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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 ® Industry Standard ❑ Professional Engineer <br />Test Type ❑ Pressure M Vacuum ❑ Hydrostatic <br />Test Equipment Used: Vacuum Pump/Vacuum Gauges in Hg. <br />Tank ID <br />1 -Race 100 <br />2 -Super 91 <br />3 -Regular 87 <br />4-Dsl-South <br />Tank Manufacturer <br />O C Tank <br />O C Tank <br />O C Tank <br />O C Tank <br />Tank Capacity <br />10K <br />10K <br />12K <br />20K <br />Test Start Time <br />9:10 <br />9:20 <br />9:30 <br />9:40 <br />Initial Reading <br />-10" Hg. <br />-10" Hg. <br />-10" Hg. <br />-10" Hg. <br />Test End Time <br />9:10 <br />10:20 <br />10:30 <br />11:40 <br />Final Reading <br />-10" Hg. <br />-10" Hg. <br />-10" Hg. <br />-10" Hg. <br />Change in Reading <br />0" Hg. <br />0" Hg. <br />0" Hg. <br />0" Hg. <br />Pass/Fail Criteria <br />No Loss <br />No Loss <br />No Loss <br />No Loss <br />Tightness Test Results <br />® Pass ❑ Fail <br />1 ® Pass ❑ Fail <br />® Pass ❑ Fail <br />I ® 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: Pressure Gauges in Psi/Nitrogen <br />Pipe Run ID <br />1 -Race 100 <br />2 -Super 91 <br />3 -Regular 87 <br />4 -Diesel <br />Pipe Manufacturer <br />Smith <br />Smith <br />Smith <br />Smith <br />Test Start Time <br />8:30 <br />8:35 <br />8:40 <br />8:45 <br />Initial Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />5 Psi <br />Test End Time <br />9:30 <br />9:35 <br />9:40 <br />9:45 <br />Final Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />5 Psi <br />Change in Reading <br />0 Psi <br />0 Psi <br />0 Psi <br />0 Psi <br />Pass/Fail Criteria <br />No Loss <br />No Loss <br />No Loss <br />No Loss <br />Tightness Test Results <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />N Pass ❑ Fail <br />Pipe Run ID <br />547 -Sat <br />648 -Sat <br />749 -Sat <br />8410 -Sat <br />Pipe Manufacturer <br />Smith <br />Smith <br />Smith <br />Smith <br />Test Start Time <br />11:33 <br />11:36 <br />11:39 <br />11:44 <br />Initial Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />5 Psi <br />Test End Time <br />12:33 <br />12:36 <br />12:39 <br />12:44 <br />Final Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />5 Psi <br />Change in Reading <br />0 Psi <br />0 Psi <br />0 Psi <br />0 Psi <br />Pass/Fail Criteria <br />No Loss <br />No Loss <br />No Loss <br />No Loss <br />Tightness Test Results <br />® Pass ❑ Fail <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 9 <br />