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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 x Industry Standard ❑ Professional Engineer <br />Test Type ❑ Pressure x Vacuum ❑ Hydrostatic <br />Test Equipment Used: Vacuum Pump/Vacuum Gauges in Hg. <br />❑ Check this box if Appendix 8.1 continuation page is attached. <br />Tank ID <br />1 -Regular 87 <br />2 -Super 91 <br />3 -Diesel <br />Tank Manufacturer <br />OC Tank <br />OC Tank <br />OC Tank <br />Test Start Time <br />8:30 <br />8:30 <br />8:30 <br />Initial Reading <br />-10" Hg. <br />-10" Hg. <br />-10" Hg. <br />Test End Time <br />10:30 <br />10:30 <br />10:30 <br />Final Reading <br />-10" Hg. <br />-10" Hg. <br />-10" Hg. <br />Change in Reading <br />0" Hg. <br />0" Hg. <br />0" Hg. <br />Pass/Fail Criteria <br />No Loss <br />No Loss <br />No Loss <br />Tightness Test Results <br />P a s s <br />P a s s <br />P a s s <br />7. PIPE SECONDARY CONTAINMENT TEST <br />Test Method Developed by ❑ Manufacturer x Industry Standard ❑ Professional Engineer <br />Test Type x Pressure ❑ Vacuum ❑ Hydrostatic <br />Test Equipment Used: Pressure Gauges in Psi/Nitrogen <br />❑ Check this box if Appendix 8.2 continuation page is attached. <br />Pipe Run ID <br />1-Regular87 <br />2 -Su per 91 <br />3 -Diesel <br />Pipe Manufacturer <br />Smith <br />Smith <br />Smith <br />Test Start Time <br />8:35 <br />8:40 <br />8:45 <br />Initial Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />Test End Time <br />9:35 <br />9:40 <br />9:45 <br />Final Reading <br />5 Psi <br />5 Psi <br />5 Psi <br />Change in Reading <br />0 Psi <br />0 Psi <br />0 Psi <br />Pass/Fail Criteria <br />No Loss <br />No Loss <br />No Loss <br />Tightness Test Results <br />P a s s <br />P a s s <br />P a s s <br />Continuity Test Results <br />P a s s <br />P a s s <br />P a s s <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 />Continuity Test Results <br />Describe in Section 9 all tests marked "Fail" and any repairs made during the test. Page 2 of 4 <br />