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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of s) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Modern Welding A El I B El I C 0 D ❑ <br /> A ❑ I B ❑ I C ❑ I D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ❑x Industry Code or Engineering Standard(Specify): PEI/RP 1200-17/Steel Tank/-6" Hg. 1 hr. <br /> ❑Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 2 <br /> Tank Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> ICC Service Technician #5246802-UT 3/21/2021 <br /> Under round Storage Tank Tester License #90-1120 12/31/2022 <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> Tank A is a 10K, Double Wall Steel, designated for Regular 87 Octane Gasoline. <br /> Tank B is a 10K, Double Wall Steel, designated for Regular 87 Octane Gasoline. <br /> Tank C is a 10K, Double Wall Steel, designated for Super 91 Octane Gasoline. <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Smith FRP 1 A l B 1 C 0 D ❑ <br /> A ❑ I B ❑ I C ❑ I D ❑ <br /> Test Method Used: ❑x Manufacturer Guidelines(Specify): *Bravo Systems Coated Steel UDC's. 3 Psi-1 Hour <br /> ❑ Industry Code or Engineering Standard(Specify): <br /> ❑Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 2 <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> ICC Service Technician #5246802-UT 3/21/2021 <br /> Under round Storage Tank Tester License #90-1120 12/31/2022 <br /> Interstitial Communication Verification Method Used: <br /> NA-Section III-Sealed System at Termination end of Product Piping Containment, at Bravo System Coated Steel UDC's. <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> *Section VII-See Test Procedure Attachment for Product Piping Containment Test Pressure, Time and Protocol, for <br /> Fiberglass Piping Systems that terminate at Bravo System Coated Steel UDC's. <br /> ID=Identification <br />