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SWRCB, January 2002 <br />Q Vrl If l l[QVD f''n VT®rNMVWT QITMP TFQTING <br />Page 7 of 8 <br />Facility is Not Equipped With Fill Riser Containment Sums <br />LX <br />Fill Riser Containment Sumps are Present, but were Not Tested U <br />Test Method Developed By: <br />U Sump Manufacturer <br />❑ Other (Specify) <br />U Industry Standard U Professional Engineer <br />Test Method Used: <br />U Pressure <br />U Other (Spec) <br />U Vacuum <br />U Hydrostatic <br />Test Equipment Used: <br />Sump Diameter: <br />Fill Sump # <br />Fill Sump # <br />Equipment Resolution: <br />Fill Sum # Fill Sump # <br />Su!np 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 />/I <br />I <br />Portion of Sum2 Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/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-Rj): <br />Pass/Fail Threshold or Criteria: <br />Test Result: <br />U Pass U Fail <br />U Pass U Fail <br />U Pass U Fail U Pass U Fail <br />Is there a sensor in the sum ? <br />U Yes U No <br />U Yes U No <br />U Yes U No U Yes U No <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />U Yes U No U NA <br />U Yes U No U NA <br />U Yes U No U NA U Yes U No U NA <br />Was sensor removed for testing? <br />(Ayes U No U NA <br />U Yes U No U NA <br />U Yes U No U NA U Yes U No U NA <br />Was sensor properly replaced and <br />verified functional after testinet <br />t„l Yes U No U NA <br />U Yes U No U NA <br />U Yes U No U NA U Yes U No U NA <br />C 0 M M e n t S — (include information on repairs made prior to testing, and recommended follow-up forfailed tests) <br />No Secondary Containment on Fill Risers at this site. <br />