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SWRCB, January 2002 Page of , <br />S. FILL RISER. CONTAINMENT SVMP TESTING <br />gFillR4", <br />Not tri ed With Fill Riser Containment Sums U <br />ontainment S4mps are Present, bun were Not Tested <br />od Developed. By: U Sumpp Manufacturer U Industry Standard U Professional Engineer <br />U Otther (Spew) <br />tt: U Pressure U Vacuum U Ry&ostatic <br />U other (S),ecr y) <br />Test Egaipmcnt Usdd; Eauioment Resn <br />Comments — {include Informarlon on repairs Horde prier to tesfi, and recommendedollou�up for failed xtwjq <br />C <br />FM Sum # <br />Fill Sum # <br />FiH Sum le <br />Fin Sum # <br />SuraO Diameter. <br />S the <br />Height from Tank Top to Top of <br />Hi est piping pepet;staon: <br />Height from Tank Top io Lowest <br />Electrical Penetratidn: <br />Condition of sump prior to <br />testing: <br />onion of StunP Tested <br />Material: <br />Wait time between applying <br />pressutelvacuumlwater and <br />starting test: <br />Test StartTime: <br />Initial Readini : <br />Test End Time: <br />Final Readin <br />Test Duration: <br />Chan in Readin <br />Pass/Pail Threshold' Criteria: <br />there a mIhe <br />Yes U No <br />U'Yes U Na <br />U Yes U No <br />U Yes No <br />Does the se r alarm when <br />' oither uct or water is <br />U Yes U No <br />U NA <br />U Yes U No U NA <br />U Yes U No U NA <br />U U No U NA <br />detect <br />Was ensor removed for testing? <br />U Yes U No <br />U NA <br />U Yes U No U NA <br />U Yes U No U NA <br />U Yes U:Ro -U NA <br />as sensor properly replaced and <br />U Yes U No <br />U NA <br />Wed functional after tes ' ? <br />U Yes U No U NA <br />U Yes U No U NA <br />U Yes U No U NA <br />Comments — {include Informarlon on repairs Horde prier to tesfi, and recommendedollou�up for failed xtwjq <br />