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May. 9. 2017 4: 12PM Donlee Pump Co No, 7237 P. 3 . <br /> Secondary Containment Testing Report Form-Page 2 of 5 <br /> D. Testing of Tank Annular SpacesNaults [❑NIA.(No Yanks have secondary containment) <br /> Test Method Developed 13y: ❑Tank Manufacturer;❑Industry Standard; PE;0 Other(Sped): <br /> Test Method Used: [)Pressure; ® Vacuum; C1 Hydrostatic; ElOther(Sped): <br /> Test Equipment Used: Equipment Resolution: <br /> Tank ti: { i - Tank#: Tank#: Tank#: <br /> Is Tank Exempt From Te <br /> .. ..__. __.. ....,. ....sting? ❑Yes;; o ❑Yes• o _0 Yes- C1 NO ❑'Yes; ❑No <br /> Tank Capacity(gallons): -L'600 12 1500 <br /> Product/GTade Stored in Tank: i- 9 k <br /> Tank Manufacturer: r,, ger ,, <br /> Tanis Model: <br /> Wait time between applying <br /> pressure/vacuum/water and p : c1 M;n5 <br /> start' test(minutes); <br /> Test start Time: 10:00 <br /> Initial kneading(R'): -to r IU <br /> Test End Time: :oa <br /> Final Reading(RF): e v o - O <br /> Change in Reading(Rr-Rj): t <br /> Is- <br /> Pass/Fail Threshold or Criteria: "{fit. R9 <br /> Test Result. Pass; ❑Fail Pass; ❑Fall ❑Pass; ❑Fail ❑Pass; ❑Fall <br /> Was leak detection sensor ❑No; 0 Yes;❑No; ❑'Yes;❑ <br /> properly lased and verified Yes;F1 No; Yes; No; <br /> Prop y re p ❑N/A(Not Removed) ❑N/A(Not RcMoved) ❑ISI/A(Not Removed) ❑N/A(Not Removed) <br /> Las functional after testing? <br /> E. Testing of Secondary Piping or Containment Trenches ❑N/A(No piping 2°containment) <br /> Test Method Developed Tay: ❑Pipe/Trench Manufacturer;Lj Industry Standard; E;❑Other(Specify): <br /> Test Method Used;JR Pressure; ❑Vacuum; ❑Hydrostatic; ❑Other(Spec); <br /> Test Equipment Used: Equipment Resolution: <br /> Pipe Run#: 8+ PL pipe Run#: AlPlpe Run#: Pipe Run#: <br /> Pipe/Trench Manufacturer: <br /> Pipe/Trench Model: a,c 1r <br /> Product/Grade in Line: al j of-+ � <br /> Wait time between applying <br /> pressure/vacuum/water and ,o rv,;., 3 o i%; , <br /> st8=tin test(minutes): <br /> Test Start Date/Time: <br /> Initial Reading(Rj): <br /> Test End Date/Time: :bo w„ <br /> Final Reading(RF): 'S <br /> Change in Reading(RF-Rj): 6. <br /> Pass/Fail Threshold or Criteria: St <br /> Test Result: ass; ❑Fail ass; ❑Fail ❑Pass; Fail ❑Pass; ❑)Fail <br /> CN•o54-7/5 www.unidoes.org QW6/02 <br />