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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of B) V. TANK SECONDARY CONTAINMENT INFORMATION Manufacturer Identi Tank ID from Section III for each Manufacturer AR] B❑ I C❑ 11 D❑ AD B❑ I C❑ I D❑ Test Method Used: ❑ Manufacturer Guidelines (Specify): 0 Industry Code or Engineering Standard (Specify): ❑ Engineered Method (Specify): Attach the testing procedures and all documentation required to determine the results. # of Attached Pages Tank Containment Testing Training and Certifications (List applicable certifications.) Expiration Date ICC Service Technician 6/19/2021 Mike Kennard VL COMMENTS Provide any additional comments here. 12/04/2020 @ 11:40 am Completed Pressure Test for Tank Capacity 20,000 Split Tank; Material: Gasoline Product Stored; Grades 87191 Tank Annular Testing: Started Test at 11:30 Initial Reading (R1) 2.5 Psi Test End at 12:30 Duration of Test 1 Hour Final Reading (Rf) 2.5 Psi VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION Manufacturer Identify Tank ID from Section III for each Manufacturer AQ I B❑ I C❑E2DB� Ax❑ B❑ C Test Method Used: © Manufacturer Guidelines (Specify): Q Industry Code or Engineering Standard (Specify): ❑ Engineered Method (Specify): Pressure Test Attach the testing procedures and all documentation required to determine the results. # of Attached Pages Product Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration pate Interstitial Communicafion Verification Method Used: VIII. COMMENTS Provide any additional comments here. Tested 87191 Annular Space (Split Tank) After repairs to Lid /Manway on 87 STP Sump 20,000 Split Tank time @ 10:30 is 2.5 to 11:30 (Duration of Testing 1 hour) Final Reading is 2.5 Psi. Test ok. ID = Identif€cation