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Secondary Containment Testing Report Form - Page 4 of 5 H. Testing of Fill Riser Containment Sumps ❑ N/A (No fill riser sumps) ❑ Fill Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: ❑ Sump Manufacturer; ❑ Industry Standard; ❑ PE; ❑ Other (Specie): Test Method Used: ❑ Pressure; ❑ Vacuum; ❑ Hydrostatic; ❑ Other (Specie): Test Equipment Used: Equipment Resolution: Sump #: Sump #: Sump #: Sump #: Dispenser # 2/4 Dispenser # Sat 2/3 Dispenser # 2 SATA Manster Dispenser # 1 SAT Is UDC Exempt from Testing? ❑ Yes; ® No ❑ Yes; ® No ❑ Yes; ® No ❑ Yes; ® No UDC Manufacturer: Unknown Unknown Unknown Unknown UDC Model: Unknown Unknown Unknown Unknown UDC Depth: 34" 34" 34" 34" Height from UDC Bottom to Top of Highest Piping Penetration: 12" 12" 12" 12" Height from UDC Bottom to Lowest Electrical Penetration: 20" 20" 20" 20' Portion of UDC Tested` Bottom Half Bottom Half Bottom Half Bottom Half If turbine shuts down when UDC sensor detects liquid, specify turbine shutdown response time. ® N/A minutes. ® N/A minutes. ® N/A minutes. ® N/A minutes. Wait time between applying pressure/vacuum/water and starting test 15 minutes. 15 minutes. 15 minutes. 15 minutes. Test Start Date/Time: 9:46 9:24 9:46 1:17 1:17 1:32 Initial Reading (Rj): 3.655 3.658 3.655 1.595 6.527 6.527 Test End Date/Time: 10:01 9:39 10:01 1:32 1:32 1:47 Final Reading (RF): 3.508 3.658 3.654 0.508 6.527 6.527 Change in Reading (RF — Rj): 0.147 0.00 0.001 1.087 0.00 0.00 Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002 Test Result: ® Pass; ® Fail ® Pass; ❑ Fail ❑ Pass; ® Fail ® Pass; D Fail Was leak detection sensor properly replaced and verified as functional after testing? ® Yes; ❑ No; ❑ N/A (Not Removed) ®Yes; [1 No; ❑ N/A (Not Removed) El Yes; ❑ No; ❑ N/A (Not Removed) E] Yes; F1 No; ElN/A (Not Removed) H. Testing of Fill Riser Containment Sumps ❑ N/A (No fill riser sumps) ❑ Fill Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: ❑ Sump Manufacturer; ❑ Industry Standard; ❑ PE; ❑ Other (Specie): Test Method Used: ❑ Pressure; ❑ Vacuum; ❑ Hydrostatic; ❑ Other (Specie): Test Equipment Used: Equipment Resolution: Sump #: Sump #: Sump #: Sump #: Sump Diameter (inches): Sump Depth (inches): Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum/water and starting test (minutes): Test Start Date/Time: Initial Reading (Rj): Test End Dat /Time: Final Reading (RF): Change in Reading (RF — Rt): 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 asterisk (*) is "NO" or "N/A", the entire UDC must be tested. [See SWRCB Local Guidance Letter LG -160] UN -054 - 4/5 www.unidoes.org 02/26/02