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Secondary Containment Testing Report Form - Page 4 of 5 <br />H. Testing of Riser Containment Sumps <br />E] N/A (No fill riser sumps) <br />❑ Fill Riser Containment Sumps are Present, but were Not Tested . . . ........... <br />Dispenser # 3/4 <br />Dispenser # Sat <br />2/Sat 3 <br />Dispenser 4 2 1 <br />Master/1 Manster <br />Dispenser # I SAT <br />Is UD I C Exempt from ? <br />F] Yes, Z No <br />Su [111) 4: <br />[:TYes; [D No <br />❑ Yes: <br />UDC Manufacturer: <br />Unknown <br />Unknown <br />Unknown <br />Unknown <br />UDC Model: <br />Unknown <br />Unknown <br />Unknown <br />Unknown <br />UDC Depth: <br />34" <br />3411 <br />34's <br />34" . ..... .. <br />Height from UDC Bottom to Top <br />of Highest Piping Penetration: <br />12" <br />12" <br />12" <br />12" <br />Height from UDC Bottom to <br />Lowest Electrical Penetration: <br />20" <br />20" <br />20" <br />20' <br />Portion of UDC Tested" <br />Bottom Half <br />Bottom Half <br />Bottom Half <br />Bottom Half <br />If turbine shuts down when UDC <br />sensor detects liquid, specify <br />turbine shutdown response time. <br />0 N/A <br />minutes. <br />Z NA <br />minutes, <br />N/A <br />minutes. <br />N/A <br />minutes <br />Wait time between applying <br />pressure/vacuumAvater and <br />starting test <br />15 minutes. <br />15 minutes. <br />15 minutes. <br />15 minutes. <br />Test Start Date/ Time: <br />9:46 <br />9:24 9:46 <br />1:17 <br />1:17 1:32 <br />Initial Reading (Ri): <br />3.655 <br />3.658 3.655 <br />1.595 <br />6.527 6.527 <br />Test End Date/Time: <br />10:01 <br />9:39 10:01 <br />1:32 <br />1:32 1:47 <br />Final Reading (RE): <br />3.508 <br />3.658 3.654 <br />0.508 <br />6.527 6.527 <br />Change in Reading (RF - Rj): <br />0.147 <br />0.00 0.001 <br />1.087 <br />0.00 0.00 <br />Pass/fail Threshold or Criteria: <br />0.002 <br />0.002 <br />0.002 <br />0,002 <br />Test Result: <br />Cl P"; Z Fail <br />Fail <br />Pass, 0 Fail <br />2 Pass; 0 Fail <br />Was leak detection sensor <br />properly replaced and verified as <br />functional after testing? <br />Yes; [I No; <br />❑ N/A (Not Removed) <br />Yes; ❑ No; <br />El N/A (Not Removed) <br />F-1 Yes; El No; <br />F-1 N/A (Not Removed) <br />J <br />0 Yes; M No; <br />❑ N/A (Not Removed) <br />H. Testing of Riser Containment Sumps <br />E] N/A (No fill riser sumps) <br />❑ Fill Riser Containment Sumps are Present, but were Not Tested . . . ........... <br />"rest Method Developed By: El Sump Manufacturer; F1 Industry Standard; El PE; El Other (Specify): <br />Test Method Used: 0 Pressure; C3 Vacuum; 0 Hydrostatic; [] Other (Specify): <br />Test Equipment Used: <br />Equipment Resolution: <br />— - - -------- <br />Sump 4: <br />Su [111) 4: <br />Sump #: <br />Sump 4:—_-4 <br />Sump Diameter (inches): <br />Sump Depth (inches): <br />Portion of Sump Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test minutes <br />Test Start Date/Time: <br />Initial Reading (111): <br />Test End Date!Time: <br />Final Reading (RF): <br />Change in Reading (RF - RO: <br />2- If the entire depth of the UDC is not tested, specify how much was tested. If the answer to M of the questions indicated with an <br />asterisk (*) is "NO" or "NIA", the entire UDC must be tested. [See SWRCB Local Guidance Letter LG- 1601 <br />UN -054 - 45 www.unidoes.org 02/26102 <br />