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Underground Storage Tank System Turbine Sumps, Fill Sumps and Under Dispenser Containment <br />Secondary Containment Certification Form <br />Page .7 of o <br />Facility #: Sy City: S Ti7C.r�loa/ Testing Contractor: G. %G S, tqOrD, p0), /y�Test Dat <br />Facility Address: .70 S L x!�, � Contractor Address: %`}- �rY1_ �� Tedi. Name: �e;zt� <br />K <br />Turbine Sumps <br />7 89 91 D <br />87 89 91 D <br />87 a) 91 D <br />87 89 91 D <br />ID (north, slave, etc.) <br />'4 <br />ManufacturerbW <br />'3'10 ryL <br />71?0.ft L <br />S 70PU L <br />/ X P" i <br />Start Time (to) <br />L <br />/- <br />Water Level <br />3.70 <br />3las'.�, L <br />Water Level <br />�� <br />Y•�Q�M <br />` C <br />3�� r+r< <br />ater Level <br />zj <br />L <br />Time 02) <br />7(P <br />!J <br />/V�vYI <br />Water Level <br />Time (t3) <br />Water Level <br />AES -5 is <br />LIQ j <br />44KC JTbW <br />461US 70 <br />Time (t4) <br />A7S-4p9V <br />� �Sg <br />4,*V <br />I&S-4iV <br />Water Level <br />L A& <br />(� f,�✓�1� <br />7 ANJ, 4!0 <br />Pass Fail <br />Test Results <br />Pass Fai <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />45ri1 <br />In <br />UDC <br />ID (1/2,3/4, etc.) <br />1-g <br />3 _ <br />�., / <br />�� <br />7-- <br />Manufacturer <br />'4 <br />-tart Time (to) <br />'3'10 ryL <br />71?0.ft L <br />S 70PU L <br />/ X P" i <br />Water Level <br />L <br />W � <br />Time (tt) <br />3.70 <br />3las'.�, L <br />Water Level <br />�� <br />Y•�Q�M <br />` C <br />3�� r+r< <br />Time (t2). <br />zj <br />L <br />Water Level <br />M <br />!J <br />/V�vYI <br />Time (t3) <br />Water Level <br />Time 04) <br />AES -5 is <br />LIQ j <br />44KC JTbW <br />461US 70 <br />Water Level <br />A7S-4p9V <br />� �Sg <br />4,*V <br />I&S-4iV <br />sTest Results <br />Pass Fail <br />Pas's Fail <br />ass Fail <br />Pass Fail <br />Signature <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <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 />'4 <br />Manufacturer <br />Start Time (to) <br />L <br />W � <br />Water Level <br />Time (tt) <br />�� <br />Y•�Q�M <br />` C <br />3�� r+r< <br />Water Level <br />Time (t2) <br />M <br />!J <br />Water Level <br />Time (t3) <br />Water Level <br />Time (t4) <br />L SS 7AWTime <br />� �Sg <br />t <br />4.sd Tim <br />Water Level <br />0&- 4 A <br />l <br />`/ C <br />/a6- 4 J <br />►GS L•� <br />Test Results <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />45ri1 <br />UDC <br />I.3 - l y <br />�sw <br />ID (1/2,3/4, etc.) <br />'4 <br />Manufacturer <br />Start Time(to) <br />L <br />W � <br />Water Levell <br />Time (tt) <br />�� <br />Y•�Q�M <br />` C <br />3�� r+r< <br />Water Level <br />Time 02)D <br />M <br />!J <br />Water Level <br />Time (t3) <br />Water Level <br />4) <br />L SS 7AWTime <br />� �Sg <br />t <br />4.sd Tim <br />WatertLevel <br />0&- 4 A <br />l <br />`/ C <br />/a6- 4 J <br />►GS L•� <br />Test Results <br />ass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />45ri1 <br />Rev. 11/01 White - Original Yellow - Arco Environmental Compliance Pink - Contractor <br />�tv <br />V� <br />