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May. 9. 207 4: 12 PM Donlee Pump Co No, 7237 P. 5 <br /> Secondary Containment Testing Repo orm-Page 4 of 5 <br /> Dispenser ft 1 DispenserN ;9/f4 Dispenser# Dispenser.# <br /> Is UDC Exempt from Testing? U Yes)- b:00 El Yes; &No El Yes-,dgNo n Yes; big-No <br /> UDC Manufacturer: <br /> UDC Model- <br /> LYDC Depth: <br /> Height from UDC Bottom to Top <br /> ofof Highest Piping Penetration; <br /> Height from UDE 13onomto (off <br /> Lowest Electrical Penetration- <br /> Portion of UDC Tested'- <br /> If turbine shuts down when UDC WN/A N/A 79 N/A '9NIA <br /> sensor detects liquid,specify minutes, minutes. minutes. minutes. <br /> turbine shutdown response time. <br /> Wait time between applying <br /> pressure/vacuum/water and minutes. minutes. .5 minutes. 50 minutes. <br /> starting test <br /> Test Start l3ate/Time: <br /> Initial heading(10; 4-689�A _JL.�rjos�� <br /> Test End Date/Time; <br /> Final Reading(Rp): 4.06104 1.0%50 V*15i �o 007 <br /> Change In Reading(Rjr—Rt}: 0.00000 6.00010 0.60010 0.0601j,00 <br /> Pass/Fall Threshold or Criteria- 0.00-LOO 0.06Lori 0.60700 <br /> Yail - <br /> Test Result. —Fail KPasi; El _9FP_a$s; .E1 "'pass; Mail <br /> Was leak detection sensor )91 Yes,F1 NO, J�q-Yes;[j Na; eFYes.F1 No; 0-Yes;El No; <br /> Properly replaced and verified as N/A(NO,Removed) ❑N/A(Not Removed) []NIA(Not Removed) F1 N/A(Not moved) <br /> functional after testing? , I , I <br /> H. Testing of Fill Riser Contaiment Sumps NIA(No fill riser sumps) <br /> ❑Fill Riser Containment Sumps are Present,but were Not Tested <br /> Test Method Developed By: E]Sump Manufacturer;[I Industry Standard;Ll PE;Ll Other(Specify): <br /> Test Method Used: E]Pressure; El Vacuum; El Hydrostatic; El Other(Specify): <br /> Test Equipment Used: Equipment Resolution: <br /> Sump#: Sump#: Sump#. Sump <br /> Sump Diameter(inches): <br /> Sump Depth(inches): <br /> Portion of Sump Tested <br /> Sump Material: <br /> Wait time between applying <br /> jjgY 0 20-17 <br /> pressure/vacuum/water and <br /> start!!jS test(minutes): <br /> V <br /> Test Start DatedTime: E H I <br /> B . <br /> 7 H, <br /> Initial Reading(R r): A_�L, 77,ffe-' .�-71M F Ff <br /> Test End Date/Time- <br /> Final Reading(RF): I <br /> Change in Reading(RF—R): <br /> z. 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 <br /> asterisk(*)is"NO"or'NIA",the entire UDC must be tested, (See SWRCA Lool Guidance Letter LG-1601 <br /> M-054-4/5 02126102 <br />