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Underground Storage Tank System Turbine Sumps, Fill Sumps and Under Dispenser Containment <br />Secondary Containment Certification Form <br />Facility #:.S y City: S TbGa�JOh/ Testing Contractor: G� %G S.�QTest D <br />Facility Address: /36 < r'C�Sp�! Contractor Address: V t Tedi. Name: <br />Sumps <br />�ID�(north, <br />7 89 91 D <br />87 89 91 D <br />87 9 91 D <br />87 89 91 D <br />slave, etc.) <br />Manufacturer <br />00 T /4 <br />WO- t L <br />570 C <br />Y � <br />/ 7 N" t <br />Start Time (to) <br />Water Level <br />S� <br />TT <br />4144 -.* � <br />Tia 1) <br />Way... Level <br />v <br />Time (t2) <br />+�TTnn <br />330"4 <br />�1 <br />�7CF0 I"L <br />�J�N'►L <br />/tlDvYl L <br />Water Level <br />L <br />Time (t3) <br />/ 0 N� L <br />L <br />C% '?0 L <br />�v P- 1. <br />Water Level <br />Time 44) <br />7r0�` <br />070 <br />�i AAIV-0' <br />/;SS 7/.4 <br />Water Level <br />L, <br />�A/1-1 <br />IwAslJ, I,,00 <br />Test Results <br />Pass Fai <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />ass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />D (1/2,3/4, etc.) <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />Mf,- facturer <br />Start Time (to) <br />� Water Level <br />J 04 <br />WO- t L <br />570 C <br />Y � <br />/ 7 N" t <br />Time (t,)3�� <br />►y (. <br />3 s'.M L <br />4144 -.* � <br />Water Level <br />Time (t2) <br />3A��/7If� <br />3t%jOw[. <br />�J�N'►L <br />/tlDvYl L <br />Water Level <br />15-6c #44L <br />Time (t3) <br />/ 0 N� L <br />L <br />C% '?0 L <br />�v P- 1. <br />Water Level <br />Time 44) <br />LAF5S CAW <br />LI -T& AAtV <br />LASS J <br />/;SS 7/.4 <br />Water Level <br />Test Results <br />Pass Fail <br />,Pas 's Fail <br />ass Fail <br />Pass Fail <br />Signature <br />ass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Page of <br />Fill Sumps <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />ID north, slave etc. <br />Manufacturer <br />Start Time (to) <br />S"20AVL <br />�`' " <br />•7 <br />Water Level <br />Time (tt) <br />4l 30,M C <br />% w. (, <br />3 L <br />Water Level <br />15-6c #44L <br />Time (t2) <br />/ 0 N� L <br />L <br />C% '?0 L <br />�v P- 1. <br />Water Level <br />Time (t3) <br />Water Level <br />Time (t4) <br />�� (��1� <br />L /-1'�C <br />a6-4A� <br />i, S 4 A6' <br />Water Level <br />ass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Test Results <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />UDS <br />ID (1/2,3/4, etc.) <br />Manufacturer <br />Start Time (to) <br />S"20AVL <br />�`' " <br />•7 <br />Water Level <br />Time (tt) <br />4l 30,M C <br />% w. (, <br />3 L <br />Water Level <br />15-6c #44L <br />Time (t2) <br />/ 0 N� L <br />L <br />C% '?0 L <br />�v P- 1. <br />Water Level <br />Time (t3) <br />Water Level <br />Time 04) <br />Water Level <br />�� (��1� <br />L /-1'�C <br />a6-4A� <br />i, S 4 A6' <br />Test Results <br />ass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />Rev. 1 1/01 White — Original Yellow — Arco Environmental Compliance <br />Pink — Contractor <br />