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This pege muat be completed aeparetely tar each tank and aasoclated piping tested at the stte. For addl- <br />tlonal tanks you may photocopy thls form prlor to completing. - ; <br />�TANKANDTESIING'INFORf41AT10N �" '- . '' .';_�"�''-..'`•?�""-.���._;,, „- <br />t. Tank 10 Number (ag regiscered wflh Ecology): <br />2 Date installed: � <br />3. Tank capaciry in gallons: /•'O�(� a. l3st substance stored: /iJ/✓c.P�%�7�% <br />5. Reason for conducting tlghtness test: To comply with leek detedlon requirements In UST rulea <br />_ System iest to (mestlgate suspected release <br />_ Olher(describe) <br />6. Date tlghtness test.was conduaed: <br />7. Type ot test concuded: Tank llgMness test Llne llgMness test ❑ <br />B. TigMness testing method used: <br />Testmethodname: PF.TRn—TTTF TT �pFTRC1�TTF i.TUF TFSTFR . <br />Testmethodmanulacturer. i�1FATH ('l1�1C11i.TANTS TYf'f1RP(1RATFn <br />Vdumeutc � Nan-volumetAc � <br />I( a nan-volumeMc method was used Indicate appro�dmate percerriage tank was <br />Ifued dwing test relative to capaclty <br />The following items shall be initialu! by thc littnsed supervisorwhosc signature appears below. <br />:3 <br />Yea <br />7. . Does tt�.:, UgMness tesUng method.�ued meet the performance standard sp�ed in theUST rules (e.g., <br />deteding at teast a 0.10 galto� per hour Ieak rate wilh probahil'ity of detecUon of et IeasF 95% and proba- � <br />� biUty d lalse aA�rm of no mote than 5%)9 � <br />2. Has ihe Iightness testing method used been demonstrated by the mar Waqurer o( tde tesling melhod lo I� <br />meet the abwe perfortnance stanGa:c1 us:ng EPA's standard test prxedures (or evaluatlnglerik detec- <br />tlan methods? <br />3. Havo al tesiing proce�uras recommended S�y the manWaaurer of the tespng melhod been followed <br />whtle the tnst.was being set up and conductedl , <br />4. Oo Ihelest resutts Indlcatq thal a leak exkts In eilher tha tank or pfping syslem7 <br />If ye5 test results ir,dlpte that tha Ieak Is bcafed tn the: Tank � Piping sysiem � <br />If knovm, Indlcate leak rate: �.Iu+-S N�%�.BL�.To �'ST, <br />NOTE Unde/ground ataags mnk rules rsqufn awners/operatm fo �opai all suspeclod roleusa.to Ns DeparF <br />msnt d.Ecdogy or dslsgeted apeney witlJn 2< hwn. <br />•Item na appllca6le <br />No NA• <br />lhereby cenify lhnt lhnve becn �helicuer� supwi.sor present on site during the nbovc listed righlnvs tu�ing auivitius and rv rhe <br />hvr ojnry h,nowledge thcylmve been conducted in conrplinnce wirh n!l npplicnhle smre mid jedera!laws, rcgularions and proco- <br />durrs purninittg to un6crbTound srorage tnnls ' <br />Persons subndtring jnLre injommrioRare subjcct ro p�lrier underChapr�73.� WA� <br />S = /�/ — 9/ <br />o.r <br />S. ADOITIONAL RE�UIRED.SIGNATURES . - <br />�- �6 -� ' <br />a.. <br />5 �/�/'—� <br />o,,, � — <br />".. i. �i::'::i.:.: :. � _ . . . <br />�a A.o�......d,. <br />• p�Q�2 <br />ECYo�o� �txvq <br />