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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: Vacuum Pump/Vacuum Gauge in Hg. <br />Tank ID <br />1 &2-87/91 <br />Tank Manufacturer <br />Modrn. Wld. <br />Tank Capacity <br />20K 2 Compt. <br />Test Start Time <br />8:30 <br />Initial Reading <br />=10" Hg. <br />Test End Time <br />10:30 <br />Final Reading <br />=10" Hg. <br />Change in Reading <br />0" Hg. <br />Pass/Fail Criteria <br />No Loss <br />Tightness Test Results <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />7. PIPE SECONDARY CONTAINMENT TEST <br />Test Method Developed by ❑ Manufacturer M Industry Standard ❑ Professional Engineer <br />Test Type ® Pressure ❑ Vacuum ❑ Hydrostatic <br />Test Equipment Used: Pressure Gauges in Psi/Nitrogen <br />Pipe Run ID <br />1=87 <br />2=91 <br />Pipe Manufacturer <br />Ameron <br />Ameron <br />Test Start Time <br />8:35 <br />8:35 <br />Initial Reading <br />5 Psi <br />5 Psi <br />Test End Time <br />9:35 <br />9:35 <br />Final Reading <br />5 Psi <br />5 Psi <br />Change in Reading <br />0 Psi <br />0 Psi <br />Pass/Fail Criteria <br />No Loss <br />No Loss <br />Tightness Test Results <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ 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 <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Additional copies of this page maybe 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 />