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Ll <br />a WTT T DTQVD VnN'rATNMVT*JT CTTMP T ..CTTN[T' r a <br />Facility is Not Equipped With Fill Riser Containment Sumps <br />Fill Riser Containment Sumps are Present, but were Not Tested Elg° # j <br />Test Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard ❑ Pqe ngineer <br />1_ HEALT W <br />❑ Other (Spec) PE, ,^ <br />Test Method Used: <br />❑ Pressure <br />❑ Other (Spec) <br />❑ Vacuum <br />❑ Hydrostatic ` <br />Test Equipment Used: <br />Sump Diameter: <br />Fill Surap # <br />Fill Sump # <br />Equipment Resolution: <br />Fill Sum # <br />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 sum rior to testing: <br />Portion of Sump Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and starting <br />test: <br />Test Start Time: <br />Initial Reading (R,): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />15 MIN <br />15 MIN <br />15 MIN <br />15 MIN <br />Chane in Reading RF -RI): <br />Pass/Fail Threshold or Criteria: <br />0.002 <br />0.002 <br />0.002 <br />0.002 <br />TCSt Re3lilt. <br />P$3$ '. Fail' <br />Pa33, F$ll.. <br />Pas3 x$11 , <br />. P$33 F$Il. <br />Is there a sensor in the sum ? <br />Yes 0 No <br />El Yes No <br />Yes Lj No <br />U Yes Ll No <br />Does the sensor alarm when either <br />or water is detected? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />product <br />Was sensor removed for testin ? <br />Yes No NA <br />❑ =Yes NA <br />Yes No NA <br />F-1 Yes ❑ 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 <br />Yes No NA <br />Comments — (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />Secondary Containment Test Results 7 of 7 <br />