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Underground Storage Tank System Tanks, Piping, Tank Sumps & Overfill Buckets ` <br />Secondary Containment Certification Form Page I of 3 <br />Facility ID: A P46) Testing Contractor: c6as �� b, 4y%9 Test Date: Q-),2-01 <br />Facility Address: �02%� ' ��t'�oY'1n�2, S7"' Contractor Address:�r7` ��.,i �_ Tech. Name: �� <br />oc/c o� GOA. Ca c, Gc. ooZ- <br />UNT Annular .Snare <br />eerl <br />nverr!] Rurkefc <br />Tank #1 Tank #2 Tank #3 <br />Tank #4 <br />Product <br />87 89 91 D 87 89 TD 87 89 91 D <br />87 89 91 D <br />Capacity <br />889 91 D <br />87 89 45D <br />Test Start Time <br />Start Time (to) <br />Water Level <br />8_S/5�•., <br />Initial Pressure <br />1014�� IM <br />:?1 Sc"' <br />Test End Time <br />; SS aw �,�s cam+ <br />D SLS.,. <br />Final Pressure <br />Time (t2) <br />Water Level <br />� c <br />03 <br />Test Results <br />CPi5Fail Fail Pass Fail <br />Pass Fail <br />Signature <br />/ <br />!Cro wr <br />s� <br />eerl <br />nverr!] Rurkefc <br />Turbine Sumas <br />Overfill #1 <br />Overfill #2 <br />Overfill #3 <br />Overfill <br />Product <br />G8 89 91 D <br />889 91 D <br />87 89 45D <br />7 9 91 D <br />Start Time (to) <br />Water Level <br />8_S/5�•., <br />s �5 /• <br />r� <br />:?1 Sc"' <br />Time (tj) <br />Water Level <br />90 CM <br />D SLS.,. <br />L <br />Time (t2) <br />Water Level <br />� c <br />03 <br />�3 <br />Az�l <br />93dt'ry <br />Time (t3) <br />Water Level <br />/ <br />!Cro wr <br />s� <br />�cSs7l�r� <br />Test Results pa Fail <br />Time (tr) <br />�•tSf 771a" <br />1•�Js7�t-� <br />Signature <br />Water Level <br />�� <br />iOs ��� <br />, DSA Ph <br />Test Results <br />Pail <br />Pass { <br />ass Fail <br />s Fail <br />ass Fail <br />Signature <br />Turbine Sumas <br />7 <br />Necandary Pinift9 <br />511a~ Abend � <br />c7 //-fdr <br />Tank #1 <br />Tank #2 <br />Tank #3 <br />Tank #4 <br />Start Time (to) <br />Water Level <br />�� -Se. -. <br />8/7 89 91 D <br />T,ai/Qd <br />Test Start Time <br />7 �t•.� <br />Time (t,) <br />Water Level <br />AY,/ <br />s �5 /• <br />S i • s/►1,� <br />`jct(c/—r�ss <br />Time (t2) <br />Water Level <br />90 CM <br />D SLS.,. <br />L <br />Final Pressure <br />Time (t3) <br />Water Level <br />I /,V,/ <br />.p,s ptI <br />Test Results <br />Time (ta) <br />Water Level <br />, <br />Signature <br />Test Results pa Fail <br />as Fail <br />C1 as Fail <br />Pass Fail <br />Signature <br />7 <br />Necandary Pinift9 <br />511a~ Abend � <br />c7 //-fdr <br />Rev. 10/01 White Ori inal Yellow - Arco Environmental Compliance <br />Pink - Contractor <br />0 <br />Line #1 <br />Line #2 ' ' 6_:z <br />#mte�ff4 <br />Product <br />89 91 D <br />87 82!9D 8 89 91 D <br />8/7 89 91 D <br />T,ai/Qd <br />Test Start Time <br />7 �t•.� <br />9SSe•-, OO <br />Initial Pressure <br />s �5 /• <br />S i • s/►1,� <br />`jct(c/—r�ss <br />Test End Time <br />d <br />�5�•.•r no <br />Final Pressure <br />S S/� <br />��s� • �f/� <br />Test Results <br />s Fail <br />s Fail e a Fail <br />Pass Fa' <br />Signature <br />Rev. 10/01 White Ori inal Yellow - Arco Environmental Compliance <br />Pink - Contractor <br />0 <br />