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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment o <br /> Secondary Containment Certification Form Page 2 of N <br /> t N <br /> Y t.335 ty: 5 elk- DOS g P��H Test Date: IO—�I—QZ m <br /> Facilit it; Ci Tessin Contractor: <br /> 1 �7 � N <br /> Facility Address: 9Ci �i'•L&I,'t 5h _ Qru-��Z qq. Contractor Address: I411AS.T \ AAjoml Ave— Tech.Name:ry joLVj1kV Nwnt7- <br /> �n <br /> rs <br /> �n <br /> Turbine Sumps H7 99 91 D 87 89 (S)D 87 89 91 D B7 89 91 D Fill Sumps 89 91 D 87 ® 91 D 87 899�D B1 89 91 D <br /> ID(nortli,slave,etc.) ID north slave etc. w <br /> N <br /> ManufacturerManufacturer <br /> 13 s. <br /> Start Time(to) Start Time(ta) <br /> �n <br /> Water Level 1000 ,000 Water Level OCO .00� ."15 iD <br /> :1to 9;41 _ Time(ti) $IO(o -%u 4% A <br /> Time(yJ X000 <br /> Water Level •OOo 1000 Water Level Rk <br /> Doo 000 <br /> Time(tZ) 9 :19 la-.q5 Time(t,) Lto `f tWater Level 000 ,ODD Water Level 0'0 000Time(ts) 9"-22 8 Time(t3) 29 q�wWater Level .000 .000 Water Level 00 X0317Time(tj 9:25 0btTime(tj 32 9 =47Water Level ODD .000 Water Level � 1000 Test Resulls ass Fal ® Fail Pass Fail Pass Fai] Test Results ss Fail as FaH Pass Fail0 <br /> z <br /> Signature SignaturemM3 5 I UDC � zUDC /IZ 3�ft ��� <br /> 1D(1/2,314,etc.) /(p �� ID(N.314,etc. z <br /> n <br /> Manufacturer we tty0k eACV� wZ6�eY•n LVw4ry,,- Manufacturer tN H pvK wes�CY v1 I V2,e,5iV-,/VI <br /> at�O ; 0 <br /> 9519 9 :33 Start Time q:48 tO.oZ 10-, 14 lo %. p <br /> Start Time(to) <br /> Water Level 1000 ,0607 Doo 0000 Water Level „00o 000 .000 •DOD <br /> 8 53 9 08 q:22 9 '3` 9 L9 06 = 34 <br /> qOTime .61 toxG L <br /> Time(ti) 0 <br /> Water Level 000 ,000 , 000 , D Water Level ,000 0000 ,000 .000 <br /> Time(Q El:5(r glil 9:25 OU 3q Time($) q 5't to:O& 1p: i-3 j,032 <br /> Water Level 000 006 Ot70 000 Water Level jPass <br /> 00 000 000 doe) <br /> 9:5,1 9! 11 6( ;28 °l uZ Time(Q 1 IO:lI (0:z5 100 =`(O <br /> Water Time tLevel ,DOL ,000 ODD .oho Water Level 0 000 000 - <br /> ( q:o1 q:t7 aI'"31 %Y(s Time(Q 0o �O:ly <br /> Time t`) <br /> Water Level OUD tld0 .000 ,Ow Water Level 0 qpa �OOO DD <br /> Tess Results Pass Fail ass Fail ass Fail Past Fail Test Results Fail Fail Fail ass '-.Fa�ti <br /> Signature JL///J ��/�' Signature ��^ koz�! a <br />