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SWRCB, January 2002 <br />dw-al-PAL41V 04 "12 1 IN IKKIRN fill 101,711 AIN WMIrm <br />Page ? of 4— <br />Facility is Not EquipEd With Spill/Overfill Containment Boxes ❑ <br />Spill/Overfill Containment Boxes are Present, but were Not Tested $K <br />"thod Developed By: 0 Spill Bucket Manufacture f [✓ Industry Standard 01 Professional Engineer <br />❑ Other (Spec) <br />Test Method ilged,,-, <br />0 Pressure ❑ Vacuum ❑ Hydrostatic, -.,., <br />0 Other (Specify) <br />Test Equipment Used: <br />Bucket Diameter: <br />I Equipment Resolution: <br />Spill lio1*1- Spill Box # Spill Box # Spill BOX # <br />Bucket Depth: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: <br />Initial Reading (11j): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change <br />Pass/Fail"Threshold or <br />Criteria: <br />Test Result: <br />❑ Pass ❑ Fail <br />❑ Pass []Fail <br />❑ Pass DFall <br />❑ Pass ❑ Fail <br />on repairs made prior to testiny, and recommended <br />