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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 ❑ Vacuum ❑ Hydrostatic <br />Test Equipment Used: <br />Tank ID <br />Tank Manufacturer <br />Tank Capacity <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 ❑ 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 />17Dsl-S-Vent <br />18Dsl-N-Vent <br />Pipe Manufacturer <br />Smith <br />Smith <br />Test Start Time <br />10:47 <br />10:52 <br />Initial Reading <br />5 Psi <br />5 Psi <br />Test End Time <br />11:47 <br />11:52 <br />Final Reading <br />5 Psi <br />5 Psi <br />Change in Reading <br />0 Psi <br />0 Psi <br />Pass/Fail Criteria <br />No Loss <br />No Loss <br />Tightness Test Results <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <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 ❑ 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 3 of 9 <br />