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`SVVRCB.January 20O2 0 <br />Page of <br />Facility is Not Equipped With Fill Riser Containment Sumps <br />Fill Riser Containment Sumps are Present, but were Not Testea C1 <br />Test Method Developed By: 0 Sump Manufacturer 0 Industry Standard 9 Professional Engineer <br />Test Method Used: 0 Pressure 0 Vacuum I Hydrostatic <br />0 Other (Specify) <br />Test Equipment Used: Equipment Resolution. <br />Fill Sump Fill Sump # <br />Fill Sump # <br />Sump Diameter: <br />Fill Sum <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 />Portion of Sump Tested___ <br />Sump Material:_ <br />Wait time between applying <br />pressure/vacuum/water and7 <br />starting test: <br />_ <br />Test Start Time: <br />Initial Reading (Rj): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF-Rj): <br />Pass/Fail Threshold or Criteria: <br />Test Result: <br />0 Pass D Fail <br />0 Pass 0 Fail 0 Pass 0 Fail <br />0 Pass 0 Fail <br />Does the sensor alarm when <br />either product or water is <br />DYes ONo [INA <br />OYes nNo DNA 0 Yes 0 No 0 NA <br />0 Yes 0 No 0 NA <br />Was sensor properly replaced and <br />jerified functional after testing? <br />DYes ONo DNA <br />I <br />Oyes ONo DNA uYes ONo [INA <br />0 Yes 0 No D NA <br />Comments — (include i1formation on repairs made prior to tesW�&, and recommendedfollow-upforfailed tests) — <br />