COMPLIANCE INFO_1999 - 2003 - Laserfiche WebLink

Home Browse Search

Underground Storage Tank System Tanks, Piping, & Spill Buckets Secondary Containment Certification Form Page Facility#: 60;_0 City: M6'fe_CTesting Contractor: Test Date: Facility Address: j 7/1 L. Vknewldr Contractor Address: ��7 et'2L_C — J Tech.Name: �[�5 �� P_✓ UST Annular S acecondary Pi in Tank#1 Tank #2 Tank#3 Tank#4 Line#1 Line #2 Line#3 Line#4 Product (9 89 91 D 87 (5) 91 D 87 89 (3)D 87 89 D Product 08991 91 D 87 091 D 87 899 D 87 89 91 Capacity /5— S 97/< Piping Type rimary Siphon rimary Siphon REaDSiphon Primary, iphon Manufacturer p� Q1 Og Manufacturer Test Start Time 5'- ;y — 1)z'3 0 Test Start Time o. ©o o 2-5— 10' cls Initial Pressure 0"� l 10�' Initial Pressure Test End Time u' /5 ; +� 2: 0 Test End Time �, ' Z !�;� �d r � Final Pressure 421 /19 tt� V Final Press�t e Test Results as Fail ass Fail as Fail Pass Fail Test Results ass ail Pass ail Pass ai Pass Fail Signature �"� �' T Signature Spill Buckets Overfill#1 Overfill#2 Overfill#3 Overfill#4 Secondary Pi in Product 87 89 91 D 87 S91 D 87 890 D 87 89 91 D Line#5 Line #6 Line#7 Line#8 ManufacturerQeez __ —9Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D ,'�,p j i _ Piping Type Primary Siphon Primary Siphon Primary Siphon Primary Siphon Start Time(to) l Z- 3 D 2 Water Level 0100 0,000 Manufacturer Time(t,) 12 ' P.:05- z`,33 Water Level O_Q�(] —�j �1' © 00 Test Start Time Time(tZ) �Z-,3;(� 2 '. j 2=3,, Initial Pressure Water Level —07/LY Test End Time Time 03) l2=✓�g .2-= IL Z=3`j Water Level V.coo � , -2-2-7 0.002– Final Pressure Time 04) l Z_-412— Z: 4Z Test Results Pass Fail Pass Fail Pass Fail Pass Fail Water Level V.0:�o on 0 .00 Z Signature Test Results ass Fail Pass ail ass Fail Pass Fail Signature Rev. 11/01 White—Original Yellow—Arco Environmental Compliance Pink—Contractor