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Underground Storage Tank System Tanks,Pipiztg, Spill Buckets <br /> Secondary Containment Certification Form Page r Of 2 <br /> Facility*. 2133 City: 5-�b v��V tA.. Testing Contractor: rest Date 10-30-0-L _ <br /> FacitityAddress• Z10$ zem tcLm&i t^ ��®l{- fir", Contractor Address: S. 1e,�uw*L Tech.Name: l✓"' �,�deuG <br /> USTAnnular S e Seconds in <br /> Tank#1 Tank #2 Ta n€c#3 Tank#4 Line Line #2 Line X13 Line#d <br /> Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D Product 87 89ADD 87 89 91 D 87 89 91 D 87 89 91 D <br /> Capacity 12,600 Piping Type .m Siphon Primary Siphon Primary Siphan Primary Siphon <br /> Manufacturer u/ Manufacturer A-V +�L ,D- <br /> Test Start Time �„Z Test Start Time s Zf <br /> Initial Pressure ? { Initial Pressure 5- �5,� <br /> Test End Time Test End Time <br /> Final Pressure ? Final Pressure L e <br /> Test Results Fail Pass Fail Pass Fail Pass Fail Test Results Pass Fail Pass sil Pass Fail Pass Fail <br /> Signature <br /> Signature fN <br /> Spill Buckets <br /> Overfill#1 Overfilt#2 Overfill#3 Overfill#4 Secontln - . <br /> Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D Line#5 Line #6 Line#7 Line#6 <br /> P rod uct 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> Manufacturer <br /> Piping Type Primary Siphon Primacy Siphon Primary Siphon Primary Sip <br /> Start Time(U) Manufacturer <br /> Water Level <br /> Time(t) Test Start Time <br /> Water Level <br /> Initial Pressure <br /> Time(t) <br /> Water Level Test End Time <br /> Time(ts) Final Pressure <br /> Water Levet <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Time(tj <br /> Water Level Signature <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> 7 <br /> Signature i w` ��� <br />