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I <br />SWRCB, January 2002 Page 'I of <br />R MITI. 1PUZI M (Y1NTA1NMF.NT SUMP TESTING <br />Facility is Not Equipped With Fill Riser Containment Sumps X <br />Fill Riser Containment Sumps are Present, but were Not Tested <br />Test Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: ❑ Pressure ❑ Vacuum Hydrostatic <br />❑ Other (Spec) <br />Test Equipment Used: Equipment Resolution: <br />Fill Sump # <br />Fill Sump # Fill Sump # <br />Fill Sump # <br />Sump Diameter: <br />Sump Depth: <br />— <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 sump prior to <br />testing: <br />- <br />Portion of Sump Tested <br />-- <br />Sump Material: <br />Wait time between applying <br />water and starting test: <br />Test Start Time: <br />Initial Reading (Rj): <br />— <br />Test End Time: <br />Final Reading (RF): <br />— <br />Test Duration: <br />-- - <br />Change in Reading (RF -RI): <br />- <br />Pass/Fail Threshold or Criteria: <br />Test Result: <br />Pass ❑ Fail <br />Pass ❑ F '1 Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Is there a sensor in the sump? <br />Yes ❑ No <br />Yes ❑ No Yes ❑ No <br />❑ Yes ❑ No <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />Yes ❑ No ❑ NA <br />Yes ❑ No ❑ NA Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor removed for testing? <br />Yes ❑ No ❑ NA <br />Yes ❑ No ❑ NA Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testi n ? <br />Yes ❑ No ❑ NA <br />Yes ❑ No ❑ NA 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 />