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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 3 of 6) <br /> IX. REMOTE FILL PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> A ❑ B ❑ C ❑ D ❑ <br /> A ❑ B ❑ I co 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 /> NA-Section III -No Remote Fill Piping Containment at this UST Facility. <br /> I <br /> E <br /> i <br /> Et <br /> XI . VENT PIPING CONTAINMENT TESTING INFORMATION <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> Smith FRP A ❑x B F] c ❑ D ❑ <br /> A ❑ B ❑ C D ❑ <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify) : <br /> i <br /> E ❑x Industry Code or Engineering Standard (Specify) : <br /> PEI / RP1200 - 17/ Fiberglass Pipe/5 Psi 1 Hour <br /> ❑ Engineered Method (Specify) : <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. 2 <br /> Vent Piping Containment Testing Training and Certifications (List applicable certifications.) Expiration Date <br /> ICC UST Service Technician #5246802- UT 3/20/2021 <br /> Underground Storage Tank Tester License #90- 1120 12/31 /2019 <br /> Interstitial Communication Verification Method Used : <br /> Release pressure at Vent Stack test boot . Note : No Vent Box Sump present at this UST Facility . <br /> XII . COMMENTS <br /> Provide any additional comments here. <br /> Vent Piping A of this report is for DiesekNorth . <br /> ID = Identification <br />