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Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> 6. TANK SECONDARY CONTAINMENT TEST <br /> Test Method Developed by M Manufacturer M Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure M Vacuum ❑ Hydrostatic <br /> Test Equipment Used: 0-30inHg. 4" Vacuum Gauges w/ 0.05 graduations <br /> Tank ID <br /> Tank Manufacturer <br /> Tank Capacity <br /> Test Start Time <br /> Initial Reading <br /> Test End Time <br /> Final Reading <br /> Change in Reading <br /> Pass/Fail Criteria <br /> 11 Tightness Test Results ❑ Pass ❑ Fail I ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> 7. PIPE SECONDARY CONTAINMENT TEST <br /> Test Method Developed by M Manufacturer M Industry Standard ❑ Professional Engineer <br /> Test Type M Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: Dual 0-15psi 4" Pressure Gauges w/ 0.05 graduations <br /> Pipe Run ID T-3 91 <br /> Pipe Manufacturer A.O. Smith <br /> Test Start Time 2:30pm <br /> Initial Reading 5.Opsi <br /> Test End Time 3:30pm <br /> Final Reading 5.Opsi <br /> Change in Reading O.Opsi <br /> Pass/Fail Criteria No Loss <br /> Tightness Test Results M Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Pipe Run ID <br /> Pipe Manufacturer <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 "Fail"and any repairs made before or during the tightness test must be described in <br /> the COMMENTS section. <br /> Page 2 of 5 <br />