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