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A ' SWRCB, January 2002 <br />0 Page (= of <br />S. FILL RISER CONTAINMENT SUMP TESTING <br />Facility is Not Equipped With Fill Riser Containment Sumps X <br />Fill Riser Containment Sumps are Present, but were Not Tested <br />Test Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: ❑ Pressure ❑ Vacuum Hydrostatic <br />❑ Other (Spec) <br />Test Equipment Used: <br />Equipment Resolution: <br />Fill Sume # <br />Fill Sump # <br />Fill Sum # <br />Fill Sum # <br />Sump Diameter: <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 />testing: <br />Portion of Sump Tested <br />Surnp Material: <br />Wait time between applying <br />water and starting test: <br />Test Start Time: <br />Initial Reading (Rj): <br />Test End Time: <br />Final Reading RF): <br />_ <br />Test Duration: <br />-Change in Reading (RF -R,): <br />Pass/Fail Threshold or Criteria: <br />Test Result: Pass ❑ Fail <br />Pass ❑ Fail <br />Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Is there a sensor in the sump? Yes ❑ No <br />Yes ❑ No <br />Yes ❑ No <br />❑ Yes ❑ No <br />Does the sensor alarm when <br />either product or water is Yes ❑ No ❑ NA <br />detected? <br />Yes ❑ No ❑ NA <br />Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor removed for testing? Yes ❑ No ❑ NA <br />Yes ❑ No ❑ NA <br />Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testing? 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 />