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Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> Test Method Developed by ❑ Manufacturer ❑ Industry Standard X Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum X Hydrostatic <br /> Test Equipment Used: Cadwell Leel Indicator, test fluid (1-120) <br /> SumplUDC 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 ❑ Fall Pass ❑ Fail Pass ❑ Fail Pass ❑ Fail <br /> Sump/UDC ID <br /> Sump Manufacturer j <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 /> Additional copies of this page may be attached <br /> All tests marked "Fall"and any repairs made before or during the tightness fest must be described in <br /> the COMMENTS section. <br /> Page 3 of 5 <br />