Laserfiche WebLink
Underground Storage Tank <br />Spill Container Testing Report Form <br />Test IvIeLHOU Developed by ❑ Manufacturer IN <br />Test Type <br />Industry Standard ❑ Professional Engineer <br />❑ Pressure ❑Vacuum <br />® Hydrostatic <br />Additional copies of this page maybe attached. <br />Page 2 of 2 <br />Tank ID <br />T4/Diesel <br />Spill Container Manufacturer: <br />OPW <br />Method of Cathodic <br />Protection <br />® <br />Nonmetallic <br />❑ <br />Nonmetallic <br />❑ <br />Nonmetallic <br />❑ <br />Nonmetallic <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />Is the spill container <br />minimum <br />® <br />Yes <br />❑ <br />Yes <br />❑ <br />Yes <br />❑ <br />Yes <br />capacity five gallons <br />excluding <br />riser volume? <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />® <br />Drain <br />❑ <br />Drain <br />❑ <br />Drain <br />❑ <br />Drain <br />M <br />Method to keep spill <br />container <br />❑ <br />Pump <br />❑ <br />Pump <br />❑ <br />Pump <br />❑ <br />Pump <br />empty <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />Spill Container Test <br />Results <br />® <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />Tank ID <br />Spill Container Manufacturer: <br />Method of Cathodic <br />Protection <br />❑ <br />Nonmetallic <br />❑ <br />Nonmetallic <br />El <br />Nonmetallic <br />❑ <br />Nonmetallic <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />Is the spill container <br />minimum <br />❑ <br />Yes <br />❑ <br />Yes <br />❑ <br />Yes <br />❑ <br />Yes <br />capacity five gallons <br />excluding <br />riser volume? <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />Drain <br />❑ <br />Drain <br />❑ <br />Drain <br />❑ <br />Drain <br />Method to keep spill <br />container <br />❑ <br />Pump <br />❑ <br />Pump <br />❑ <br />Pump <br />❑ <br />Pump <br />empty <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />Spill Container Test <br />Results <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />Additional copies of this page maybe attached. <br />Page 2 of 2 <br />