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Underground Storage Tank System <br />Secondary Containment Certification Form <br />Tanks, Piping, Tank Sumps & Overfill Buckets <br />Page of <br />Facility ID: eoY9 -- TestingContrihcrtor: t_r�s Pl% 8dr9K I Test Date: —, %-0--- <br />Facility Address: J A47 !P1 LUy_ Contractor Address: Y T- CO//i�s� GO Tech. Name: AkAI,gL,l1,41 <br />UV Annular Snace <br />Overfrll•Buckets )!4 1/3 <br />Tank #1 Tank 0 3 <br />Tank 43 <br />Tank #4 <br />Product <br />8 89 91 D 87 8 913 <br />87 89 91 D <br />87 89 91 D <br />Capacity <br />D Qd0 GOON <br />Start Time (to) <br />Water Level <br />�idi'"I <br />Test Start Time <br />rsr er+� <br />dbe� <br />Time (tj) <br />Water Level <br />Initial Pressure <br />1p �vtq <br />"!„SDwr <br />Fail ass Fail P Fail <br />Test End Time <br />�QGy <br />v��•f• <br />fjUL.+y <br />Final Pressure <br />ae//-, I'M '/6ir <br />� <br />!� <br />Test Results <br />a Fail a s Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />6esfs71►-,4 <br />lrs-r 74y-, <br />Water Level <br />Overfrll•Buckets )!4 1/3 <br />Turbine Sumps <br />Overfill #1 <br />Overfill #it <br />Overfill Wj <br />OverfiIIA03 <br />Product <br />6289 91 D <br />89 91 D <br />8791 D <br />87 8�1 D <br />Start Time (to) <br />Water Level <br />�idi'"I <br />g OGY'^ <br />rsr er+� <br />dbe� <br />Time (tj) <br />Water Level <br />zee oo'rfl <br />1p �vtq <br />"!„SDwr <br />Fail ass Fail P Fail <br />Time (t2) <br />Water Level <br />�QGy <br />v��•f• <br />fjUL.+y <br />/se••� <br />Time 03) <br />Water Level <br />� <br />!� <br />Time (t,) <br />Left 77(,V'f <br />el; 57 -Ary <br />6esfs71►-,4 <br />lrs-r 74y-, <br />Water Level <br />y675J P <br />!OS P <br />Las 91^ <br />aOS <br />Test Results <br />Fail <br />as Fail <br />as Fail <br />Fail <br />Signature <br />p h <br />1 O5 SP h <br />"1!5'"Al <br />Turbine Sumps <br />Secandary Pinin-0 <br />Tank #1 <br />Tank #2 <br />Tank #3 <br />Tank #4 <br />Start Time (to) <br />Test Start Time <br />Oen ��- <br />Initial Pressure <br />Water Level <br />M <br />Test End Time <br />rsr er+� <br />Time (ti) <br />Water Level <br />zee oo'rfl <br />1p �vtq <br />"!„SDwr <br />Fail ass Fail P Fail <br />Time (t2) <br />Signature <br />300 <br />Water Level <br />Time (t3) <br />Water Level <br />SP,4J <br />�5d y/ <br />Time (t,) <br />�fis 7%fty <br />J,,-- *.,f 7 -*--l' <br />f, elf Vii. <br />Water Level <br />p h <br />1 O5 SP h <br />"1!5'"Al <br />Test Results <br />ss Fail <br />s Fail <br />as Fail <br />Pass Fail <br />Signature <br />Secandary Pinin-0 <br />Rev. 10/01 White - Original Yellow - Arco Environmental Compliance <br />Pink - Contractor <br />tine #1 Line #2 Line #3 <br />Line #4 <br />Product <br />8 89 91 D 891 D 87 89(IDD <br />87 89 91 D <br />Test Start Time <br />Oen ��- <br />Initial Pressure <br />S O P5 <br />Test End Time <br />rsr er+� <br />Final Pressure <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 />