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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment ' <br /> Secondary Containment Certification Form Page 3 of 3 <br /> Facility tt: Qi600 City: STOc�kA-civ-j. Testing Contractor: (0 'R [<r R-&-4 In Test Date: vti a ea h f C o <br /> Facility Address: 1Z. SO1� 0-\"" LJ'Ary Contractor Address: ee-r. t.} L to % rvt Tech.Name: V✓IMt"w <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(ti) <br /> Water Level Water Level <br /> Time 02) Time(t2) <br /> Water Level Water Level <br /> Time(t3) Time(t3) <br /> Water Level Water Level <br /> Time(ta) Time(ta) <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.) 1-7-I I?,-' 11-Z O ID(1/2,3/4,etc.) <br /> Manufacturer ur�T - h/tpj�rJ Manufacturer <br /> Start Time(to) b djo 11 N S Start Time(to) <br /> Water Level 000 o o t Water Level <br /> Time(tt) 1133 v149 Time(tt) <br /> Water Level p p eola Water Level <br /> Time(t2) I 1 s Time 02) <br /> Water Level o 0 0 Water Level <br /> Time-(t3) 1131 Time(t3) <br /> Water Level - p p f Water Level <br /> Time(ta) A&A Time(ta) <br /> Water Level — CO 01 Water Level <br /> Test Results G� Fail Pass a' Pass Fail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Signature Signature <br /> S <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor\ <br />