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Underground Storage Tank System <br />Secondary Containment Certification Form <br />Tanks, Piping, Tank Sumps & Overfill Buckets <br />Page / of <br />Facility ID: Testing Contractor: ®/.Jdi� �yD� Test Date: 4� <br />Facility Address:' r Contractor Address: ��._ _ Tech. Name: ��er h/rAT�ist�ry <br />�i L <br />Frr'r A--../-. V- <br />// IAS% ®1L Turhine Sumps <br />r � <br />.4ernndary Pining l'�•nSc�,s,or <br />Tank #1 <br />Tank #2 <br />Tank #3 <br />Tank #4 <br />Product <br />89 91 D <br />89 91 D <br />87 8942�DD <br />Q -00 D <br />Capacity <br />,jrQpl� <br />Qdyyr' <br />60s•�/ <br />SDO <br />Test Start Time306 <br />�QSQ <br />SCS <br />Initial Pressure <br />140 <br />"01 - <br />End Time <br />9 <br />O.�Daw <br />�, <br />Final Pressure <br />N <br />6 , <br />/,Ajd q' <br />jD) <br />Test Results <br />ass Fail <br />a s Fail <br />ass Fail <br />ass Fail <br />Signature <br />%GAfawl <br />�tl <br />r � <br />.4ernndary Pining l'�•nSc�,s,or <br />Overfill #1 <br />Overfill #2 <br />Overfill #3 <br />Overfill #4 <br />Product <br />89 91 D <br />89 91 D <br />87 89dPI) <br />-� <br />Start Time (to) <br />,jrQpl� <br />Qdyyr' <br />60s•�/ <br />Water Level <br />�QSQ <br />SCS <br />Time (t,) <br />140 <br />ves/b/e <br />Water Level <br />!OSgov <br />-'0JgP111 <br />f / <br />Time (ti) <br />Water Level <br />DQ��' <br />��7G� <br />�e•.,s► <br />Pass Fail <br />Time (t3) <br />Water Level <br />690 <br />Time (t,) <br />%GAfawl <br />�tl <br />Water Level <br />/of 0PJ7 <br />i�f9AIV <br />/a-vooy <br />Test Results <br />Fail <br />a s Fail <br />a Fail <br />Pass Fail <br />Signature <br />r � <br />.4ernndary Pining l'�•nSc�,s,or <br />Tank #1 <br />Tank #2 <br />Tank #3 <br />Tank #4 <br />Start Time (to) <br />Water Level <br />�9 91 D <br />("8— <br />87 8 <br />D89 91 D <br />87 89 91 <br />Time (tj) <br />Water Level <br />,jrQpl� <br />Qdyyr' <br />60s•�/ <br />Time (tz) <br />Water Level <br />�QSQ <br />SCS <br />Time (t3) <br />Water Level <br />140 <br />�! <br />Time (ta) <br />Water Level <br />!OSgov <br />-'0JgP111 <br />4a=zr-Wo' <br />t'o se P11 <br />Test Results <br />s Failass <br />Fail <br />A <br />as Fail <br />-� <br />Pass Fail <br />Signaturenwe <br />690 <br />r � <br />.4ernndary Pining l'�•nSc�,s,or <br />Rev. 10/01 White - Original Yellow - Arco Environmental Compliance <br />Pink - Contractor <br />WM <br />)1��i /0� <br />Line #1 <br />Line 42 <br />64"-Q <br />Line #4 <br />Product <br />�9 91 D <br />("8— <br />87 8 <br />D89 91 D <br />87 89 91 <br />Test Start Time <br />lled 7b <br />C <br />Initial Pressure <br />7'4j <br />Test End Time <br />140 <br />�! <br />Final Pressure <br />�lCss�i'G <br />Si - <br />Test Results <br />Pass (DaiPassail <br />ass Fail <br />Pass Fail <br />Signature <br />Rev. 10/01 White - Original Yellow - Arco Environmental Compliance <br />Pink - Contractor <br />WM <br />)1��i /0� <br />