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Underground Storage Tank Secondary Containment Testing Report Form 6. TANK SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer ❑ Industry Standard ❑ Professional Engineer Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Tank ID Tank Manufacturer Tank Capacity Test Start Time Initial Reading Test End Time Final Reading Change in Reading Pass/Fail Criteria Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail 7. PIPE SECONDARY CONTAINMENT TEST Test Method Developed by ❑ Manufacturer 10 Industry Standard ❑ Professional Engineer Test Type 12 Pressure ❑ Vacuum ❑ Hydrostatic Test Equipment Used: Nitrogen / Pressure Gauges Pipe Run ID Diesel Syphon T1 Dsl Trans to 19-20 T2 Dsl Complete Line to 21-25 Disp 27-28 Satellites Pipe Manufacturer NOV Fiberglass Systems NOV Fiberglass Systems NOV Fiberglass Systems NOV Fiberglass Systems Test Start Time 9:00am 9:00am 9:00am 10:30am Initial Reading 5 psi 5 psi 5 psi 5 psi Test End Time 10:00am 10:00am 10:00am 11 :30am Final Reading 5 psi 5 psi 5 psi 5 psi Change in Reading 0 psi 0 psi 0 psi 0 psi Pass/Fail Criteria 0 psi 0 psi 0 psi 0 psi Tightness Test Results 0 Pass ❑ Fail 1 12 Pass ❑ Fail 1 10 Pass ❑ Fail 2 Pass ❑ Fail Pipe Run ID Dlsp 29-30 Satellites T4 87 Product Complete Line Pipe Manufacturer NOV Fiberglass Systems NOV Fiberglass Systems Test Start Time 10:30am 9:00am Initial Reading 5 psi 5 psi Test End Time 11 :30am 5 psi Final Reading 5 psi 5 psi Change in Reading 0 psi 0 psi Pass/Fail Criteria 0 psi 0 psi Tightness Test Results ® Pass ❑ Fail I [;?I Pass ❑ Fail I ❑ 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