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mG RS UST Spill Bucket <br /> SOLUTIONS DELIVERED ntegrity Testing Form <br /> Underground Storage Tanks ( UST) Program <br /> Instructions on Page 3 <br /> Purpose : This procedure is to test the leak integrity of single - and double-walled spill buckets . See reverse side for <br /> basic hydrostatic testing instructions . Consult PEIIRP1200 , Section 6 . 2 for hydrostatic test method , Section 6 . 3 for <br /> single -walled vacuum test method , and Section 6 .4 for double -walled vacuum test method . <br /> Testing Information <br /> 1 . Tank number 91 89 67 <br /> 2. Product stored Unleaded Unleaded Unleaded <br /> 3. Spill bucket capacity 5 Gallons 5 Gallons 5 Gallons <br /> 4. Manufacturer OPW OPW OPW <br /> ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single -walled ❑ Single -walled ❑ Single-walled <br /> Be Construction I] Double-walled I] Double-walled I] Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled <br /> 91 Hydrostatic I] Hydrostatic 9 Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Hydrostatic <br /> ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum <br /> ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled <br /> 6. Testtype ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled <br /> ❑Q Product ❑� Product N Product ❑ Product ❑ Product ❑ Product <br /> 7. Spill bucket type ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor <br /> Be Liquid and debris <br /> removed from spill <br /> bucket: * 0 Yes ❑ No I] Yes ❑ No [!] Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> 9. Visual inspection <br /> (No cracks, loose parts or <br /> separation of the bucket <br /> from the fill i e.)? ❑ Pass ❑ Fail ❑ Pass ❑ Fail 9 Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> 10. Tank riser cap included in <br /> test? DYes ❑ No ❑ NA DYes ❑ No ❑ NA E] Yes ❑ No ❑ NA E] Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA El Yes ❑ No ❑ NA <br /> 11 . Is drain valve included in <br /> test? EYes ❑ No ❑ NA [E Yes ❑ No ❑ NA DYes ❑ No ❑ NA E] Yes ❑ No ❑ NA [I Yes ❑ No ❑ NA El Yes ❑ No ❑ NA <br /> 12. Starting level 12.25" 12.25" 12" <br /> 13. Test start time 9:23 am 9:23 am 9:23 am <br /> 14. Ending level 12.25" 12.25" 12" <br /> 15. Test end time 10:23 am 10:23 am 10:23 am <br /> 16. Test period 1 hour 1 hour 1 hour <br /> 17. Level chap e 0 0 0 <br /> Test results : p Pass ❑ Fail Pass ❑ Fail I] Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail I ❑ Pass ❑ Fail <br /> Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 9/8 inch; Vacuum single-walled only; <br /> Maintain at least 26 inches water column; Vacuum double-walled; maintain at least 92 inches water column. <br /> Comments : <br /> * All liquids and debris must be disposed of properly. <br /> Testing company CGRS <br /> name : 0 =`�U °° - °`"°"' _D Testers name : Garrett Warren <br /> Date : 6- 19- 19 Tester's signature : �a <br /> GPH = Gallons per hour, Y = Yes, N = No, NA = Not applicable, VPH = Vacuum/Pressure/Hydrostatic, ID = Identification <br />