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May. '9. 2017 4: 12PM Donlee Pump Co No. 7237 P. 5 <br /> W <br /> Secondary Containment Testing Report Form-Page 4 of 5 <br /> Dispenser <br /> 1/1 Dispenser N ;;/,,,i Dispenser# r, Dispenser <br /> Is UDC Exempt from Testing? —Yes; RNo Cl Yes; &No El Yes; o Yes; KNo <br /> UDC Manufacturer: 2�rmw a r&4 B&AW <br /> UDC Model- Fi)� 1 F%64ml"15 <br /> T IJ <br /> DDC Depth: 'V <br /> Height from UDC Bottom to Top <br /> er r<of Highest Pipg Penetration; IL 16 rt' <br /> Height from UDC)Bottom to ®` I o (off <br /> Lowest Electrical Penetration- %6 <br /> Portion of UDC Tested'- to Or Z6 If zo Ar zo*V <br /> If turbine shuts down when UDC ON/A �N/A 14N/A '9NIA <br /> sensor detects liquid,specify ininutcs, minutes. minutes. minutes. <br /> turbine shutdown response time. <br /> Wait time between applying <br /> pressure/vacuum/water and minutes. Oy minutes- 056 minutes. 50 minutes. <br /> starting test <br /> Test Start DatoTime: Aft <br /> Initial Reading(R& (0.01%0(0 419 6 <br /> Test End Date/Time: 10,14 ta-.58 jo-,5A <br /> Final Reading C&): 4-01664 1.0%r7a (P.0115i ko-102 <br /> Change in Reading(RF—RO: 0,00000 6.0oolo 0.60010 0.OOOUO <br /> Pass/Fail.Threshold or Criteria- 0.00-LO i 0"040 Lao 0.60700 <br /> Tat Result- fail Kpasi; 0 Fall T Pass; .E]Fait JA'Pass,";El Fall <br /> Was leak detection sensor >r] <br /> properly replaced 'Yes;El No; 'Y'es;[:1 No-, 6-yes.[I No; J�-Yes;[:]Na; <br /> functional after testing? <br /> and verified as N/A Removed) E]N/A(Not Removed) F,N/A(Not Removed) ❑NIA(Not Removed) <br /> , — I <br /> H. Testing of Fill Riser Containment Sumps NIA(No fill riser sumps) <br /> ❑Fill Riser Containment Sumps are Present,but were Not Tested <br /> Test Method Developed By: El Sump Manufacturer;El Industry Standard;Ll PE;[j Other(Sped}: <br /> Test Method Used: E]Pressure; D vacuum; El Hydrostatic; El Other(Specify): <br /> Test Equipment Used: Equipment Resolution: <br /> Sump#., Sump N: Sump#. Sump <br /> Sump Diameter(inches): <br /> Sump Depth(inches): <br /> Portion of Sump Tested <br /> Sump Material: <br /> 7 <br /> Waft time between applying 17 <br /> pressure/vacuum/water and <br /> starting test(minutes): <br /> Test Start Date/Time: <br /> Initial Reading(R& <br /> Test End Date/Time- <br /> Final Reading(RF): <br /> Change in Reading(Rp—R): <br /> 2- 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 IVO"or'N/N',the entire UDC must be tested. [8cc SWRCA Local Guidance Utter LG-1601 <br /> LNI -054-415 1VWW.uQidOC3.Org 02/26102 <br />