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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> W <br /> Secondary Containment Certification Form <br /> p, �D 2.. <br /> Facility H: Oo City: +"" Testing Contractor:P <br /> ~ Test Date;Page I of <br /> 1l-f —O Z <br /> Facility Address; (Z50 N, W�L Sow (I,�u Contractor Address:L'{11fb S.T,.,.1 r ,.b,•J <br /> Tech.Name:qC' <br /> Turbine Sumps 87 IS 91 D 87 89 ® D 97 89 91 D 97 99 91 D <br /> ID(nonh,stave, etc.) Fill Sumps ® 89 91; D 87 (E) 91 D 87 89 91 D 87 89 91 D <br /> Manufacturer <br /> ID north slave etc,W ,� w }v► Manufacturer " <br /> Start Time(ta) :O( ` 8:34 Star!Time(ta) 4 oS t jtJ <br /> Water Level .000 000 - ' <br /> Water Level ODb .000 <br /> Water Level O Time(11) at 9'•43 <br /> Time(tz) $:07 g;yD Water Level ODD .e:o0 <br /> Water Level .000 D00 Time{t,) al..I f :y V <br /> Water Level <br /> Time(Q $:1D X93 •moo •ODo <br /> Water Level D D00 Time(t,) I',M :y 9 <br /> Time(t.) 8:I j g;y Water Level _ o1 ,000 <br /> Water Level aOO O00 Time(tj °1: 17 9 jz <br /> Water Level _ 00( logo <br /> Test Results Fail Pass Fail Pass Fail Pass Fail Test Results <br /> Fail P <br /> Signature Fail Pass Fail Pass Fail <br /> Signature <br /> UDC ��$ 9 IUDC 19/ <br /> IDprz,314,et�.} YZ //b �1 <br /> ID(1/2,314,ate.) Z D <br /> Manufacturer <br /> Manufacturer <br /> Start Time(ta) e:lv 8:19 8:58 <br /> Water Level ODO Start Time(ts) Cl%40 <br /> ODD CDp 000 Water Level <br /> Time(tL) �: ;�Z •OOp <br /> Water Level p p 000 9 .01 Z7 Time(tt) %43 <br /> opo 000 Water Level <br /> Time(ti) g'io 8:vs 9:049130 <br /> .C>VO <br /> Water Level 0O _ t _ � Time(y) 4:4(e <br /> Time(t,) . 0p 8; t 0 Water Level <br /> Water Level 000 _0p l 9--07 1 33 Time(t,) . 49 <br /> td) B: Zb t —.00 Water Level ODD <br /> Time{ <br /> g:15 9: Time(tJ %5L <br /> Water Level .000 <br /> —'00 —DO( Opp Water Level <br /> Signature O� <br /> Test Results ® Fail Pass Fail Fail as Fail Test Results �1A <br /> Fail Pass Fail Pass Fail P s <br /> Signature <br /> f/ � <br />