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Secondary Containment Testing Report Form-Page 5 of 5 <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: El Pass; DFail 0 Pass; El Fail Pass; Fail 0 Pass; El Fail <br /> Was leak detection sensor <br /> properly replaced and verified as ❑Yes;❑Na; ❑Yes;[�No; ❑Yes;❑No; ❑Yes;[]Na; <br /> properly <br /> r afterdantesting? ❑N/A(Hot Removed) ❑NIA(Not Removed) ❑N/A(Not Removed) ❑N/A(Plot Removed) <br /> funcI. Testing of Spill Buckets ❑NIA(No spill buckets installed) <br /> ill bucket(s)not tested <br /> Test Method Developed By: ❑Bucket Manufacturer;❑Industry Standard-,E]PE;❑Other(Specify): <br /> Test Method Used: ❑Pressure; ❑Vacuum; ❑Hydrostatic; ❑Other(Spec): <br /> Test Equipment Used: Equipment Resolution: <br /> Bucket#: Bucket#: Bucket#: Bucket#: <br /> Bucket Diameter: <br /> Bucket Depth: <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(RI): <br /> Test End Time: <br /> Final Reading(RF): <br /> Change in Reading(RF--Rt): <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: JE1 Pass; ❑Fail ❑Pass; ❑Fail ❑Pass; ❑ Fail ❑Pass; ❑Fall <br /> J. Additional Information <br /> Were any repairs made to secondary containment systems prior to testing? aYes(describe in"Comments");❑No <br /> Were any secondary contaimuent systems unable to be tested? ❑Yes(describe in"Comments");KNo <br /> Is any follow-up action recommended? ❑Yes(describe in"Comments");,,No <br /> Was any cleaning of secondary containment systems done? ❑ Yes(describe management of wastewater in"Comments");`LNo <br /> If hydrostatic testing was performed,describe in"Comments"what was done with the water after completion of testing. <br /> Comments: �e�\o.et �-OV \,jAa)r five aj- 4%,. Reee{�\Q� �4� ',-.tae 10oy- <br /> vJ�-der h a Nfaf(N ko )DC- Ce- 06 CA <br /> ,h$ s <br /> } <br /> 2 20'1 <br /> DEP RTIVIENT <br /> UN-05d-5/5 wl'Ay.unidocs.org OZ/UM <br />