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®v Vnderground Storage Tank System <br />rSecondary Containment Certirication Form <br />Facility ID: Gd b <br />Facility Address: <br />Tanks, Piping, Tank Sumps & Overfill Buckets Page J of <br />Test Date: <br />Testing Contractor: •� ®--� <br />Tech. Name: <br />y� Contractor Address: e— LG <br />(IST Annutar a ace Tank #3 Tank #4 <br />Tank #1 Tank #2 <br />Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br />Capacity <br />Test Start Time <br />initial Pressure <br />Test End Time <br />� Final Pressure <br />Pass Fail Pass <br />Test Results <br />v Signature <br />w <br />a� <br />E'Pass Fail Pass Fail <br />RStart <br />l Buckets <br />Overfill #1 Overfill #2 Overfill #3 Overfill #4 <br />ct 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br />r. 1 Time (to) <br />i <br />Water Level <br />c <br />Time (t,)' <br />/�^ <br />`i?15VM4 <br />Water Level00 <br />1 <br />Time (tz) <br />Water Level <br />Time (t,) <br />�! <br />Time (t�^� <br />P, <br />Water Level <br />e <br />Time (t4) <br />Water Level <br />Pass Fait <br />Test Results <br />M <br />Signature <br />0 <br />Time 03) <br />Water Level <br />al <br />Rev. 10/01 <br />Pass Fail Pass Fail , Pass Fail <br />Turbine Sum s <br />Tank #1 Tank #2 <br />Tank #3 Tank #4 <br />Start Time (to) <br />/�^ <br />`i?15VM4 <br />Water Level <br />Time (t,) <br />�! <br />Water Level <br />Time (tz) <br />Water Level <br />Time 03) <br />Water Level <br />Time (t4) <br />Water Level <br />P4 <br />Test Results <br />a" Fail Pass Fail <br />Pass Fail Pass Fail <br />Signature <br />SecondaN Pi in <br />`ea 4%4 <br />Sf��pEt <br />Line #1 <br />Line #3 Line #4 <br />a 89 91 D <br />87 89'91 D <br />87 89 91 D 87 89 91 D <br />Product <br />Test Start Time <br />.7,`/,%ems <br />--7 e <br />/< <br />initial Pressure <br />5', ,2 ps rte <br /><-51SI, <br />Test End Time <br />•'"7 <br />Vol toe —V <br />Final Pressure <br />2,05 r <br />1'S 0'1. <br />Test Results <br />Fail <br />as Fail <br />Pass Fail Pass Fail <br />White - Original Yellow - Arco Environmental Compliance <br />�T <br />Pink - Contractor 1 <br />fig.%�' li <br />