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UNDERGROUNDSTORAGETANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of s) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> A ❑ I B ❑ IC ❑ D ❑ <br /> A ❑ I B 1 C ❑ I D <br /> Test Method Used: ❑ Manufacturer Guidelines(Specify): <br /> ® Industry Code or Engineering Standard (Specify): Vacuum <br /> ❑Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Tank Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> N/A <br /> " No Inspector present. <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Iden ify Tank ID from Section III for each Manufacturer <br /> Environ A B 0 C D ❑ <br /> A ❑ B ❑ C ❑ D ❑ <br /> Test Method Used: ❑ Manufacturer Guidelines(Specify): <br /> ® Industry Code or Engineering Standard(Specify): Pressure <br /> ❑Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Product Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC UST Certification#5254516 7/12/2021 <br /> Interstitial Communication Verification Method Used: <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> 87 product replaced test boots and retest at 12:45 pm at 5 psi ended at 1:45 pm at 5 psi. <br /> 89 product replaced test boots and retest at 12:55 pm at 5 psi ended at 1:55 pm at 5 psi. <br /> 91 product replaced test boots and retest at 1:05 pm at 5 psi ended at 2:05 pm at 5 psi. <br /> ID=Identification <br />