Laserfiche WebLink
Underground Storage Tank System Tanks, Piping, & Spill Buckets <br />Secondary Containment Certification Form Page of <br />Facility #: City: ,ST Cy. Testing Contractor. �5,,. • & ALZ �Q �p /Awest Date: S �^ <br />Facility Address: ��a S".&4ZAPAI Contractor Address: �q e7ay'CA'Ar Cd Tech. Name:,, <br />1, L Cii u, M nl+ E6ac <br />UST Annular Snare <br />Sni/1 Buckets <br />Tank#1 <br />Tank #2 Tank #3 Tank#4 <br />Product <br />89 91 D <br />97 89 (3 D 870 91 D 87 89 91 D <br />Capacity <br />87 89 D I <br />1470400 1-2000 <br />Manufacturer <br />Manufacturer <br />A—Y Siphon <br />Test Start Time <br />7'450 <br />`' <br />Initial Pressure <br />A+ <br />Test End Time <br />tlr"AS- APP. <br />130 aft, I <br />Final Pressure <br />IVaw A <br />X.V AAfkaA <br />Test Results <br />Signature <br />Pass Fail <br />Pass Fail Fail Pass Fail <br />Time (t.1) <br />Water Level <br />Sni/1 Buckets <br />Secunda" Pininn <br />Overfill ##1 <br />Overfill ##2 <br />Overfill #3 <br />Overfill #4 <br />Product <br />87 9 91 D <br />87 89 D I <br />8 89 1 D <br />87 99 91 D <br />Manufacturer <br />A—Y Siphon <br />Start Time (to) <br />level <br />1///d rest. <br />s?Q �� <br />q.Water <br />7008% <br />Time (t,) <br />V 20 <br />Y q0` <br />y <br />Final Pressure <br />Water Level <br />Test Results <br />Pass Fail ass Fail Pass F,�il <br />Pass Fail <br />Time (t.1) <br />Water Level <br />y.� hv�(. <br />7.w% a,L <br />Test End Time <br />Time (t3) <br />Final Pressure <br />Water Level <br />-Test Results. <br />Pass Fail <br />Time (t4) <br />Q' 7 <br />a Q�fi <br />2 <br />Water Level <br />Test Results <br />Pass ail <br />Pass Fail <br />Pass ail <br />Pass Fait <br />Signature <br />Secunda" Pininn <br />Secondaev Pining <br />Line #1 Line #2 Lane #3 <br />L'me #4 <br />Product <br />7 9 911 D 87 8901D 87 9 ] D <br />87 89 91 D <br />Piping Type <br />'ri: Siphon Siphon <br />Pi'a'ar} Siphon Q:9 <br />pfimffiy Siphan <br />Manufacturer <br />Piping Type <br />A—Y Siphon <br />Test Start Time <br />ft --y Siphon <br />Primary Siphon <br />Initial Pressure <br />Test End Time <br />,: ,�+ `� / ff '3dt <br />Test Start Time <br />Final Pressure <br />nr s� <br />Test Results <br />Pass Fail ass Fail Pass F,�il <br />Pass Fail <br />Sigpatnre <br />Secondaev Pining <br />Rev. 11101 White - Original Yellow -Arco Enviromnental Compliance Pink - Contractor ^i <br />�� r"Y <br />Line ##5 <br />Line #6 <br />Line #7 <br />Line #8 <br />Product <br />87 89 91 D <br />87 89 91 D <br />87 99 91 D <br />87 89 91 D <br />Piping Type <br />A—Y Siphon <br />Primary S'PkM <br />ft --y Siphon <br />Primary Siphon <br />Manufacturer <br />Test Start Time <br />Initial Pressure <br />Test End Time <br />Final Pressure <br />-Test Results. <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass . Fail <br />Signature <br />Rev. 11101 White - Original Yellow -Arco Enviromnental Compliance Pink - Contractor ^i <br />�� r"Y <br />