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Underground Storage Tank System Tanks,Piping, &Spill Buckets <br /> Secondary Containment Certification Form <br /> Page Z of Z <br /> Facility#:9(000 City: 5--6r—k6y` Testing Contractor: <br /> Facility Address:L,Z.CjQ N. W� I ur+ wew Test Date:f/—/—02 Contractor address: 14118 S I� � d_ p� <br /> Tech. Name:lSp6ndp �}e�ytl?i2 <br /> USTAnnularS ace <br /> Tank#1 Tank #2 Tank#3 Tank#4 Secunda P' in <br /> Product 97 89 91 D 87 89 91 D 87 89 91 D 87 99 91 D Line ,1 Line #2 Line#3 Line#4 <br /> Product 67®91 D 87 890 <br /> Capacity 87 89 91 D 87 89 91 D <br /> Manufacturer Piping Type im Siphon im Siphon Primary Siphon primary Siphao <br /> L <br /> Test Start Time Manufacturer *W&11K i"w`wrph <br /> Initial Pressure Test Start Time T 5 o <br /> 7:So <br /> Test End Time Initial Pressure b P.5.1: <br /> S P• <br /> Final Pressure Test End Time $• 5V <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail Final Pressure 5" 0 P• $ Y <br /> . o P.S•2 <br /> Signature TestResutts ® Fail Fail Pass Fail Pecs Fai] <br /> S HI Buckets Signature <br /> Overfill#1 Overfill#2 Overfill#3 Overfill 44 Seconda in <br /> Product (ID 89 91 D 970 91 D 87 89® D 87 89 91 D Line#5 Line #6 <br /> Line#7 Line#8 <br /> Manufacturer Product <br /> 70 (40 Pool 87 69 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> Start Time((o) 10.01 10:1'1 10"55 Piping Type primary Siphon Primary Siphon Primary Siphon Primary Si <br /> Water Level ,Opp <br /> 0 --- <br /> Time <br /> Manufacturer <br /> Time(t,) IO:bS lO;Zp 10:3$ <br /> Water Level 1006 .000000 Test Start Time <br /> Time(ti) 10:08 10123 10 ' 41 Initial Pressure <br /> Water Level 000 DOD <br /> Time(t3) 10:11 10 s Z 000 10 :Yy Test End Time <br /> Water Level .000 .000 r cop Final Pressure <br /> Time1D:14 <br /> (t a) 10=7 V 10 :Y I Test Results Pass Fail Pass <br /> Water el 0 Do-O <br /> Fail Pass Fail Pass Fail <br /> Lev <br /> Pass Fail ® Signature <br /> TestResntts Fail Pass Fail Pass Fail <br /> Signature <br />