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HomeMy WebLinkAbout2015 SB989 RESULTSSWRCB, January 2002 Page ____ of ____ Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name:Date of Testing: Facility Address: Facility Contact:Phone: Date Local Agency Was Notified of Testing : Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Technician Conducting Test: Credentials: SWRCB, January 2002 Page ____ of ____ 4. TANK ANNULAR TESTING Test Method Developed By: SWRCB, January 2002 Page ____ of ____ 5. SECONDARY PIPE TESTING Test Method Developed By: SWRCB, January 2002 Page ____ of ____ 6. PIPING SUMP TESTING Test Method Developed By: SWRCB, January 2002 Page ____ of ____ 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: SWRCB, January 2002 Page ____ of ____ 8. FILL RISER CONTAINMENT SUMP TESTING Facility is Not Equipped With Fill Riser Containment Sumps SWRCB, January 2002 Page ____ of ____ 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes