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Underground Storage Tank Secondary Containment Testing Report Form Test Method Developed by ❑ Manufacturer X Industry Standard ❑ Professional Engineer J Test Type ❑ Pressure X Vacuum ❑ Hydrostatic LTest Equipment Used:vacuum motor, gauges in -Hg, stop watch /timer Tank lD Regular T Supreme Diesel Tank Manufacturer Xexes Xexes Xexes Tank Capacity Test Start Time Initial Reading Test End Time Final Reading Change in Reading Pass/Fail Criteria Tightness Test Resulfi7 ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer X Industry Standard ❑ Professional Engineer Test Type X Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: PSI pressure gauges, air, stop watch /timer Pipe Run ID Regular line Supreme line Diesel line Regular vent Pipe Manufacturer Ameron Ameron Ameron Ameron Test Start Time 60minutes 60minutes 60 minutes 60minuies Initial Reading 5psi 5psi 5psi 5psi Test End Time 0 minutes 0 minutes 0 minutes 0 minutes Final Reading 5psi 5psi 5psi 5psi Change in Reading 0 0 0 0 Pass/Fail Criteria 0160 minutes 0160 minutes 0/60 minutes 0/60 minutes Tightness Test Results X Pass ❑ Fail X Pass ❑ Fail X Pass ❑ Fail X Pass ❑ Fail Pipe Run ID Supreme vent Diesel vent Vapor return Pipe Manufacturer Ameron Arneron Ameron Test Start Time 60minutes 60minutes 60minutes Initial Reading 5psi 5psi 5psi Test End Time 0 minutes 0 minutes 0 minutes Final Reading 5psi 5psi 5psi Change in Reading 0 0 0 Pass/Fail Criteria 0160 minutes 0/60 minutes 0/60 minutes 0160 minutes Tightness Test Results }[ Pass ❑ Fail X Pass ❑ Fal! X Pass ❑ Fail ❑ Pass ❑ Fail Additional copies of this page may be attached. ' 8. SUMPIUDC TEST All tests marked "Fail"and any repairs made before or during the Tightness fest must be described in the COMMENTS section. Page 2 of 5