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UNDERGROUND STORAGE TANK <br />SECONDARY CONTAINMENT TESTING REPORT FORM (Page z of 6) <br />V. TANK SECONDARY CONTAINMENT INFORMATION <br />Manufacturer Identify Tank ID from Section III for each Manufacturer <br />A❑ <br />B❑ <br />I C❑ <br />I D❑ <br />A❑ <br />I B❑ <br />I C❑ <br />I D❑ <br />Test Method Used: <br />❑ Manufacturer.Guidelines (Specify): <br />❑ Industry Code or Engineering Standard (Specify): <br />❑ Engineered Method (Specify): ' <br />Attach the testing procedures and all documentation required to determine the results. <br /># of Attached Pages <br />Tank Containment Testing Training and Certifications (List applicable certificationr,) <br />Expiration Date <br />VI. COMMENTS <br />Provide any additional comments here. <br />VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br />Manufacturer Identify Tank ID from Section III for each Manufacturer <br />Smith A❑x <br />Bx❑ <br />C❑ <br />D❑ <br />A❑ <br />B❑ <br />C❑ <br />D❑ <br />Test Method Used: <br />❑ Manufacturer Guidelines (Specify): <br />❑x Industry Code or Engineering Standard (Specify): PEI RP 1200 <br />❑ Engineered Method (Specify): <br />Attach the testing procedures and all documentation required to determine the results. <br /># of Attached Pages <br />Product Piping Containment Testing Training and Certifications (List applicable certifications.) <br />Expiration Date <br />ICC 5275452 <br />5/7/2021 <br />Incon 1016213708 <br />10/22/2021 <br />Fiberglass System <br />12/10/2022 <br />Interstitial Communication Verification Method Used: <br />VIII. COMMENTS <br />Provide any additional comments here. <br />Passed (1) Hour test 6 PSI <br />ID = Identficabon <br />