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RECEIVED <br />SWRCB, January 2002 OCT JP9age _ _ °f_ _ <br />A FIFT.i. WWR CnNTATNMF.NT SUMP TESTINVIR N ENTAL HEALTH <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 (Specie) <br />Test Method Used: <br />❑ Pressure <br />❑ Other (Spec) <br />❑ Vacuum <br />® Hydrostatic <br />Test Equipment Used: INCON SUMP TESTER <br />Equipment Resolution: + / - 0.002" <br />Sum Diameter: <br />ITFillSump# <br />Fill Sump # <br />Fill Sump # Fill Sum # <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 />pressurelvacuum/water and <br />starting test: <br />Test Start Time: <br />Initial Reading (R,): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF -R,): <br />Pass/Fail Threshold or Criteria: <br />+/-0.002" <br />+/-0.002" <br />+ ! - 0.002" +/-0.002" <br />Test Result: <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass Q Fail ❑ Pass ❑ Fail <br />Is there a sensor in the sump? <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No ❑ Yes ❑ No <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />❑ Yes ❑ No ❑ NA <br />[:]Yes ❑No ❑ NA <br />❑ Yes [:]No ❑NA ❑ Yes ❑ No ❑ NA <br />Was sensor removed for testing? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA Elves ❑ No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testing? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br />Comments —(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />DIRECT BURY FILL RISERS <br />