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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page a of 6) <br /> XIII. VAPOR RECOVERY PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> N/A A❑ I B ❑ I C ❑ D ❑ <br /> A❑ I B ❑ I C ❑ I D ❑ <br /> Test Method Used: ❑Manufacturer GuidelinesS eci <br /> ( p fY): <br /> ❑x 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 /> Vapor Recovery Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Interstitial Communication Verification Method Used: <br /> XIV. COMMENTS <br /> Provide any additional comments here. <br /> XV. TURBINE/ PRODUCT PIPING SUMP TESTING INFORMATION <br /> Manufacturer Identi Tank ID from Section III for each Manufacturer <br /> Unknown A❑x I B ❑x C ❑X D ❑X <br /> A Bx❑ C ❑ I D ❑ <br /> Test Method Used: ❑ Manufacturer Guidelines(Specify): <br /> ❑x Industry Code or Engineering Standard (Specify): Hydrostatic test using Incon Unit (15 Minute Test <br /> ❑Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 1 <br /> Turbine/Product Piping Sump Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Service Tech 8004551-UT 10/28/2021 <br /> Incon Sump Tester Cert# 1002753709 8/23/2021 <br /> XVI. COMMENTS <br /> Provide any additional comments here. <br /> RECEIVED <br /> NOV 7 2019 <br /> ENVIRONMENTAL HE TH <br /> ID=Identification p F PA RTM F NT <br />