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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page 2 of 3 <br /> Facility#: G 33 J City: 570 c.KTo tJ Testing Contractor: Test Date: m*rc,k 1 zoo-a- <br /> Facility Address: `18SS c,a 54A,+*.UAL 4ot Contractor Address: /a-14-7 S.erraGlr Bub1;n Tech.Name: K-mak W1�stcn <br /> Turbine SumItt'31 <br /> 91 D 87 aV91 D 87 89 �� 87 89 91 D Fill Sumps 87 89 91 D 87 I D 87 89 D 87 89 91 D <br /> ID(north,slave,etID north slave etc. <br /> Manufacturer Z )� Manufacturer ,t > <br /> Start Time(to) 8 to35 11 StartTime(to) Izot It33 twQ, <br /> Water Level 000 O o o L Water Level +a b 4003, +00 <br /> We(t,) I0s8 lt� S Time(t,) 1109 17.34 11 ''14 <br /> Water Level - 010 p n o _ o o lr Water Level - 001t coo 00-3 <br /> Time(t2) t 101 Time(t2) t236 <br /> Water Level p 0 Water Level <br /> Time(t3) 1104 Time(t3) <br /> Water Level 000 Water Level <br /> Time(tj t1 a Time(tj <br /> Water Level (70o Water Level <br /> Test Results Pass Fail Pass Fail Pass Fai Pass Fail Test Results Pass Fail Pass ail Pass Fail Pass Fail <br /> Signature � Signature <br /> UDCUDC <br /> ID(1/2,3/4,etc.) Z� 3-Li <br /> 1 5 ^ fo '1 ID(1/2,3/4,etc.) - -14 l S- CC. <br /> 11kanufacturer 15a Ljt i.V,,w W ".6.., vlManufacturer tJs }ear ra+i+w <br /> Start Time(to) 3 0* 30S 3°4 a It I Start Time(to) L 39 z 35 3. 0 4 i o C. <br /> Water Level .rop1 +A 4 °tQ + aq3 Water Level 4.06.5 * t1$ L tIt a 33 <br /> Time(t,) '3*'L 306 305 23Z Time(tj) 315 }3t ZIc� 2,0'7 <br /> Water Level -004t - cot *. 003 - oo Water Level r o 10 1- 013 + �3 - o°'t <br /> Time(t2) 30f. Time(t2) .1.4 o <br /> Water Level - 065 Water Level o° <br /> Time(t3) Time(t3) <br /> Water Level Water Level <br /> Time(tj Time(tj <br /> Water Level Water Level l <br /> Test Results Pass ai Plass ail Pass a Pass Fai Test Results Pass Fai Pass nail Pass d Pass Fai <br /> SignatureSignature Ot J� <br /> u.., t t/n t V.11.-- e.,,.. �� <br />