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May. 9. 2017 4: 12PM Donlee Pump Co No. 7237 P. 3 <br /> Secondary Containment Vesting Report Form-Page 2 of 5 r <br /> A Testing of`dank Annular SpacesNaults ❑NIA.(No tanks have secondary containment) ��T <br /> Test Method Developed By: ❑Tank Manufacturer;❑Industry Standard; PE;[]Other(Spec): <br /> Test Method Used: Lj Pressure; © Vacuum; [I Hydrostatic; [)Other(Spec): <br /> Test Equipment Used: Equipment Resolution: <br /> Tank#: ij - Tank#; Tank#: Tank#• <br /> Is Tank E m t From Testing? ❑YesjgNo ❑Yes o ❑Yes; C.]No ❑Yes; ❑No <br /> Tank Capacity(gallons): -• coo kl.600 <br /> Product/Grade Stored in Tank: �- <br /> Tank Manufacturer: <br /> Tank Model: 6: <br /> Wait time between applying <br /> pressure!vacuum/water andp �: ,� � V";"5 <br /> start' test(minutes): <br /> Test Start Time: `o:®a� 10'Wo" <br /> Initial Reading(h,): -to -to <br /> Test End Time: 11.pp <br /> Final Reading(RF): to - <br /> Change in Reading(RF-R'). `a— <br /> Pass/Fail Threshold or Criteria: 'tom ! <br /> 'rest Result,. g)Pass; ❑Fail Pass; ❑Fall (:)Pass; ❑Fail ❑Pass; ❑Fail <br /> Was leak detection sensor ❑No; ❑Yes;❑No, ❑'Yes;❑No; <br /> properly replaced grad verified .'Yes;❑No; Yes; , <br /> as functional replaced <br /> aver testing? ®N/A(Not Removed) ❑NIA(Not Removed) ❑N/A(Not Removed) ❑N/A(Not Removed) <br /> E. Testing of Secondary Piping or Containment Trenches ❑N/A(No piping 2°containment) <br /> Test Method Developed By: ❑Pipe/Trench Manufacturer;Lj Industry Standard;WE,❑Other(Specify): <br /> Test Method Used;.9 Pressure; EI Vacuum; ❑Hydrostatic; ❑Other(Sped): <br /> Test Equipment Used: Equipment Resolution: <br /> Pipe Run M. PL Pipe Run#: L PipeRun#: Pipe Run.#I: <br /> Pipe/Trench Manufacturer: ; <br /> Pipe/Trench Model: �- <br /> Product/Grade in Line: - + <br /> Wait time between applying <br /> pressure/vacuum/water and 30 3 o <br /> starting test(minutes)- <br /> Test <br /> minutes :Test Start Date/Time: <br /> Initial heading(Ry): <br /> Test Dad Date/Time: :.00 Vf^ 0,106 <br /> Final Reading(RF): 05 <br /> Change in Reading(RF-N: 6 'Ok <br /> Pass/Fail Threshold or Criteria: . <br /> Test Result; ass; ❑Fail ass; ❑Fail ❑Pass; ❑Fail ❑Pass; ❑vail <br /> XN1 454-715 w�vsr.unidaes.org 0? 6f�2 <br />