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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> $econdary Containment Certification Form Page L_ of <br /> Facility#: 6020 City: Mao t e-cat Testing Contractor: Test Date:03-'11 '-o Z <br /> Facility Address: 7 I !' �, }J9 tee ;�� /4y�. Contractor Address: 6 7 LI 7 S 1 6!WrCA_ Ci- -j Tech.Name. �G�S�y✓�c�I�+� <br /> Turbine Sumps 87 89 911 D 87 8 t91 D 87 89 (9- 87 89 9l Fill Sumps 87 89 91 D 87 91 D 87 89 91 D 87 89 91 <br /> ID(north,slave,etc.) ID north slave etc. D, <br /> 1 10 10 <br /> Manufacturer P� �2✓ c' Manufacturer <br /> Start Time(to) 1� 5 �' Z�- Start Time(to) <br /> Water Level 1000 0,000 • Water Level 01000 .00 0.000 <br /> Time(t,) 11 �� ,'L'.03 2 Z3 Time(t,) Z.=S3 a z3 3=43 <br /> Water Level 01000 0,000 Water Level 0.0o 0 D 0.000 <br /> Time 02) Z; 0(0 2.Z_�' Time 02) Z! 5'6 3;Lglo <br /> Water Level 01.00 O'Col 01001 Water Level 0.000 1).00 0.00 1 <br /> Time(t3) l l : 5`y �, �� 22,29 Time(t3) 3%Z/ 3 9 <br /> Water Level 6) .001 0.000 ©,0D Z, Water Level - (9.00&j92 420Z "2. <br /> Time 04) 11 5-7 2`• ! Z,32, Time 04) 3-,6-2- <br /> Water <br /> ;SZWater Level 01 0 0 Z 01 no 0.002 Water Level 0 Z (0.000_ <br /> Test Results ass Fail (PLO Fail Pass Fail Pass Fail Test Results Pass ailPass Fail ass Fail Pass Fail <br /> Signature 'T - Signature :T U <br /> uDc unc 9 /D �l 12- 13/ /5--/,6 <br /> ID(1/2,3/4,etc.) 1 -? 3—'�] S'Y� �—� [D(1/2,3/4,etc.) <br /> Manufacturer Manufacturer <br /> Start Time(to) Y S� Al Z 3 �'n Start Time(to) 1 6 <br /> 5-1Z <br /> Water Level D_000 0 •00 V-000 Water Level 000 0,coo 01000 0.O00 <br /> ( `{ !'i Zf''-L !O 5- 13 I :�3 ! 3 <br /> Time tt) �'y I 4 8 Watert evel 0,O0O ( . W30 - 1 , 2-30 0 . 000 <br /> Water Level Q7•� b�©� •-� � , yy Z, -•-�, <br /> Time(t2) J4'4�_j �1 !I t. Time(t2) 2 -2-. 700` t3 <br /> Water Level 0 o t�,�0 -to,O f 2. Water Level V-1 – ;•' ` 0V e) 0(no <br /> Time 3)(t L4 y'.16— Time 03) 3 <br /> Water Level Q�,0©� 0 -0, 01 Water Level (�,0D tv.C�o <br /> Time(t4) � y'.32, q;4 Time 04) ,42- 5-14 2— <br /> Water <br /> Water Level V,0©o 0,100 Z 0210 Water Level 6 -00 2— q 0-000 <br /> Test Results as Fail as Fail Pass Fail Pass Fail Test Results Pass Fail Pass Fai Pass Fail Pass Fail <br /> Signature � -- T�E Signature Z-9— <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor _� <br />