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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 3 of 6) <br /> IX. REMOTE FILL PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> A 0 +___BU C ❑ D <br /> A Ll B1 C Ej I D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> Pe fY) <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. <br /> Remote Fill Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> -TCC #bU249b2-U 1 02-21-2022 <br /> ICU #bU24962-Ul U21 <br /> Interstitial Communication Verification Method Used: <br /> X. COMMENTS <br /> Provide any additional comments here. <br /> This system does not have a remote fill. <br /> XI. VENT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identi Tank ID from Section III for each Manufacturer <br /> A ❑ B C D <br /> A B ❑ C ❑ I D <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ® Industry Code or Engineering Standard(Specify): PEI 1 200 <br /> ❑Engineered Method(Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Vent Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> IL;b1-1:30124b'13 A, ulu, HAZ- 11-3U-2U21 <br /> Interstitial Communication Verification Method Used: <br /> XII. COMMENTS <br /> Provide any additional comments here. <br /> Vent piping is single wall, does not have containment. <br /> I D=Identification <br /> UN-064 www.unidocs.org 3/6-Rev.06/14/18 <br />