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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM ( Page 2 of 6) <br /> V. TANK CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from section III for each Manufacturer <br /> ZLC , Xerxes T-1 87 ® T-2 91 <br /> Test Method Used : <br /> ❑ Manufacturer Guidelines : (Specify) <br /> ® Industry Code or Engineering Standard : (Specify) RP-1200 / Guidelines Adopted by CAL CUPA Forum <br /> ❑ Engineered Method : (Specify) <br /> Attach the testing procedures and all documentation required to determine the results. # of Attached Pages <br /> 1 <br /> Tank Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC California Service Technician UT Cert . #5254736 11 /03/2020 <br /> ICC Tank Tightness Testing U3 Cert. #5254736 03/08/2020 <br /> Xerxes Installer Cert. #11894 12/10/2020 <br /> VI . COMMENTS <br /> Provide any additional comments here. <br /> VII . PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from section III for each Manufacturer <br /> NOV A . O . Smith T-1 87 ® T-2 91 <br /> Test Method Used : <br /> ❑ Manufacturer Guidelines : (Specify) <br /> ® Industry Code or Engineering Standard : (Specify) RP-1200 / Guidelines Adopted by CAL CUPA Forum <br /> ❑ Engineered Method : (Specify) <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 1 <br /> Product Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC California Service Technician UT Cert. #5254736 11 /03/2020 <br /> NOV Fiberglass Systems 12/03/2020 <br /> Interstitial Communication verification Method Used : Visual drop @ test gauge when pressure released at piping furthest most ends . <br /> VIII . COMMENTS <br /> Provide any additional comments here. <br /> CERS = California Environmental Reporting System, ID = Identification , UST = Underground storage tank, ICC = International Code Council , <br /> NA = Not applicable, UDC = Under-dispenser containment <br />