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07/2x/2009 14:14 FAX 209 744 0116 <br />S W RCB, January 2002 <br />S. F111, R1CF.R CONT AINMii.NT RiTMP TV.QTirN!`_ <br />Cin0005/0006 <br />Page 6 of <br />Facility is Not Equipped With Fill Riser Containment Sum s <br />Fill Riser Containment Sumps are Present, but were Not Tested 0 <br />est Method Developed By: 0 Sump Manufacturer 0 Industry Standard D Professional Engineer <br />D Other (Spec0) "J <br />Test thod Used: D Pressure D Vacuum D Hydrostatic <br />❑ Other (Specify) <br />Test Equipmen�tUsed: Equipment Resolution-,,, <br />Fill Sum # <br />Fill Sump # <br />Fill Sump# <br />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 />Material: <br />-Sump <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />" <br />Test Start Time: <br />Initial Reading (RL): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Chan&e in Reading (RF -V. <br />Threshold or asteria: <br />Test Result: ❑ Pass 0 Fail <br />❑ Pass 0 Fail <br />❑ Pass D Fail <br />0 Pass ❑ Fail <br />Is there a senso the sump? D Yes D No <br />D Yes D No <br />❑ Yes D No <br />N, ❑ Yes D No <br />Does the sen r alarm when <br />either pr ct or water is D Yes D No DNA <br />detect . <br />D Yes 0 No DNA <br />D Yes ❑ No ❑ NA <br />D Yeses O No ❑ NA <br />111, <br />Was s6nsor removed for testing? D Yes D No DNA <br />D Yes ❑ No DNA <br />D Yes D No D NA <br />D Yes D N��,D NA <br />Was sensor properly replaced and Dyes D No CNA <br />verified functional after testing? <br />D Yes D No DNA <br />D Yes 0 No ❑ NA <br />D Yes D No 0 NA <br />Comments — (include information on repairs made prior to testing; and recommended follow-up for failed tests) <br />