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SWRCB,January 2002 • .R E C E I VEPage_of <br /> SEP 3 0 2016 <br /> 4. TANK ANNULAR TESTING <br /> Test Method Developed By: 17 Tank Manufacturer "Industry Standard ENARGN4s1WUJOII L <br /> ❑Other(Sped) DEPARTMENT <br /> Test Method Used: 0 Pressure ❑Vacuum ❑Hydrostatic <br /> ❑Other(Specify) <br /> Test Equipment Used: Equipment Resolution: <br /> Tank# Tank# Tank# Tank# <br /> Is Tank Exempt From Testing?' ❑Yes ❑No ❑Yes ❑No ❑Yes ❑ No ❑Yes ❑No <br /> Tank Capacity: <br /> Tank Material: <br /> Tank Manufacturer: <br /> Product Stored: <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(R4): <br /> Test End Time: <br /> Final Reading(RF): <br /> Test Duration: <br /> Change in Reading(RF-R): <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: ❑ Pass ❑Fail ❑ Pass ❑Fail 13 Pass 0 Fail ❑ Pass ❑Fail <br /> Was sensor removed for testing? ❑Yes ❑No ❑NA t7 Yes ❑No ❑NA t7 Yes ❑No [INA l7 Yes t7 No [INA <br /> Was sensor properly replaced and <br /> verified functional after testing? C Yes C No ❑NA ❑Yes t7 No O NA ❑Yes ❑No [INA ❑Yes ❑No l7 NA <br /> Comments—(include information on repairs made prior to testing, and recommended ollow-up orfailed tests) <br /> Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br /> containment,such as systems that are hydrostatically monitored or under constant vacuum,are exempt from periodic containment <br /> testing. (California Code of Regulations,Title 23,Section 2637(a)(6)) <br />