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Underground Storage Tank System Tanks, Piping, & Spill Buckets <br /> Secondary Containment certification Form Page 2 of - - <br /> Facility#: B 1 City: MPJ�e GG, Testing Contractor: pe- co n 4,2C Test Date: g o Z <br /> Facility Address: I DO 5. main ST Contractor Address: ID« S, Ing fie- Ltloo� Alt Tech, Name: &0►' (� <br /> UST Annular S ace Secondary Piping <br /> 491K"I T ank i12 T anis 93 Tank#4 Line#1 Line #2oArylero^ <br /> Line#4 <br /> FCa <br /> uct 87 ® 91 D 89 91 D 87 89(rD 87 89 91 D Product 87Q)91 D 889 91 DD 87 89 91 D <br /> city , 000 20,Op0 �C�60C Piping Type rimary Siphon rim Siphonon Primary Siphufacturer XeVle� S /�Meron rr�� �vn <br /> r es Manufacturer <br /> Test Start Time :3 1 TestStart Time 10:S-0 <br /> /o;S3 <br /> I "05 <br /> Initial Pressure 'pitmucu 10" locul Ap, mevciry Initial Pressure <br /> Test End Time 2 ,31 3 C) 3 II <br /> ;Z4 Test End Time <br /> Final Pressure Io" 10"Moo 10"AllerCU(/ No+ Te5-Fab Nc-1 no} <br /> Final Pressure b <br /> Test Results ass Fail .ass Fail as Fail ss Fail �s�bf e 1q <br /> Signaturemacx <br /> Test Results Pass ail Pass Fai Pass Fail Pas Fail <br /> (/�°� <br /> `� Signature Fs Ga%�e atof E <br /> S ill Buckets <br /> Q1d�2 <br /> Overfill#1 Overfill#2 Overfill#3 Overfill#4 Secondaq P' in <br /> Product 87 89 91 D (g)89 91 D 089 91 D 87 8 9 D Line#5 Line #6 Line#7 Line#8 <br /> ManufacturerAMQCo PlOt1ic-00 dome co co <br /> Product 870 91 D 87 89111 D 87 89 91 D 87 89 91 D <br /> ��Me <br /> Piping Type Primaryi hon Prim Si Primary Siphon Primary Siphon <br /> Start T81 <br /> ime(t�) �� ' 2`� 2 : oZ / 2' P2 ' ZS n +ve ►o <br /> Water Level 0.O00 ,Ooo 0,000 ,coo Manufacturer <br /> Time(ti) X1 :32 ) 2 ' DS- /Z '/7 12 -' 28 •Nmerory Remeron <br /> Water Level Test Start Time �2 ;s T <br /> ,�oPo o,00�J n, o3� 0. 286 ; S <br /> Time(t,) I l 3 5- /2 ; 0 g Initial Pressure S-'0 95 L S,0 S r <br /> Water Level o•ool o, Test End Timei <br /> I;S- 7 J. <br /> Time(t3) 11 , 3S /Z ; 0 ) Final Pressure ' <br /> Water Level _0,002 a S o 1'sl <br /> Time(t.) I l :U l 12 -1q Test Results asFail �S•o QsL <br /> Fail Pass Fail <br /> Water Level 0.00 7- I ��7 <br /> 6lorgt Y <br /> asFail <br /> Test Results <br /> Signature 6T s� <br /> a{ ; V <br /> Rev. 1 1/O1 White—Original Yellow—Arco Environmental Compliance Pink—Contractor `•� <br />