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b%�joo \kf-,ne7E'cvxy <br /> lift EX-04&-"n bo-t- <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> 6. TANK SECONDARY CONTAINMENT TEST <br /> Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer <br /> Test Type {d Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <br /> Tank ID Diesel <br /> Tank Manufacturer Modern <br /> Tank Capacity 6016 <br /> Test Start Time 0 Min <br /> Initial Reading 4 WC <br /> Test End Time 60 Min <br /> Final Reading 4 WC <br /> Change in Reading 0 <br /> Pass/Fail Criteria Pass <br /> Tightness Test Results la Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> 7. PIPE SECONDARY CONTAINMENT TEST <br /> Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <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 ❑ 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 ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Additional copies of this page may be attached. <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 5 <br />