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FEB/24/2021/WED 06: 06 PM Tracy Truck Stop FAX No, 209832 2312 P, 007 <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> ' I i li; 'i�1�9i�11 ISI!,,`,., � 1 i 1 ''a� s I R, � „ •e { <br /> Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <br /> Sump/UDC ID <br /> Sump Manufacturer <br /> Sump Depth (inches) <br /> Sump Bottom to Top of <br /> Highest Pipe Penetration <br /> (inches) <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 ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Sump/UDC ID <br /> Sump Manufacturer <br /> Sump Depth (inches) <br /> Sump Bottom to Top of <br /> Highest Pipe Penetration <br /> (inches) <br /> r <br /> t Start Time <br /> EEndTime <br /> g <br /> Final Reading <br /> Change in Reading <br /> Pass/Fail Criteria <br /> Tightness Test Results ❑ Pass ❑ Fail L01Pa]ssLEDFaIiII03LPass]03LFail <br /> E3 Pass LJ 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 4 of <br />