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SWRCB, January 2002 <br />Facility is Not Equipped <br />Fill Riser Containment Sumps are Present but were Not Tested 0 <br />Test Method Developed By: 0 Sump Maintfacturer D Industry- Standard 0 Professional Engineer <br />El Other (Specify) <br />1 Test Method Used: 0 Pressure 0 Vacuum El Hydrostatic <br />0 Other (S'pecifv) I <br />Test Equipment Used: <br />Equipment Resolution: <br />MiSEEM. <br />FM Sump # <br />FM sump# <br />Fill Sump # <br />FBI Sump # <br />Sump Diameter: <br />Sump Depth: <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 />Portion of Sum p Tested <br />Sump Material: <br />Wait time bctAveen applying <br />pressure/A actiunV-%,, ater and <br />starting test: <br />Test Start Time: <br />Initial Reading (R,): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF -R,): <br />Pass/Fail Threshold or Criteria: <br />Test Result: <br />0 Pass 11 Fail <br />0 Pass UFail <br />11 Pass 0 Fail <br />11 Pass 0 Fail <br />Is there a sensor in the sump? <br />0 Yes 0 No <br />0 Yes 0 No <br />11 Yes 0 No <br />0 Yes 0 No <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />DYes ONo DNA <br />DYes DNo [INA <br />DYes DNo DNA <br />DYes DNo DNA <br />Was sensor removed for testing? <br />[]Yes, ONo [INA <br />DYes ONo DNA <br />DYes EINo DNA <br />OYes ONO DNA <br />Was sensor properly replaced and <br />verified ftinctional after testing? <br />U Yes U No D NA <br />I <br />11 Yes 11 No 0 NA <br />11 Yes 11 No 11 NA <br />11 Yes G No <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />