Laserfiche WebLink
0 0 RECEIVEL <br />Secondary Containment TestingReport Form MAR 112015 <br />This,foran hs, ittteneledfr)r use by crontrccetrors p,r�firr»tiiii pei-ieatlir testing c f t STsec ondary containmentse e S S'> the <br />appropriate pages of this Morin to report results,fur all components tested the cotrtpleted form, written t NTAL <br />printouts froom tests (tf gpplioahle), should he provided to the fircvlttj, owner coperalor for submittal to the lo"CA4,M&ftMMMWhrr <br />1. FACILITY INFORMATION <br />Maintenance <br />Technician Conductina Test: KELVIN CRUZ <br />4 <br />License Type: I icense Number: 433159 <br />Manufacturer Com onent( I S) Date f'raininLL-x-P-i.!e5 <br />INCON "I's -STS 8/1/2016 <br />. SUMMARY OF TEST <br />RESULTS <br />� Not Repairs <br />Component ; Pass Fail Tested Witte <br />7tot 7zeliaire <br />Component Pass � Failt` ted Made_ <br />DSL ANNULAR <br />_.._.__.................... <br />........... <br />F-1 <br />El <br />1:1 <br />. <br />..' <br />___.._......... .._..___._r <br />_.__....__._.......__....__._......_._ <br />_�Y <br />1:11 <br />El <br />I <br />F-1 <br />F1 <br />?� <br />If hydrostatic testing was performed, describe <br />what <br />was <br />drone <br />with <br />the <br />water atter completion of tests: <br />TOOK. AS TEST WATER <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To lite best of my knowledge, thefacts stated in this doc meat are accurate and in full compliance with lural requirements <br />ents <br />Technician's Signature:. _ [_tate: 2/24/2015 <br />S(x ondary Containment Test Results 1 of 2 <br />