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Underground Storage Tank <br />Spill Container Testing Report Form <br />1. SPILL CONTAINER DETAILS <br />Test Methods Developed by ❑ Manufacturer <br />® Industry Standard ❑ Professional Engineer <br />Tank ID <br />87 <br />91 <br />DSL <br />Spill Container Manufacturer <br />OPW <br />OPW <br />OPW <br />Method of Cathodic Protection <br />N Nonmetallic <br />N Nonmetallic <br />N Nonmetallic <br />❑ Nonmetallic <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill container minimum <br />N Yes <br />N Yes <br />N Yes <br />❑ Yes <br />capacity five gallons excluding <br />❑ No* <br />❑ No* <br />❑ No* <br />❑ No* <br />riser volume? <br />N Drain <br />N Drain <br />N Drain <br />❑ Drain <br />Method to keep spill container <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />empty <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />N Pass <br />N Pass <br />N Pass <br />❑ Pass <br />Spill Container Test Results <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />TanklD <br />Spill Container Manufacturer <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />Method of Cathodic Protection <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill container minimum <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />capacity five gallons excluding <br />❑ No* <br />❑ No* <br />❑ No* <br />❑ No* <br />riser volume? <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />Method to keep spill container <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />empty <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />Spill Container Test Results <br />❑ Fail <br />❑ Fail <br />E] ail <br />❑ Fail <br />2. COMMENTS <br />Describe all answers marked "Other" "No ; or "Fail" and each proposed remedy. <br />*Mark here if <br />❑ Spill containers do not have minimum capacity of five gallons and require replacement. <br />Page 9 of 9 <br />