fail ❑ Pass ❑Fail ❑ Pass 0 Fail <br /> Was sensor removed for testing? — es ❑No NA es ❑No ❑NA ❑Yes Lo No [3 NA D Yes ❑No ❑NA <br /> Was sensor properly replaced and - es ❑No ❑NA --L-4 ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA <br /> verified functional after testing? <br /> Comments—(include information on repairs made prior to testing and recommended follow-up for failed tests) <br /> fir 1 9 2016 <br /> _ <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br /> containment,such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment <br /> testing. {California Code of Regulations,Title 23,Section 2637(a)(6)) <br />