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Undergrisand Storage Tank System Tanks, Piping, & Spill Buckets <br /> Secondary Containment Certification Form Page L of <br /> Facility#: g600 City: STC)c+k-Tof2 Testing Contractor: foLffiee IeAyn Test Date: vN"u1,rs2.ees, <br /> Facility Address: 12 So tJ Contractor Address: 5i`cee ,cA- 0%,IP - (*-Tech.Name: 14 Tr or, Nn*s'f'gr. <br /> USTAnnularS ace Secondary Pi in <br /> Tank#1 Tank #2 Tank#3 Tank#4 Line#1 Line #2 Line#3 Line#4 <br /> Product 7 89 91 D 91 D 87 89 D 87 89 91 D Product 6] 89 91 D 87 ®9 91 D 87 89 D 87 89 91 D <br /> Capacity .-L o 0 1 x, CIOC 12,00% Piping Type �m Siphon Primary Siphon Primary Siphon Primary Siphon <br /> Manufacturer STuI F►ar I C.bc� Sltal ltiL+i ;1N10 Manufacturer A3+"ean a.o w. <br /> Test Start Time k a go co 30 t o 3o Test Start Time g 2.41 t t I t t J <br /> Initial Pressure 1 S SiKu6p 1011 to – S v s L <br /> Test End Time v t So ti 30 It 20 Test End Time Q 3 '1 I t 15 It 'Li <br /> Final Pressure to' NL t C`c 14.c Final Pressure <br /> ,�,,//�� 131 <br /> Test Results Fail Fail i Fail Pass Fail Test Results s Fail Pass C71✓ Pass a1 Pass Fail <br /> as <br /> Signature �— (� <br /> Signature <br /> Spill Buckets <br /> Overfill#1 Overfill#2 Overfill#3 Overfill#4 Seconda Pi in <br /> Product ®89 91 D 87 � 91 D 87 89 &D 87 89 91 D Line#5 Line #6 Line#7 Line#8 <br /> Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> Manufacturer <br /> ?evM!«+ �e�< <-�- Piping Type Prim ' Siphon Prim ' Si hon Prima rySi hon Prim Si ho <br /> Start Time(ta) <br /> Water Level 0042, o J a e o tJ Manufacturer <br /> Time(tr) Test Start Time <br /> Water Level .p .L„T . 02- S - a=-5 <br /> Initial Pressure <br /> Time(t2) <br /> Water Level Test End Time <br /> Time(t3) Final Pressure <br /> Water Level <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Time(tc) <br /> Water Level Signature <br /> Test Results Pass F '1 Pass Pass ail Pass Fail <br /> Signature <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor ( <br />