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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM{Page s of s) <br /> XVII. FILL RISER SUMP TESTING INFORMATION <br /> Manufacturer I ldenti Tank ID from Section III for each Manufacturer <br /> XerxesA x❑ I B x 1 C ❑x D ❑ <br /> A Lj I B❑ I C ❑ I D ❑ <br /> Test Method Used ❑Manufacturer Guidelines(Specify) <br /> ❑x Industry Code or Engineering Standard(Specify) Incon TS-STS, Probes, Hydrostatic <br /> ❑Engineered Method(Specify) <br /> # <br /> Attach the testing procedures and all documentation required to determine the results. of Attached Pages <br /> Fill Riser Sump 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 /> XVIII. COMMENTS <br /> Provide any additional comments here <br /> Performed hydrostatic testing on all fill sumps <br /> -AII test passed <br /> XIX. VENT/TRANSITION SUMP TESTING INFORMATION <br /> Manufacturer ldentifv Vent f Transition Sump ID from Section III for each Manufacturer <br /> aLJ I b Ll c❑ d ❑ <br /> a ❑ I b❑ C ❑ I d <br /> Test Method Used. ❑Manufacturer Guidelines(Specify) <br /> ❑Industry Code or Engineering Standard(Specify) <br /> ❑Engineered Method(Specify) <br /> Attach the testing #of Attached Pages <br /> procedures and all documentation to determine the results. <br /> Vent 1 Transition Sump Testing Training and Certifications(List applicable certifications) Expiration Date <br /> XX. COMMENTS <br /> Provide any additional comments here <br /> 1D=Iderilifira6on <br />