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E <br /> UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 2 of 6) <br /> V. TANK SECONDARY CONTAINMENT INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Xerxes A © B ❑ C ❑ D ❑ <br /> A ❑ I B ❑ I C ❑ I D ❑ <br /> Test Method Used : ❑ Manufacturer GuidelinesS eci <br /> ( P fy): <br /> ® Industry Code or Engineering Standard (Specify) : Vacuum <br /> ❑ Engineered Method (Specify): <br /> Attach the testing procedures and all documentation required to determine the results. # of Attached Pages <br /> Tank Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC UST Certification # 8819839 10/25/2019 <br /> VI . COMMENTS <br /> Provide any additional comments here. <br /> Diesel Tank tested at 1 : 15 pm at 7 hg ended at 2 : 15 pm at 7 hg . <br /> Inspector Shewit Woldearegay on site. <br /> VII . PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identifv Tank ID from Section III for each Manufacturer <br /> A ❑ B ❑ I C ❑ ID ❑ <br /> A ❑ B ❑ IC ❑ D ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify): <br /> ® Industry Code or Engineering Standard (Specify) : Pressure <br /> ❑ Engineered Method (Specify): <br /> Attach the testing procedures and all documentation required to determine the results. # of Attached Pages <br /> Product Piping Containment Testing Training and Certifications (List applicable certifications) Expiration Date <br /> ICC UST Certification # 8819839 10/25/2019 <br /> Interstitial Communication Verification Method Used : <br /> VIII . COMMENTS <br /> Provide any additional comments here. <br /> ID = Identification <br />