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CC; RS UST Spill Bucket <br /> w_rj <br /> SOLUTIONS � EL. IVERE � • <br /> Integr •* ty Testing Form <br /> Underground Storage Tanks ( UST) Program <br /> Instructions on Page 3 <br /> Purpose : This procedure is to test the leak integrity of single - and double -walled spill buckets . See reverse side for <br /> basic hydrostatic testing instructions . Consult PEI/ RP1200 , Section 6 . 2 for hydrostatic test method , Section 6 . 3 for <br /> single -walled vacuum test method , and Section 6 . 4 for double -walled vacuum test method . <br /> Testing Information <br /> 1 . Tank number T1 :91 T2:89 T3:87 T4:Diesel <br /> 2. Product stored 91 89 87 Diesel <br /> 3. Spill bucket capacity 5 Gallons 5 Gallons 5 Gallons 5 Gallons <br /> 4. Manufacturer OPW OPW OPW DPW <br /> ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled <br /> 5. Construction I] Double-walled 9 Double-walled ❑ Double-walled Double-walled ❑ Double-walled ❑ Double-walled <br /> 9Hydrostatic I] Hydrostatic I] Hydrostatic Hydrostatic ❑ Hydrostatic [I Hydrostatic <br /> ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum <br /> ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled <br /> 6. Testtype ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled <br /> 0 Product J!lj Product 9 Product 'SP-rod u ct ❑ Product ❑ Product <br /> 7. Spill bucket type ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor <br /> 8. Liquid and debris <br /> removed from spill <br /> bucket:* 3 Yes ❑ No [5 Yes ❑ No 0 Yes ❑ No 0 Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> 9. Visual inspection <br /> (No cracks, loose parts or <br /> separation of the bucket <br /> from the fill pipes)? © Pass ❑ Fail N Pass ❑ Fail © Pass ❑ Fail N Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> 10. Tank riser cap included In <br /> test? Yes ❑ No ❑ NA © Yes ❑ No ❑ NA E Yes ❑ No ❑ NA R Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br /> 11 . Is drain valve included in <br /> test? I] Yes ❑ No ❑ NA Yes ❑ No ❑ NA O Yes ❑ No ❑ NA O Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br /> 12. Starting level 13.00" 14.00" 13.00" 13.75" <br /> 13. Test start time 8:05am 8:05am 8:05am 8:05am <br /> 14. Ending level 13.00" 14.00" 13.00" 13.75" <br /> 15. Test end time 9:05am 9:05am 9:05am 9:05am <br /> 16. Test period 1 hour 1 hour 1 hour 1 hour <br /> 17. Level chane 0 0 0 0 <br /> Test results : p Pass ❑ Fall Pass ❑ Fail Pass ❑ Fail 91 Pass [] Fall ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 1/8 inch; Vacuum single-walled only; <br /> Maintain at least 26 inches water column; Vacuum double-walled; maintain at least 12 inches water column. <br /> Comments : <br /> * All liquids and debris must be disposed of properly. <br /> Testing company CGRS Garrett Warren <br /> name : Testers name : <br /> Date : 8- 11 -20 Tester's signature : <br /> RF OFIVED <br /> SEP 0 2 zozo <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> GPH = Gallons per hour, Y = Yes, N = No, NA = Not applicable, VPH = Vacuum/Pressure/Hydrostatic, ID = Identification <br />