Laserfiche WebLink
SWRCB, January 2002 <br />0 <br />R_ Fli,i, RICI%R f'(1NT®INML'NT C®iAdD mscmri►Tr <br />Page 4a of <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 E, Professional Engineer <br />❑ Other (.Specify) <br />Test Method Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic j <br />a ❑ Other (Specify) / <br />= <br />Test Equipment Used: "''-m Equipment Resolution:! <br />Fill Sump # <br />Fill Sump # <br />Fill Sump # j <br />Fill Sump # <br />Sum Diameter: <br />Sump Depth: <br />�J <br />Height from Tank Top to Top of <br />Highest Piping Penetration: <br />/ <br />Height from Tank Top to Lowest <br />Electrical Penetration: <br />Condition of sump prior to <br />testing: <br />, <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 (R►): <br />Test End Time: <br />iz <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF -R►): <br />Pass/Fail Threshold or Crite ' : <br />Test Result: <br />Is there a sensor in theAmp? <br />❑ Pass ❑ Fail <br />❑ Yes ❑ No <br />❑ Pass ❑ Fail <br />❑ Yes ❑ No <br />❑ Pass ❑ Fail <br />❑Yes ❑ No <br />❑ Pass ❑ Fail <br />❑Yes ❑ No <br />Does the sensor ala when <br />either product or, ater is <br />detected? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />N, <br />❑ Yes ,, ❑ No ❑ NA <br />Was sensor r moved for testing? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />0 Yes ❑ No 0, NA <br />❑ Yes ❑ 'Io 1-1NAWas <br />sensor properly replaced and <br />verified functional after testing? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Comments — (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />