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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 ❑ Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used: <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 /> Tightness Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> 7. PIPE SECONDARY CONTAINMENT TEST <br /> Test Method Developed by ❑ Manufacturer 0 Industry Standard ❑ Professional Engineer <br /> Test Type 0 Pressure ❑ Vacuum ❑ Hydrostatic <br /> Test Equipment Used:Pressure Gauge <br /> Pipe Run ID 87 91 <br /> Pipe Manufacturer Smith Smith <br /> Test Start Time 09:25 09:25 <br /> Initial Reading 5PSI 5PSI <br /> Test End Time 10:25 10:25 <br /> Final Reading 5PSI 5PSI <br /> Change in Reading 0 0 <br /> Pass/Fail Criteria +i-0 +i-0 <br /> Tightness Test Results p Pass ❑ Fail 0 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 />