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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 3 of 6) X REMOTE FILL PIPING CONTAINME STING INFORMATION Manufacturer Identify Tank ID from section III for each Manufacturer Test Method Used : ❑ Manufacturer Guidelines: (Specify) M Industry Code or Engineering Standard : (Specify) RP -1200 / Guidelines Adopted by CAL COPA Forum ❑ Engineered Method : (Specify) # of Attached Pages Attach the testing procedures and all documentation required to determine the results. None Remote Fill Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date Interstitial Communication Verification Method Used : X. COMMENTS Provide any additional comments here. Site is not equipped with any remote fill sumps . XI . VENT PIPING CONTAINMENT TESTING INFORMATION Manufacturer Identify Tank ID from section III for each Manufacturer NOV A . O . Smith T-1 87 M T-2 91 Test Method Used : E] Manufacturer Guidelines: (Specify) M Industry Code or Engineering Standard : (Specify) RP -1200 / Guidelines Adopted by CAL COPA Forum ❑ Engineered Method : (Specify) Attach the testing procedures and all documentation required to determine the results. # of Attached Pages1 Vent Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date ICC California Service Technician UT Cert. #5254736 11 /03/2020 NOV Fiberglass Systems 12/03/2020 Interstitial Communication verification Method Used : Visual drop @ test gauge when pressure released at piping furthest most ends . XII . COMMENTS Provide any additional comments here. CERS = California Environmental Reporting System, ID = Identification, UST = Underground storage tank, ICC = International Code Council, NA = Not applicable, UDC = Under-dispenser containment