Laserfiche WebLink
Underground Storage Tank System Turbine Sumps,Fill Sumps and Under Dispenser Containment <br /> Secondary Containment Certification Form Page of .� <br /> Facility#: ' .�3L7 City: �'1'0G\1A C Testing Contractor: )- l c t, Test Date:71 f, <br /> Facility Address: %r c,,ko Contractor Address; <br /> c�? Y7 SiM''c-, yVR.!"" Tech.Name: /VG" <br /> v r <br /> Q VC_ Cot C6.A_ <br /> Turbine Sumps 87 89 :9I D 87 89 91 D 7 89 91 D 87 89 91 D Fill Sumps 87 89 OD 7 89 91 D 8y 89 91 D 89 91 D <br /> ID(north,slave,etc.) uJ�(— d�U tdr f" ID north slave etc. V-jf(aVI.L_ ('$t"' <br /> Manufacturer .g ALVe rt `7 -2 Ce 2YC, Manufacturert� t �Y�,2 C:LlOc <br /> Start Time(to) /i:SD r � /(�;�S' y'� w.Lt �g�' Start Timet i�.'i 0 t 7~1 S'O i <br /> Water Level r060 &CX2 DDO 1-rlI µA_ Water Level obi pd , 00 <br /> Time(tt) Time(ti) /21l"3 I�-%S� 1 : 19 <br /> Water Level Ooq D 07 Water Level � p).(y , � "'M3 <br /> Time(t2) /� : 6 !n:s 6 <br /> /0"31 Time(t2) i�.l t (� /�-%Sb i ; '31 <br /> Water Level I co 5 "1 O0 15' Water Level 7 4q �,t?57.. ��D 65- ,0 <br /> Time(t3) if • Tel L ®% S°! Ib: 3`I . Time(t3) !a-' IR <br /> Water Level ' 013 �'� U SLI Water Level p ,� _10-7S UU <br /> No <br /> Time(t4) !! : �! I 1 i O� 1 O% "7 C,�l.rtit- Time(t4) i9..%1,i1. i !OL �.�? ; ;l`'( <br /> Water Level r", 0 E 7 Q�� �, 01'7 IO'taA.. Water Level " . ()'L� p(a � Olt <br /> Test Results Pass Fail Pass Fa' Pass ail Pass Fai Test Results Pass sil Pass ail Pass Fail Pass ail <br /> Signature ti , Signature <br /> -214 <br /> UDC �, S( N UDC <br /> 1D(1/2,314,etc.) L �'7' ID(1/2,3/4,etc.) <br /> Manufacturer ? ? 7 Manufacturer <br /> Start Time(to) 1 1 I D ` ,� IZ " To AV, U"A Start Time(to) <br /> Water Level Water Level <br /> Time(tt) 3 1,s i S Time(tt) <br /> Water Level : C= Water Level <br /> Time(t2) 1 ' a1' 1$ Time(t2) <br /> Water Level i aoo Water Level <br /> Time(t3) ( � ! 'L'I I.I Time(t3) <br /> Water Level { ,Opt Q 14 Water Level <br /> Time(t,) ;,1, 2-11 Time(t4) <br /> Water Level Qp p(1 Water Level <br /> Test Results Aass Fail [P%q Fail Pass ail Pass Fail Test Results Pass Fail Pass Fail Pass Fail Pass Fail <br /> Signature Signature <br /> Rev. 11/01 White-Original Yellow-Arco Environmental Compliance Pink-Contractor <br />