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Underground Storage Tank <br />Secondary Containment Testing Report Form <br />Test Method Developed by x Manufacturer ❑ Industry Standard ❑ Professional Engineer <br />Test Type ❑ Pressure x Vacuum ❑ Hydrostatic <br />Test Equipment Used: Vacuum Pump/Vacuum Gauges in Hg <br />Tank ID <br />T11:87 <br />T2: 87191 <br />Pipe Manufacturer <br />SMITH <br />Tank Manufacturer <br />XERXES <br />XERXES <br />Test Start Time <br />11:15 a.m. <br />Tank Capacity <br />19,703 <br />10369111849 <br />Initial Reading <br />5 psi <br />Test Start Time <br />2:10 p.m. <br />2:26 p.m. <br />Test End Time <br />12:15 p.m. <br />Initial Reading <br />-12" Hg <br />-12" Hg <br />Final Reading <br />5 psi <br />Test End Time <br />3:10 p.m. <br />3:26 p.m. <br />Change in Reading <br />0 psi <br />Final Reading <br />-12" Hg <br />-12" Hg <br />Pass/Fail Criteria <br />No loss <br />Change in Reading <br />0" Hg <br />0" Hg <br />Tightness Test Results <br />x Pass ❑ Fail <br />Pass/Fail Criteria <br />+1-0" Hg <br />+1-0" Hg <br />Pipe Run ID <br />#5 91 <br />Tightness Test Results <br />x Pass ❑ Fail <br />x Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />7. PIPE SECONDARY CONTAINMENT TEST <br />Test Method Developed by x Manufacturer ❑ Industry Standard ❑ Professional Engineer <br />Test Type x Pressure ❑ Vacuum ❑ Hydrostatic <br />Test Equipment Used: Pressure Gauges in Psi/Nitrogen <br />Pipe Run ID <br />#1 87 Master <br />#2 87 Syphon <br />#3 87M191 <br />#4 87 Syp191 <br />Pipe Manufacturer <br />SMITH <br />SMITH <br />SMITH <br />SMITH <br />Test Start Time <br />11:15 a.m. <br />11:30 a.m. <br />12:00 p.m. <br />12:15 p.m. <br />Initial Reading <br />5 psi <br />5 psi <br />5 psi <br />5 psi <br />Test End Time <br />12:15 p.m. <br />12:30 p.m. <br />1:00 P.M. <br />1:15 P.M. <br />Final Reading <br />5 psi <br />5 psi <br />5 psi <br />5 psi <br />Change in Reading <br />0 psi <br />0 psi <br />0 psi <br />0 psi <br />Pass/Fail Criteria <br />No loss <br />No loss <br />No loss <br />No loss <br />Tightness Test Results <br />x Pass ❑ Fail <br />x Pass ❑ Fail <br />x Pass ❑ Fail <br />x Pass ❑ Fail <br />Pipe Run ID <br />#5 91 <br />Pipe Manufacturer <br />SMITH <br />Test Start Time <br />12:30 p.m. <br />Initial Reading <br />5 psi <br />Test End Time <br />1:30 p.m. <br />Final Reading <br />5 psi <br />Change in Reading <br />0 psi <br />Pass/Fail Criteria <br />No loss <br />Tightness Test Results <br />x Pass ❑ Fail <br />❑ Pass ❑ Fail <br />I ❑ Pass ❑ Fail <br />I ❑ Pass ❑ Fail <br />Additional copies of this page may be attached. <br />8. SUMPIUDC TEST <br />All tests marked "Fail' and any repairs made before or during the tightness test must be described in <br />the COMMENTS section. <br />Page 2 of 5 <br />