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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment Page 3 of <br /> Secondary Containment Certification Form <br /> Facility#: 01600 City: 5T'o0c:t-40.7 Testing Contractor: (Q+ * Test Date: v"a.tc..H L Lee <br /> Facility Address: \Z 50 Contractor Address: `} 174—�1i+� Tech.Name: 1CNnM[ e+t <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) <br /> Start Time(to) Water Level <br /> Water Level <br /> Time <br /> Time(tt) <br /> Water Level Waterr Level <br /> Time 02) Time(t2) <br /> Water Level Water Level <br /> Time(t3) Time(t3) <br /> WWater Level <br /> Water Level <br /> Time(t4) Time(t4) <br /> Water Level <br /> 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—1�� 1-k-20 ID(12,3/4,etc.) <br /> Manufacturer <br /> L+cs- t j• l� Manufacturer <br /> , <br /> Start Time(to) M�a 11 a S Start Time(to) <br /> Water Level 000 - e O Z Water Level <br /> Time(tj) ".33 <br /> Time t <br /> Water Level O 0 Yl eot, Water Level <br /> Time(t2) 11 s c Time(t2) <br /> Water Level o o 0 Water Level <br /> 1131 Time(t3) <br /> Time-(t3) <br /> Water Level - 00 ( Water Level <br /> Time 04) 042 Time(t4) <br /> Water Level _ 001 Water Level <br /> Test Results as Fail Pass a' Pass Fail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Signature Signature <br /> Yellow—Arco Environmental Compliance Pink—Contractors C <br />