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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 5 of 6) <br /> XVII. FILL RISER SUMP TESTING INFORMATION <br /> Manufacturer I Identify Tank ID from Section III for each Manufacturer <br /> Fiberglass A ® B Z I C D <br /> A ❑ B❑ C ❑ I D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ® Industry Code or Engineering Standard(Specify): 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 /> ICC UST Certification#8819839 10/25/2019 <br /> INCON TS-STS L4-Certification#1019623710 9/24/2020 <br /> XVIII. COMMENTS <br /> Provide any additional comments here. <br /> 87 and 91 Fill sumps failed due to conduit penetrations. <br /> XIX. VENT/TRANSITION SUMP TESTING INFORMATION <br /> Manufacturer Iden/' Vent 1 Transition Sump ID from Section III for each Manufacturer <br /> a I b❑ I c ❑ I d ❑ <br /> a I b I c Lj I d ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ❑Industry Code or Engineering Standard(Specify): <br /> ❑Engineered Method(Specify): <br /> # <br /> Attach the testing procedures and aff documentation required to determine the results. of Attached Pages <br /> Vent/Transition Sump Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> XX. COMMENTS <br /> Provide any additional comments here. <br /> NIA <br /> ID=Identification <br />