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Underground Storage Tank <br /> Spill Container Testing Report Form <br /> fi. SPILL CONTAINER DETAILS <br /> Test Method Developed by ❑ Manufacturer 0 Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum 0 Hydrostatic <br /> Tank 10 87 91 Dsl <br /> Spill Container Manufacturer. Opw Opw Opw <br /> Method of Cathodic Protection 0 Nonmetallic 6Q Nonmetallic 21 Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Other Ll Other ❑ Other <br /> Is the spill container minimum A Yes R1 Yes R1 Yes ❑ Yes <br /> capacity five gallons excluding <br /> riser volume? Ll No- LJ No* Ll No* ❑ NO* <br /> R) Drain R) Drain 0 Drain ❑ Drain <br /> Method to keep spill container ❑ Pump ❑ Pump LJ Pump Ll Pump <br /> empty ❑ Other ❑ Other ❑ Other D Other <br /> ® Pass ® Pass 21 Pass LlPass <br /> Spill Cer}#ainer Test Results ❑ Fail ❑ Fail ❑ Fail ❑ Fait <br /> Tank ID <br /> Spill Container Manufacturer: <br /> Method of Cathodic Protection ❑ Nonmetallic ❑ Nonmetallic LJ Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Oth er LJ Other Ll Other <br /> Is the spill container minimum ❑ yes ❑ Yes ❑ Yes ❑ Yes <br /> capacity five gallons excluding ❑ NO* ❑ Ala* ❑ No* ll No* <br /> riser volume? <br /> Method to keep spill container ❑ Drain CE Drain ❑ Drain l! Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump J Pump <br /> ❑ Other LJ Other ❑ Other ❑ Other <br /> Spill Container Test Results ❑ Pass D Pass L Pass Ll Pass <br /> Q Fail L Fail ❑ Fail El Fail <br /> 8. COMMENTS <br /> Describe all answers marker! `'Other," "No, Or"Fail''and each proposed rernedy. <br /> * Mark here if: <br /> ® Spill containers do not have a minimum capacity capaGity Of five gallons and require replacement. <br /> Additional copies Of this page r,ray be attached. <br /> Page 2 of 2 <br />