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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page_L of <br /> Facility#: 4 600 City: S T ec t.-6V:'r� Testing Contractor:G,Q�Lex- e-awq b Test Date: Mgext.,,h <br /> Facility Address: IZSo -3 1.11%0 jft! Contractor Address: Slerre Cor ' jott,, C4 Tech.Name: V41e- r. 1M4•a+tM <br /> Turbine Sumps 89 9l D 87 91 D 87 89 ® D 87 89 91 D Fill Sumps 87 89 91 D 87 91 D 87 89 91 D 87 89 91 D <br /> ID(north,slave,etc.) ID north slave etc. <br /> Manufacturer Mod'�M lVl44AM M Manufacturer <br /> Start Time(to) <br /> tea 7 I L41 Z o 'I Start Time(te) 1 1St 1 1 o Z I I :10 <br /> Water Level a e e 1 + o01 oma Water Level - o0 3 0 0 o v o 0 <br /> 16.1� 1x.14 t z o'k Time(tl) 1 1 5j nog 1'1 13. <br /> Time([Level + e Z r o•5 - '4 a Water Level - o e 1 - -.e S - o o I <br /> Water Time(t2) 10:11 nAlt Time(t2) H f t 11 a lla 6 <br /> Water Level oo 3 r o05 Water Level <br /> w ;t I- MCI- Time(t3) 11:14 <br /> Time(t3) Water Level 'oe <br /> Water Level 4. 00 '3 <br /> au;;{,$ Iz Z5 Time(Q <br /> In,i2 <br /> Time(t4) <br /> Water Level 4003 <br /> Water Level <br /> Test Results ass Fail Fail ass ai Pass Fail Test Results Pass Pass Fail 19 Fail Pass Fail <br /> Signature` `. Signature � k� <br /> UDC ✓ ✓ ✓ <br /> UDC <br /> rIDD n,3/a,eto.) A - L oID(I/2,3/4,etc.) 1 —Z 1� 5 7Manufacturer Wi } v, 1Jo►tny. bJea}., t1.> - . nufacturer Wei} , OCJA;+..... LI-07-41, tAAP <br /> 1 9 3 c Start Time(to) <br /> 9 4 7.. 4 4s laze 1014 R <br /> Start Time(to) 832 g 9 9 s o <br /> Water Level -oct h Dol oeo 00o Water Level 006 o0o 000 e e o <br /> 835 8Zt 0.Z'S 4311 .Time(ty) 9.45 451 1e31 10 so <br /> Time(ti) Water Level - ot) �00'5 00 <br /> Water Level _ 00s too 1 Oo0 — OIL oeo 0 <br /> Time(t2) 838 8L5 <br /> $L5 Time(t2) gSel 1034 -e $s <br /> Water Level -005 *-Oct o0o Water Level ► - oo boo 000 <br /> Lo 31 I�T7 <br /> Time(t3) Q,4 <br /> $LE 9 A O Time(y) <br /> Water Level -oo$ }.Dol coo Water Level �eio d <br /> 00 <br /> 4161. Time(t4) <br /> fa4o fled <br /> Time(ta) $`t e1 $31 oa <br /> Water Level - 010 .6 oo �0�0o Water Level O <br /> Test Results Pass ass Fail IEass' Fail Pass Fail Test Results Pass at Pass �s Fail ass Fail <br /> Signature <br /> _, Signature <br /> ..,.., urhifn-nriolnal Yellow-Arco Environmental Comnliance Pink-Contractor <br />