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UST Spill Bucket Integrity Testing Form Underground Storage Tanks (UST) Program Instructions on Page 3 Purpose: This procedure is to test the leak integrity of single- and double-walled spill buckets. See reverse side for basic hydrostatic testing instructions. Consult PEI/RP1200, Section 6.2 for hydrostatic test method, Section 6.3 for single-walled vacuum test method, and Section 6.4 for double-walled vacuum test method. Testing Information 1. Tank number 87 Waste Oil 2. Product stored Unleaded Waste Oil 3. Spill bucket capacity 5 Gallons 5 Gallons 4. Manufacturer OPW OPW 5. Construction Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled 6. Test type Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled 7. Spill bucket type Product Vapor Product Vapor Product Vapor Product Vapor Product Vapor Product Vapor 8. Liquid and debris removed from spill bucket:* Yes No Yes No Yes No Yes No Yes No Yes No 9. Visual inspection (No cracks, loose parts or separation of the bucket from the fill pipe.)? Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail 10. Tank riser cap included in test? Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA 11. Is drain valve included in test? Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA 12. Starting level 13.25” 13.50” 13. Test start time 9:05 am 9:05 am 14. Ending level 13.25” 13.50” 15. Test end time 10:05 am 10:05 am 16. Test period 1 hour 1 hour 16. Level change 0 0 Test results: Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 1/8 inch; Vacuum single-walled only; Maintain at least 26 inches water column; Vacuum double-walled; maintain at least 12 inches water column. Comments: * All liquids and debris must be disposed of properly. Testing company name: CGRS Inc Tester’s name: Garrett Warren Date: 12-4-19 Tester’s signature: