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Underground.Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page of - <br /> Facility#: 'L I SO City: ®�`�� �'� Testing Contractor: & }-4°- (c-/L- Test Date:7� f? <br /> Facility Address: 1 o& E o v-^&k® Contractor Address: `/7 Si`C`t��`a. (c)04,1 ' Tech.Name: 6, j_T Gj 1'1>p� <br /> v 1 tin <br /> c�. 0,)C- C-0 t a:A- <br /> Turbine Sumps 87 89 91 D 87 89 91 D 7 89 91 D 87 89 91 D Fill Sumps 87 8991 D 7 89 91 D =�� <br /> �/ 89 91 D <br /> ID(north,slave,etc.) fit"' �(�� ttlCSf- ID north slave etc.) j4" tat"` <br /> Manufacturer e,2'1XC`-7 V 5 /C 14017 .2 Manufacturer PJL V VOL&Cc I 4L, <br /> mC,'0 d— e <br /> /I:S[� / .'�.5" y' w;tt >ti�t- Start Timet i�Q'1C9 i?-;�l� ; 33, <br /> Start Time(to) ., tot's t- ( o) <br /> Water Level f000 OCO " 000 Water Level 1 000 0® 000 00 <br /> Time(t,) /1 3 3 1(,:5I 10; -.-8 Time(ti) /21 13 12-16's l r �L i 2.: 3S7 <br /> Water Level , 001( 00 —, 007 Water Level �101„S, ,oo3 1 <br /> Time(t2) 1/: 316 /0"-1-6- /0.31 Time(t2) (� /1:S'6 i f 31 -�-: 3 29 <br /> Water Level W CI 10011S Water Level 0qq �,05�1- 'm;O os'" - ' 05 <br /> rp <br /> Time(t3) <br /> `! 3. 1 b. S°1 /U: 3 Y Time(t3) 1'q I�! S. 1 '3q ;L: 44 1 <br /> Water Level �, 013 rap/41 Water Level �.. C)75- , o-73 ',(>o <br /> Time 04) 0. B®; -7 Time(t4) /•'l.;�2 i ! oa— ? 3? <br /> Water Level , 0 l C?�b ', 02'1 tom'lw,L, Water Level !J', t o(© CA' <br /> Test Results Pass Fail Pass Fa' Pass ail Pass (Fail) Test Results Pass ail Pass ail Pass Fai Passail <br /> Signature ti t y, Signature m` L <br /> UDC 1 S(� 'l/ UDC <br /> ID(1/2,3/4,etc.) ID(1/2,3/4,etc.) <br /> Manufacturer ? ? Manufacturer <br /> Start Time(to) ° i To atm VFW, Start Time(to) <br /> Water Level &Vx L4va 000 , Water Level <br /> Time(tt) 1 : i 3 �, l ; Time(ti) <br /> Water Level = C " ,Obi Water Level <br /> Time 02) Time(t2) <br /> Water Level 00't Water Level <br /> Time(t3) t ' t�.1 Time(t3) <br /> Water Level , ®[ , Q 1 Water Level <br /> Time 04) ( r ` 2-41 Time 04) <br /> Water Level Qp oil Water Level <br /> Test Results Aass FailP ss Fail Pass ail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Signature ,i ^a Signature <br /> ®� <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor <br />