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Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> 6. TANK SECONDARY CONTAINMENT TEST <br /> Test Method Developed by ❑ Manufacturer N Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure N Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <br /> Tank ID 87 91 Diesel <br /> Tank Manufacturer j <br /> Tank Capacity <br /> Test Start Time <br /> Initial Reading <br /> Test End Time <br /> Final Reading <br /> Change in Reading <br /> Pass/Fail Criteria <br /> Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> 7. PIPE SECONDARY CONTAINMENT TEST <br /> Test Method Developed by ❑ Manufacturer N Industry Standard ❑ Professional Engineer <br /> Test Type N Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <br /> Pipe Run 1D 87 Product 91 Product Diesel Prod <br /> Pipe Manufacturer Smith Smith Smith <br /> Test Start Time 9:00 9:00 9:00 <br /> Initial Reading 5 5 5 <br /> Test End Time 10:00 10:00 10:00 <br /> Final Reading 5 5 5 <br /> Change in Reading 0 0 0 <br /> Pass/Fail Criteria 0 0 0 <br /> Tightness Test Results LN Pass ❑ Fail N Pass ❑ Fail N Pass ❑ Fail ❑ Pass ❑ Fail <br /> Pipe Run ID <br /> Pipe Manufacturer <br /> Test Start Time <br /> Initial Reading <br /> Test End Time <br /> Final Reading <br /> Change in Reading <br /> Pass/Fail Criteria <br /> Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Additional copies of this page may be attached. <br /> Al!tests marked "Fail"and any repairs made before or during the tightness test must be described in <br /> the COMMENTS section. <br /> Page 2 of 5 <br />