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underground Storage Tank System Tanks, Piping, & Spill Buckets <br /> Secondary Containment Certification Form <br /> p 1 Page l of <br /> Facility 4: 130 City: rjt-26C ron Testing Contractor• ` ,Tcovti 10-7—®2- <br /> . _ Test Date: <br /> Facility Address: 10 0(m Al, ppY -1 Contractor Address:�� g 5• Tip d►`EW0401 A-Ve Tech.Name: E (/,g Ale Z <br /> USZProdit(l <br /> e SecoRdcr <br /> Tants 41 Tank #2 Tank#3 Tank#4 Ljne#1 Line #2 Line#3 Line#4 <br /> 97 89 91 D 87 89 9l D 87 89 91 D 87 89 91 D Product { 89 91 D 87 89®D 87 89 9l D 87 89 91 DFi jn Si hon m SiP l;TYPe P prom Primary Sipb PrPrimary Sip <br /> Test Start TiManufacturer A 5v431,, A.®SM.-� <br /> me <br /> Test Start Time -1 �r3 115 3 <br /> Initial Pressure <br /> Test End Time Initial Pressure 5%0 ?..c&.3: 9.0 74.r <br /> Final Pressure <br /> Test End Time <br /> Test Results P Fail P FailFail Fail <br /> Final Pressure $-.® �.�,� �•D Q,� <br /> ass <br /> Signature Test Results Fail Fail P Fail P Fail <br /> Signature v <br /> Sill Backus <br /> Overfill#1 Overfill#2 Overcall 93 Overfill#d Second Pi in <br /> Product 87 89 91 D 97 89 91 D 87 89 91 D 87 89 91 D Line#5 Ljae #ti Line#7 Line#8 <br /> Manufacturer Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> Start Time(to) Piping Type Primary Sigh a Primary Sip Primary SIM Primary Siphon_ <br /> Water Level Manufacturer <br /> Time(t,) <br /> Water Level Test Start Time <br /> Time(ta) Initial Pressure <br /> Water Level <br /> Time(t3) Test Ead Time <br /> Water Level Final Pressure <br /> Time(t4) <br /> Water Level Test Results P s Fail P Fail ass Feil ass Fail <br /> Signature <br /> Test Results P s Fail Pass Fail Pass Fail Pass Fail <br /> Signature T <br /> Rev. 11/01 White—Qriginai Yellow—Arco Environmental Compliance Pink—Contractor <br />