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s <br />SWRCB, January 2002 <br />o cvrr .t .rnvF.0 rYi .T . f"nNTA iN MF.NT RnXF.S <br />Page of <br />Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ <br />Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ <br />Test Method Developed By: ❑ Spill Bucket Manufacturer ❑ Industry Standard 0 Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br />❑ Other (Specify) <br />Test Equipment Used: <br />Spill Box # Spill Box # <br />Equipment Resolution: <br />Spill Box # <br />Spill Box # <br />Bucket Diameter: <br />Bucket Depth: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: <br />Initial Reading (RI): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF-RO: <br />Pass/Fail Threshold or <br />Criteria: <br />Test Result: <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />STILL CONTANIMENT TESTED W TH ANNUAL MONITOR_ <br />CERTIFICATION <br />MAY <br />