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Underground Storage Tank <br /> Spill Container Testing Report Form <br /> 6. SPILL CONTAINER DETAILS <br /> Test Method Developed by ❑ Manufacturer ❑ Industry Standard Q Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum Q Hydrostatic <br /> Tank ID <br /> Unleaded Regular Unleaded Premium Diesel#2 <br /> Spill Container Manufacturer: <br /> OPW OPW OPW <br /> Method of Cathodic Protection W1 Nonmetallic 0 Nonmetallic 0 Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum 0 Yes 0 Yes R1 Yes ❑ Yes <br /> capacity five gallons excluding ❑ No* ❑ No* ❑ No* ❑ No* <br /> riser volume? <br /> Drain 0 Drain P Drain El Drain <br /> Method to keep spill container El ElPump ElPump ElPump <br /> empty <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results R1 Pass ❑ Pass R1 Pass ❑ Pass <br /> ❑ Fail 0 Fail ❑ Fail ❑ Fail <br /> Tank ID <br /> Spill Container Manufacturer: <br /> Method of Cathodic Protection ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> capacity five gallons excluding ❑ No* ❑ No* ❑ No* ❑ No* <br /> riser volume? <br /> ❑ Drain ❑ Drain ❑ Drain ❑ Drain <br /> Method to keep spill container ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> empty ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results ❑ Pass ❑ Pass ❑ Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> 8. COMMENTS <br /> Describe all answers mare ter, o, or"Fail"and each proposed remedy. <br /> The Unleaded Supreme Spill Container failed to pass the hydrostatic integrity test. Proposed remedy is to replace the <br /> spill container and re-test in the presence of a San Joaquin Environmental Health Specialist. <br /> * Mark here if: <br /> g Spill containers do not have a minimum capacity of five gallons and require replacement. <br /> Additional copies of this page may be attached. <br /> Page 2 of 2 <br />