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SWRCB, January 2002 <br />to 10 lM XMIJURN I�1u 141 a I MIT1' 1R <br />Page � of a <br />Facility is Not Equipped With Fill Riser Containment Sumps <br />Fill Riser Containment Sumps are Present, but were Not Tested ❑ <br />ethod Developed By: ❑ Sump Manufactures ❑ Industry Standard ❑ Professional Engineer <br />r❑ Other (Spec) <br />Test Nht) od Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br />I'll ❑ Other (Spec) F <br />Test Equipment bse,,d: Equipment Resoluitiori: <br />- .,..:., <br />Fill Sump # <br />Fill Sump # Fill Sum <br />Fill Sump # <br />Suinp 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 />testin <br />Portion of of Sum Tested <br />-- <br />— - <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: <br />Initial Readin (Ri): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (Fr -RI): <br />ass/Fail Threshold or C� eria: <br />est Result: ❑ Pass ❑ Fail <br />rI <br />❑ Pass ❑Fail ❑ Pass ❑ Fail❑ <br />Pass ❑ Fail <br />there a sensor in a sump? ❑ Yes ❑ No <br />❑ Yes ❑ No ❑ Yes ❑ No <br />Yes ❑ No <br />Does the -sensor arm when <br />either produc or water is ❑ Yes ❑ No ❑ NA <br />detected? <br />❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br />❑ Yes o ❑ NA <br />Was se or removed -for testing? ❑ Yes- ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA ❑ Yes. ❑ No ❑ NA <br />❑ Yes- ❑ No 9 NA <br />Wasp nsor properly replaced and <br />verified functional after testing? Oyes ❑ No ❑ NA <br />❑Yes ❑ No ❑ NA ❑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 />