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Underground Storage Tank <br /> Spill Container Testing Report Form <br /> Service Technician §jgnature Date Total # of Pages <br /> 23 7Z <br /> 6. SPILL CQ AINER DETAILS <br /> Test Method Developed by ❑ Manufacturer 0 Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum Hydrostatic <br /> Tank ID C6-::�- 91 lei?5-e- ( <br /> Spill Container Manufacturer: G rw 6 f w f V✓ <br /> Method of Cathodic Protection D�Nonmetallic 9 Nonmetallic 15� Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum RLYes []9_Yes .Z Yes ❑ Yes <br /> capacity five gallons excluding ❑ No* ❑ No* ❑ No* ❑ No* <br /> riser volume? <br /> Method to keep spill container I5�-Drain Drain C51�Drain ❑ Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results 9 Pass EZ Pass 1Y,Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> Tank ID <br /> Spill Container Manufacturer: <br /> Method of Cathodic Protection ❑ Nonmetallic ❑ Nonmetallic ❑ 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 /> ❑ Drain ❑ Drain ❑ Drain ❑ Drain <br /> Method to keep spill container ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> empty ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results ❑ Pass ❑ Pass ❑ Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> 8. 'COMMENTS <br /> Additional copies of this page may be attached. <br /> Page 2 of 2 <br />