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Underground Storage Tank <br /> Spill Container Testing Report Form <br /> 6. SPILL CONTAINER DETAILS <br /> Test Method Developed by 0 Manufacturer 0 Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure 0 Vacuum ❑ Hydrostatic <br /> Tank ID REG.#1 REG.#2 PREM. DSL <br /> Spill Container Manufacturer. OPW OPW OPW OPW <br /> Method of Cathodic Protection 0 Nonmetaflic R3 Nonmetallic 0 Nonmetallic 0 Nonmetallic <br /> ❑ Other ❑ Other 11 Other ❑ Other <br /> Is the spill container minimum 0 Yes 0 Yas R1 Yes 0 Yes <br /> capacity five gallons excluding <br /> riser volume? ❑ No* ❑ No* Q No* Ll Flo" <br /> 0 Drain V) Drain 0 Drain A Drain <br /> Method to keep spill container ® Pump ❑ Pump Ll Pump Ll Pump <br /> empty ❑ Other ❑ Other Ll Other ❑ Other <br /> Spill Container Test Results ❑ Pass ❑ Pass Q Pass ® Pass <br /> ❑ Fail L❑ Fail I Ll Fail ❑ Fail <br /> Tank ID <br /> SpiJI Container Manufacturer: <br /> ❑ Nonmetallic LA Nonmetallic Ll Nonmetallic J Nonmetallic <br /> Method of Cathodic Protection ❑ Other ® Other Ll Other LJ Other <br /> Is the spill container minimum ❑ Yes ❑ Yes Q Yes Ll Yes <br /> capacity five gallons excluding ❑ No* ❑ No* Q Igo* ❑ No* <br /> riser volume? <br /> ❑ Drain ❑ Drain ❑ Drain ❑ Drain <br /> Method to keep spill container ❑ pump ❑ Pump Q Pump ❑ Pump <br /> empty ❑ Other ❑ Other ❑ Other ❑ Othef <br /> SpiJI Container Test Results ❑ Pass ❑ Pass Ll Pass LA Pass <br /> Q Fail ❑ Fail L1 Fail ❑ Fail <br /> 8. COMMENTS <br /> Describe all answers marked "`Other." "No,"or"Fail'and each proposed remedy. <br /> *Mark here if: <br /> Ll Spill containers do not have a minimum capacity of five gallons and require replacement. <br /> Additional copies of this page maybe attached. <br /> Page 2 of 2 <br />