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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment2, <br /> Secondary Containment Certification Form Page 2- of <br /> Facility#: 2133 City: 5`0c.k+k% Testing Contractor: 1;OYC41n Test Date: )0-2Q`ti7_ <br /> Facility Address: AM O'B (3 Cv1,jam i K N 0 4- V" Contractor Address: OA_(ry a Tecli.Name:Rt)g0►hOW 0 wizi <br /> Turbine Sumps87 89 91 D 87 89 41 D 97 89 91 0 87 99 91 D Fill Sumps 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> ID(north,slave,etc.) ID(nortk slave etc)— <br /> Manufacturer <br /> Manufacturer a„v%irdv- -Cftv j Via h Manufacturer <br /> Start Time(to) t i 13 't D Start Time(to) <br /> Water Level .000 .000 Water Level <br /> Time(ti) 1 Z'l(• 1 '.13 Time(tj) <br /> Water Level .000 - Water Level <br /> Time(t2) Ix! LIn'),I, Time(t2) <br /> Water Levet ,®®a -90 Or Water Level <br /> Time(t,) I2:22 Time(t,) <br /> Water level .000 Water Level <br /> Time(tj) Zlj Time(t4) <br /> Water Level . ®UV Water Level <br /> Test Results Fail Pa a Pass Fail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Signature Signature <br /> UDC UDCID(1/1,3t4,etc.) <br /> Manufacturer Manufacturer <br /> Start Time(ta) Start Time(t@ <br /> Water Levet Water Level <br /> Time(tj Time(t) <br /> Water Level Water Level <br /> Time(t2) Time(t2) <br /> Water Levet Water Level <br /> Time(%) Time(t2) <br /> Water Level Water Level <br /> Time(tj Time(Q <br /> Water Level Water Level <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Faq,, ti <br /> t Signature <br /> Signature <br />