Laserfiche WebLink
Underground Storage Tank System Tanks, Piping, & Spill Buckets , <br /> Secondary Containment Certification Form Page Z-ef Z <br /> Facility#: 600 City: Testing Contractor: (9�-i? (,as- �,/ Test Date:0 3z- <br /> Facility Address: 17// L, V6 1�3L&4L Contractor Address: 6 7q7 Is ertzx Tech.Name:J ga_5a_nme__' P_✓ <br /> UST Annular S acecondary Pi in <br /> Tank#1 Tank #2 Tank#3 Tank#4 Line#1 Line #2 Line#3 Line#4 <br /> Product 089 91 D 87 91 D 87 89 (S)D 87 89 D Product 089 91 D 87 091 D 87 899 D 87 89 91 <br /> Capacity 15— j Piping Type L-5) Siphon rimary Siphon imary Siphon Primary iphon <br /> Manufacturer �S Manufacturer <br /> Test Start Time 0 :L/ — :3 o Test Start Timej— <br /> Initial Pressure O !oN 10" , <br /> Initial Pressure <br /> Test End Time Y 0 Test End Time <br /> Final Pressure /17 r rFinal Pressure ` <br /> Test Results ass Fail ass Fail as Fail Pass Fail <br /> Test Results Pass ail Pass ail Pass ai Pass Fail <br /> Signature �'� <br /> - tSignature <br /> Sill Buckets <br /> Ji� T L74 <br /> Overfill#1 Overfill#2 Overfill#3 Overfill#4 econdary Pi in <br /> Product 87 89 91 D 87 091 D 87 89(5 D 87 89 91 D Line#5 Line #6 Line#7 Line#8 <br /> Manufacturer _QinProduct 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> Start Time(to) Z= 3(7 2�p� <br /> 2 30 Piping Type Primary Siphon Primary Siphon Primary Siphon Primary Siphon <br /> l <br /> Water Level 0 .00 01mo o Manufacturer <br /> Time(ti) Z-' Test Start Time <br /> Water Level V_= ©,Cod <br /> Time(t2) ( 31- 2.'_ )) 2:3�(, Initial Pressure <br /> Water Level ;7/ (t) .CD I Test End Time <br /> Time(t,) 12:3 g ;?-: IL4 2-,3� <br /> Water Level Q�, , 'ZZ v.©Q 2 Final Pressure <br /> ' Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Time(t,) ( Z: Z Z- 4Z <br /> Water Level V. 00 Z Signature <br /> Test Results ass Fail Pass ail ass Fail Pass Fail <br /> Signature —j-PV �3 <br /> ' 1/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor <br />