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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 ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <br /> Tank ID 1-Diesel 2-Gasoline <br /> Tank Manufacturer XERXES XERXES <br /> Tank Capacity 12K 12K <br /> Test Start Time Exempt Bftsc Exempt Bftsc <br /> Initial Reading NA NA <br /> Test End Time NA NA <br /> Final Reading NA NA <br /> Change in Reading NA NA <br /> Pass/Fail Criteria NA NA <br /> Tightness Test Results ❑ Pass ❑ Fail I ❑ 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: Pressure Gauges in Psi/Nitrogen <br /> Pipe Run ID 1-Diesel-E 2-Diesel-W 3-Gasoline-E 4-Gasoline-W <br /> Pipe Manufacturer Smith Smith Smith Smith <br /> Test Start Time 9:15 9:15 9:20 9:20 <br /> Initial Reading 5 Psi 5 Psi 5 Psi 5 Psi <br /> Test End Time 10:15 10:15 10:20 10:20 <br /> Final Reading 5 Psi 5 Psi 5 Psi 5 Psi <br /> Change in Reading 0 Psi 0 Psi 0 Psi 0 Psi <br /> Pass/Fail Criteria No Loss No Loss No Loss No Loss <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 2of5 <br />