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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of 6) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> XERXES A Q 1 B 0 I C x❑ D ❑ <br /> A ❑ I B ❑ I C ❑ D <br /> Test Method Used: ❑ Manufacturer Guidelines(Specify): <br /> Z Industry Code or Engineering standard(Specify): PEI/RP1200-17/Fiberglass Tank/-10" Hg. 1 Hour <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 /> Underground Storage Tank Tester License #90-1120 12/31/2019 <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> Tank#1-A-is a 12 K Diesel <br /> Tank#2-B-is a 12K Super 91 <br /> Tank#3-C-is a 12K Regular 87 <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Smith Fibercast FRP A Xx B IC ❑x D ❑ <br /> A ❑ B I C ❑ I D ❑ <br /> Test Method Used: ❑ Manufacturer GuidelinesS eci <br /> ( p fY) <br /> ❑ Industry Code or Engineering Standard (Specify): <br /> ❑Engineered Method (Specify): <br /> Attach the testing procedures and all documentation required to determine the results. #of Attached Pages <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Interstitial Communication Verification Method Used: <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> NA-Section III-Product Piping Containment not tested with this testing event. <br /> ID=Identification <br />