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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 6 of 6) <br /> XXI. UNDER-DISPENSER CONTAINMENT TESTING INFORMATION <br /> Manufacturers Identify UDC ID from Section III for each Manufacturer <br /> 1 Z2 ✓❑ 3 04 ✓❑ 5 ✓❑ 6 ✓❑ <br /> Environ 7 ❑ 8 ❑ 9 ❑ 10 ❑ 11 ❑ 1 12 ❑ <br /> 1 ❑ 2 ❑ 3 ❑ 4 ❑ 5 ❑ 1 6 ❑ <br /> 7 ❑ 8 ❑ 9 ❑ 10 ❑ 11 ❑ 1 12 ❑ <br /> Test Method Used: ❑ Manufacturer Guidelines (Specify): <br /> ® Industry Code or Engineering Standard (Specify): Hydrostatic <br /> ❑ Engineered Method(Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> UDC Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> ICC UST Certification#8819839 10/15/2021 <br /> INCON TS-STS L4-Certification# 1019623710 9/24/2020 <br /> XXII. COMMENTS <br /> Provide any additional comments here. <br /> UDC 1/2, 3/4, 5/6 failed due to torn test boots. <br /> UDC 7/8 failed, made adjustments retested and failed. Tightened hose clamps on conduit penetrations, retested and passed. <br /> If the facility has more components than this form accommodates,additional copies of these pages may be attached. <br /> UDC=Under-Dispenser Containment;ID=Identification <br />