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Y `t <br />Page 0 <br />of <br />d_ 'TANK ANNITT.AR TFNTTNG <br />Test Method Developed By: <br />❑ Tank Manufacturer ® Industry Standard ❑ Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: <br />❑ Pressure <br />❑ Other (Spec) <br />® Vacuum <br />❑ Hydrostatic <br />Test Equipment Used: DIAL GAUGE <br />Equipment Resolution: 0 to 15" Hg Vacuum <br />MEM I <br />Tank g 7 <br />Tank <br />Tank <br />Tank <br />Is Tank Exempt From Testing?' <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Tank Capacity: <br />GALLONS <br />GALLONS <br />GALLONS <br />GALLONS <br />Tank Material: <br />Fiberglass <br />Fiberglass <br />Fiberglass <br />Fiberglass <br />Tank Manufacturer: <br />Product Stored: <br />cca. , <br />6.14 91 <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />15 Minutes <br />15 Minutes <br />15 Minutes <br />15 Minutes <br />Test Start Time: <br />Initial Reading (RI): <br />jgy " HG <br />le) " HG <br />" HG <br />"HG <br />Test End Time: <br />�� <br />/�,• <br />Final Reading (RF): <br />HG <br />/p " HG <br />"HG <br />"HG <br />Test Duration: <br />1 Hour <br />1 Hour <br />1 Hour <br />1 Hour <br />Change in Reading (RF -RI): <br />O"HG <br />; " HG <br />"HG <br />" HG <br />Pass/Fail Threshold or Criteria: <br />Zero <br />Zero <br />Zero <br />Zero <br />Test Result: <br />[Pass ❑ Fail <br />ass ❑ Fail <br />❑ Pass ' ❑ Fail <br />D Pass Fail <br />Was sensor removed for testing? <br />Was <br />❑ Yes No ❑ NA <br />❑ Yes No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testing? <br />Yes ❑ No ❑ NA <br />Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Comments — (include information on repairs madeprim- to testing, and recommended ollow-u for ailed tests) <br />Chevron # 208117 <br />755 S Tracy Blvd <br />Tracy, Ca <br />08128 SB989 <br />' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br />containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment <br />testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} <br />5 <br />