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PEURP1200-17 SPILLD•OOD SINGLE- AND DOUBLEAVALLED VACUUM TEST METHOD Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. #: Phone #: Testing Company: Phone #: I Date: This procedure is to test the leak integrity of single- and double -walled spill buckets. See PEI/RP1200 Section 6.2 for hydrostatic test method, Section 6.3 for single -walled vacuum test method and Section 6.4 for double -walled vacuum test method. Tank Number Product Stored Spill Bucket Capacity Manufacturer Construction ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled Test Type ❑ Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Single -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled ❑ Double -walled Spill Bucket Type ❑ Product ❑ Product ❑ Product ❑ Product ❑ Product ❑ Product ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor Liquid and debris removed from ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No spill bucket?* Visual Inspection (No cracks, loose parts or separa- ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail tion of the bucket from the fill pipe.) Tank riser cap ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No included in test? ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA Drain valve ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No included in test? ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA Starting Level Test Start Time Ending Level Test End Time Test Period Level Change Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 1/8 inch; Vacuum single -walled only: Maintain at least 26 inches water column; Vacuum double -walled: maintain at least 12 inches water column. Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail I ❑ Pass ❑ Fail 1 ❑ Pass ❑ Fail I ❑ Pass ❑ Fail Comments: *All liquids and debris must be disposed of properly. Tester's Name (print) 0 pei.org Tester's Signature