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Underground Storage Tank System Tanks, Piping, Tank Sumps & Overfill Buckets <br />Secondary Containment Certification Form <br />Page 1- of <br />L <br />1D:G, �- Testing Contractor: ��? S �� Bb➢� i 8 Test Date: Address: �_L-!�e✓�jy Contractor Address: Y i CO//i�► Gam_ Tech. Name: �f <br />�� GALL ooZ <br />11V An" nlnr .Cnnro <br />el— <br />Overrll-Buckets )a 1/:? <br />Tank #1 <br />Tank W 3 <br />Tank #3 <br />Tank #4 <br />Product <br />08P 89 91 D <br />87 8 9 D <br />87 89 91 D <br />87 89 91 D <br />Capacity <br />p ODd <br />U'nDa <br />5 ,•� <br />Test Start Time <br />/ <br />Time 02) <br />Water LevelQQ <br />4" a-' <br />v�aJ_ <br />Initial Pressure <br />�� �;, <br />G.U�s/Ay <br />Fail ass Fail P Fail <br />Pass Fail <br />Test End Time <br />/ <br />Time 04) <br />`fsS <br />LG557-A-r <br />Final Pressure <br />/es -f 74�'f <br />Water Level <br />f(75P4 <br />!05 P <br />Test Results <br />a Fail <br />a s Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />-- <br />�z <br />01��2 e <br />, p h <br />105 O�, <br />el— <br />Overrll-Buckets )a 1/:? <br />C <br />Turbine Sumps <br />Overfill #1 <br />Overfill #t <br />Overfill 40.2 <br />OverfiII A0 3 <br />Product <br />89 91 D <br />89 91 D <br />87 g 9 I D <br />87 8�1 D <br />Start Time (to) <br />Water Level <br />if ••a <br />C <br />5 ,•� <br />Time (ti) <br />Water Level <br />/ <br />Time 02) <br />Water LevelQQ <br />4" a-' <br />v�aJ_ <br />6UL.+,► <br />/fe-M <br />Time (t3) <br />Water Level <br />Fail ass Fail P Fail <br />Pass Fail <br />Signature <br />/ <br />Time 04) <br />`fsS <br />LG557-A-r <br />57faM <br />/es -f 74�'f <br />Water Level <br />f(75P4 <br />!05 P <br />05'A P <br />aOs y <br />Test Results <br />Fail <br />as Fail <br />as Fail <br />Fail <br />Signature <br />, p h <br />105 O�, <br />las Fail <br />Pass Fail <br />C <br />Turbine Sumps <br />ivrondarr Pinino <br />Tank 41 <br />Tank #2 <br />Tank #3 <br />Tank #4 <br />Start Time (to) <br />891 D 87 89(IDD <br />87 89 91 D <br />Test Start Time��- <br />Water Level <br />if ••a <br />8 x, <br />5 ,•� <br />Time (t,) <br />Water Level <br />/ <br />�0,41 <br />4" a-' <br />Final Pressure <br />Time 02) <br />Water Level <br />Test Results <br />Fail ass Fail P Fail <br />Pass Fail <br />Signature <br />/ <br />Time 03) <br />Water Level <br />�%S y� <br />-5 ,7149--, 7y9--, <br />S t,,fj <br />Time (0 <br />),zsf ,-f <br />�cs� <br />Water Level <br />, p h <br />105 O�, <br />las Fail <br />Pass Fail <br />Test Results <br />49,7s Fail I as Fail/-- <br />Signature <br />ivrondarr Pinino <br />Rev. 10/01 White - Original Yellow - Arco Environmental Compliance <br />Pink - Contractor <br />Line #1 <br />Line #2 Line #3 <br />Line #4 <br />Product8 <br />89 91 D <br />891 D 87 89(IDD <br />87 89 91 D <br />Test Start Time��- <br />Initial Pressure <br />Test End Time <br />Final Pressure <br />f <br />Test Results <br />Fail ass Fail P Fail <br />Pass Fail <br />Signature <br />Rev. 10/01 White - Original Yellow - Arco Environmental Compliance <br />Pink - Contractor <br />