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* SWRCB, January 2002 <br />E <br />Page of <br />Test Method Developed By: Q Tank Manufacturer ndustry Standard G Professional Engineer <br />0 Other (Spec) <br />Test Method Used: G Pressure acuum G Hydrostatic <br />G Other (Spec) <br />Test Equipment Used: <br />Equipment Resolution: ' <br />t_ s '+, s M .j _.•. .t? _.:� _ - <br />e r _ <br />Tank # Ta k# - <br />....; s, is — : i <br />Tank <br />.a _ .ca: - <br />Tank # <br />Is Tank Exempt From Testing?' <br />❑Yes 1 To <br />Q Yes 110, <br />0 Yes G No <br />❑ Yes G No <br />Tank Capacity: <br />,i 2 , el -c 0 <br />Tank Material.- <br />aterial:Tank <br />TankManufacturer: <br />VA/ <br />t <br />Product Stored: <br />`, .ti°aC yc/ed�,�� <br />e "? -I& <br />VVa1i dint between applying <br />pressure/vacuum/water and <br />starting test: <br />i <br />Test Start Time: <br />/lriG� <br />Initial Reading (Rj): <br />Test End Time: <br />G? <br />e 0 <br />Final Reading (RF): <br />Test Duration:—, <br />A/ � <br />Change in Reading (RF -R,): <br />6171 <br />Pass/Fail Threshold or Criteria: <br />zc��, <br />YG� <br />Test Result: <br />ass 0 Fail <br />Q Pass ` "_ Q Fail <br />Q Pass . CI Fail <br />Was sensor removed for testing? <br />— es Q o C NA <br />V7s G No ❑ NA <br />Q Yes Q No 07 NA <br />Q Yes ONO Q NA <br />Was sensor properly replaced and <br />verified functional after testing?s <br />0 No '--j NA <br />❑ No G NA <br />❑Yes Q No \TAI <br />❑Yes G No ❑ NA <br />9 <br />Comments — (inchide information on repairs made prior to testing,acrd recommended folloip-up for failed tests) <br />' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br />containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic <br />