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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment ' <br /> Secondary Containment Certification Form Page 2 of <br /> Facility#: fpm City: $T O L(C-T G to Testing Contractor: .k}{ct^ P ov n Test Date:}-»nr a v% l Z-00?- <br /> Facility <br /> -ooLFacility Address: 4'As5 Seui-%I S kt Qo ��t 4el Contractor Address: (04-1 Tecb.NameX:.-tr. wv,o�ev+ <br /> Turbine Sumps 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D Fill Sumps 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> ID(north,slave,etc.) ID north slave etc. <br /> Manufacturer Manufacturer <br /> Start Time(to) Start Time(to) <br /> Water Level Water Level <br /> Time(tt) Time(tt) <br /> Water Level Water Level <br /> Time(tz) <br /> Time(t=) <br /> Water Level Water Level <br /> Time 03) Time(ta) <br /> Water Level Water Level <br /> Time(t4) Time(t4) <br /> Water Level Water Level <br /> Test Results Pass Fail Pass Fail Pass Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Signature Signature <br /> UDC UDC <br /> ID(1/2,3/4,etc.) { — I <br /> ID(1/2,3/4,etc.) <br /> Manufacturer Manufacturer <br /> Start Time(to) t a y Start Time(to) <br /> Water Level t 0,14 Water Level <br /> Time(tt) t 3 b Time(tt) <br /> Water Level - Ot3 Water Level <br /> Time(tz) Time(tz) <br /> Water Level Water Level <br /> Time(t3) Time(t3) <br /> Water LI Water Level <br /> Time(tTime(t4) <br /> (t4) Time <br /> Water Level ater Level <br /> Test Results Pass ai Pass Fail Pass Fail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Signature Signature <br /> V— t t mt white-nrioinal Yellow-Arco Environmental Compliance Pink-Contractor <br />