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Underground Storage Tank <br /> Spill Container Testing Report Form <br /> 6. SPILL CONTAINER DETAILS <br /> Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br /> Tank ID Gasoline-91 <br /> Spill Container Manufacturer: OPw <br /> Method of Cathodic Protection ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic <br /> Z Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum ® Yes ❑ Yes © Yes ❑ Yes <br /> capacity five gallons excluding 0 No* 0 No* M No* ❑ No* <br /> riser volume? <br /> Method to keep spill container ❑ Drain ❑ Drain ❑ Drain ❑ Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results 0 Pass ❑ Pass ❑ Pass ❑ Pass <br /> ❑ Fail I ❑ Fail I ❑ Fail I ❑ Fail <br /> Tank ID <br /> Spill Container Manufacturer: <br /> Method of Cathodic Protection 0 Nonmetallic ❑ Nonmetallic [r] Nonmetallic ❑ Nonmetallic <br /> ® Other © Other ❑ Other ❑ Other <br /> Is the spill container minimum ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> capacity five gallons excluding ❑ No* ❑ No* © No* ❑ No* <br /> riser volume? <br /> Method to keep spill container ® Drain ❑ Drain ❑ Drain ❑ Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results ❑ Pass ❑ Pass ❑ Pass ❑ Pass <br /> Q Fail ❑ Fail © Fail © Fail <br /> 8. COMMENTS <br /> Describe all answers marked "Other," "No,"or "Fail"and each proposed remedy. <br /> CUPA on site to witness test. <br /> * Mark here if: <br /> 0 Spill containers do not have a minimum capacity of five gallons and require replacement. <br /> Additional copies of this page may be attached. <br /> Page 2 of 2 <br />