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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of s) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Modern Welding AxQ B ❑ C ❑ I D ❑ <br /> A ❑ B ❑ I C ❑ I D ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify): <br /> Vacuum <br /> 0 Industry Code or Engineering Standard (Specify): PEI RP1200 <br /> ❑ Engineered Method (Specify): <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Tank Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> VI . COMMENTS <br /> Provide any additional comments here. <br /> UE0420001 Annular - <br /> - 10" HG for two hours , 9 : 00am to 11 : 00am - PASSED <br /> VII . PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Western Fiberglass A Q B ❑ C ❑ D ❑ <br /> AO Smith A ❑ I B 1 C ❑ I D ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify) : <br /> Pressure <br /> Q Industry Code or Engineering Standard (Specify) : PEI RP1200 <br /> ❑ Engineered Method (Specify): <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Product Piping Containment Testing Training and Certifications (List applicable certifications) Expiration Date <br /> Interstitial Communication Verification Method Used: <br /> N/A <br /> VIII . COMMENTS <br /> Provide any additional comments here. <br /> UE0420001 Supply # 1 - <br /> 5 PSI for one hour, 9 : 00am to 10: 00am - Passed <br /> UE0420001 Supply # 2 - <br /> 5 PSI for one hour, 9 : 00am to 10: 00am - Passed <br /> UE0420001 Emergency Return - <br /> 5 PSI for one hour, 9: 00am to 10 : 00am - Passed <br /> ID = Identification <br />