Laserfiche WebLink
e <br />Secondary Containment Testing Report Form - Page 4 of 5 <br />H. Testing of Fill Riser Containment Sumps ❑ N/A (No fill riser sumps) <br />❑ Fill Riser Containment Sumps are Present, but were Not Tested <br />Dispenser # 1/2 <br />Dispenser # 3/4 <br />Dispenser # 5/6 SAT <br />Dispenser # <br />Is UDC Exempt from Testing? <br />❑ Yes; ® No <br />❑ Yes; ® No <br />❑ Yes; ® No <br />[:]Yes; ❑ No <br />UDC Manufacturer: <br />Bravo <br />Bravo <br />Bravo <br />UDC Model: <br />Bravo <br />Bravo <br />Bravo <br />UDC Depth: <br />12" <br />12" <br />12" <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />Height from UDC Bottom to Top <br />of Highest Piping Penetration: <br />NA <br />NA <br />NA <br />Height from UDC Bottom to <br />Lowest Electrical Penetration: <br />NA <br />NA <br />NA <br />Portion of UDC Tested <br />Entire <br />Entire <br />Entire <br />If turbine shuts down when UDC <br />sensor detects liquid, specify <br />turbine shutdown response time. <br />® N/A <br />minutes. <br />® N/A <br />minutes. <br />® N/A <br />minutes. <br />❑ N/A <br />minutes. <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test <br />15 minutes. <br />15 minutes. <br />15 minutes. <br />minutes. <br />Test Start Date/Time: <br />4:51 9:29 <br />4:51 5:29 <br />4:35 4:51 <br />Initial Reading (Ri): <br />0.324 0.692 <br />0.034 0.034 <br />1.253 1.252 <br />Test End Date/Time: <br />5:06 9:44 <br />5:06 5:44 <br />4:50 5:06 <br />Final Reading (RF): <br />0.324 0.693 <br />0.034 0.034 <br />1.252 1.251 <br />Change in Reading (RF — Rt): <br />0.00 0.001 <br />0.00 0.00 <br />0.001 0.001 <br />Pass/Fail Threshold or Criteria: <br />0.002 <br />0.002 <br />0.002 <br />Test Result: <br />® Pass; ❑ Fail <br />® Pass; ❑ Fail <br />® Pass; ❑ Fail <br />❑ Pass; ❑ Fail <br />Was leak detection sensor <br />properly replaced and verified as <br />functional after testing? <br />® Yes; ❑ No; <br />❑ N/A (Not Removed) <br />® Yes; [-I No; <br />F]N/A (Not Removed) <br />® Yes; ❑ No; <br />❑ N/A (Not Removed) <br />❑Yes; ❑ No; <br />ElN/A (Not Removed) <br />H. Testing of Fill Riser Containment Sumps ❑ N/A (No fill riser sumps) <br />❑ Fill Riser Containment Sumps are Present, but were Not Tested <br />Test Method Developed By: ❑ Sump Manufacturer; ❑ Industry Standard; ❑ PE; ❑ Other (Spec): <br />Test Method Used: ❑ Pressure; ❑ Vacuum; ❑ Hydrostatic; ❑ Other (Spec): <br />Test Equipment Used: I Equipment Resolution: <br />Sump #: <br />Sump #: Sump #: <br />Sump #: <br />Sump Diameter (inches): <br />Sump Depth (inches): <br />Portion of Sump Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test (minutes): <br />Test Start Date/Time: <br />Initial Reading (Rt): <br />Test End Date/Time: <br />Final Reading (RF): <br />Change in Reading (RF — Rt): <br />If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an <br />asterisk (*) is "NO" or "N/A", the entire UDC must be tested. [See SWRCB Local Guidance Letter LG -160] <br />LJN-054 - 4/5 www.unidocs.org 02/26/02 <br />