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t <br /> UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 6 of 6) <br /> XXI . UNDER-DISPENSER CONTAINMENT TESTING INFORMATION <br /> Manufacturers IdentifyUDC ID from Section III for each Manufacturer <br /> Western Fiberglass 1 ✓❑ 2 ❑✓ 3 0✓ 1 4 ✓❑ 1 5 ✓❑ 1 6 ✓❑ <br /> 7 ❑✓ 8 ❑ 9 ✓❑ 1 10 ✓❑ 1 11 E1--L 12 ❑ <br /> 1 ❑ 2 ❑ 3 ❑ 1 4 ❑ 1 5 ❑ 6 ❑ <br /> 7 ❑ 1 8 ❑ 1 9 ❑ 1 10 ❑ 11 ❑ 12 ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify) : <br /> ® Industry Code or Engineering Standard (Specify) : Hydrostatic <br /> ❑ Engineered Method (Specify): <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> UDC Testing Training and Certifications (List applicable certifications) Expiration Date <br /> ICC UST Certification # 8819839 10/ 15/2021 <br /> INCON TS-STS L4 - Certification # 1019623710 9/24/2020 <br /> XXII . COMMENTS <br /> Provide any additional comments here. <br /> UDC 1 /2 , 15/16 Failed due to torn penetration boots . <br /> UDC 3/4 , 5/6 , 7/8 , 9/10 , 11 /12 , 13/14 , 17/18 , 19/20 Failed due to torn test boots . <br /> If the facility has more components than this form accommodates, additional copies of these pages maybe attached. <br /> UDC = Under-Dispenser Containment; ID = Identification <br /> E <br /> i <br />