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ARACGRS UST Spill Bucket VERED 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 T1 : Unleaded 87 T2 Diesel DFR 2 . Product stored Gas Diesel DFR 3. Spill bucket capacity 5 Gallons 5 Gallons 4. Manufacturer OPW OPW N Single-walled 0 Single-walled [ISingle-walled ElSingle-walled [ISingle-walled ❑ Single-walled 5. Construction ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled I] Hydrostatic i] Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single -walled ❑ Single-walled 6 . Test type ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled I] Product 0 Product ❑ Product ❑ Product ❑ Product ❑ Product 7. Spill buckettype ❑ Vapor ❑ Vapor ❑ vapor ❑ Vapor ❑ Vapor ❑ Vapor 8 . Liquid and debris removed from spill bucket:* [!] Yes ❑ No 0 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.)? E Pass ❑ Fail N Pass [] Fall ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail [] Pass ❑ Fail 10. Tank riser cap included in test? [5 Yes ❑ No ❑ NA 15 Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 11 . Is drain valve included in test? EYes ❑ No ❑ NA El Yes ❑ No ❑ NA El Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA E] Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 12. Starting level 12.25" 12.00" 13. Test start time 9:00am 9:00am 14. Ending level 12.25" 11 .75" 15. Test end time 10:00am 10:00am 16. Test period 1 hour 1 hour 17. Level chan e 0 .25" Test results : I p Pass ❑ Fail [] Pass E Fail I ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass [:] Fall 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 CGRS Garrett Warren name : �� ° °"'°`"`° Testers name : Date : 01 /04/2019 Tester's signature : GPH = Gallons per hour, Y = Yes, N = No, NA = Not applicable, VPH = VacuumlPressurelHydrostatic, ID = Identification