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SWRCB , January 2002 Page 4 of 13 <br /> 4. TANK ANNULAR TESTING <br /> Test Method Developed By : ❑ Tank Manufacturer J Industry Standard ❑ Professional Engineer <br /> ❑ Other (Specify) <br /> Test Method Used : ❑ Pressure A Vacuum ❑ Hydrostatic <br /> ❑ Other (Specify) <br /> Test Equipment Used : Analog Vacuum Gauge Equipment Resolution : +/-0 . 25 <br /> r <br /> _ . W16101�W MEMO= <br /> 1112� <br /> _ Tank # 5 Tank # Tank # Tank # <br /> Is Tank Exempt From Testing? l K Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Tank Capacity : 12 , 000 Gallons <br /> Tank Material : Fiberglass <br /> Tank Manufacturer: Xerxes <br /> Product Stored : 91 Premium <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test: <br /> Test Start Time : <br /> Initial Reading (RI) : <br /> Test End Time : <br /> Final Reading (RF) : <br /> Test Duration : <br /> Change in Reading (RF-RI) : <br /> Pass/Fail Threshold or Criteria: <br /> Test Result : ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Was sensor removed for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br /> Was sensor properly replaced and ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br /> verified functional after testing? <br /> Comments — (include information on repairs made prior to testing, and reconzniended follotin-up for failed tests) <br /> * All Tanks Are Liquid Fill " <br /> ' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary <br /> containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment <br /> testing. { California Code of Regulations, Title 23 , Section 2637(a) (6) } <br />