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From DIALYSIS NORTH 19494501177 at 1`1812002 2 . 16 PM 00. <br /> S W RCB,January 2602 Page_J_? of <br /> 4. TANK ANNULAR TE51"'[NG <br /> Fest Method Developed By: 11 Tank Manufacturer _industry Standard Professional Engineer <br /> I <br /> 1 :Other(Specify) I <br /> Test Method Used: I Pressure it Vacuum tiydroatatic <br /> '_Other�Spech) <br /> Test Equipment Used: Equipment Resolution: `+ <br /> Tank# Took# Z Tink# Tank# <br /> Is,Tank£xcrrrpt Froth Testing?' Yes No Yes .No Yes No Yes No <br /> Tank Capacity: <br /> Tank Material: bl3L t JJ; dL s r Y/ ?Z L 7 <br /> Tank ManufacturerProduct Slored: 91 <br /> Wait time between applying <br /> pressurOvacuurn(watcr and [� �'` <br /> stsrtin test.- �� I t�m r J 1/ J I <br /> Test Start Time: Q '� 0 % <br /> Initial Reading(Rj. /0- 49 " 0 '+ a s <br /> Test End"Time: <br /> Final Reading(RF): 0+• (}+' ,rtf� <br /> Tcst Duration: <br /> Change in Reading(tit--R,)• ,, C)" Ht C) 144„ <br /> PAWFail Threshotd or Criteria: _ +. ti4 Ht( 0 f{ <br /> Test Result: 0 Pass U_ Fait Paas :+Fall • Pus I :Fail 0 Pass Fail <br /> Was sensor removed for basting? Yes Ir No NA <br /> m <br /> : :Yes VNo . !NA Yes ■No -NA I:Ycs B No ,]NA <br /> Was sensor properly replaced and Yes #No NA <br /> vcrified functional after testing!__ Yes r No !NA Yes rNo NA i—.Yes *No ._NA <br /> Calltltl'itent8—(melted inform d—on repairs made prior to!wring, acrd reeorvrnteadedfollow.up f0►'faArd reds) <br /> ' Secondary containment systems where the eoniinuous monitoring automatically monitum both the primary and secondary <br /> containment,such as systema that are hydmsbrtically monitored or under congtant vacuum,arc exempt from periodic cordainntent <br /> testing, (CalifomiaC',odc of Rcgulations,Titic 23,Scction2637(axb)} <br /> `�`IV <br />