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Underground Storage Tank <br /> Spill Container Testing Report Form <br /> S. SMIL CONTA NER DEA S <br /> Test Method Developed by a Manufacturer ❑ Industry Standard ❑ Professional Engineer <br /> Test Type 0 Pressure ['Vacuum ❑ Hydrostatic <br /> Tank ID -�� <br /> Spill Container Mc,nufacturer. <br /> Method of Cathod Protection Nonmetallic PM Nonmetallic ❑ Nonmetallic ❑ Nonmetallic <br /> ❑ Other ® Other ❑ Other ❑ Other <br /> Is the spill container minimum <br /> 10 capacity five gallons excluding Yes Yes ❑ Yes El Yes <br /> riser volume? <br /> 10 No* ❑ No ❑ No ❑ No <br /> Method to keeps ill container 19 Drain Drain ❑ Drain ❑ Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Tet Results ❑ Pass 10 Pass ® Pass ❑ Pass <br /> ❑ Fail ❑ Fail 10 Fail ❑ Fail <br /> Tank ID <br /> Spill Container Manufacturer: <br /> Method of Cathod Protection r] Nonmetallic El Nonmetallic ❑ Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill contain r minimum In Yes ❑ Yes ❑ Yes ® Yes <br /> capacity five gallo is excluding ❑ No* ❑ No* ❑ No* In No* <br /> riser volume? <br /> Method to keep sl iill container In Drain ❑ Drain ® Drain ❑ Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump in Pump <br /> ❑ Other 110 Other ❑ Other In Other <br /> Spill Container Test Results In Pass ❑ Pass ❑ Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail in Fail <br /> 8. Col1NTS <br /> Describe all answ marked`Other,D`No,r or'Fair and each proposed remedy. <br /> * Mark here if: <br /> ❑ Spill contain do not have a minimum capacity of five gallons and require replacement. <br /> Additional copies of this page may be attached. <br /> Page 2 of 2 <br />