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Underground Storage Tank <br />Secondary Containment Testing Report Form <br />All tests marked "Fail" and any repairs made before or during the tightness test must be described in <br />the COMMENTS section. <br />Page 2 of 6 <br />Test Method Developed by □ Manufacturer  Industry Standard □Professional <br />Test Type □Pressure  Vacuum □ Hydrostatic <br />Test Equipment Used: 0 to 30 inch hg. glycerin filled vacuum gauge(s). <br />Tank ID T1 Diesel <br />Tank Manufacturer Xerxes <br />Tank Capacity 550 <br />Test Start Time 12:00 <br />Initial Reading 10 <br />Test End Time 13:00 <br />Final Reading 10 <br />Change in Reading 0 <br />Pass/Fail Criteria 0 <br />Tightness Test Results  Pass □ Fail □Pass □ Fail □Pass □ Fail □Pass □ Fail <br />Test Method Developed by □ Manufacturer  Industry Standard □Professional <br />Test Type  Pressure □Vacuum □ Hydrostatic <br />Test Equipment Used: 0 to 15 psi glycerin filled pressure gauge(s). <br />Pipe Run ID Supply Return Vent <br />Pipe Manufacturer Environ Environ Environ <br />Test Start Time 12:00 12:00 12:00 <br />Initial Reading 5 5 5 <br />Test End Time 13:00 13:00 13:00 <br />Final Reading 5 5 5 <br />Change in Reading 0 0 0 <br />Pass/Fail Criteria 0 0 0 <br />Tightness Test Results  Pass □ Fail  Pass □ Fail  Pass □ Fail □Pass □ Fail <br />Pipe Run ID <br />Pipe Manufacturer <br />Test Start Time <br />Initial Reading <br />Test End Time <br />Final Reading <br />Change in Reading <br />Pass/Fail Criteria <br />Tightness Test Results □Pass □ Fail <br /> <br />□Pass □ Fail <br /> <br />□Pass □ Fail <br /> <br />□Pass □ Fail <br /> Additional copies of this page may be attached. <br />6. TANK SECONDARY CONTAINMENT TEST <br />7. PIPE SECONDARY CONTAINMENT TEST