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Underground Storage Tank System Turbine Sump►, Fill Sumps god [ander Dispenser Contaio.meot <br />Secondary Containment Certification Form <br />P.— 7,n <br />Facility At:. L f' Citi'= Tenting Contractor. Ci• s �� ��x /Teat ©at f p,� <br />Facility Address: ��d .—(.�ta�aw� Contractor Address: —OG- ��L,E-�� �n Tech. Name: <br />— left30 <br />Turbine Sumps <br />99 91 D <br />87 89 9 D <br />87 91 D <br />87 89 91 D <br />LD (north, slave, etc_) <br />�N <br />Manufacturer <br />WT <br />a•'4 C <br />Start Time (W <br />- <br />Water Level <br />5 P4L <br />Walter Level <br />3 �� >,•. <br />Time (t,) <br />3��% M(. <br />346--O" L <br />Time (tj <br />�O� <br />t' <br />,M <br />(��.(J H L <br />Water Level <br />Tv A.4 <br />Time(tl) <br />pis <br />rr(. <br />Time (t,J <br />+fin <br />✓/�► <br />�/ r <br />V� <br />LrM'>t <br />Water Level <br />Time (t3) <br />Time (t3) <br />Water level <br />► �4 <br />Water Level <br />Time (tJ <br />Water Level <br />1 4POV <br />Time (t4) <br />► ?o <br />/ Q <br />G XAVAW <br />Pass Fail <br />Water Level <br />L F <br />,r ,� <br />IV"k 4A <br />I <br />Test Results <br />Pass Fail <br />Pass Fail <br />Pass ail <br />Pass Fail <br />Signature <br />Pass Fail <br />�~ <br />UDC <br />ID (1/2,3/4, etc.) <br />87 39 91 D <br />3 - <br />-li <br />7- � <br />Manufacturer <br />Start Time(4) <br />TIC? w <br />a•'4 C <br />s%0�( <br />7/1w I� l <br />Water Level <br />5 P4L <br />3 �� >,•. <br />Time (t,) <br />3��% M(. <br />346--O" L <br />Water Level <br />t' <br />,M <br />(��.(J H L <br />3 Q '� L <br />Tv A.4 <br />Time(tl) <br />pis <br />rr(. <br />� <br />to <br />Water Level <br />Time (t3) <br />Water level <br />► �4 <br />S 2 t <br />Time (tJ <br />Water Level <br />1 4POV <br />tar <br />05-44* <br />Test Results <br />Pass all <br />Pass Fail <br />ass Fail <br />Pass Fail <br />S*nature <br />Rev, 11 /01 White - tribal <br />Fi1J .Sumps <br />87 39 91 D <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />ID} a,orth slave,etc. <br />Maautaeturer <br />'S�� L <br />w <br />U ZTim <br />Start Time (t,) <br />5 P4L <br />3 �� >,•. <br />Water Level <br />Time (tt) <br />t' <br />,M <br />(��.(J H L <br />3 Q '� L <br />Tv A.4 <br />Water Level <br />/ <br />- <br />Time (til <br />Water Level <br />IIIme(t3) <br />► �4 <br />S 2 t <br />Water Level <br />t� {, <br />`' <br />t�v �► <br />r�� fsl <br />Time (t.) <br />s Fail <br />Pass Fail <br />s Fad <br />Fait <br />Water Level <br />Test Results <br />Pass Fail <br />Pass Fait <br />Pass Fail <br />Pass Fail <br />Signature <br />�� 3/4, cw.) <br />77/6 <br />�� �� <br />!3— <br />Manufacturer <br />Start Time (to) <br />Water Level <br />'S�� L <br />w <br />U ZTim <br />WatertLevel <br />5 P4L <br />3 �� >,•. <br />Time (12) <br />t' <br />,M <br />(��.(J H L <br />3 Q '� L <br />Tv A.4 <br />Water Level <br />/ <br />- <br />Time (t3) <br />Water Level <br />Time (tj� <br />► �4 <br />S 2 t <br />Water Level <br />t� {, <br />`' <br />t�v �► <br />r�� fsl <br />7ea Results <br />s Fail <br />Pass Fail <br />s Fad <br />Fait <br />Signature <br />• <br />Yellow - Arco Fmvh mnental Cwwliauce <br />Pink - Conhaetor <br />