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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 0 I B x❑ IC ❑ D ❑ <br /> Modern Weldinq A ❑ B ❑ I C z I D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> X Industry Code or Engineering Standard(Specify): *PEI/RP1200-17/Glass/Steel Tank/-10"Hg. 1 hr. <br /> ❑Engineered Method(Specify). <br /> Attach the testing procedures and all documentation required to determine the results. #of Attached Pages2 <br /> Tank Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> ICC Service Technician #5246802-UT 3/21/2021 <br /> Underground Storage Tank Tester License #90-1120 12/31/2019 <br /> VI. COMMENTS <br /> Provide any additional comments here. <br /> Tank A is a 15K Double Wall Fiberglass designated for Regular 87 Octane Gasoline. <br /> Tank B is a 15K Double Wall Fiberglass designated for Super 91 Octane Gasoline. <br /> `Tank C is a 12K Double Wall Glass/Steel designated for Diesel. <br /> NA-Section III-Tanks A& B have Brine Filled Tank Secondary Containment and are Exempt from periodic testing. <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Smith FRP A ❑x I B x❑ I C ❑x D ❑ <br /> A 1 B I C ❑ I D ❑ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ❑x Industry Code or Engineering Standard(Specify): PEI/RP1200-17/Fiberglass Pipe/5 Psi 1 hr. <br /> ❑ Engineered Method (Specify): <br /> #of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 2 <br /> Product Piping Containment Testing Training and Certifications(List applicable certifications.) Expiration Date <br /> ICC Service Technician #5246802-UT 3/20/2021 <br /> Under round Storage Tank Tester License #90-1120 12/31/2019 <br /> Interstitial Communication Verification Method Used: <br /> Release pressure at end of Product Piping Containment Runs, at UDC's where applicable. <br /> VIII. COMMENTS <br /> Provide any additional comments here. <br /> ID=Identification <br />