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Underground Storage Tank Secondary Containment Testing Report Form 6. TANK SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer N Industry Standard ❑ Professional Engineer Test Type ❑ Pressure ®Vacuum ❑Hydrostatic Test Equipment Used: Vacuum Pump/Vacuum Gauge in Hg. Tank ID Jet A Tank Manufacturer O C Tank Tank Capacity 12K Test Start Time 8:55 Initial Reading -10" Hg. Test End Time 9:55 Final Reading -10" Hg. Change in Reading 0" Hg. Pass/Fail Criteria No Loss Tightness Test Results N Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail 1 ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer N Industry Standard ❑ Professional Engineer Test Type N Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Pressure Gauges in Psi/Nitrogen Additional copies of this page maybe attached. All " tests marked Fail" and any repairs made before or during the tightness test must be described in the COMMENTS section. Page 2of5 Pipe Run ID 1 -Jet A -Sup. 2 -Jet A -Ret. 3 -Jet A -Vent Pipe Manufacturer Smith Smith Smith Test Start Time 8:50 8:50 8:50 Initial Reading 5 Psi 5 Psi 5 Psi Test End Time 9:50 9:50 9:50 Final Reading 5 Psi 5 Psi 5 Psi Change in Reading 0 Psi 0 Psi 0 Psi Pass/Fail Criteria No Loss No Loss No Loss Tightness Test Results N Pass ❑ Fail N Pass ❑ Fail N Pass ❑ Fail ❑ Pass ❑ Fail Pipe Run ID Pipe Manufacturer Test Start Time Initial Reading Test End Time Final Reading Change in Reading Pass/Fail Criteria Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Additional copies of this page maybe attached. All " tests marked Fail" and any repairs made before or during the tightness test must be described in the COMMENTS section. Page 2of5