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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 5 of 6) XVII. FILL RISER SUMP TESTING INFORMATION Manufacturer Identify Tank ID from Section III for each Manufacturer Unknown Fiberglass/Tank E A ❑ B ❑ 1 C ❑ D ❑ A ❑ B ❑ I C ❑ D ❑ Test Method Used: ❑ Manufacturer Guidelines(Specify): ❑ Industry Code or Engineering Standard(Specify): Z Engineered Method (Specify): Caldwell Systems/Hydrostatic 30 Minutes Attach the testing procedures and all documentation required to determine the results. #of Attached Pages2 Fill Riser Sump Testing Training and Certifications(List applicable certifications.) Expiration Date Caldwell Level Change Indicator 6/10/2023 ICC UST Service Technician #5246802-UT 3/21/2021 Underground Storage Tank Tester License #90-1120 12/31/2022 XVIII. COMMENTS Provide any additional comments here. XIX. VENT/TRANSITION SUMP TESTING INFORMATION Manufacturer Identify Vent/Transition Sump ID from Section III for each Manufacturer Bravo S stems/Fi berg lass a 0 I b ❑ C I d ❑ a ❑ I b 1 c ❑ I d Test Method Used: ❑Manufacturer Guidelines(Specify): ❑ Industry Code or Engineering Standard(Specify): X Engineered Method (Specify): Caldwell Systems/Hydrostatic 30 Minutes Attach the testing procedures and all documentation required to determine the results. #of Attached Pages2 Vent/Transition Sump Testing Training and Certifications(List applicable certifications.) Expiration Date Caldwell Level Change Indicator 6/10/2023 ICC Service Technician #5246802-UT 3/21/2021 Underground Storage Tank Tester License #90-1120 12/31/2022 XX. COMMENTS Provide any additional comments here. NA-Section III-No Vent/Transition Sump-E. All Tanks Vent Piping and Vent Piping Containment terminate at Vent Sump A. ID=Identification