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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of s) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Modern Weldina A Q I B D I C 0 I D ❑ <br /> A 1 B 1 C ❑ I D <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> Z Industry code or Engineering Standard(Specify): PEI/RP1200-17/Glass/Steel Tank/-10" Hg. 1 Hour <br /> ❑Engineered Method(Specify): <br /> Attach the testing procedures and all documentation required to determine the results. #of Attached Pages2 <br /> Tank Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> ICC Service Technician #5246802-UT 3/21/2021 <br /> Underground Storage Tank Tester License #90-1120 12/31/2022 <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> Tank A is a 1 OK Double Wall Glass Steel, designated for Regular 87 Octane Gasoline. <br /> Tank B &Tank C is a 1 OK Two Compartment, Double Wall Glass Steel with a Single Tank Secondary. Tank B is 5K, <br /> designated for Super 91 Octane Gasoline and Tank C is a 5K, designated for Diesel. <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Ameron A 0 B 0 C 0 D ❑ <br /> A❑ B ❑ C ❑ D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> Z Industry Code or Engineering Standard(Specify): PEI/RP1200-17/Fiberglass Pipe/5 Psi 1 hour <br /> ❑Engineered Method(Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 2 <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> ICC Service Technician #5246802-UT 3/21/2021 <br /> Under round Storacje Tank Test License #90-1120 12/31/2022 <br /> Interstitial Communication Verification Method Used: <br /> Release pressure at end of piping runs at UDC's where applicable. <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> ID=Identification <br />