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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM ( Page s of s) <br /> IX . REMOTE FILL PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> A 1 B ❑ = C ❑ D ❑ <br /> A ❑ I B ❑ I C ❑ I D ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify) : <br /> ❑ Industry Code or Engineering Standard (Specify) : <br /> ❑ Engineered Method (Specify) : <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Remote Fill Piping Containment Testing Training and Certifications (List applicable certifications) Expiration Date <br /> Interstitial Communication Verification Method Used : <br /> X. COMMENTS <br /> Provide any additional comments here. <br /> NA- Section III -No Remote Fill Piping Containment at this UST Facility , <br /> XI . VENT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer j Identify Tank ID from Section III for each Manufacturer <br /> Smith FRP A ❑X B C ❑x D ❑ <br /> A ❑ I B ❑ I C ❑ I D ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify) : <br /> Z Industry Code or Engineering standard (Specify) : PEI / RP1200 - 17/Fiberglass Pipe/5 Psi 1 Hour <br /> ❑ Engineered Method (Specify) : <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 2 <br /> Vent Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC UST Service Technician #5246802 - UT 3/20/2021 <br /> Underground Storage Tank Tester License #90 - 1120 12 /31 /2019 <br /> Interstitial Communication Verification Method Used : <br /> NA-Section III -Vent Piping is direct bury at Vent Stack . <br /> XII . COMMENTS <br /> Provide any additional comments here. <br /> ID = Identification <br /> t <br /> E <br />