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<br />Underground Storage Tank <br />Secondary Containment Testing Report Form <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 2 of 5 <br />Test Method Developed by ☐ Manufacturer ☒ Industry Standard ☐ Professional Engineer <br />Test Type ☐ Pressure ☒ Vacuum ☐ Hydrostatic <br />Test Equipment Used: Vacuum Pump/Vacuum Gauges in Hg. <br /> <br />Tank ID 1-Regular 87 2-Super 91 3-Diesel <br />Tank Manufacturer Modern Wld Modern Wld Modern Wld <br />Tank Capacity 10K 10K 10K <br />Test Start Time 11:30 11:40 11:50 <br />Initial Reading -10" Hg. -10" Hg. -10" Hg. <br />Test End Time 12:30 12:40 12:50 <br />Final Reading -10" Hg. -10" Hg. -10" Hg. <br />Change in Reading 0" Hg. 0" Hg. 0" Hg. <br />Pass/Fail Criteria No Loss No Loss No Loss <br />Tightness Test Results ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☐ Pass ☐ Fail <br /> <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 /> <br />Pipe Run ID 1-Regular 87 2-Super 91 3-Diesel 4-Gas Vapor <br />Pipe Manufacturer Smith Smith Smith Smtih <br />Test Start Time 11:35 11:45 11:55 11:37 <br />Initial Reading 5 Psi 5 Psi 5 Psi 5 Psi <br />Test End Time 12:35 12:45 12:55 12:37 <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 /> <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 />6. TANK SECONDARY CONTAINMENT TEST <br />7. PIPE SECONDARY CONTAINMENT TEST