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Underground Storage Tank <br /> Spill Containment Testing Report Form <br /> 6. SPILL CONTAINMENT DETAILS <br /> Test Method Developed by ❑ Manufacture{ V Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum A Hydrostatic <br /> Check this box if Appendix 5.1 continuation page is attached. <br /> Tank ID T1: Regular T2: Premium TI Diesel <br /> Spill Containment Manufacturer: OPw OPw OPw <br /> Method of Cathodic Protection 21 Nonmetallic 0 Nonmetallic R1 Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill containment 0 yes 0 Yes V Yes ❑ Yes <br /> minimum capacity five gallons <br /> excluding riser volume? El No* El No* ❑ Noy El No* <br /> Method to keep spill 0 Drain Z Drain V Drain ❑ Drain <br /> containment empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Containment Test Results 2 Pass 0 Pass L Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> Tank ID <br /> Spill Containment Manufacturer: <br /> Method of Cathodic Protection ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic O Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill containment ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> minimum capacity five gallons ❑ No* ❑ No* ❑ No* ❑ No* <br /> excluding riser volume? <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 /> 7. COMMENTS <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 T. <br /> Page 2 of 2 <br />