Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 6 of 6) <br /> XXI. UNDER-DISPENSER CONTAINMENT TESTING INFORMATION <br /> Manufacturers IdentifyUDC ID from Section III for each Manufacturer <br /> 1 ✓❑ 1 2 :V1 M3 [01 4 El5 ❑ 6 ❑Environ7 ❑ 8 :j10 El11 [012 ❑1 F] 2 :j4 ❑ 5 F] 6 ❑7 ❑ 8 :110 ❑ 1 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 # 5254516 7/ 12/2021 <br /> INCON TS-STS L4 - Certification # 1012573708 1 /27/2020 <br /> XXII . COMMENTS <br /> Provide any additional comments here. <br /> Tightened hose clamps to conduit penetrations in UDC 1 /2 , 3/4 . <br /> No Inspector on site . <br /> If the facility has more components than this form accommodates, additional copies of these pages may be attached. <br /> I <br /> UDC = Under-0ispenser Containment; ID = Identification <br /> I <br /> i <br />