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SWRCB, January 2002 <br />Test Method Developed By: <br />Test Method Used: <br />e <br />I Test Equipment Used: (' ev t <br />Is Tank Exempt From Testing?' <br />Tank Capacity: <br />Tank Material: <br />Tank Manufacturer: <br />Product Stored: <br />Wait time betty en applying <br />Press acu ter and <br />Test Start Time: <br />Initial Reading (P4); <br />Test End Time: <br />Final Reading (R# <br />4. TANK ANNUI <br />iT`ank <br />0 then (Specify) <br />13 Pressure . . <br />11 Other (Specify) <br />Tank # t (, L, <br />13 yes 0�f <br />-114-501 4cf/ <br />e - <br />X, E=P'X� _T <br />, - ; r_ <br />?w6w eirw <br />I IA -,o UV <br />L <br />TESTING <br />RIIIRRRwn Industry Standard <br />nk# <br />11 Yes 0 No <br />Page 2- Of a <br />13 Professional Engineer <br />0 Hydrostatic <br />t Resolution: — <br />ink # / 'Tank # <br />0 Yes 0 No / , " 0 Yes ONo <br />Test Duration: <br />Change in Reading (RF -R,).. <br />Pass/Fail Threshold or Criteria: <br />-t n <br />-OSS irr <br />Test Result: <br />JW <br />Pass -0 Fall 0 <br />VM El ail <br />L Pass 1,0 Fail Pass Fail <br />- <br />Was sensor removed for testing? <br />es 0 No El NA <br />11 No ONA <br />_P Yes 0 N4 0 NA Yes 0 No \3 NA <br />I <br />Was sensor Properly replaced and <br />verified functional after ? <br />Y e, <br />Yes 11 No, 0 NA <br />0 No 0 A <br />40 Yes 0 N NA yes 0 No �-NA <br />Comm eats — (mdude information on repairs made prior to testing; <br />and recommended follow-upfor failed tests) <br />Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br />containment, such as systems that 8re'hYdrOstaticaDY monitored or under constant vacuum, are exempt from periodic containment <br />testing. {California Code of Regulations, Title 23, Section 2637(a)(6)) <br />9T00/90001n 9TTO VVL 60Z XVJ OV:TT 60OZ/ZO/TT <br />