Laserfiche WebLink
Underground Storage Tank <br />Spill Container Testing Report Form <br />6. SPILL <br />CONTAINER DETAILS 4 <br />Test Method Developed by ❑ <br />Manufacturer <br />❑✓ <br />Industry Standard 0 Professional Engineer <br />Test Type ❑ <br />Pressure <br />❑ <br />Vacuum <br />❑ Hydrostatic <br />Tank ID <br />87 <br />DIESEL <br />Spill Container Manufacturer: <br />OPW <br />OPW <br />111 <br />Nonmetallic <br />❑ <br />Nonmetallic <br />O <br />Nonmetallic <br />❑ <br />Nonmetallic <br />Method of Cathodic Protection <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />Is the spill container minimum <br />p <br />Yes <br />❑ <br />Yes <br />EZI <br />Yes <br />❑ <br />Yes <br />capacity five gallons excluding <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />riser volume? <br />EZI <br />Drain <br />❑ <br />Drain <br />O <br />Drain <br />❑ <br />Drain <br />Method to keep spill container <br />❑ <br />Pump <br />❑ <br />Pump <br />❑ <br />Pump <br />❑ <br />Pump <br />empty <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />[21 <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />Spill Container Test Results <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />Tank ID <br />Spill Container Manufacturer: <br />❑ <br />Nonmetallic <br />❑ <br />Nonmetallic <br />❑ <br />Nonmetallic <br />❑ <br />Nonmetallic <br />Method of Cathodic Protection <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />Is the spill container minimum <br />❑ <br />Yes <br />❑ <br />Yes <br />❑ <br />Yes <br />❑ <br />Yes <br />capacity five gallons excluding <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />❑ <br />No* <br />riser volume? <br />El <br />Drain <br />El <br />Drain <br />El <br />Drain <br />E] <br />Drain <br />Method to keep spill container <br />El <br />Pump <br />El <br />Pump <br />El <br />Pump <br />El <br />Pump <br />empty <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Other <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />❑ <br />Pass <br />Spill Container Test Results <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />❑ <br />Fail <br />8. COMMENTS' <br />Describe all answers marked "Other," "No," or <br />"Fail' and each proposed remedy- <br />* Mark here if: <br />❑ Spill containers do not have <br />a minimum capacity <br />of five gallons and <br />require replacement, <br />Additional copies of this page maybe attached. <br />Page 2 of 2 <br />