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02/28/2012 13:40 000000000e PAGE 06/06 <br /> Secondary Containment Testing Report Form-Page 5 of 5 <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: Pass; EJ Fail Pass; Fail ❑Pass; LJ Fail LJ Pass; Fail <br /> Was leak detection sensor <br /> properly replaced and verified as ©Yes; No; ❑Yes;❑No; ❑Xes; El El Yes; No; <br /> functional atter testing? ❑N/A(N"t Removed) ❑N/A(Not Rcm cd) ❑N/A(Not Removed) ❑N/A(Not RcmovW) <br /> _J — <br /> I. Testing of Spill Buckets ❑N/A(No spin buckets installed) <br /> ❑ Spill buckets)not tested <br /> Test Method Developed By: ❑Bucket Manufacturer; ©Industry Standard;❑PE;❑Other(Specify): <br /> Test Method Used: ❑Pressure; ❑Vacuum;_❑Hydrostatic; ❑other(Specify): <br /> Test Equipment Used: Equipment Resolution: <br /> Bucket#: Bucket#: Bucket# Bucket#: <br /> Bucket Diameter: <br /> Bucket Depth: <br /> Wait time between applying <br /> pressure/Vacuum/water and <br /> startin test: <br /> 'rest Start Time; <br /> Initial Reading(Rt): <br /> Test End Time: <br /> Final Reading(RF): <br /> Change in Reading(RF—Rt): <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: ❑Pass; ❑ Fail ❑Pass; ❑ Fail T❑ 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"); IS 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.5/5 w .unidoes.org ey/ye/ap <br />