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SWRCB, January 2002 <br />S. FILL RISER CONTA NT SUMP TESTING <br />Facility is Not Equipped With Fill Riser Containment Sum <br />Fill Riser Containment Sumps are Present, but were Not Tested ❑ <br />T t Method Developed By: ❑ Sump Mant!L4cture'r ❑ Industry Standard <br />❑ Other (Spec) <br />Test Meth Used: ❑ Pressure ❑ Vacuum <br />❑ Other (Specify) <br />Page -7 of 8 <br />- ❑ Professional Engineer ,/I <br />❑ Hydrostatic <br />Test Equipment Used` I Equipment Resolutions --1 <br />' <br />Sump Diameter: <br />Fill Sump # <br />%k -...k'.' �M ^:i .e,.k'., <br />Fill Sump # <br />a'.hsaf .v. :Y :M1 •i... ,X'' <br />Fill Sump # <br />.�'@:. ": .EC! <br />Fill Sum # <br />Sump Depth: <br />Height from Tank Top to Top of <br />Highest Pi2ing Penetration: <br />A'"ry"YI <br />HeightfromTank Top to Lowest <br />Electrical Penetration: <br />,- <br />Condition of sump prior to <br />testing;rf' <br />Portion of Sump Tested <br />Sump. Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />, <br />Test Start Time: <br />Initial Reading (RI): <br />Test End Time: <br />Final Reading (RF): ,• <br />Test Duration: <br />Change in Reading (RF -RI): <br />Pass/Fail Threshold or C ' eria: <br />Test Result: <br />❑ Pass ❑ Fair <br />❑ Pass ❑Fail <br />❑ Pass ❑Fail <br />❑ Pass ❑ Fail <br />Is there a sensor' a sump? <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Yes ❑ No <br />Does the senso . larm when <br />either produ or water is <br />detected? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes o ❑ NA <br />Was se or removed. for. testing?. <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No NA <br />Was sensor properly replaced and <br />verified functional after testin ? <br />❑ yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />