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Underground Storage Tank System Turbine Sumps, Fill Sumps and Under Dispenser Containment I <br /> Secondary Containment Certification Form Page 1 of �. <br /> Facility#: 1 city:tY: A14,t)4 CA Testing Contractor:_12e�(pA/ Test Date: �� 8 ly C <br /> i ] <br /> ? Facility Address: ��OQ S. /1'lG��l S T Contractor Address: �7�I8 �, yr9/C l.Jo ,06 Tech.Name: 6' 'r <br /> [Turbine Sumps 87 9l D 89 91 �DV 89 O�D8189 9l D Fill Sumps 87 89 �D 87 89 91 D 87 ® 91 D 87 89 91 D <br /> 1n nor h S!z': 'C i <br /> ID north- slave etc. <br /> Manufacturer Xe S Xu s offs L Manufacturer Xerxe j fr PS Ler PS <br /> Start Time(to) 10: SZ 1 I 0(o1 I : '40 Start Time(to) 1 �-S ( qO &I,V 5- <br /> Water Level Water Level <br /> Time(t,) `0�( �t�C , 1� Time(t,) k D <br /> Water Level N N Water Level a0� ►�D <br /> Time(t2) CkQr Q 1Q b�. Time(tz) <br /> Water Level �Q QS� keS Water Level <br /> Time(t3) Time(t3) <br /> Water Level Water Level <br /> Time(Q Time(t,) <br /> Water Level Water Level <br /> Test Results Pass Fail Pass Fail Pass Fai s Fail Test Results Pass Fail Pass Fai Pass Fai P s Fail <br /> Signature s � ' v Signature Cl— <br /> UDC 21 6 F1/b UDC <br /> ID(112,3/4,etc.) ID(1/2,314,etc.) 8/�� r 2- <br /> Manufacturer <br /> Manufacturer AfllQrican Arrler,cAn Am e(;Cdrl Ar)+erI Mn Manufacturer <br /> C In en� cen4A�nm n C0nk&;nOlt? 000 1,1 fi <br /> Start Time(to) 2 , Z9 2!o '7 Start Time(to) '`43 <br /> Water Level 0.000 000 Water Level 0.000 p.0ob <br /> Time(tI) 2 :30 Z,08 Time(t,) <br /> Water Level I�O� 0.05-1 �0,00� ry Water Level - 6 76 <br /> o, gs <br /> Time 02) Io' �y ( 1) <br /> Water Level eS ��" '1�5 � Water Level <br /> Time 03) Time(t3) <br /> Water Level Water Level <br /> Time(t,() Time(t.) <br /> Water Level Water Level <br /> Test Results PassFail Pass Fail Pass CgPass Fail Test Results Pass GF,a�il Pass Fai Pass Fail Pass Fail <br /> Signature iJlCl Signature e Y <br /> Rev. 1 1/0l White-Original Yellow-Arco Environmental C'nmnknnrP ..r- <br />