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Underground Storage Tank System <br />Secondary Containment Certification Form <br />Tanks, Piping, Tank Sumps & Overfill Buckets <br />Page '/ of <br />Facility ID: _ARCO /�b Testing Contractor: �,p0,,/i�d�Test Date: <br />Facility Address: G(� Contractor Address: Tech. Name:��i <br />L /OOL <br />VVT Annular Snace <br />Overfill Ruckvh <br />Tank #1 <br />Tank #2 <br />Tank #3 <br />Tank #4 <br />Product <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />Capacity <br />Initial Pressure <br />�. �s,' <br /><S/�si� <br />Test Start Time <br />Test End Time <br />Initial Pressure <br />5 • 2,03'J' ,0SJ' <br />Test Results <br />Test End Time <br />ass Fail Pass Fail <br />Pass Fail <br />Signature <br />Final Pressure <br />Test Results <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />Overfill Ruckvh <br />Turbine Sumps <br />Overfill #1 <br />Overfill #2 <br />Overfill #3 <br />Overfill 94 <br />Product <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />87 89 91 D <br />Start Time (to) <br />Initial Pressure <br />�. �s,' <br /><S/�si� <br />Water Level <br />Test End Time <br />Time (ti) <br />5 • 2,03'J' ,0SJ' <br />Test Results <br />Water Level <br />ass Fail Pass Fail <br />Pass Fail <br />Signature <br />Time (tz) <br />Water Level <br />Time (t3) <br />Water Level <br />Time (ta) <br />rQS S P11 <br />Water Level <br />45 Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Test Results <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />Turbine Sumps <br />Secondary Pipine wte-le-Ao/d s%AL.,Vw <br />Tank #1 <br />Tank #2 <br />Tank #3 <br />Tank #4 <br />Start Time (to) <br />87 89 91 D 87 89 91 D <br />87 89 91 D <br />Test Start Time7� <br />���„y <br />Water Level <br />Initial Pressure <br />�. �s,' <br /><S/�si� <br />Time (ti) <br />Test End Time <br />Water Level <br />5 • 2,03'J' ,0SJ' <br />Test Results <br />Time (tz) <br />ass Fail Pass Fail <br />Pass Fail <br />Signature <br />Water Level <br />Time (t3) <br />Water Level <br />Time (ta) <br />Water Level <br />rQS S P11 <br />Test Results <br />45 Fail <br />Pass Fail <br />Pass Fail <br />Pass Fail <br />Signature <br />4 <br />Secondary Pipine wte-le-Ao/d s%AL.,Vw <br />Rev. 10/01 White - Original Yellow -- Arco Environmental Compliance Pink - Contractor <br />r4m <br />1 <br />J <br />1 <br />A <br />Line #1 <br />— Line #3 <br />Line #4 <br />Product <br />® 89 91 D <br />87 89 91 D 87 89 91 D <br />87 89 91 D <br />Test Start Time7� <br />���„y <br />7/���� <br />Initial Pressure <br />�. �s,' <br /><S/�si� <br />Test End Time <br />Final Pressure <br />5 • 2,03'J' ,0SJ' <br />Test Results <br />ass Fail <br />ass Fail Pass Fail <br />Pass Fail <br />Signature <br />oe/ <br />Rev. 10/01 White - Original Yellow -- Arco Environmental Compliance Pink - Contractor <br />r4m <br />1 <br />J <br />1 <br />A <br />