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For <br />PLASTEELO Double -Wall Underground Tank <br />1. Third Party Evaluation: This leak tightness <br />test method has been third party evaluated per the <br />Alternate EPA Test Protocols for Plasteel Inc. The <br />third party environmental consulting firm that per- <br />formed the evaluation was: <br />Installation Location: <br />Ken Wilcox Associates, Inc. <br />19401 E. 40 Highway, Suite 100 IV. Test Results: The interstitial vacuum test was <br />Independence, MO 64055 <br />(816) 795-7997 performed per Appendix B. The following data was <br />recorded: <br />A copy of the evaluation is on file at each authoriz- Nominal Tank Capacity: <br />ed PLASTEEL° tank manufacturer and at: (Gallons) <br />Plasteel Inc. Primary Tank Product: <br />1189 Industrial Ave. (air, gasoline, diesel, water) <br />Escondido, CA 92029 Required Test Period: <br />(619) 745-0333 (Hours, per Appendix B, Figure 6.0) <br />11. TankDescription: Initial Gauge Reading: inches Hg. <br />Date Time am/pm <br />Capacity: Gallons Final Gauge Reading: inches Hg. <br />Jacketed: Date Time am/pm <br />Total Elapsed Time Period: <br />Composite:. <br />Compartmented: Yes <br />U.L. Number <br />Tank Manufacturer: <br />Name: <br />Address: <br />(Hours) <br />_ No Pass Fail (Initial) <br />V. Statement of Test: I certify that the <br />PLASTEEL° Double -Wall tank described` above has <br />been tested leak tight per Appendix B of the <br />PLASTEEL® Tank Installation Instructions. <br />Testing Company: <br />Name: <br />Address: <br />Ill. Installation Information: Telephone: <br />Tank Owner: <br />Name: <br />Address <br />Signature <br />Printed Name <br />Title <br />IVT -CERT 694 <br />Date <br />