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,Piping,Pi in & S <br /> Underground StorageTank System , ill Buckets P <br /> Secondary Containment Certification Form Page 2 of Z r <br /> o <br /> 1 ��hh 4 - ��fr a <br /> Facility#: `� City: J�l Uh Tcsttng Contractor. �t??"C r, 4C l f Test Bnte: �' � ° �- � � <br /> 0 <br /> Facility Address: .1 r S� Contra etc rAddress: 605 5, Len k irCloac AW tech, Nsent: <br /> x <br /> r <br /> r <br /> UST Annular S uce Seconda2 P! [n <br /> Tank#1 Tank 92 Tank 03 Tank#4 Line#1 Line #2 Line V3 LI at 4ITI <br /> � <br /> Product 87 ® 91 1) (f)89 41 D 87 890D 87 89 91 D Product 87 89 91 D8239 91 D 87 89 6 D 87 89 91 D <br /> Capacity Odd �goo0 rOr�C Piping Type rim Siphon rim Siphon Primary Siphon Primary Siph I o <br /> Ito <br /> Manufacturer }(Qv�t� y, S e ryes f Manufacturer Afneron m(? r-on Ameron u <br /> 0 <br /> Test Start Time E:5 t , 3 2 Teat Start Time 1 o:SCJ /0, <br /> Initial Pressure 1Qi� �fW? (D" 1PYCUQ �f1`Ift?PIC�Ir Initial Pressure -� <br /> Test End Time Z;3) r 3GJ �' Z4 Test End Time <br /> Final Pressure ID rflntzy��{ Id+�/j�Q�C1/t Final Pressure M0+ Te >Q M5�,�te rlo+ <br /> }� <br /> 'fest Resultsas Fail <1�w_ Fail as Faii s Fail <br /> � Test Results Pass it Pass Fai Pass Fail Pas Fail <br /> J,� M <br /> Signature v Signature 41�eGr eo <br /> Spill Buckets `~ <br /> Overfill#1 Overfill 02 Overfill 93 Overfill#4 Second P in <br /> Product 87 89 91 D (D89 91 D (D 89 91 D 87 8 4 D Line#5 Line 96 Line ill Line#8 <br /> Product 87 91 D 87 89 C4D D 87 84 91 D E7 89 9l D <br /> Manufacturer �oM2Cd iD01F�Cd �prneCO �aMeCa 89 <br /> Piping Type Primary hon Prim Primary Siphon Frimuy Siphon <br /> Start Time (to) 11: 2� 12 : oZ 1 1-2 ' ZS <br /> a e +0,91 <br /> Water Level app '006 0.coo 0,000 Manufacturer 11`�+ntror\ pfd e ron <br /> Time(tr) 1 i 3'7- 1 2 1 aS 12 !/7 / 2 -' 28 Test Start Time 14 !S 7 - <br /> Wates Level o0o p.OQ L1 0,031 2 b6 / S r <br /> Initial Pressure <br /> Time(t,) <br /> Water Level m.00l Test End Time <br /> Time(ta) t 38 l2 1 0 1 Final Pressure $ p fs1 5.0 PSI <br /> Water Level _000,02 0 � <br /> 1 j Test Results `�J Fail � Fail Pass Fail Pass Faii <br /> Time(t,} /Z � � _ <br /> Water Level .pp 0' 0 1 Signature 6eaf9< y <br /> LTestResults � Fail Pass � Pass Fail Passture <br /> 0 <br /> o <br /> Rev. 11/DI White-Original Yellow-Arco Environmental Compliance Pink-Contractor \b <br /> n <br />