Laserfiche WebLink
Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page I? of 2 <br /> Facility#: Q 70 City: K,,,n+C,-GI Testing Contractor: —c"- Test Date: (U-/I-d Z <br /> Facility Address: 1-7/1 Yo Se W4r C Contractor Address:lyl/ff 5- Tech.Name: A e� 0.."n.e��3 <br /> Turbine Sumps 87 89 91 D 87 89 91 D 87 89 91 D 67 89 9l D Fill Sumps 87 89 91 D 87 89 91 D 67 89 91 D 87 89 91 D <br /> ID(north,slave,etc.) D norm siave etc. <br /> Manufacturer Manufacturer e r <br /> Start Time(to) Start Time(to) <br /> ir: z3 <br /> Water Level Water Level C3 0(2(P <br /> Time(tt) <br /> Time(tt) '�r"2 <br /> Water Level Water Level C2 000 <br /> Time(tl) <br /> Time(tz) :Sr-'2-1 <br /> Water Level Water Level -ct>& <br /> Time(t3) <br /> Time(t3) tr3 <br /> Water Level Water Level O• <br /> Time(t,) Time(t4) fV' <br /> 35 <br /> Water Level Water Level p,OUGt <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fail Test Results as Fail Pass Fail Pass Fail Pass Fail <br /> Signature Signature <br /> UDCTo I�s of �t Lisp- UDC <br /> ID(1/2,3/4,etc.) -5/6 II Z 3�/y ID(1/2,3/4,etc.) <br /> Manufacturerv�Yi7^ �t�) ,� Manufacturer <br /> Start Time(to) 1 : ZO -7"3`5 -7 yy Start Time(to) { <br /> Water Level v.aQv G. o,000 0-000 Water Level <br /> -),7,37, 7: Z g:0 <br /> Time(ti) Time(it) <br /> Water Level b. b o.oGo O. av V D Water Level <br /> Time(t,) I;Z4, '7111f/ IZ.5 $-/0 Time 02) <br /> Water Level "00 0,000 0.000 0,000 Water Level <br /> Time(t3) <br /> 71IC1 7:11,q 7:S,14r a 13 I Time(t3) <br /> Water Level D.OQo C'),qpp 0,000 Water Level <br /> 1137, -7:4-7 e'lot fG <br /> Time 44) j Time t4) .. e. <br /> Water Level 0,00d 0101042 00 D G Op O LWater Level <br /> Test Results Pass Fail Pass Fail Pass Fail Pass i <br /> Test Results as Fail Fail as Fail Pas Fail �_ \ <br /> C <br /> Signature <br /> Signature <br /> R Pv 1/(11 / White- neinal Yellow-Arco Environmental Compliance Pink-Contractor <br />