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Underground Storage Tank Secondary Containment Testing Report Form 6. TANK SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ® Industry Standard ❑ Professional Engineer Test Type ❑ Pressure ® Vacuum ❑ Hydrostatic Test Equipment Used: 4" Oil Filled Gauge Tank ID 87 91 Test Method Developed by ❑ Manufacturer ® Industry Standard ❑ Professional Engineer Test Type N Pressure ❑ Vacuum ❑ Hydrostatic Tank Manufacturer Pipe Run ID 87 Prod 91 Prod Tank Capacity 91 Vent Pipe Manufacturer Test Start Time 9:30 9:30 Test Start Time Initial Reading 10"hg 10"0hg 9:15 9:15 Test End Time 11:30 10:30 5 psi 5 psi Final Reading 10"hg 10"hg 10:15 10:15 Change in Reading 0 0 Final Reading 5 psi Pass/Fail Criteria 0 0 5 psi Change in Reading Tightness Test Results ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail 7.. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ® Industry Standard ❑ Professional Engineer Test Type N Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: 4" Oil Filled Gauge Pipe Run ID 87 Prod 91 Prod 87 Vent 91 Vent Pipe Manufacturer Test Start Time 9:15 9:15 9:15 9:15 Initial Reading 5 psi 5 psi 5 psi 5 psi Test End Time 10:15 10:15 10:15 10:15 Final Reading 5 psi 5 psi 5 psi 5 psi Change in Reading 0 0 0 0 Pass/Fail Criteria 0 0 0 0 Tightness Test Results N Pass ❑ Fail R Pass ❑ Fail N Pass ❑ Fail N Pass ❑ Fail Pipe Run ID Vapor Return Pipe Manufacturer Test Start Time 9:15 Initial Reading 5 psi Test End Time 10:15 Final Reading 5 psi Change in Reading 0 Pass/Fail Criteria 0 Tightness Test Results N 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