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Underground Storage Tank System Turbine Sumps, Fill Sumps and Under Dispenser Containment <br />Secondary Containment Certification Form <br />Page 07 of a <br />Facility #:.�y City: s T �TQ�,,/ . Testing Contractor: G. R- S. er0. &OY f Test Dat 3/ O; <br />Facility Address: 340 [ ,�tSplyl Contractor Address: � ��,LCAAS ��, Tedi. Name`: A C.. <br />Turbine Sumps <br />7 89 91 D <br />87 89 6 D <br />87 0 91 D <br />87 89 91 D <br />ID (north, slave, etc.) <br />/ a <br />X <br />Manufacturer <br />Ow r <br />�O <br />Start Time (to)fi <br />S-96 <br />�0/Vj7 <br />Watar Level <br />04 t <br />tt) <br />3YO (. <br />345".4+ <br />Sl S".�► l <br />(�/ <br />/ VON0 L <br />Water Level <br />W <br />/NL. <br />Time (t <br />L <br />-7CF <br />Water Level evel <br />Time (t3) <br />Water Level <br />Time 04) <br />9 70 <br />, O 7d <br />C449f T <br />ous 7006 <br />Water Level <br />L� � <br />(„/r/4/� <br />�� % /iJ0 <br />•os 4)0)° <br />Test Results <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />. <br />u <br />Fill Sumps <br />— <br />87 89 91 D <br />5`4 <br />7— T- <br />D (1/22,, 3/4, etc.) <br />/ a <br />✓ <br />P ifacturer <br />Start Time (to) <br />3y0 <br />Water Level <br />Time (ti) <br />3YO (. <br />345".4+ <br />Sl S".�► l <br />(�/ <br />/ VON0 L <br />Water Level <br />/NL. <br />Time 02) <br />(t2) <br />SYD NaL <br />/ <br />Water Level <br />Time (t3) <br />Water Level <br />Time 04) <br />L'F-Is CAW' <br />LIQ j <br />C449f T <br />ous 7006 <br />Water Level <br />O JO.S- Li d' <br />t 04— 4?IA <br />•os 4)0)° <br />Test Results <br />Pass Fail <br />Pass) Fail <br />ass Fail <br />Pass Fail <br />Signature <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'70ry ` <br />Water Level <br />Time (tt) <br />Y% w►L <br />3c?c �+L <br />Water Level <br />/NL. <br />Time (t2) <br />SYD NaL <br />6COH L <br />Water Level <br />Time (t3) <br />Water Level <br />Time (t4) <br />4L Ss 7tiYli✓ <br />1 <br />4 &Y." i <br />fit1SC 7-4WAO <br />Water Level <br />GM <br />•os 4)0)° <br />Test Results <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />uvc <br />)3- l y <br />ID (1/2,3/4, etc.) <br />Manufacturer <br />Start Time (to) <br />S'70ry ` <br />Water Level <br />Time (tt) <br />Y% w►L <br />3c?c �+L <br />Water Level <br />/NL. <br />Time 02) <br />SYD NaL <br />6COH L <br />Water Level <br />Time (t3) <br />Water Level <br />Time 04) <br />4L Ss 7tiYli✓ <br />1 <br />4 &Y." i <br />fit1SC 7-4WAO <br />Water Level <br />GM <br />•os 4)0)° <br />Test Results <br />ass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />RPV 1 1 /01 White — C)rioinsl VPIInw — Arrn Fnvirnnmantal C mmnlinnra Pink — C'nntrnrtnr <br />