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&FILL RISER CONTAINMENT SUMP TESTING <br /> Facility is Not Equipped With Fill Riser Containment Sumps <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: Equipment Resolution:+/-0.002" <br /> amFill Sump# Fill Sump# Fill Sump# Fill Sump# <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 /> Sump Material: <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(RI): <br /> Test End Time: <br /> Final Reading(RF): <br /> Test Duration: <br /> Change in Reading(RF-RI): <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: ❑Pass ❑Fail ❑Pass ElFail ❑Pass E]Fail ElPass ❑Fail <br /> Is there a sensor in the sump? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑Yes ❑No <br /> Does the sensor alarm when <br /> either product or water is ❑Yes ❑No ❑NA ❑Yes ❑No [-INA ❑Yes [--]No <br /> ❑NA ❑Yes [:]No ❑NA <br /> detected? <br /> Was sensor removed for testing? ❑Yes [:]No ❑NA ❑Yes []No ❑NA ❑Yes ❑No ❑NA ❑Yes <br /> ❑No [INA <br /> Was sensor properly replaced and <br /> verified functional after testi <br /> ? F-1 Yes [--]No ❑NA ❑Yes ❑No ❑NA ❑Yes [-]No ❑NA ❑Yes ❑No ❑NA <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />