COMPLIANCE INFO 2001-2004 - Laserfiche WebLink

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Undergr6and Storage Tank System Tanks, Piping, & Spill Buckets Secondary Containment Certification Form Page I- of _ZL- - Facility#: Q feop City: SToc►c ro n Testing Contractor: 6ctfftr' lean Test Date: ruva,,•.,t,6z�es, Facility Address: I L Scz Y.1 w.t��o.a v:)& Contractor Address: y;trro ch- 4r-Tech.Name: y.7r Pa wtw s'rpM USTAnnularS ace Seconda Pi in Tank#1 Tank #2 Tank#3 Tank#4 Line#1 Line #2 Line#3 Line#4 Product 7 89 91 D 91 D 87 89 D 87 89 91 D Product 89 91 D 87 0 91 D 87 89 D 87 89 91 D Capacity tZ o C t 7, poo t Oa a tI Piping Type �m Siphon Primary Siphon Primary Siphon Primary Siphon Manufacturer e,T l Fla✓ 10.bc/ $4eal fib✓ -M-OManufacturer AWWO rs ue.n Weareh Test Start Time F e 3o t0 30 1030 Test Start Time $2..41 l Y It'Lv Initial Pressure 40 It 1,446 10`r t+G 1 all t-[to Initial Pressure s DSL $ OsL SFur- %'L s L Test End Time �ta0 lr 30 trio Test End Time Q 3 Ills Final Pressure tt i t tO� lie oKals. Lorisa Final Pressure PSL Test Results Fail d!Z? Fail <Tasr Fail Pass Fail Test Results ass Fail Pass Pass at Pass Fail Signature Signature Spill Buckets Overfill#1 Overfill#2 Overfill#3 Overfill#4 Seconda Pi in Product ®89 91 D 87 ® 91 D 87 89 ®D 87 89 91 D Line#5 Line #6 Line#7 Line#8 ManufacturerProduct 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D '?owaecta l7e wa< e.c> e�+s a-o Start Time(to) Piping Type Primary Siphon Primary Siphon Primary Siphon Primary Siphon Water Level 0 0 0 0 .o a o 0 D Manufacturer Time(t,) Water Level Test Start Time p eL T o i 5 - oL S Time(t2) Initial Pressure Water Level Test End Time Time(t3) Water Level Final Pressure Time(ta) Test Results Pass Fail Pass Fail Pass Fail Pass Fail Water Level Signature Test Results Pass F it PassPass ail Pass Fail Signature Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor