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Underground Storage Tank <br /> Spill Container Testing Report Form <br /> Test Type ❑ Pressure ❑ Vacuum x Hydrostatic <br /> Tank ID T1 : 87M West T1 : 87M East T2 : 87 Syphon T3 : 91 <br /> Spill Container Manufacturer: OPW OPW OPW OPW <br /> Method of Cathodic Protection xNonmetallic xNonmetallic xNonmetallic xNonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum xYes xYes xYes xYes <br /> capacity five gallons excluding riser ❑ No* ❑ No* ❑ No* F1 No* <br /> volume? <br /> xDrain xDrain xDrain xDrain <br /> Method to keep spill container ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> empty ❑ Other ❑ Other ❑ Other ❑ Other <br /> xPass xPass xPass xPass <br /> Spill Container Test Results <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> Tank ID <br /> Spill Container Manufacturer: <br /> Method of Cathodic Protection ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic <br /> El Other ❑ Other ❑ Other El Other <br /> Is the spill container minimum ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> capacity five gallons excluding riser ❑ No* ❑ No* ❑ No* ❑ No* <br /> volume ? <br /> ❑ Drain ❑ Drain ❑ Drain ❑ Drain <br /> Method to keep spill container ❑ pump ❑ Pump ❑ Pump ❑ Pump <br /> empty ❑ Other ❑ Other ❑ Other ❑ Other <br /> El Pass ❑ Pass ❑ Pass ❑ Pass <br /> Spill Container Test Results <br /> ❑ Fail ❑ Fail [] Fail ❑ Fail <br /> I3y �oMI�nEN`V$ <br /> < : <br /> Describe allanswers marked "Other, ""No, " or "Fail" and each proposed remedy. <br /> * Mark here if: <br /> ❑ Spill containers do not have a minimum capacity of five gallons and require replacement . <br /> RECEIVED <br /> OCT 18 2022 <br /> Additional copies of this page may be attached. <br /> ENVIRONMENTAL HEALTH Page 2 of 2 <br /> DEPARTMENT <br />