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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of 6) <br /> V . TANK CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from section III for each Manufacturer <br /> Xerxes T1 -91 ® T2-89 ® T3 -87 El T4-Diesel <br /> Test Method Used : <br /> ❑ Manufacturer Guidelines : (Specify) <br /> ® Industry Code or Engineering Standard: (Specify) RP -1200 / Guidelines Adopted by CAL CUPA Forum <br /> ❑ Engineered Method : (Specify) <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 1 <br /> Tank Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC California Service Technician UT Cert. #8185019 09/10/2021 <br /> VI . COMMENTS <br /> Provide any additional comments here. <br /> VII . PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from section III for each Manufacturer . <br /> NOV A.O . Smith T1 -91 El T2-89 ® T3-87 ® T4-Diesel <br /> Test Method Used: <br /> ❑ Manufacturer Guidelines : (Specify) <br /> i <br /> ® Industry Code or Engineering Standard : (Specify) RP-1200 / Guidelines Adopted by CAL CUPA Forum <br /> S <br /> t <br /> ❑ Engineered Method : (Specify) <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 1 <br /> i <br /> Product Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC California Service Technician UT Cert. #8185019 09/10/2021 <br /> Interstitial Communication verification Method Used : Visual drop on gauge by pressure released from furthermost piping runs . <br /> VIII , COMMENTS <br /> Provide any additional comments here. <br /> T-3 87 product line secondary failed 1 hr 5 .Opsi pressure testing . Confirmed gross leaks inside UDC #9 -10 <br /> on termination test boot. Deep style UDCs and will require dispenser to be pulled in order to replace test boot <br /> with an Icon ISR3 .5x2 .4OSA . <br /> CERS = California Environmental Reporting System , ID = Identification, UST = Underground storage tank, ICC = International Code Council, <br /> NA = Not applicable, UDC = Under-dispenser containment <br />