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SWRCB January,2002 Page of <br /> S. FSER CONTAINMENT SUMP TES <br /> Facility is Not Equipped With Fill Riser Containment Sumps [:] <br /> Fill Riser Containment Sumps are Present,but were Not Tested ❑ <br /> Test Method Developed By: ❑Sump Manufacturer [—]Industry Standard Professional Engineer <br /> E]Other(Specify) <br /> Test Method Used: Pressure Vacuum E] Hydrostatic <br /> Other(Specify) <br /> Test Equipment Used: Equipment Resolution: <br /> Fill Sump# Fill Sump# Fill Sumps# Fill Sump# <br /> Sump Diameter: <br /> Sump Depth: <br /> Height from Tank Top to Top of <br /> Highest Piping Penetration: <br /> Height from Tank Top to Lowest <br /> Electrical Penetration: <br /> Condition of sump prior to <br /> testing: <br /> Portion of Sump Tested <br /> Sump Material: <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(Rj): <br /> Test End Time: <br /> Final Reading(RF): <br /> Test Duration: <br /> Change in Reading(RrR,): <br /> Pass/Fail Threshold or Criteria.: <br /> Test Result: ❑ Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑pass ❑Fail <br /> is there a sensor in the sump? ❑ Yes ❑ No [:]Yes ❑ No ❑Yes [--] No ❑Yes ❑ No <br /> Does the sensor alarm when <br /> either product or water is ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA <br /> detected? <br /> Was sensor removed for testing? ❑Yes ❑No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA <br /> Was sensor properly replaced and <br /> verified functional after testing? ❑Yes ❑ No [3NA ❑Yes ❑ No ❑ NA El Yes ❑ No ❑ NA El Yes ❑ No ❑ NA <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />