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SWRCB. January 2002 0 <br />Page 6 of 7 <br />Facility is Not Equipped With Fill Riser Containment Sums [ ] <br />Fill Riser Containment Sumps are Present, but were Not Tested [ <br />Test Method Developed By: [ ] Sump Manufacturer [ ] Industry Standard [ ] Professional Engineer <br />[ ] Other (Specify) <br />Test Method Used: [ ] Pressure [ ] Vacuum [ ] Hydrostatic <br />Other S eci <br />Test Equipment Used: Equipment Resolution: <br />Fill Sump # <br />Fill Sump # <br />Fill Sump # <br />Sump Diameter: <br />Sump Depth: <br />Height from Tank Top to <br />Top of Highest Piping <br />Penetration: <br />Height from Tank Top to <br />Lowest Electrical <br />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 & <br />starting test <br />Test Start Time: <br />Initial Reading (Rl): <br />Test End Time: <br />Final Reading (Rf): <br />Test Duration: <br />Chane in Reading (Rf-RI) <br />Pass/Fail Threshold or <br />Criteria: <br />TestResult: <br />I, I PASS I FAIL <br />f, 1, PASS !I I FAIL <br />PASS FAIL <br />Is there a sensor in the sump? <br />[ ] Yes [ ] No INA <br />[ ] Yes []No [INA <br />[ ] Yes [ No [ ] NA <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />[ ]Yes [ ] No [ INA <br />[ ] Yes [ ] No [ ] NA <br />[ ] Yes [ ]No [ ] NA <br />Was sensor removed for <br />testing? <br />[ ] Yes [ ] No [ ] <br />N/A <br />[ ] Yes [ ] No [ ] N/A <br />[ ] Yes [ ]No [ ]N/A <br />Was sensor properly replaced <br />and verified functional after <br />testing? <br />[ ] Yes [ ] No [ ] <br />N/A <br />[ ] Yes [ ] No [ ] N/A <br />[ ] Yes [ ]No [ ]N/A <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />