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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page o3 of <br /> Facility#: GVZ City: VToGILTOf/1 Testing Contractor: C ,({la^ ", 'I Test Date:pvinr� vi7 Z00?— <br /> Facility <br /> ooZ,Facility Address: 4!BS D &*,& 2 S��e. Qo Jr,- 4`f Contractor Address: C) Sl err�y,A, (V" _ Tech.NameX;r I= Nk%.� -✓— <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 /> e(tt) Time(tt) <br /> Water Level Water Level <br /> Time 02) Time(t2) <br /> Water Level Water Level <br /> Time(t,) Time(t3) <br /> Water Level Water Level <br /> Time(t4) Time(Q <br /> Water Level Water Level <br /> Test Results Pass Fail Pass Fail Pass Fail 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.) ID(1/2,3/4,etc.) <br /> nufacturer �J Manufacturer <br /> Start Time(to) 13 y Start Time(to) <br /> Water Level t• 074 Water Level <br /> Time(tt) t 3 b Time(tI) <br /> Water Level — p 13 Water Level <br /> Time(t2) Time(t2) <br /> Water Level Water Level <br /> Time(t3) Time(t3) <br /> Water Leg] Water Level <br /> Time(t4) � Time(tj <br /> Water Level Water 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 /> Rev. 11/Ol White—nrivinsl Vellnw—Aran Fnvirnnmental Cmmnlinnce Pink—Contractor <br />