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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 6 of 6) <br /> XXI . UNDER-DISPENSER CONTAINMENT TESTING INFORMATION <br /> Manufacturers Identify UDC ID from Section III for each Manufacturer <br /> Bravo Systems- Coated Steel- RT 1 C1 1 2 X 3 X 1 4 x❑ 1 5 ❑ 1 6 ❑ <br /> 7 ❑ 1 8 ❑ 9 ❑ 1 10 ❑ 1 11 ❑ 12 ❑ <br /> Bravo Systems- Coated Steel - CL 1 2 ❑x 3 ❑x 4 x❑ 1 5 x❑ 6 ❑ <br /> 7 ❑ 1 8 ❑ 9 ❑ 10 ❑ 1 11 ❑ 1 12 ❑ <br /> Test Method Used : ❑ Manufacturer GuidelinesS eci <br /> ( p fy): <br /> ❑ Industry Code or Engineering Standard (Specify) : <br /> ❑x Engineered Method (Specify): Caldwell Systems/ Hydrostatic 30 Minutes <br /> Attach the testing procedures and all documentation required to determine the results. # of Attached Pages2 <br /> UDC Testing Training and Certifications (List applicable certifications) Expiration Date <br /> Caldwell Level Change Indicator 6/ 10/2023 <br /> ICC Service Technician #5246802 - UT 3/21 /2021 <br /> Underground Storage Tank Tester License #90 - 1120 12/31 /2022 <br /> XXII . COMMENTS <br /> Provide any additional comments here. <br /> Note : RT= Retail Island . <br /> Note : CL= Card Lock Island . <br /> x� <br /> F <br /> If the facility has more components than this form accommodates, additional copies of these pages maybe attached <br /> UDC = Under-Dispenser Containment; ID = Identification <br />