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Underground Storage Tank Secondary Containment Testing Report Form 6. TANK SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Tank ID 1-87 2&3-91-Dsl 3-91 4 -91 -Vent Tank Manufacturer XERXES XERXES Ameron Ameron Tank Capacity 30K 20K 2 Compt 9:13 9:16 Test Start Time Exempt Exempt 5 Psi 5 Psi Initial Reading 10:00 10:03 10:13 10:16 Test End Time 5 Psi 5 Psi 5 Psi 5 Psi Final Reading 0 Psi 0 Psi 0 Psi 0 Psi Change in Reading No Loss No Loss No Loss No Loss Pass/Fail Criteria ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail Tightness Test Results ❑ Pass ❑ Fail I ❑ Pass ❑ Fail ❑ Pass ❑ Fail I ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ® Industry Standard ❑ Professional Engineer Test Type ® Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Pressure Gauges in Psi/Nitrogen Pipe Run ID 1-87 2 -87 -Vent 3-91 4 -91 -Vent Pipe Manufacturer Ameron Ameron Ameron Ameron Test Start Time 9:00 9:03 9:13 9:16 Initial Reading 5 Psi 5 Psi 5 Psi 5 Psi Test End Time 10:00 10:03 10:13 10:16 Final Reading 5 Psi 5 Psi 5 Psi 5 Psi Change in Reading 0 Psi 0 Psi 0 Psi 0 Psi Pass/Fail Criteria No Loss No Loss No Loss No Loss Tightness Test Results ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail Pipe Run ID 5 -Diesel 6-Dsl Vent 7 -Gas Vapor Pipe Manufacturer Ameron Ameron Ameron Test Start Time 9:20 9:23 9:05 Initial Reading 5 Psi 5 Psi 5 Psi Test End Time 10:20 10:23 10:05 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 ® 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