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FEB/24/2021/WED 06: 06 PM Tracy Truck Stop FAX No, 209832 2312 P, 005 <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> N111 ! �, <br /> �V� <br /> Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ <br /> Test Type Professional Engineer <br /> 10Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <br /> Tank ID <br /> Tank Manufacturer <br /> Tank Capacity i <br /> Test Start Time <br /> Initial Reading <br /> Test End Time <br /> Final Reading <br /> Change in Reading <br /> Pass/Fail Criteria <br /> Tightness Test Results El Pa ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> �.i � �,� i i�V�V li F�41, i I �i�s i�,5 ��I!°{tll, ll 1. i�i��ill,;�i <br /> Test Method Developed by ❑ Manufacturer ® Industry Standard 11 Professional Engineer <br /> Test Type ® Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: Pressure Gauge in Psi/Nitrogen <br /> Pipe Run ID Diesel <br /> Pipe Manufacturer Smith FRP <br /> Test Start Time 12:20 <br /> Initial Reading 5 Psi <br /> Test End Time 1:20 <br /> Final Reading 5 Psi <br /> Change in Reading 0 Psi <br /> Pass/Fail Criteria No Loss <br /> Tightness Test Results N Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Pipe Run ID <br /> Pipe Manufacturer <br /> Test Start Time <br /> Initial Reading <br /> Test End Time <br /> Final Reading <br /> Change in Reading <br /> Pas /Fail Criteria <br /> Tightness Test Results ❑ Pass ❑ Fail 1 ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Additional copies of this page may be attached. <br /> All tests marked "Fail"and any repairs made before or during the tightness test must be described in <br /> the COMMENTS section. <br /> Received Time Feb, 24. 2021 6 : 02PM No- 6614 Page 2of5 <br />