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Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> 6. TANK SECONDARY CONTAINMENT TEST <br /> Test Method Developed by ❑ Manufacturer 0 Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure El Vacuum ❑ Hydrostatic <br /> Test Equipment Used:4" Dial Gauge <br /> Tank ID 00010u001 <br /> Tank Manufacturer Modern Welding <br /> Tank Capacity 1,000 gal <br /> Test Start Time 9:00am <br /> Initial Reading -10" Hg <br /> Test End Time 10:00am <br /> Final Reading -10" Hg <br /> Change in Reading 0 <br /> Pass/Fail Criteria 0 <br /> 11 Tightness Test Results ❑✓ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> 7. PIPE SECONDARY CONTAINMENT TEST <br /> Test Method Developed by ❑ Manufacturer ❑✓ Industry Standard ❑ Professional Engineer <br /> Test Type ❑✓ Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: 4" Dial Gauge <br /> Pipe Run ID Supply Secondary Return Secondary Vent Secondary <br /> Pipe Manufacturer Western Fiberglass Western Fiberglass A.O. Smith <br /> Test Start Time 9:00am 9:00am 9:00am <br /> Initial Reading 5 psi 5 psi 5 psi <br /> Test End Time 10:00am 10:00am 10:00am <br /> Final Reading 5 psi 5 psi 5 psi <br /> Change in Reading 0 0 0 <br /> Pass/Fail Criteria 0 0 0 <br /> Tightness Test Results ❑✓ 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 />