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z SWRCB, January 2002 Page of % <br />S. FILL RISER CONTA NT SUW TESTING <br />Facility is Not Equipped With Fill Riser Containment Sumps <br />Fill Riser Containment Sumps are Present, but were Not Tested ❑ <br />st Method Developed By _ O Sump Manufacturer._._.,--.--❑ industry, Standard �-w.��---❑ Professional En „er I <br />_...,..�.��.. .... w,. <br />❑Other (Sped) <br />.._ ._ <br />Test Method Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br />❑ Other (Sped) <br />Test Equipment sed: I <br />Flll Sump # <br />Fill Sump # <br />Fill Sump# j Fill Sump# <br />Sum Diameter: `°g <br />� <br />Sump Depth: <br />r '` <br />Height from Tank Top to Top of <br />Highest Piping Penetration: <br />Z <br />111 <br />Height from Tank Top to Lowest "} <br />Electrical Penetration: <br />r' <br />Condition of sump prior to <br />testin <br />Portion of Smp Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: <br />Initial Reading <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading RF -RI): 17 <br />Pass/Fail Threshold or Criteri <br />Test Result: ❑ PBSS ❑Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑Fall <br />❑ P8S3 ❑ I+'all <br />Is there a sensor in the s p? ❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Yes ❑ No <br />Does the sensor al hen <br />either product or w er is ❑ Yes ❑ No ❑ NA <br />detected? <br />❑ Yes []No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor r#moved-for testing? ❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑Yes ❑ No ❑ NA <br />Was sensor properly replaced and ❑ Yes ❑ No ❑ NA <br />verified functional after testin ? <br />❑ Yes ❑ No ❑ NA <br />❑ 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 />