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^03/22/2012 07:31 0000000000 0EE`�t`t`�t`�E`F`�t`�t`ON PAGE 05/07 <br />Secondary Containment Testing Report Form - Page 4 of 5 <br />H. Testing of Fxii Riselr Containment Sumps <br />❑ NIA (No fill riser sumps) <br />❑ Fill Riser Containment Sumps are Present, but were Not'rested <br />Dispenser # 3/4 <br />Dispenser # Sat <br />2/Sut 3 <br />Dispenser # 2 <br />Master/1 Manster <br />Dispenser # 1 SAT <br />Is UDC Exempt frorn'Testing? <br />❑Yes; No <br />❑ Yes; N No <br />❑Yes; ®No <br />El Yes; ®No <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 />34" <br />34" <br />34" <br />Height froin UDC .Bottom to Top <br />of Hi a hest Pii)ing Penctration: <br />12" <br />_ <br />12" <br />1.2" <br />12" <br />Height from UDC Bottom to <br />T..owest 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 />Bottoms Half <br />if turbine shuts clown when UDC <br />sensor detects liquid, specify <br />turbine shutdown response time_ <br />NIA <br />minutes. <br />Q N/A <br />minutes. <br />NiA <br />minutcs, <br />N/A <br />minutes. <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test -- <br />15 minutcq, <br />15 minutes. <br />15 minutcs, <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 />Tnitial Reading (Ri): <br />3.655 <br />3.6.58 3.655 <br />1.595 <br />6.527 6.527 <br />Test .End Date/Time: <br />1.0:01 <br />9:39 10:01 <br />1:32 <br />1:32 1:47 <br />Final Reading (RF): <br />3.508 <br />3.658 3.654 <br />0.508 <br />6.527 6.527 <br />Change in .Reading (lir — Rt): <br />0.147 <br />0.00 0.001 <br />1.087 <br />0.00 0.00 <br />Pass/Fail Threshold or Criteria: <br />01002 <br />0.002 <br />0.002 <br />0.002 <br />Test Results <br />Pass; 1~ail <br />Pass;. Fail <br />Pass; ]?ail <br />Pass; )Fail <br />Was leak detection sensor <br />properly replaced and verified as <br />functional after testing? <br />Yes; F1 No; <br />❑ N/A (Nnt Removed) <br />X Yes; [—]No; <br />❑ N/A (Not Removc(l) <br />El Yes; El NO; <br />❑ N/A. (Not Removed) <br />❑Yes; El No, <br />❑ N/A (Not Rcmovc(l) <br />H. Testing of Fxii Riselr Containment Sumps <br />❑ NIA (No fill riser sumps) <br />❑ Fill Riser Containment Sumps are Present, but were Not'rested <br />Test Method Developed 13y: ❑ Sump Manufacturer, [IIndustry Standard; ❑ PE; E]Other (Specifi): <br />Test Method Used: ❑ Pressure; ❑ Vacuum; ❑ .Hydrostatic: ❑ Other (Sp+ecfry): <br />Test Equipment Used: <br />Equipment Resolution: <br />=; <br />Sump Diameter (inches): <br />Sump # <br />Sump it • <br />Sump #: <br />Sump A. <br />Sump Depth (inches): <br />Portion of Sump Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />statting test (minutes): <br />Test Start Date/Time: <br />Tnitial Reading (R.t): <br />Tess: End ]late/Time: <br />Final Reading (RF): <br />Change in Reading (Rr — Rt): <br />If the entire depth of the UDC is not tested, specity how much was tested. If the answer to any of the questions indicated with an <br />asterisk (*) is "NO" or "N/A", the entire UDC must be tested_ [Sec SWRCB Local Guidance Letter LO -)(101 <br />UN -054.4/5 �vlrtv.unidnca.ar 0212G102 <br />