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1 03/13/2012 15:24 00000&0 PAGE 06/06 <br /> Secondary Containment Testing Report Form,-Page 5 of 5 <br /> Pass/FaiI Threshold or Criteria: <br /> Test Result: 0 Pass; ❑Fail ❑Pass; C3 Fail Pass; Fail Pass; Fail <br /> Was leak detection sensor <br /> Properly replaced and verified as ❑Yes`❑No; ❑Yes;❑No; ❑Yes;❑No; ❑Yes;❑No; <br /> functional after tcatin ? ❑N/A(Not Removed) ❑NIA(Not Removed) ❑N/A(Not Remmed) ©N/A <br /> (Not Removed) � <br /> I. Testing of Spill Buckets ❑NIA(No spill buckets installed) <br /> ❑ Spill buekat(s)not tested <br /> Test Method Developed,13y; ❑Bucket Manufacturer;❑Industry Standard;❑PE;❑Other(Specify)! <br /> Test Method Used: ❑Pressure; ❑Vacuum; ❑Hydrostatic; ❑Other(Specify): <br /> Test Equipment Used: Equipment Resolution: <br /> Bucket#t Bucket#: Bucket#: Bucket#: <br /> Rocket Diameter: <br /> Bucket Depth: <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> startin test: <br /> Test Start Time: <br /> Initial Reading(130: <br /> Test End Time: <br /> Final Reading(RO: <br /> Change in Reading(RP—Ri): <br /> Pass/Fail Threshold or Criteria: <br /> Teat Result: ❑Pass; ❑ Fail ❑Pass; ❑Fail ❑Pass; ❑Fail ❑Pass; [] Fail <br /> J. Additional Information <br /> Were any repairs made to secondary containment systems prior to testing? ❑Yes(describe in "Comments");®No <br /> Were any secondary containment systems unable to be tested? ❑Yes(describe in"Comments"):®No <br /> Is any follow-up action recommended? ❑Yes(describe in"Comments");®No <br /> Was any cleaning of secondary containment systems done? ❑Yes(describe management of wastewater in"Comments");®No <br /> If hydrostatic testing was performed,describe in"Comments"what was done with the water after completion of testing. <br /> Comments:Pumped water into tank for reuse <br /> UN-05a-5!s www.unido org 92n"2 <br />