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Secondary Containment Testing Report Form-Page 5 of 5 <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: Pass; -7 Fail Pass; El Fail El Pass; El F 0 Pass; D Fail <br /> Was leak detection sensor <br /> properly replaced and verified as [IYes;[]No; ❑Yes;El No; ❑Yes;MNo; F1 Yes; No; <br /> functional after testing? ElN/A(Not Removed) 0 N/A(Not Removed) ❑N/A(Not Removed) 0 N/A(Not Removed) <br /> I. Testing of Spill Buckets ❑N/A(No spill buckets installed) <br /> 0 Spill bucket(s)not tested <br /> Test Method Developed By: 0 Bucket Manufacturer;[]Industry Standard;0 PE;[]Other(Spec): <br /> Test Method Used: 0 Pressure; 0 Vacuum; 0 Hydrostatic; 0 Other(Spec): <br /> Test Equipment Used: Equipment Resolution: <br /> atm s�P � V .... .. <br /> ,, 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—Rr): <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: ❑Pass; 0 Fail 0 Pass; 0 Fail 0 Pass; 0 Fail 0 Pass; 0 Fail <br /> J. Additional Information <br /> Were any repairs made to secondary containment systems prior to testing? [ Yes(describe in"Comments");E]No <br /> Were any secondary containment systems unable to be tested? 0 Yes(describe in"Comments");0 No <br /> Is any follow-up action recommended? 0 Yes(describe in"Comments");0 No <br /> Was any cleaning of secondary containment systems done? []Yes(describe management of wastewater in"Comments");❑No <br /> If hydrostatic testing was performed,describe in "Comments"what was done with the water after completion of testing. <br /> Comments: 4..� ,,, 18 'Z9 SSG t3.ciL�r4l�T Cau44,...,L.Ade^;u"� 7'���6 Al r=: CA—), <br /> u!v s 7^a J �r �. �=- S ca/ a t r �y-�— � f�► �u,J �z ,Q��c,�c_.. <br /> UN-054-5/5 www.unidocs.ore 02/26/02 <br />