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Underground Storage Tank Secondary Containment Testing Report Form 6. TANK SECONDARY CONTAINMENT TEST Test Method Developed by E Manufacturer E Industry Standard ❑ Professional Engineer Test Type ❑ Pressure E Vacuum ❑ Hydrostatic Test Equipment Used: 0-30inHg. 4" Vacuum Gauges w/ 0.05 graduations Tank ID T-1 87 T-2 911 T-3 DSL Tank Manufacturer Modern Welding Modern Welding Tank Capacity 12k 6k/ 6k Test Start Time 8:35am 8:35am Initial Reading -10.0 inHg -10.0 inHg Test End Time 9:35am 9:35am Final Reading -10.0 inHg -10.0 inHg Change in Reading 0.0 inHg 0.0 inHg Pass/Fail Criteria No No Loss Tightness Test Results E Pass ❑ Fail 1 E Pass ❑ Fail 113 Pass ❑ Fail ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by E Manufacturer E Industry Standard ❑ Professional Engineer Test Type E Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Dual 0-15psi 4" Pressure Gauges w/ 0.05 graduations Pipe Run ID T-1 87 PL T-2 91 PL T-3 Diesel PL Pipe Manufacturer A.O. Smith A.O. Smith A.O. Smith Test Start Time 8:45am 8:45am 8:45am Initial Reading 5.0psi 5.Opsi 5.Opsi Test End Time 9:45am 9:45am 9:45am Final Reading 5.0psi 5.0psi 5.0psi Change in Reading O.Opsi O.Opsi O.Opsi Pass/Fail Criteria No Loss No Loss No Loss Tightness Test Results E Pass ❑ Fail E Pass ❑ Fail E 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 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