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SWRCB, January 2002 Page of Comments — (include information on repairs made prior to testing and recommended ollow-asp for ailed tests) ' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment tPctintr f rolifnmia rr%(Jp nr Paoidntinnc Titles 7Z Cvrtinn 'MIWaVF.11 4. TANK ANNULAR "YES 111NU Test Method Deed By: velop ❑ Tank Manufacturer dustry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure acuum ❑ Hydrostatic ❑ Other (Specify) Test Equipment Used: Equipment Resolution: Tank # Tank # X@nk # Tank # Is Tank Exempt From Testing?' ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Tank Capacity: Tank Material: Tank Manufacturer: Product Stored: r Wait time between applying pressure/N acuum/11 iter and starting test: r j Test Start Time: Initial Reading (RI): — _ er Test End, Time: ` ` , , D a + r Final Reading (RF): — Test Duration: r Change in Reading (Rr-RJ: Pass/Fail Threshold or Criteria: no 6 <® Test Result: Pass ❑ ail :�Xpass Fail��E] Fail ❑ Pass ❑ Fail Was sensor removed for testing? Yes ❑ No ❑ NA Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced andyes El No ❑ NA Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 11 Yes 11 No C] NA verified fiuictional after testing? Comments — (include information on repairs made prior to testing and recommended ollow-asp for ailed tests) ' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment tPctintr f rolifnmia rr%(Jp nr Paoidntinnc Titles 7Z Cvrtinn 'MIWaVF.11