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Underground Storage Tank Secondary Containment Testing Report Form 16. TANK SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: N/A Tank ID 87 91 Tank Manufacturer Smith Smith Tank Capacity 10:30 am 10:30 am Test Start Time 3 psi 3 psi Initial Reading 11:30 am 11:30 am Test End Time 3 psi 3 psi Final Reading 0 0 Change in Reading 0 0 Pass/Fail Criteria p Pass ❑ Fail 0 Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Tightness Test Results ❑ Pass ❑ Fail I ❑ Pass ❑ Fail I ❑ Pass ❑ Fail I ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Pressure Guages Pipe Run ID 87 91 Pipe Manufacturer Smith Smith Test Start Time 10:30 am 10:30 am Initial Reading 3 psi 3 psi Test End Time 11:30 am 11:30 am Final Reading 3 psi 3 psi Change in Reading 0 0 Pass/Fail Criteria 0 0 Tightness Test Results p Pass ❑ Fail 0 Pass ❑ Fail ❑ Pass ❑ Fail ❑ 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 I ❑ 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