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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM(Page 2 of s) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer I <br /> Identitv Tank ID from Section III for each Manufacturer <br /> Xerxes A x B Lxj C x❑ I D Ej <br /> --A-LJ I B 1 C ❑ I D <br /> Test Method Used- ❑Manufacturer Guidelines(Specify)- <br /> ❑x Industry Code or Engineering Standard(Specify). Vacuum Gauge, Vacuum Pump <br /> ❑Engineered Method(Specify) <br /> Attach the testing #of Attached Pages <br /> procedures and al!documentation to determine the results. <br /> Tank Containment Testing Training and Certifications{List applicable certifications) Expiration Dale <br /> Incon level 4 cert# 1005763709 6/25/2020 <br /> ICC Tech Cert# 8728836 7/22/2019 <br /> V1. COMMENTS <br /> Provide any additional comments here. <br /> Performed vacuum test on both annular @-10 psi <br /> -All test passed <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Xerxes A p B x C x p <br /> A B Lj C Li I D Lj <br /> Test Method Used ❑Manufacturer Guidelines(Specify), <br /> ❑x Industry Code or Engineering Standard(Specify) Pressure Gauge , Nitrogen <br /> ❑Engineered Method(Specify) <br /> Attach the testingQ #of Attached Pages <br /> procedures and all documentation required to determine the results. <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> Incon Level 4 Tech Cert# 1005763709 6/25/2020 <br /> ICC Tech Cert# 8728836 7/22/2019 <br /> Interstitial Communication Verification Method Used <br /> Test Boots <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> Performed pressure test on the secondary line <br /> 87 product line <br /> 87 siphon line <br /> 91 product line <br /> -All test passed after repairs <br /> Replaced secondary test boot on 87 siphon <br /> ID=Identification <br />