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SWRCB, January 2002 _ e Page 2 of Z -- <br />Test Method Developed By: 0 Tank Manufacturer ndustry Standard 0 Professional Engineer <br />0 Other (Specify) <br />Test Method Used: 0 Pressure acuum u Hydrostatic <br />0 Other (Specify) <br />Test Equipment Used: <br />Equipment Resolution: <br />'fes Tank # <br />Tank # <br />Tank # <br />Tank # <br />Is Tank Exempt From Testing?' 0 Yes 21;fo <br />0 Yes 0 No <br />0 Yes 0 No <br />0 Yes 0 No <br />Tank Capacity: ` t <br />Tank Material:--� <br />' <br />Tank Manufacturer: <br />Product Stored: E ;;SeL- <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: d /,j <br />Test Start Time: Z> 7..C> <br />Initial Reading (RI): <br />Test End Time: Z p <br />Final Reading (RF); <br />Test Duration: <br />Change in Reading (RF -Rt): <br />PaWFail Threshold or Criteria: <br />Test Result: �PasS 0 Fail <br />1. Pass f�' Faii <br />0 . Pass ❑ Fail <br />. l� 'Pass Cl Fait <br />Was sensor removed for testing? .1'es 0 N 0 NA <br />0 Yes 0 No 0 NA <br />0 Yes 0 No 0 NA <br />0 Yes 0 No 0 NA <br />Was sensor properly replaced and 2- i es 0 No 0 NA <br />verified functional after testin ? <br />0 Yes 0 No 0 NA <br />0 Yes 0 No C NA <br />0 Yes 0 No 0 NA <br />Comments — (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />1 Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br />containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic <br />