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Underground Storage Tank <br /> Spill Containment Testing Report Form <br /> 6. SPILL CONTAINMENT DETAILS <br /> Test Method Developed by ❑ Manufacturer ❑✓ Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum Z Hydrostatic <br /> ❑Check this box if Appendix 6.1 continuation page is attached. <br /> Tank ID T1 : Regular T2 : Premium T3 : Diesel <br /> Spill Containment Manufacturer: cNl cNl cNl <br /> Method of Cathodic Protection ❑✓ Nonmetallic ❑✓ Nonmetallic ❑✓ Nonmetallic ❑Nonmetallic <br /> ❑Other ❑Other ❑Other ❑Other <br /> Is the spill containment ❑✓ Yes ❑✓ Yes ❑✓ Yes ❑Yes <br /> minimum capacity five gallons <br /> excluding riser volume? ❑No* ❑No* ❑No* ❑No* <br /> Method to keep spill ❑✓ Drain ❑✓ Drain ❑✓ Drain ❑Drain <br /> containment empty ❑Pump ❑Pump ❑Pump ❑Pump <br /> ❑Other ❑Other ❑Other ❑Other <br /> Spill Containment Test Results ❑✓ Pass ❑✓ Pass ✓❑Pass ❑Pass <br /> ❑Fail ❑Fail ❑Fail ❑Fail <br /> Tank ID <br /> Spill Containment Manufacturer: <br /> Method of Cathodic Protection ❑Nonmetallic ❑Nonmetallic ❑Nonmetallic ❑Nonmetallic <br /> ❑Other ❑Other ❑Other ❑Other <br /> Is the spill containment ❑Yes ❑Yes ❑Yes ❑Yes <br /> minimum capacity five gallons <br /> excludingriser volume? <br /> [:]No* [:]No* [:]No* ❑No* <br /> Method to keep spill ❑Drain ❑Drain ❑Drain ❑Drain <br /> containment empty ❑Pump ❑Pump ❑Pump ❑Pump <br /> ❑Other ❑Other ❑Other ❑Other <br /> Spill Containment Test Results El Pass El Pass El Pass El Pass <br /> ❑Fail ❑Fail ❑Fail ❑Fail <br /> 7. COMMENTS <br /> Verification for Overfill Prevention Testing. <br /> *❑Check this box if any spill containment has less than 5 gallons capacity and requires <br /> replacement. <br /> Describe all answers marked "Other," "No,"or "Fail'and each proposed remedy in Section 7. <br /> Page 2 of 2 <br />