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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of s) V. TANK SECONDARY CONTAINMENT INFORMATION Manufacturer Identify Tank ID from Section III for each Manufacturer . Modern welding A © 1 B ® I C ✓❑ D ❑ A ❑ I B ❑ I C ❑ I D ❑ Test Method Used : ❑ Manufacturer Guidelines (Specify): ® Industry Code or Engineering Standard (Specify): Vacuum ❑ Engineered Method (Specify): # of Attached Pages Attach the testing procedures and all documentation required to determine the results. Tank Containment Testing Training and Certifications (List applicable certifications.) Expiration Date ICC UST Certification # 8819839 10/ 15/2021 VI . COMMENTS Provide any additional comments here. Tested 87 annular at 11 : 00 am at 7 hg ended at 12 : 00 pm at 7 hg . Tested 91 annular at 11 : 30 am at 7 hg ended at 12 : 30 pm at 7 hg Tested Diesel annular at 12 : 30 pm at 7 hg ended at 1 : 30 pm at 7 hg *note* no inspector present VII . PRODUCT PIPING CONTAINMENT TESTING INFORMATION Manufacturer Identify Tank ID from Section III for each Manufacturer Smith A0 1 BW1 I CD ❑ A ❑ I B ❑ I C ❑ I D ❑ Test Method Used : ❑ Manufacturer Guidelines (Specify) : ® Industry Code or Engineering Standard (Specify) : Pressure ❑ Engineered Method (Specify): # of Attached Pages Attach the testing procedures and all documentation required to determine the results. Product Piping Containment Testing Training and Certifications (List applicable certifications) Expiration Date ICC UST Certification # 8819839 10/15/2021 Interstitial Communication Verification Method Used : Villa COMMENTS Provide any additional comments here. Started 87 product at 10 : 15 am at 5 psi ended at 11 : 15 am at 5 psi . Started 91 product at 5 psi at 10: 15 am ended at 11 : 15 am at 5 psi . Started Diesel product at 5 psi at 10 : 15 am ended at 11 : 15 am at 5psi ID = Identification i I I i C