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Secondary Containment Testing Report Form - Page 3 of 5 F. Testing of Piping Sumps/Turbine Sumps n ❑ N/A (No piping/turbine sumps) Test Method Developed By: ® Sump Manufacturer; ❑ Industry Standard; ❑ PE; ❑ Other (Spec): Test Method Used: ❑ Pressure; ❑ Vacuum; ® Hydrostatic; ❑ Other (Spec): Test Equipment Used: Incon TS -STS Equipment Resolution: 0.001" Sump #: Sump #: Sump #: Sump #: Sump Diameter (inches): Sump Depth (inches): Sump Material: Height from Tank Top to Top of Highest Pipe Penetration (inches): Height from Tank Top to Lowest Electrical Penetration (inches): Portion of Sump Tested: If turbine shuts down when sump sensor detects liquid, specify turbine shutdown response time. El N/A minutes. El N/A minutes. [I N/A minutes. El N/A minutes. Wait time between applying pressure/vacuutn/water and starting test: minutes. minutes. minutes. 15 minutes. Test Start Date/Time: Initial Reading (Rj): Test End Date/Time: Final Reading (RF): Change in Reading (RF — Rj): Pass/Fail Threshold or Criteria: Test Result: ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail ❑ Pass; ❑ Fail Was leak detection sensor properly replaced and verified as functional after testing? Yes No ❑ � ❑ � ❑ N/A (Not Removed) El ❑ No; ❑ N/A (Not Removed) Yes; No; ❑ ❑ ElN/A (Not Removed) Yes; No; ❑ ❑ ❑ N/A (Not Removed) G. Testing of Under -Dispenser Containment (UDC) ❑ N/A (No dispensers or no UDC) Test Method Developed By: ® UDC Manufacturer; ❑ Industry Standard; ❑ PE; ❑ Other (Specify): Test Method Used: ❑ Pressure; ❑ Vacuum; ® Hydrostatic; ❑ Other (Spec): Test Equipment Used: Incon TS -STS I Equipment Resolution: 0.001 UN -054 - 3/5 www.unidoes.org 02/26/02