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i0 Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page:.Z of ; <br /> Facility#: s�s City: �T Testing Contractor: E7rl-ilz " Test Date: <br /> Facility Address: Contractor Address: b7g7 .5l CT, Tech.Name: <br /> 01 �O <br /> m <br /> m Turbine Sumps 87 89 91 D 87 89 91 D 87 89 OD 87 89 91 D Fill Sumps 89 91 D B 89 91 D 87 89 OD 87 89 91 D <br /> ` ID(north,slave,etc.) ID north slave etc. P— 5uku E <br /> N ManufacturerManufacturer <br /> GUuY�Rr1 k?F�STZ1Q►S WE5�r2n1 Wl✓STEAra Wb`ST6 wt�s� <br /> C� Start Time(to) O4'�0 b$'�S 22 Start Time(to) 1Z�3 30t7 1155 <br /> Water Level +..0000.3 + O +x000 Water Level t 000b`I �OLEO(, +! 00007 <br /> Time(t,) t �3 Ob`t$ � � Time(tt) I Z`{(� 1 303 1(578 <br /> Water Level t000S5' +f00O,q5 coo45Water Level 70005? +jo003% p60411 <br /> Time 42) Oct 4 r0 1 l`ti -- Time(t2) 12`'1,4 i 30 Of, 12-01 <br /> Water Level 'Ft 00101 1',-00091 +&-,000?7 Water Level 7000$7 x',0005(0 +w7071 <br /> Time 03) tlq - ! Time(t3) 12-52, l 3 04 12.10 H <br /> Water Level �cotq{ 1 0- }i0013q Water Level ri'000 Z 'f;QOlt($' 'x;000$ <br /> Time 04) 0°152. 0$57 1(34 Time(t4) I'ZSS {3 l Z IZ0 <br /> Water Level t501 0017 '�.DOt Water Level 4- <br /> Z t ,0012- <br /> Test Results ass Fail Fail Pass Fail Pass Fail Test Results Pass Fail ass Fail < as Fail Pass Fail <br /> Signature Signature <br /> UDC # -7 p UDC <br /> ID(1/2,314,etc.) '+Z �+� es+-tp !}U ID(1/2,3/4,etc) <br /> Manufacturer WE-211-rRN WE�sqE*4.) WES�R4,.� L05Sf6Rti1 Manufacturer <br /> Start Time(to) 0010(° 0q7 0 5 IS Start Time(to) <br /> Water Level +tt)000"3 4--Ocooy t cgoo f,0000 Z Water Level <br /> Time(tl) ogoq M?�Y 33 Ti_jqme(t2) <br /> Water Level ' 006(00 -,000'17 14,6000q pees? Water Level � <br /> Q Time(t2) 0 r2 Oq2? 3� Time(t2) <br /> co Water Level ;000 —; 000g2- f,00118 7;OopaZ Water Level <br /> Time(t3) /04 LT 'J� Time(t3) <br /> N Water Level 601 LLS —,00157 t 0001 V -0.G90g1 Water Level <br /> Time(t4) �Q 3 Z7 Time(t4) <br /> Water Level $0007 lDQ1 oq +00/99 /57Y Water Level <br /> Test Results Pas Fail ass Fail ass Fail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail k/ <br /> Signature Signature <br />