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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page Z of 3 <br /> Facility#: G 3 3 5 City: 51oc.KT6pl Testing Contractor: Test Date: rnnr" 1 aoo2 <br /> Facility Address: `1 SSS Seu 11 5'6+e Q.au+e. %'I Contractor Address: 1011+1 Sltrra G(- -J%u101;n Tech.Name: le..r lC W1�ateK <br /> Turbine Sumps (Y89 91 D 87 aV91 D 87 89 e>fr 87 89 91 D Fill Sumps 87 89 91 D 87 ) 1 D 87 89 1 -D 87 89 91 D <br /> ID(north,slave,etc.) ID north slave etc. <br /> Manufacturer Zlog >L'_ CeA Manufacturer <br /> Start Time(to) I I%.IL l o S S it O Iq Start Time(to) 12 01 1233 t t 4 Q� <br /> Water Level 000 000 peL Water Level +034 .4 0030 +00 <br /> Time(tt) t 131 10 s$ I t� S Time(ti) 12.0 q 12.3 4 %141 <br /> Water Level — Ol O p 0 0 _ o n b Water Level _ 0011 000 003 <br /> Time 02) t 1 o 1 Time 02) 1236 <br /> Water Level 00 o Water Level _ 0110 <br /> Time(t3) 1104 Time(t3) <br /> Water Level 000 Water Level <br /> Time(t.) 110") Time(t4) <br /> Water Level (000 Water Level <br /> Test Results Pass Fail Pass Fail Pass Pass Fail Test Results Pass Fail Pass ail Pass Fail Pass Fail <br /> Signature Signature <br /> UDC UDC WO <br /> ID(1/2,3/4,etc.) "Z� 3-L{ _ 1- ID(1/2,3/4,etc.) 01-('0 - -1 t - 1 t. - <br /> Manufacturerca O�ST(Iw W Ii I ear. <br /> fa.� ` d Manufacturer a9 }tea e�}e*" LJeY�,4 <br /> 1•� �f1N N WI r�► <br /> Start Time(to) 3 04t S O S 361 z s I Start Time(to) L 3 y 2 3$ 2. o q 22. 0 1. <br /> Water Level r0p1 +A 4 CIS + cOg3 Water Level 1.0405 * ,1 l5 t I t + Fe 33 <br /> Time(tt) 301.. $0(y 30 Cl 23'L Time(ti) 1.35 . 321 2.t c, 2. 01 <br /> Water Level . 001 - Oat x003 — Do Water Level roto u13 + c 3 — o0-t <br /> Time(t2) 30f. Time(t2) 1.110 <br /> Water Level — 005 Water Level — 60( <br /> Time(t3) Time(t3) <br /> Water Level Water Level <br /> Time.04) Time(t4) <br /> Water Level Water Level t <br /> Test Results Pass ai Pass ail Pass a' 3PassFail Test Results Pass Fai Pass ail Pass a' Pass .Fai <br /> Signature �� v� Signature �a �( — 16 <br /> Rev- 11/01 White-Orieinal Yellow-Arco EnvironmentalComoliance Pink-Contractor !1 <br />