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02/28/2012 13:40 0000000000 PAGE 03/06 <br /> Secondary Containment Testing Report Form-Page 2 of 5 <br /> D. 'Testing of Tank Annular SpacesNaults ®N/A(No tanks have sccondaty containment) <br /> Test Method Developed By: ❑Tank Manufacturer;®Industry Standard;❑PE; ❑Other(Specify): <br /> Test Method Used: ❑Pressure; ®Vacuum; ❑Hydrostatic; ❑Other(Spec): <br /> Test Equipment Used:gauge Equipment Resolution: 0.5"HG <br /> Tank#: 87/Red DSL Tank#: Tank#: Tank#: <br /> Is an Exempt From Testing? ❑Yes; ®No [] Yes; ❑No ❑Yes; ❑No ❑Yes; ❑No <br /> Tank Capacity(gallons): 12000 <br /> Product/Grade Stored in Tank: 87/Red Diesel <br /> Tank Manufacturer: Unknown <br /> Tank Model: Unknown <br /> Wait time between applying <br /> pressure/vacuum/water and 30 Min, <br /> starting test(minutes): <br /> Test Start Time: 9:00 <br /> Initial Reading(RI): 10"HG <br /> Test End Time: 10:00 <br /> Final Reading(Rp): 10"HG <br /> Change in Reading(Rr—R,): 0.0"HG <br /> Pass/Fail Threshold or Criteria: 0.0"',1IG <br /> Test Result: ®Pass; ❑Fail ❑Paas; ❑ Fail ❑Pass; ❑Fail ❑Pass; ❑Fail <br /> Was leak detection sensor ®Yes; ❑No; ❑Yes;❑No; ❑Yes; ❑No; ❑Yes;❑No; <br /> properly replaced and verified ❑N/A(Not Removed) ❑N/A(Not Removed) ❑N/A(Not Removed) ❑N/A(Not Pemend) <br /> as functional after testing? <br /> E. Testing of Secondary Piping or Containment 'Trenches ❑NIA(No piping 20 containment) <br /> Test Method Developed 13y: ❑Pipe/Trench Manufacturer; ®Industry Standard; ❑PE; ❑Other(Spec): <br /> Test Method Used: ® Pressure; ❑Vacuum; ❑Hydrostatic; ❑Other(Specify): <br /> Test Equipment Used:gauge Equipment Resolution:0.2 PSI <br /> Pipe Run#: Red <br /> Diesel Pipe Run#: 87 Pipe Run#: Pipe Run #: <br /> Pipe/Trench.Manufacturer Ameron Ameron <br /> Pipe/Trench Model: AaaIoy Dualloy <br /> Product/Grade in Line: �. Red Diesel 87 <br /> Wait time between applying <br /> pressure/vacuum/water and 30 Min, 30 Min. <br /> starting test minutes <br /> Test Start Date/Time: 9:00 9:00 <br /> Initial Reading(RI): 5.2 PST 5.1 PSI <br /> Test End Datc/Time: 1.0:00 10:00 <br /> Final Reading(RP): 5.2 PST 5.1 PST <br /> Change in Reading(RF—R,): 0.0 PSI 0.0 PSI <br /> Pass/Fail Threshold or Criteria: 0.0 Psi 0.0 PSI <br /> Test Result: ®Pass; ❑ Fail ®Pass, ❑Fail ❑Pass; ❑Fail ❑Pass; ❑Fail <br /> UN-0-A-2/5 www.unidecs.org 0226/112 <br />