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Underground Storage Tank System Tanks, Piping, Tank Sumps & Overfill Buckets <br /> Secondary Containment Certification Form Page 2 of <br /> Facility ID: � �� Test ®ate: <br /> BclJ3 Testing Contractor: <br /> Facility Address: `a rs Contractor Address: , <br /> — �--- -- Tech. (Name: 4Af .a 144_44y <br /> -CAL G c. J OO zr <br /> UST Annular Sp ace Turbine Sums <br /> Tank#1 Tank #2 Tank#3 Tank#4 Tank#1 Tank #2 Tank#3 Tank#4 <br /> Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D Start Time(t(,) <br /> Water Level <br /> Capacity <br /> Time(t,) <br /> Test Start Time Water Level <br /> Initial Pressure Time 02) <br /> Test End Time Water Level <br /> Final Pressure Time(t3) <br /> Water Level <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> — Time(t,) <br /> Signature Water Level <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Overfill Bimpkiets &UZ G 01/ — <br /> #1 Overfill#2 Overfill#3 Overfill#4 Signature <br /> Product 87 89 91 D 87 89 91 D 87 89®D 87 89 91 D <br /> - Seconitary Piping _ <br /> Start Time(to) � I Line#1 Line #2 Line#3 Line#4 <br /> Water Level �/ 107 83 Se -- i— <br /> Time(t,) / Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> Water Level �t�1� p( �sf/ Test Start Time 40 <br /> Time(t2) <br /> Initial Pressure <br /> Water Level <br /> Time 03) Test End Time <br /> Water Level dol rpt/ Final Pressure <br /> Time(t,) <br /> Water Level / i®-5 Q.) 17 Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Test ResultsPass Fa' Pass Fail s Fail Pass Fail Signature <br /> 1; <br /> Si nature—� <br /> i <br /> Rev. 10/01 White-Original Yellow--Arco Environmental Compliance Pink-Contractor f%/ <br />