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UST Spill Bucket ♦, CGRS Integrity Testing Form SOLUTIONS DELIVERED Underground Storage Tanks ( UST) Program Instructions on Page 3 Purpose : This procedure is to test the leak integrity of single - and double -walled spill buckets . See reverse side for basic hydrostatic testing instructions . Consult PEI/RP1200 , Section 6 .2 for hydrostatic test method , Section 6 . 3 for single -walled vacuum test method , and Section 6 .4 for double -walled vacuum test method . Testing Information 1 . Tank number T-1 Diesel T-2 87 T-3 91 T4 Diesel 2, Prod uctstored Diesel #2 87 unleaded 91 supreme Waste Oil 3. Spill bucket capacity 5 gallons 5 gallon 5 gallon 5 gallons 4. Manufacturer OPW OPW OPW CNI ® Single-walled ® Single-walled ® Single-walled ® Single -walled ❑ Single-walled ❑ Single-walled 5. Construction ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ® Hydrostatic ® Hydrostatic ® Hydrostatic ® Hydrostatic ❑ Hydrostatic ❑ Hydrostatic ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Vacuum ❑ Single -walled ❑ Single -walled ❑ Single-walled ❑ Single-walled ❑ Single-walled ❑ Single -walled 6. Test pe ❑ Double -walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ❑ Double-walled ® Product N Product ® Product ® Product ❑ Product ❑ Product 7 . Spill bucket type ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor ❑ Vapor 8 . Liquid and debris removed from spill bucket:* ® Yes ❑ No ® Yes ❑ No ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 9. Visual inspection (No cracks , loose parts or separation of the bucket from the fill pipe,)? E Pass [] Fail ® Pass ❑ Fail ® Pass ❑ Fail [] Pass ® Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail 10. Tank riser cap included in test? ® Yes ❑ No ❑ NA ® Yes ❑ No ❑ NA ® Yes ❑ No ❑ NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 11 . Is drain valve included in test? ® Yes ❑ No ❑ NA ® Yes ❑ No ❑ NA ® Yes ❑ No ❑ NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 12. Starting level 12" 11 %53 11 WI Visual Failure 13. Test start time 9 : 00am 9 : 00am 9 : 00am 14. Ending level 12" 11 %35 11 %15 15. Test end time 10 : 00am 10 : 00am 10 : 00am 16 . Test period 1 hour 1 hour 1 hour 17. Level chane 0 . 0" 0 . 0 " 0 . 0 " Test results : ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ® Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 118 inch; Vacuum single-walled only; Maintain at least 26 inches water column; Vacuum double-walled; maintain at least 12 inches water column. Comments : 1 . T4 Waste Oil spill container is damaged and is torn / cut all around entire container. Recommend to replace with OPW below grade spill container. * All liquids and debris must be disposed of properly. 60 CGRS Testing company name : I S�UUTIaNS Tester's name : Richard Thomas Date : 05/22/19 Tester's signature : C4� c� GPH = Gallons per hour, Y = Yes, N = No, NA = Not applicable, VPH = Vacuum/Pressure/Hydrostatic, ID = Identification