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Underground Storage Tank System Tanks,Piping,Tank Sumps & Overfill Buckets <br /> Secondary Containment Certification Form Page / of r <br /> Facility ID: Testing Contractor: ��4.fO{ej!ke Test Date: <br /> Facility Address: Contractor Address: �� Tech. Name: <br /> x ' CAG <br /> -A� <br /> UST Annular S ace ,QST 0iL Turbine Sumps <br /> Tank#1 Tank #2 Tank#3 Tank#4 Tank#1 Tank 42 Tank#3 Tank#4 <br /> Product elD 89 91 D 89 91 D 87 89�? D D Start Time(to) <br /> CapacityWater Level �`,3 3'KCA <br /> ® JC®o Time(ti) <br /> Test Start Time ®Z"w e o* 306 n—. Water Level ,jrQ , 90owl <br /> Initial Pressure 9 ,�j,; �/ ®�y `Otw Time(t2) <br /> Test End Time ®�® ctiw. (. Water Level <br /> Final Pressure , �, !,y y /®/•� /?9� (D)y1 Time(t3) <br /> Test Results ass Fail a s Fail ass Fail ass Fail Water Level J�6q, 9/& �sO <br /> Time(t,) 1�sS ��fjr�e+sGs � <br /> Signature Mp 00,P Water Level !®S� "OSPA, �S h <br /> Test Results s Fail ass .Fail as Fail Pass Fail <br /> Ovet/Buckets W40 6 <br /> r i �G <br /> Overfill#1 Overfill#2 Overfill#3 Overfill#4 Signature <br /> Product 8 89 91 D 40 89 91 D 87 89D <br /> Secondary Pi in Goass^ <br /> Start Time(to) <br /> Water Level � � � y J�� Line#1 Line #2 Line#4 <br /> GM `j,Jl,' l� <br /> Product 8fi 9 91 D 87 8<91 (D89 91 D 87 89 91 D <br /> Time(t,) 411516/d <br /> Water Level Test Start Time 7'6 49 <br /> T <br /> Time(t2) Initial Pressure <br /> Water Level �Q�,� �.ssG.� yc^,, <br /> �! <br /> Test End Time ® <br /> Time(t3) <br /> Water Level � � �j®A�� sem/ Final Pressure <br /> Time(ta) l•�ss' a"! �ttf �/fl'T�►� � Ss. <br /> Water Level Test Results Pass Faip Pass ai ass Fail Pass Fail <br /> Test Results C_.%�'' Fail a s Fail a Fail Pass Fail Signature <br /> Signature <br /> Rev. 10101 White—Original Yellow—Arco Environmental Compliance Pink—Contractor <br /> p � <br />