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GPH = Gallons per hour, Y = Yes, N = No, NA = Not applicable, VPH = Vacuum/Pressure/Hydrostatic, ID = Identification UST Spill Bucket Integrity Testing Form 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 T-4 Diesel 2. Product stored 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 5. Construction Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled Single-walled Double-walled 6. Test type Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled Hydrostatic Vacuum Single-walled Double-walled 7. Spill bucket type Product Vapor Product Vapor Product Vapor Product Vapor Product Vapor Product 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.)? 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 ¾” 11 ¾” Visual Failure 13. Test start time 9:00am 9:00am 9:00am 14. Ending level 12” 11 ¾” 11 ¾” 15. Test end time 10:00am 10:00am 10:00am 16. Test period 1 hour 1 hour 1 hour 17. Level change 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 1/8 inch; Vacuum single-walled only; Maintain at least 26 inches water column; Vacuum double-walled; maintain at least 12 inches water column. Comments: 1. T-4 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. Testing company name: Tester’s name: Richard Thomas Date : 05/22/19 Tester’s signature: