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Underground Storage Tank <br />Spill Containment Testing Report Form <br />6. SPILL CONTAINMENT DETAILS <br />Test Method Developed by 9 <br />Manufacturer ❑ Industry Standard ❑ Professional Engineer <br />Test Type ❑ <br />Pressure ❑ Vacuum <br />❑■ Hydrostatic <br />❑ Check this box if Appendix 6.1 <br />continuation page is attached. <br />Tank ID <br />87 <br />91 <br />DSL <br />Spill Containment Manufacturer: <br />OPW <br />OPW <br />OPW <br />Method of Cathodic Protection <br />p Nonmetallic <br />19 Nonmetallic <br />0 Nonmetallic <br />❑ Nonmetallic <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill containment <br />p Yes <br />H Yes <br />0 Yes <br />❑ Yes <br />minimum capacity five gallons <br />excluding riser volume? <br />El No* <br />❑ No* <br />❑ No* <br />El No* <br />Method to keep spill <br />❑■ Drain <br />9 Drain <br />❑■ Drain <br />❑ Drain <br />containment empty <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Spill Containment Test Results <br />9 Pass <br />8 Pass <br />0 Pass <br />❑ Pass <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />Tank ID <br />Spill Containment Manufacturer: <br />Method of Cathodic Protection <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill containment <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />minimum capacity five gallons <br />excluding riser volume? <br />El No* <br />El No* <br />El No* <br />El No* <br />Method to keep spill <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />containment empty <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Spill Containment Test Results <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />7. COMMENTS <br />* ❑ Check this box if any spill containment has less than 5 gallons capacity and requires <br />replacement. <br />Describe all answers marked "Other, " "No, " or "Fail" and each proposed remedy in Section 7. <br />Page 2 of 2 <br />