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Secondary Containment Testing Report Form - Page 5 of 5 Pass/Fail Threshold or Criteria: Test Method Used: ❑ Pressure; ❑ Vacuum; ❑ Hydrostatic; ❑ Other (Specie): Test Equipment Used: Equipment Resolution: Test Result: ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail Was leak detection sensor properly replaced and verified as F] Yes; ❑ No; El Yes; ❑ No; El Yes; ❑ No; ❑Yes; ❑ No; functional after testing? FlN/A (Not Removed) E]N/A (Not Removed) ❑ N/A (Not Removed) ❑ N/A (Not Removed) I. Testing of Spill Buckets ❑ N/A (No spill buckets installed) ❑ Spill bucket(s) not tested Test Method Developed By: ❑ Bucket Manufacturer; ❑ Industry Standard; ❑ PE; ❑ Other (Spec): Test Method Used: ❑ Pressure; ❑ Vacuum; ❑ Hydrostatic; ❑ Other (Specie): Test Equipment Used: Equipment Resolution: Bucket #: Bucket #: Bucket #: Bucket #: Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (Rt): Test End Time: Final Reading (RF): Change in Reading (RF — R,): Pass/Fail Threshold or Criteria: Test Result: ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail , Were any repairs made to secondary containment systems prior to testing? ❑ Yes (describe in "Comments"); ® No Were any secondary containment systems unable to be tested? ❑ Yes (describe in "Comments"); ® No Is any follow-up action recommended? ❑ Yes (describe in "Comments"); ® No Was any cleaning of secondary containment systems done? ❑ Yes (describe management of wastewater in "Comments" ); ® No If hydrostatic testing was performed, describe in "Comments" what was done with the water after completion of testing. Comments: Pumped water into tank for reuse UN -054 - 5/5 www.unidocs.org 02/26/02