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Underground Storage Tank Secondary Containment Testing Report Form 6. TANK SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer © Industry Standard ❑ Professional Engineer Test Type ❑ Pressure © Vacuum ❑ Hydrostatic Test Equipment Used: Vacuum Pump/Vacuum Gauges in Hg. Tank ID 1 &2-91-Dsl. 3-87 3 -Regular 87 Tank Manufacturer Mosier Bros. Mosier Bros. Ameron Tank Capacity 12K 2 Compt. 12K 8:35 Test Start Time 8:50 8:40 5 Psi Initial Reading -10" Hg. -10" Hg. 9:35 Test End Time 9:50 9:40 5 Psi Final Reading -10" Hg. -10" Hg. 0 Change in Reading 0 0 No Loss Pass/Fail Criteria No Loss No Loss ® Pass ❑ Fail ❑ Pass ❑ Fail Tightness Test Results ® Pass ❑ Fail I ® Pass ❑ Fail I ❑ Pass ❑ Fail I ❑ Pass ❑ Fail 17. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ® Industry Standard ❑ Professional Engineer Test Type ® Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Pressure Gauges in Psi/Nitrogen Pipe Run ID 1 -Super 91 2 -Diesel 3 -Regular 87 Pipe Manufacturer Ameron Ameron Ameron Test Start Time 8:55 8:45 8:35 Initial Reading 5 Psi 5 Psi 5 Psi Test End Time 9:55 9:45 9:35 Final Reading 5 Psi 5 Psi 5 Psi Change in Reading 0 0 0 Pass/Fail Criteria No Loss No Loss No Loss Tightness Test Results © Pass ❑ Fail © Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail Pipe Run ID Pipe Manufacturer Test Start Time Initial Reading Test End Time Final Reading Change in Reading Pass/Fail Criteria Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Additional copies of this page may be attached. All tests marked "Fail' and any repairs made before or during the tightness test must be described in the COMMENTS section. Page 2of5