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PEI/RP1200-17 _ <br />SECONDARYAPPENDIX C-1 <br />Facility Name: <br />TANK <br />DRY <br />TEST METHOD <br />Owner: <br />Address: <br />Address: <br />City, State, Zip Code: <br />City, State, Zip Code: <br />Facility I.D. #: <br />Phone #: <br />Testing Company: <br />Phone #: <br />Date: <br />This data sheet is for testing the integrity of the dry secondary containment of a underground storage tank (UST). See PEI/RP1200 <br />Section 4.2 for the test procedure. <br />Tank Number <br />Tank Material <br />Product Stored <br />Tank Capacity,* gallons <br />Test Start Time <br />Initial Vacuum Reading, <br />inches Hg (See Table <br />4-1 below.) <br />Specified Test Duration <br />(See Table 4-1 below.) <br />❑ 1 hour <br />❑ 2 hours <br />❑ 1 hour <br />❑ 2 hours <br />❑ 1 hour <br />❑ 2 hours <br />❑ 1 hour <br />❑ 2 hours <br />❑ 1 hour <br />❑ 2 hours <br />❑ 1 hour <br />❑ 2 hours <br />Test End Time <br />Final Vacuum Reading, <br />inches Hg <br />Is the Annular Space <br />Dry After the Test? <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Test Results <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />TABLE 4-1 <br />Vacuum, <br />inches Hg <br />Capacity, <br />gallons <br />Duration, <br />hours <br />10 <br /><20,000 <br />1 <br />20,000+ <br />2 <br />Comments: <br />*Total tank capacity, including all compartments in a multi -compartment tank, <br />Tester's Name (print) <br />0 pei.org <br />Tester's Signature <br />