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Underground Storage Tank Secondary Containment Testing Report Form 6. TANK SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer M Industry Standard ❑ Professional Engineer Test Type ❑ Pressure M Vacuum ❑ Hydrostatic Test Equipment Used: Vacuum Gauge Tank ID 87 Annular 91 Annular Tank Manufacturer Unknown Unknown Tank Capacity 15000 Gal 10000 Gal Test Start Time 9:50 AM 9:55 AM Initial Reading 5 HG 5 HG Test End Time 10:50 AM 10:55 AM Final Reading 5 HG 5 HG Change in Reading 0 HG 0 HG Pass/Fail Criteria 0 HG 0 HG 11 Tightness Test Results M Pass ❑ Fail 1 M Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Pipe Run ID 87(Disp3-4,7-8) 87(Disp1-2,5-6) 91(Disp3-4,7-8) 91(Disp1-2,5-6) Pipe Manufacturer Unknown Unknown Unknown Unknown Test Start Time 9:35 AM 9:40 AM 9:35 AM 9:45 AM Initial Reading 5 PSI 5 PSI 5 PSI 5 PSI Test End Time 10:35 AM 10:40 AM 10:35 AM 10:45 AM Final Reading 5 PSI 5 PSI 5 PSI 5 PSI Change in Reading 0 PSI 0 PSI 0 PSI 0 PSI Pass/Fail Criteria 0 PSI 0 PSI 0 PSI 0 PSI Tightness Test Results M Pass ❑ Fail M Pass ❑ Fail M Pass ❑ Fail M Pass ❑ Fail Pipe Run ID Pipe Manufacturer Test Start Time Initial Reading Test End Time Final Reading Change in Reading Pass/Fail Criteria Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Additional copies of this page may be attached. All tests marked "Fail"and any repairs made before or during the tightness test must be described in the COMMENTS section. Page 2 of 5