Laserfiche WebLink
Secondary Containment Testing Report Form - Page 2 of 5 <br />D. Testing of Tank Annular SpacesNaults <br />® N/A (No tanks have secondary containment) <br />Test Method Developed By: ❑ Tank Manufacturer; ® Industry Standard; ❑ PE; ❑ Other (Specify): <br />Test Method Used: ❑ Pressure; ® Vacuum; ❑ Hydrostatic; ❑ Other (Specify): <br />Test Equipment Used: gauge <br />Equipment Resolution: 0.5" HG <br />Pipe Run #: Diesel <br />Pipe Run #: 87 <br />Pipe Run #: <br />Pipe Run #: <br />Tank #: DSL <br />Tank #: 87 <br />Tank #: <br />Tank #: <br />Is Tank Exempt From Testing? <br />❑Yes; ®No <br />❑ Yes; ® No <br />❑ Yes; ❑ No <br />❑ Yes; ❑ No <br />Tank Capacity (gallons): <br />12000 <br />12000 <br />87 <br />Product/Grade Stored in Tank: <br />Diesel <br />87 <br />30 Min. <br />Tank Manufacturer: <br />Unknown <br />Unknown <br />12:15 <br />Tank Model: <br />Unknown <br />Unknown <br />5.2 PSI <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />30 Min. <br />30 Min. <br />1:15 <br />Test Start Time: <br />12:15 <br />12:15 <br />5.2 PSI <br />Initial Reading (R,): <br />10" HG <br />10" HG <br />0.0 PSI <br />Test End Time: <br />1:15 <br />1:15 <br />0.0 PSI <br />Final Reading (RF): <br />10" HG <br />10" HG <br />® Pass; ❑ Fail <br />❑ Pass; ❑ Fail <br />Change in Reading (RF — Rj): <br />0.0" HG <br />0.0" HG <br />Pass/Fail Threshold or Criteria: <br />0.0" HG <br />0.0" HG <br />Test Result: <br />® Pass; ❑ Fail <br />® Pass; ❑ Fail <br />❑ Pass; ❑ Fail <br />❑ Pass; ❑ Fail <br />Was leak detection sensor <br />properly replaced and verified <br />as functional after testing? <br />® Yes; F1 NO; <br />E]N/A (Not Removed) <br />®Yes; ❑ No; <br />ElN/A (Not Removed) <br />❑ Yes; [—]No; <br />❑ N/A (Not Removed) <br />❑ Yes; [:1 No; <br />F-1N/A (Not Removed) <br />E. Testing of Secondary Piping or Containment Trenches ❑ N/A (No piping 2° containment) <br />Test Method Developed By: ❑ Pipe/Trench Manufacturer; ® Industry Standard; ❑ PE; ❑ Other (Specie): <br />Test Method Used: ® Pressure; ❑ Vacuum; ❑ Hydrostatic; ❑Other (Sped): <br />Test Equipment Used: gauge <br />Equipment Resolution: 0.2 PSI <br />Pipe Run #: Diesel <br />Pipe Run #: 87 <br />Pipe Run #: <br />Pipe Run #: <br />Pipe/Trench Manufacturer: <br />Ameron <br />Ameron <br />Pipe/Trench Model: <br />Dualloy <br />Dualloy <br />Product/Grade in Line: <br />Red Diesel <br />87 <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />30 Min. <br />30 Min. <br />Test Start Date/Time: <br />12:15 <br />12:15 <br />Initial Reading (Ri): <br />5.2 PSI <br />5.2 PSI <br />Test End Date/Time: <br />1:15 <br />1:15 <br />Final Reading (RF): <br />5.2 PSI <br />5.2 PSI <br />Change in Reading (RF — RI): <br />0.0 PSI <br />0.0 PSI <br />Pass/Fail Threshold or Criteria: <br />0.0 PSI <br />0.0 PSI <br />Test Result: <br />® Pass; [:]Fail <br />® Pass; ❑ Fail <br />❑ Pass; ❑ Fail <br />❑ Pass; ❑ Fail <br />UN -054 - 2/5 www.unidoes.org 02/26/02 <br />