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Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page of <br /> Facility#: City: Ma4g+dzp- Testing Contractor: 6-:e0 ✓ <br /> I•wr Ova- L Test Date: <br /> Facility Address: 7 / / �, �g ;e- v% Contractor Address: 6 2 IV7 S e e✓l-J�A- Ci" --F Tech.Name. I"IG-S�yh�►�✓ <br /> Turbine Sumps 87 89 91 D 87 8 91 D 87 89 9 87 89 91 Fill 87 Sumps 89 91 D 87 91 D 87 89 91 D 87 89 91 <br /> ID(north,slave,etc.) �,�'t 1 �7 I/ �/ ID north slave etc. IV" <br /> " 10 <br /> Manufacturer p� Q� Manufacturer <br /> Start Time(to) 11'4,5- -;L,.00 Z�" � Start Time(to) 1! SD 3 : <br /> Water Level 0-1000 0,000 n 100 0 Water Level 0.000 <br /> Time(tt) 11 �� 2:-43 2 Z3 Time(tt) 2.%S3 a Z3 3�`�3 <br /> Water Level 0,000 O,000 000n Water Level 016700 V-000 0.000 <br /> Time 02) 2' 0G 2.2-6 Time 02) Z= 5-6 i 3%` I0 <br /> Water Level 0100 1 0101 01001 Water Level .000 m.00 M.Q0g1 <br /> Time(t3) L I `� %-1 0? 2=-2-9 Time(t3) 312, 3' 1 <br /> Water Level 0 .001 0.000 Q0 Z. Water Level' .. �•O0� 2- Z <br /> Time 04) (1 , 5-7 a,. I Z'.•3Z, Time 04) 'x'•.3 2 3-.5-2- <br /> Water <br /> :SZWater Level 0 2. Q4K 1 0.00 2 Water Level Z (5)-00Z <br /> Test Results ass Fail (PUS Fail ass Fail Pass Fail Test Results Passffail' Pass Fail ass Fail Pass Fail <br /> Signature J 'j' T Signature T <br /> UDC2 / UDC 9 IO 11-12- <br /> ID(1/2,3/4,etc.) 1 -2- 7 ^y r(� 7—� ID(1/2,3/4,etc.) <br /> Manufacturer Manufacturer <br /> Start Time(to) q-, 1-1 3 t "n5 Start Time(to) bio 6 i <br /> Water Level D.000 .00 V-000 Water Level .000 ©-coo 01000 o-000 <br /> Time(ti) � ' q'L 'O 5- 13 '- 1 ;�'3 5 =3 <br /> ( ) �I'y I N• 8 Time(tt) <br /> Water Level VZVO d x©00 1 , 4/41Z, -0.008 Water Level Q.QOP7 I . W301 , 2.30 0 .ODD <br /> Time 02) N' S-7 t-�'�L y :I Z Time 02) 6^ Lb (p 1 S" �lO�j <br /> Water Level 0 0 0,000 "{�.0(Z Water Level e .00 Z Z• `I©Q �' 0.000 <br /> Time 03) 1.1'15-� t4 ,2-1 y'. 1 S— Time 03) 5-'1 5-,.3 / <br /> Water Level (19.000 0-co t -0,01 / Water Level (0, 0 ,(900 <br /> Time 04) Li'-5-7 LI=32. Lr" Time 04) ,L2- q Z <br /> Water Level V.000 n0 ,h,02'D Water Level m -CO Z. 0-000 <br /> Test Results as Fail as Fail Pass Fail Pass Fail Test Results PassFail Pass Fai Pass Fail ass Fail <br /> Signature � -- Signature <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor <br />