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PEI/RM 200-17 <br /> HYDROSTATICAPPENDIX C-3 <br /> SPILL BUCKET INTEGRITY TESTING OD <br /> SINGLE-AND DOOD <br /> Facility Name: Owner: <br /> Address: Address: <br /> City,State,Zip Code: City,State,Zip Code: <br /> Facility I.D.#: Phone#: <br /> Testing Company: Phone#: Date: <br /> This procedure is to test the leak integrity of single-and double-walled spill buckets.See PEI/RP1200 Section 6.2 for hydrostatic test <br /> method,Section 6.3 for single-walled vacuum test method and Section 6.4 for double-walled vacuum test method. <br /> Tank Number <br /> Product Stored <br /> Spill Bucket <br /> Capacity <br /> Manufacturer <br /> Construction ❑Single-walled ❑Single-walled ❑Single-walled ❑Single-walled ❑Single-walled ❑Single-walled <br /> ❑Double-walled ❑Double-walled ❑Double-walled ❑Double-walled ❑Double-walled ❑Double-walled <br /> Test Type ❑Hydrostatic ❑Hydrostatic ❑Hydrostatic ❑Hydrostatic ❑Hydrostatic ❑Hydrostatic <br /> ❑Vacuum ❑Vacuum ❑Vacuum ❑Vacuum ❑Vacuum ❑Vacuum <br /> ❑Single-walled ❑Single-walled ❑Single-walled ❑Single-walled ❑Single-walled ❑Single-walled <br /> ❑Double-walled ❑Double-walled ❑Double-walled ❑Double-walled ❑Double-walled ❑Double-walled <br /> Spill Bucket Type ❑Product ❑Product ❑Product ❑Product ❑Product ❑Product <br /> ❑Vapor ❑Vapor ❑Vapor ❑Vapor ❑Vapor ❑Vapor <br /> Liquid and debris <br /> removed from ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> spill bucket?* <br /> Visual Inspection <br /> (No cracks,loose <br /> parts or separa- ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail <br /> tion of the bucket <br /> from the fill pipe.) <br /> Tank riser cap ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> included in test? ❑NA ❑NA ❑NA ❑NA ❑NA ❑NA <br /> Drain valve ❑Yes ❑No ❑Yes ❑Nc ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No []Yes ❑No <br /> included in test? ❑NA ❑NA ❑NA ❑NA ❑NA ❑NA <br /> Starting Level <br /> Test Start Time <br /> Ending Level <br /> Test End Time <br /> Test Period <br /> Level Change <br /> Pass/fail criteria: Must pass visual inspection.Hydrostatic:Water level drop of less than 1/8 inch;Vacuum single-walled only: <br /> Maintain at least 26 inches water column;Vacuum double-walled:maintain at least 12 inches water column. <br /> Test Results ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail I ❑Pass ❑Fail 1 ❑Pass ❑Fail ❑Pass ❑Fail <br /> Comments: <br /> All liquids and debris must be disposed of properly. <br /> Tester's Name(print) Tester's Signature <br /> 0 pei.org <br />