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Underground Storage Tank Secondary Containment Testing Report Form [:Mr_1►1:h'ix0%]►107_1WK0187►Ill r_11►1Ly, l=1►Ill i111x+1 Test Method Developed by ❑ Manufacturer 0 Industry Standard ❑ Professional Engineer Test Type ❑ Pressure 0 Vacuum ❑ Hydrostatic Test Equipment Used: Tank ID 87 91/Diesel Annular Diesel Tank Manufacturer Unknown Unknown Smith Tank Capacity 11,400 5,700 12:30 Test Start Time 12:30 12:30 5Psi Initial Reading -10PS1 -10PS1 1:30 Test End Time 1:30 1:30 5Psi Final Reading -10PS1 -10PS1 0 Change in Reading 0 0 0 Pass/Fail Criteria 0 0 0 Pass ❑ Fail ❑ Pass ❑ Fail Tightness Test Results ® Pass ❑ Fail I 0 Pass ❑ Fail I ❑ Pass ❑ Fail ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer 0 Industry Standard ❑ Professional Engineer Test Type 0 Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Pipe Run ID 87 91 Diesel Pipe Manufacturer Smith smith Smith Test Start Time 12:30 12:30 12:30 Initial Reading 5Psi 5Psi 5Psi Test End Time 1:30 1:30 1:30 Final Reading 5Psi 5Psi 5Psi Change in Reading 0 0 0 Pass/Fail Criteria 0 0 0 Tightness Test Results -,I Pass ❑ Fail R1 Pass ❑ Fail 0 Pass ❑ Fail ❑ Pass ❑ Fail Pipe Run ID Pipe Manufacturer Test Start Time Initial Reading Test End Time Final Reading Change in Reading Pass/Fail Criteria Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Additional copies of this page may be attached. All tests marked "Fail" and any repairs made before or during the tightness test must be described in the COMMENTS section. Page 2 of 5