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Underground Storage Tank Secondary Containment Testing Report Form Test Method Developed by x Manufacturer ❑ Industry Standard ❑ Professional Engineer Test Type ❑ Pressure x Vacuum ❑ Hydrostatic Test Equipment Used: Vacuum Pump/Vacuum Gauges in Hg Tank ID T1: 87 T2: 87/91 Tank Manufacturer XERXES XERXES Tank Capacity 19,703 10369/11849 Test Start Time 1:05 P.M. 1:30 p.m. Initial Reading -12" Hg -12" Hg Test End Time 2:05 p.m. 2:30 p.m. Final Reading -12" Hg -12" Hg Change in Reading 0" Hg 0" Hg Pass/Fail Criteria +/-0" Hg +l-0" Hg Tightness Test Results x Pass ❑ Fail x Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by x Manufacturer ❑ Industry Standard ❑ Professional Engineer Test Type x Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Pressure Gauges in Psi/Nitrogen Pipe Run ID #1 87 Master #2 87 Syphon #3 87M/91 #4 87 Syp/91 Pipe Manufacturer SMITH SMITH SMITH SMITH Test Start Time 10:56 a.m. 11:05 a.m. 11:32 a.m. 11:42 a.m. Initial Reading 5 psi 5 psi 5 psi 5 psi Test End Time 11:56 a.m. 12:05 p.m. 12:32 p.m. 12:42 p.m. Final Reading 5 psi 5 psi 5 psi 5 psi Change in Reading 0 psi 0 psi 0 psi 0 psi Pass/Fail Criteria No loss No loss No loss No loss Tightness Test Results x Pass ❑ Fail x Pass ❑ Fail x Pass ❑ Fail x Pass ❑ Fail Pipe Run ID #5 91 Pipe Manufacturer SMITH Test Start Time 11:55 a.m. Initial Reading 5 psi Test End Time 12:55 p.m. Final Reading 5 psi Change in Reading 0 psi Pass/Fail Criteria No loss Tightness Test Results x Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Additional copies of this page may be attached. 8. SUMP/UDC TEST All tests marked "Fail"and any repairs made before or during the tightness test must be described in the COMMENTS section. Page 2of5