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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 3 of 6) <br /> Ixw REMOTE FILL` PIPING 'CONTAINMENT TESTING INFORMATION <br /> Manufacturer I Identify Tank ID from Section III for each Manufacturer <br /> A ❑ I B ❑ I 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 /> x1a VENT PIPING CONTAINMENT :TESTING , INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> AO Smith A ❑X B ❑ C ❑ D ❑ <br /> A ❑ I B ❑ I C ❑ I D ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify): <br /> i <br /> Q Industry Code or Engineering Standard (Specify): PEI RP1200 <br /> i <br /> ❑ Engineered Method (Specify): <br /> k <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Vent Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> i <br /> i <br /> i <br /> i <br /> I <br /> Interstitial Communication Verification Method Used : <br /> N/A <br /> XII . COMMENTS <br /> Provide any additional comments here. <br /> UE0420001 Vent - R E 1) <br /> Y <br /> 5 PSI for one hour, 9 : 00am to 10 : 00am - Passed ik <br /> s _ . -A a <br /> 0 E PAIR <br /> ID = Identification <br />