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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 M Industry Standard ❑ Professional Engineer <br />Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br />Test Equipment Used: preSSUVC(t <br />3 <br />Tank ID <br />91 <br />Pipe Manufacturer <br />Tank Manufacturer <br />Modern <br />Test Start Time <br />Tank Capacity <br />:5�(—Db <br />Initial Reading <br />Test Start Time <br />0 Min <br />Test End Time <br />Initial Reading <br />2 PSI <br />Final Reading <br />Test End Time <br />60 Min <br />Change in Reading <br />Final Reading <br />2 PSI <br />Pass/Fail Criteria <br />Change in Reading <br />0 <br />Tightness Test Results <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Pass/Fail Criteria <br />0 <br />Pipe Run ID <br />Tightness Test Results <br />0 Pass ❑ Fail I <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ 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: <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 <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Faii <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 <br />❑ Pass ❑ Fail 1 <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ 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 2 of 5 <br />