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Secondary Contaitnnent`resting Report I+orin-Page 4 of 5 <br /> ---- -- <br /> Dispenser# 11,4 Dispenser# /H Dispenser# r, Dispenser# <br /> Is UDC Exempt from Testing? El Yes; KNO Yes; o ❑Yes; o Yes; No <br /> UDC Manufacturer: o a5ceofg anptw <br /> UDC Model: ; <br /> UDC Depth: ® • p•• '�jp a <br /> Height from UDC Bottom to Top rr It <br /> of Highest Piping Penetration: <br /> Height from UDC Bottom to <br /> Lowest Electrical Penetration: t 0 6 0 i� tS Cr <br /> Portion of UDC Tested' zo 11 Z0 61 Zo�� ZZ <br /> If turbine shuts down when UDC { NIA ')S NSA 14 NIA -.N/A <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. jo minutes. �a minutes. minutes. <br /> starting test <br /> Test Start Date/Tiene: <br /> Initial Reading(RI): 9, SdK 7.011Aok to e. <br /> Test End Datc/Time: '10.514 O 5tt <br /> Fiscal Reading(RF): ti.8160 LA b•00 z ol <br /> Change in Reading(RF—Rj): 0.00000 epp[O O,0 00 40 0.000too <br /> Pass/Fail Threshold or Criteria: 0.*aLoo 0.00&00 O.ooZ0G' 0, 00-100 <br /> Test Resgit Pass; Fait Pass; .` 'Fil Pass,,. : .Fail; 'Pass;:Q I+all <br /> Was leak detection sensor ❑No; <br /> properly replaced and verified as Yes; 29-yes;❑No; f9-Yes;❑No; E-Yes;❑No; <br /> properly <br /> r atter testing? <br /> v ❑NIA(Not Removed) ❑N/A(Not Removed) ❑NIA(Not Removed) ❑NIA(Not Removed) <br /> functiH. 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: ❑Sump Manufacturer;❑Industry Standard;❑PE;❑Other(Speci&: <br /> Test Method Used: ❑Pressure; ❑vacuum; ❑Hydrostatic; ❑Other(Spec): <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: "I 41111; <br /> Wait time between applying " <br /> pressurelvacuutnlwaterand <br /> starting test minutes <br /> Yrs1 x24 �. 8h <br /> Test Start Date/Time: - <br /> Initial Reading(Rj): <br /> Test End Date/Time: ENVI RON iVEEM'AL HEALTH <br /> Final Reading(RF): DEPARTMENT <br /> Change in Reading(RF—Rj):' <br /> s. If the entire depth of the UDC is not tested,specify how much was tested. If the answer to as of the questions indicated with an <br /> asterisk(*)is"NO"or"1V/A",the entire UDC must be tested. [See SNVRCB Local Guidance Letter LG-160) <br /> UN-054-4/5 wrnv.unidocs.org 02(26/02 <br />