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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of 6) <br /> V. TANK CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from section III for each Manufacturer <br /> U/K AO B ❑ CO D ❑ <br /> A ❑ B ❑ C ❑ D <br /> Test Method Used: <br /> ❑Manufacturer Guidelines:(Specify) <br /> ®Industry Code or Engineering Standard: (Specify) PE{ 1200 <br /> ❑Engineered Method:(Specify) <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Tank Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Service Tech $13112020 <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> Annular space brine fill continuosly monitored <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from section II I for each Manufacturer <br /> A.0 Smith AS B ❑ C ❑ D ❑ <br /> A ❑ B❑ C ❑ D ❑ <br /> Test Method Used: <br /> ❑Manufacturer Guidelines:(Specify) <br /> ® industry Code or Engineering Standard:(Specify) PEI 1200 <br /> ❑Engineered Method:(Specify) <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Fiberglass Systems 01-10-2022 <br /> interstitial Communication Verification Method Used: <br /> Vlll. COMMENTS <br /> Provide any additional comments here. <br /> PSI Tested for 1 hr with no Loss <br /> 10=Identification <br />