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Underground Storage Tank <br />Spill Container Testing Report Form <br />B. SPILL CONTAINER DETAILS <br />Test Method Developed by LManufacturer �/ Industry Standard LProfessional Engineer <br />Test Type Pressure Vacuum,/ Hydrostatic <br />Tank ID <br />87 Fill <br />91 Fill <br />DSL Fill <br />Spill Container Manufacturer: <br />oPW <br />oPW <br />aPW <br />Method of Cathodic Protection <br />❑,I <br />Nonmetallic <br />,/ Nonmetallic <br />,/ Nonmetallic <br />Nonmetallic <br />❑Other <br />Other <br />❑ <br />Other <br />Is the spill container minimum <br />-[::]Other <br />❑r/ Yes <br />OYes <br />[Z]Yes <br />❑ <br />Yes <br />capacity five gallons excluding <br />E] No* <br />❑No* <br />❑Na* <br />❑No* <br />riser volume? <br />Method to keep spill container <br />❑Drain <br />Pump <br />Drain <br />Pup <br />m <br />Drain <br />Pump <br />[Z]Pump❑ <br />❑Drain <br />Pump <br />f <br />empty <br />Other <br />Other <br />L10ther <br />Other <br />Spill Container Test Results&ass <br />[:]Fail <br />F,77 <br />❑Fail <br />Pass <br />J❑Pass <br />❑Fail <br />tE]Pass <br />Fail <br />Tank ID <br />87 vapor <br />91 Vapor <br />DSL vapor <br />Spill Container Manufacturer: <br />aPw <br />oPW <br />oPW <br />Method of Cathodic Protection <br />❑; Nonmetallic <br />Other <br />ONonmetallic <br />=Other <br />►I <br />❑Other <br />Nonmetallic <br />LjNonmetallic <br />=Other <br />Is the spill container minimum <br />OYes <br />Oyes <br />z <br />Yes <br />❑Yes <br />capacity five gallons excluding <br />❑No* <br />[:]No* <br />[:]No* <br />No* <br />riser volume? <br />[:]Drain <br />=Drain <br />Drain <br />=Drain <br />Method #a keep spill container <br />OPump <br />W]Pump►/❑Pump <br />❑Pump <br />empty <br />Other <br />F70ther <br />=Other <br />Other <br />Spill Container Test Results <br />,=Fail <br />❑; Pass <br />FTPass[Z]Pass <br />❑Fail <br />❑Pass <br />=Fail <br />=Fail <br />S. GO[U MENTS <br />Describe all answers marked "Other," "No," or "Fail" aad each proposed remedy. <br />* Mark here if: <br />Spill containers do not have a minimum cad <br />Additional copies of this page may be attached. <br />of five gallons and reouire replacement. <br />Page 2 of 2 <br />