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.. o <br /> U-3derground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment U <br /> Secondary Containment Certification Form Page--L of -- CD <br /> Facility#: LO Q City: Testing Contractor: �yTest Date: <br /> Facility Address: _ LCUA$ Contractor Address: � 7 S��/!�. � Tech. same: % I' +LO H <br /> x <br /> 0 <br /> Turbine Sumps 89 91 D 87 91 D 87 89 D 87 89 91 Fill Sumps 87 89 91 D 67 89 91 D 87 89 91 87 89 1 D N <br /> ID(north,slave,etc.) lD north slave etc. s ``I <br /> y <br /> Manufacturer Manufacturer <br /> li0 ��� Start Time 2'ZZ" <br /> Start Time{to) (tn) <br /> Water Level b CV0 0.000 O.wo Water Level 0-000 © u <br /> o <br /> Time(t,) i I 1 Li Time(ti} ZI t . t? ?.; t <br /> Water Level 0-00() 001v Water Level 0.00 Q �• �j , 0.00 r r <br /> Time 02) ti 9 i Time(t,) : y �'. y Z OL% <br /> Water Level —E).Cw j {x.002 eqZ190 Water Level ®.QVO ©-COO 0 .Om l 0.00 Z- <br /> Time(t3) t 13 12-P. we L�e 3 1 1 <br /> Time(t3} � 'Z7 i, <br /> Water Level Water Level .00 00 Q7-00 1 <br /> Time(t4) �� % ZO 1r2+'• J Time(t4) 2� <br /> Water Level --�. "�• - � Water Level Q�•�� l �.� ,•t 3: Z-- <br /> Test Results Fail ass Fail ;lssd Fail Pass Fail Test Results Fail Fail ass Fail _ Fail <br /> Signature �- }- � / [signature <br /> UD <br /> U13C <br /> LD(112,314,etc.) r 2 3 7 t0 7 ID(112,314,etc_) <br /> Manufacturer Manufacturer <br /> Start Time(to) 6--07 0 f : Start Time(4) <br /> Water Level 0-001c) V-000 0- QVb Water Level <br /> Time(ti) G S% 3—S 5-t 91 (0 '- ZO Time(t.) <br /> Water Level 0V 0. 000 dv. 0 o Water Level <br /> Time(t2) S"l!3 sl 4 13 & ' -0 Time(tz) <br /> Water Level IS) .040 Q . &741 Water Level <br /> Time(t3) �' '�� % Z Time 43) <br /> Water Level gW 0 Water Level <br /> Time(t4) 6, 1 of s: 1, 2►1 Time(Q <br /> Water Levet o.coo Water Level <br /> Test Results Pass Fail Pass Fail Pass Fail Fait Test Results Pass Fail Pass Fail Pass Fail Pass Fail IN <br /> 0 <br /> Signature (Z-+V..._ y,1.. - Signature ` A <br /> _ .. .,.. .rn_°`_ r._ ___. •r_11_.__ a___r._..:___�__._t r+__..1t_..,.., n..1. !•_�........a.._ �i` <br />