Laserfiche WebLink
Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form <br /> Page -Z of <br /> Facility k iZ,.l'3® City.atDw_k ovl Testing Contractor: §e14_.O h <br /> TestDate: <br /> Facility Address-]90(p N. Ej 100,r - Contraetor Add ,5, q e&0/ (I�Ia�e <br /> Tech.Name: <br /> Turbine Sumps 0 89 91 D � B9 91 D 87 89 91 D 67 69 1 D Fill Sumps � B9 91 D � 99 91 D B9 9I D 87 89 1 D <br /> 1D(north,slave,etc.) r y 6 •�- 1D no slave etc, a�r <br /> V <br /> Manufacturer LYj,C6 es Xt: a Manufacturer GY <br /> Osl 4e <br /> V_ 651 xe <br /> Start Time(to) a>` 10;0 .$2 11 Start Time(to) '1:Sl 9 NO 11:Z5; <br /> Water Level .000 .000 .000 <br /> Time 1 °l: I j® ti0:D , .00 Water Level . 000 •000 .000 to p <br /> ( t) <b.S6' tl . Time(ti) 7:54 8:og Lt.'LIS I>l. <br /> Water Level .poo .000 .000 Water Level <br /> Time(t1) 9:t 9. ]o_oQ 10:6-8 I I:53Time(t1) 7:57 $I0t k Z� 1 . <br /> Water Leve) -app -. 001gotWater Levet 1000 . 000 pjj y� <br /> Time(t3) •22 1®• 17. RIO O( 11.:5 /� Q q O <br /> 4 Time{t3) $+oe� °�: ,s 1ZiJ4 17._ {} <br /> Water Level -,coO 00 t -1 0 -. Water Level r. 001 <br /> .(}Qp Q <br /> Time 9.25 1 O:1 1 .0 <br /> tt 11:5a1 Time(t,� •01 • 1 1000 <br /> Water �i 12.5 <br /> Water Level 3. <br /> ;000 ',001 -- D =,QQ Water Level 001 - .0p wo 0� <br /> Test Results <br /> Fail as Fail ass Fail Pass Fail Test Results ass Fail ass Fail ass Fail Fail <br /> Signature -' - <br /> �� Signature �- <br /> vat vecj <br /> UDCUDC <br /> ID(WN, .) ��Z /(a ?�g <br /> ]D(112,3/4,etc.) <br /> Manufacturerr"ErIca n Afrt,•,rQn 0" r.pst <br /> coh tq;re,r }e®s�;,eaer Ge+y : f Manufacturer <br /> Start Time(to) a q ^®s Start Time(to) <br /> Water Level ,00o coo .OOp Water Level <br /> Time(1:1) 8 3 2 = Time 01) <br /> Water Level •000 .DOD ,ODD Water Level <br /> Time(t?) :S3 q :l t Time(Q <br /> Water Level 001 ,DOo , 00b Water Level <br /> Time{t3) 8. 4 g * ct :lit Time(t3) <br /> Water Level 00 t ,ODO .100 D Water Level <br /> Time{t,) '4 7 G%-.0% °C;17 Time(td) <br /> WETest <br /> ter Level , ODO .060 ,j Water Level <br /> Results ass Faii as Fail Fail l ail Test Results P Fail P Fail Pture Signature <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor <br />