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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: Vacuum Pump/Vacuum Gauge in Hg. <br />Tank ID <br />5-Dsl-North <br />Tank Manufacturer <br />O C Tank <br />Tank Capacity <br />20K <br />Test Start Time <br />9:50 <br />Initial Reading <br />-10" Hg. <br />Test End Time <br />11:50 <br />Final Reading <br />-10" Hg. <br />Change in Reading <br />0" Hg. <br />Pass/Fail Criteria <br />No Loss <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 />9411 -Sat <br />10412 -Sat <br />11x#13 -Sat <br />12414 -Sat <br />Pipe Manufacturer <br />Smith <br />Smith <br />Smith <br />Smith <br />Test Start Time <br />11:46 <br />11:49 <br />12:43 <br />12:46 <br />Initial Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />5 Psi <br />Test End Time <br />12:46 <br />12:49 <br />1:43 <br />1:46 <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 />Pipe Run ID <br />13 -Gas Vapor <br />14 -Race Vent <br />15-91 Vent <br />16-87 Vent <br />Pipe Manufacturer <br />Smith <br />Smith <br />Smith <br />Smith <br />Test Start Time <br />8:43 <br />9:16 <br />9:18 <br />9:21 <br />Initial Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />5 Psi <br />Test End Time <br />9:43 <br />10:16 <br />10:18 <br />10:21 <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 4of 9 <br />