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E <br />Secondary Containment Testing Report Form - Page 4 of 5 <br />E <br />H. Testing of Fill Riser Containment Sumps [I N/A (No fill riser sumps) <br />El Fill Riser Containment Sumps are Present, but were Not Tested <br />Test Method Developed By: El Sump Manufacturer; [] Industry Standard;E] PE;E] Other (Specify): <br />Test Method Used: El Pressure; 0 Vacuum; ❑ Hydrostatic; ❑ Other (Specify): <br />Test Equipment Used: Equipment Resolution: <br />Sump #: Sump Sump Sump 9: <br />Sump Diameter (inches): <br />Sump Depth (inches): <br />Portion of Sump Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />Test Stan Date/rime: <br />Initial Reading (Ri): <br />Test End DatetTime: <br />Final Reading (Rk): <br />Change in Reading (14 - <br />2 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to my of the questions indicated with an <br />asterisk(*) is "NO" or "NIX, the entire UDC must be tested. [see SWRCB Low Guidance Lena LG -1601 <br />1JN4A4 - 4/5 www.nnidwsorg 02/26/02 <br />Dispenser # <br />Dispenser # <br />Dispenser # <br />Dispenser # <br />Is UDC Exempt from Testing? <br />Li Yes; 40 <br />E] Yes; Lj No <br />Yes; <br />-ET—Yes-, -0 No <br />UDC Manufacturer. <br />UDC Model: <br />< <br />UDC Depth: <br />Height from UDC Bottom to Top <br />of Highest Pi in Penetration: <br />Height from UDC Bottom to <br />Lowest Electrical Penetration: <br />0 <br />Portion of UDC Tested' <br />a 'a a <br />If turbine shuts down when UDC <br />El-fVA <br />E] N/A <br />❑ N/AN/A <br />sensor detects liquid, specify <br />turbine shutdown response time. <br />minutes. <br />minutes. <br />minutes. <br />minutes. <br />Wait time between applying <br />pressure/vacuum/water and <br />minutes. <br />minutes. <br />minutes. <br />minutes. <br />starting test <br />Test Start Date/Time: <br />'All1 o . a Z) <br />Initial Reading <br />Test End DatefTime: <br />&O -L 10,CO <br />Final Reading (RF}: <br />Change in Reading (RI, — Rj): <br />Pass/Fail Threshold or Criteria: <br />Test Result <br />ass; Lj Fail <br />Pass;, Fa <br />11 Pan; El Fall <br />TIP—ass; [I Fail <br />Was leak detection sensor. <br />El Yes; E] No; <br />El Yes; 11 No; <br />[_1 Yes; E:1 No; <br />El Yes; R No; <br />properly replaced and verified as <br />faN/A (Not Removed) <br />N/A (Not Removed) <br />❑ NIA (Not Removed) <br />[:] N/A (Not Removed) <br />functionalr teskL? <br />aftej <br />H. Testing of Fill Riser Containment Sumps [I N/A (No fill riser sumps) <br />El Fill Riser Containment Sumps are Present, but were Not Tested <br />Test Method Developed By: El Sump Manufacturer; [] Industry Standard;E] PE;E] Other (Specify): <br />Test Method Used: El Pressure; 0 Vacuum; ❑ Hydrostatic; ❑ Other (Specify): <br />Test Equipment Used: Equipment Resolution: <br />Sump #: Sump Sump Sump 9: <br />Sump Diameter (inches): <br />Sump Depth (inches): <br />Portion of Sump Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />Test Stan Date/rime: <br />Initial Reading (Ri): <br />Test End DatetTime: <br />Final Reading (Rk): <br />Change in Reading (14 - <br />2 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to my of the questions indicated with an <br />asterisk(*) is "NO" or "NIX, the entire UDC must be tested. [see SWRCB Low Guidance Lena LG -1601 <br />1JN4A4 - 4/5 www.nnidwsorg 02/26/02 <br />