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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page s of 6) <br /> IX. REMOTE FILL PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Fidentify Tank ID from Section III for each Manufacturer <br /> A ❑ B ❑ I C ❑ I D ❑ <br /> A ❑ B I C 1 D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ❑ Industry Code or Engineering Standard (Specify): <br /> ❑ Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Remote Fill Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Interstitial Communication Verification Method Used: <br /> X. COMMENTS <br /> Provide any additional comments here. <br /> XI. VENT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> AO Smith A B ❑ I C D ❑ <br /> A ❑ B ❑ I C ❑ I D <br /> Test Method Used: ❑ Manufacturer Guidelines(Specify): <br /> ❑x 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 /> Vent Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Interstitial Communication Verification Method Used: <br /> N/A <br /> XII. COMMENTS <br /> Provide any additional comments here. <br /> UG01 00001 Vent- <br /> 5 PSI for one Hour, 9:00am to 1 OMam -PASSED <br /> ID=Identification <br />