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Underground Storage Tank <br />Secondary Containment Testing Report Form <br />Test Method Developed by ❑ Manufacturer ❑ Industry Standard x Professional Engineer <br />Test Type ❑ Pressure ❑ Vacuum x Hydrostatic <br />Test Equipment Used:Caldwell Level Change Indicator <br />Sump/UDC ID <br />UDC 1&2 <br />UDC3&4 <br />UDC5&6 <br />UDC 7&8 <br />Sump Manufacturer <br />Western <br />Western <br />Western <br />Western <br />Sump Depth (inches) <br />32 1/4" <br />33 112" <br />32 112" <br />33" <br />Sump Bottom to Top of <br />Highest Pipe Penetration <br />(inches) <br />9" <br />9" <br />9" <br />9" <br />Test Start Time <br />9:30 a.m. <br />9:30 a.m. <br />9:30 a.m. <br />10:20 a.m. <br />Initial Reading <br />.001 <br />.001 <br />.001 <br />.001 <br />Test End Time <br />10:00 a.m. <br />10:00 a.m. <br />10:00 a.m. <br />10:50 a.m. <br />Final Reading <br />.001 <br />.001 <br />.001 <br />.001 <br />Change in Reading <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Criteria <br />.005130 min. <br />.005130 min. <br />.005130 min. <br />.005130 min. <br />Tightness Test Results <br />x Pass Fail <br />x Pass Fail <br />x Pass Fail <br />x Pass Fail <br />Sump/UDC ID <br />UDC # 9&10 <br />UDC 11&12 <br />87 STP SUMP <br />87 SYP SUMP <br />Sump Manufacturer <br />Western <br />Western <br />XERXES <br />XERXES <br />Sump Depth (inches) <br />33" <br />33" <br />75 112" <br />76" <br />Sump Bottom to Top of <br />Highest Pipe Penetration <br />(inches) <br />9" <br />9" <br />53" <br />50" <br />Test Start Time <br />10:30 a.m. <br />10:30 a.m. <br />11:45 a.m. <br />12:40 p.m. <br />Initial Reading <br />.001 <br />.001 <br />.001 <br />.001 <br />Test End Time <br />11:00 a.m. <br />11:00 a.m. <br />12:15 p.m. <br />1:10 P.M. <br />Final Reading <br />0.001 <br />.001 <br />.001 <br />.001 <br />Change in Reading <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Criteria <br />.005130 min. <br />.005/30 min. <br />.005130 min. <br />.005130 min. <br />Tightness Test Results <br />x Pass Fail <br />x Pass Fail <br />x Pass Fail <br />x Pass Fail <br />Additional copies of this page may be attached. <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 3 of 5 <br />