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FROM NRCB, January 2002 7. Method Developed By: Test Method Used: Test Equiprnent used: Lit c UDC Manufacturer: UDC Material: UDC Depth: - Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC orior to (WED)SEP 13 2006 1 4 /ST,18:03/No.6843597367 P 3 1r ldb Page '2- of ER -DISPENSER CONTAINMENT UDC TESTING ❑ UDC Manufacturer jiQndustry Standard ❑ Professional Engineer ❑ Other (Specify) ❑ Pressure ❑ Vacuum -83lydfostatic ❑ Other (Specify) - 57-5 1 Equipment Resolution: , o a , rr UIQ # 6 y TOR # -) S t V I UI1C # UDC # Does turbine shut down when r UDC sensor detects liquid (both Yes ❑ No ❑ NA .KYes ❑ No ❑ NA 0 Yes E1 No Q NA ❑ Yes ❑ No ❑ NA, product and water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown,?* W yes ❑ No ❑ NA R Yes ❑ No CNA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was fail-safe verified to be operational?" Ryes ❑ No ❑ NA A'Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Q Yes ❑ No ❑ NA Wait time between applying ressure/vacuum/watef and ��04;h �M;A artin testest rT Start Time: I - . i L I T: V 1 1, 1 z 2 �a . r rVr•%—r .Fri Test End Time' 10 Final Read" M: 9 /, t x Test Duran tion:'h / ^ ;^ Chane in Readin (R, -R� : — . ao - . n ® 2, & p- Pass/Fail Threshold or Criteria: , oat_ Test Result: ass ❑ Fail gpaw ❑ pan ❑ Pass ❑ Fait Q Pass ❑ Fail Was sensor removed for testing? ❑ es D No ❑ NA ❑ Yes ❑ No ❑ NA Q Yes Q No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and ❑ yes ❑ No ❑ NA Q Yes 0 No ❑ NA Q Ycs Q No ❑ NA ❑ Yes 0 No 0 NA verified functional after testine. Comments —(include informailon on repairs madeELOr to tesdng, and recommended follow-up_forfalled tests) ` If the entire depth of the UDC is not tested, specify how much was tested. If the answer to = of the questions indicated with an asterisk (e) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG -160)