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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 ❑ Hydrostatic <br /> ❑ Check this box if Appendix 6.1 continuation page is attached. <br /> Tank ID 87 OCT - W 87 OCT - E 91 OCTANE DIESEL <br /> Spill Containment Manufacturer: O P W O P W O P W O P W <br /> Method of Cathodic Protection p Nonmetallic p Nonmetallic 0 Nonmetallic p Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill containment p Yes 0 Yes p Yes 0 Yes <br /> minimum capacity five gallons <br /> excluding riser volume? El No* El No* El No* El No* <br /> Method to keep spill p Drain p Drain p Drain p Drain <br /> containment empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Containment Test Results p Pass p Pass p Pass p 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 /> excluding riser volume? El No* El No* El No* El 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 /> 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 7. <br /> Page 2of2 <br />