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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of 6) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> N/A A❑ B ❑ T C ❑ D <br /> A❑ B ❑ I C ❑ I D ❑ <br /> Test Method Used: ❑Manufacturer GuidelinesS eci <br /> ( P fY): <br /> ❑ Industry Code or Engineering Standard(Specify): <br /> ❑Engineered Method(Specify): <br /> Attach the testing procedures and all documentation required to determine the results. #of Attached Pages <br /> Tank Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Smith A D B ❑x C x❑ D D <br /> AD B ❑x C ❑ D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ❑x Industry Code or Engineering Standard(Specify): 1 Hour pressure test @ 5.00 PSI <br /> ❑Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 2 <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Service Tech 8004551-UT 10/28/2021 <br /> Interstitial Communication Verification Method Used: <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> ID=Identification <br />