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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of 6) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> anufacturer Identify Tank ID from Section III for each Manufacturer <br /> A B 1 C D ❑ <br /> Modern Welding A Ej I B N I C Ej I D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ®Industry Code or Engineering Standard(Specify): PEI 1200 <br /> ❑Engineered Method(Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 5 <br /> Tank Containment Testing Training and Certifications(List applicable certifications) Expiration Date <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> See attached Secondary Containment Test Report. <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> anufacturer IdentifyTank ID from Section III for each Manufacturer <br /> A H I B C El D <br /> A Ll I B 0 1 C ❑ D <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ®Industry Code or Engineering Standard(Specify): PEI 1200 <br /> ❑Engineered Method(Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results_ 5 <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Interstitial Communication Verification Method Used: <br /> Verify loss at gauge from bleed down at each other end. <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> Only the Unleaded piping is double wall. The Diesel piping is a"Safe suction system", and was verified 8-11-08 during <br /> testing. <br /> ID=Identification <br /> UN-054 www.unidocs.org 2/6-Rev.06/14118 <br />