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• � � !/��vp�Cf <br /> Page 6 of S <br /> $, FILL RISER CONTAINMENT SUMP TESTING <br /> Facility is Not Equipped With Fill Riser Containment Sumps EI <br /> Fill Riser Containment Sumps are Present,but were Not Tested ❑ <br /> Test Method Developed By: ❑Sump Manufacturer ❑ Industry Standard ❑Professional Engineer <br /> ❑ Other(Specify) <br /> Test Method Used: ❑Pressure ❑Vacuum ❑ Hydrostatic <br /> ❑ Other(Specify) <br /> Test Equipment Used: Equipment Resolution: <br /> Fill Sump # Fill Sump # Fill Sump # Fill Sump # <br /> Sump Diameter: <br /> Sump Depth: <br /> Height from Tank Top to Top of <br /> Hi hest Pi6nQ Penetration: <br /> Height from Tank Top to Lowest <br /> Electrical Penetration: <br /> Condition of sum rior to testing: <br /> Portlon of Sump Tested <br /> Sump Material: <br /> Wait time between applying <br /> pressurelvacuumlwater and starting <br /> 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-Ri <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: ❑ Pass E3 Fail] ❑.Pass ❑.Fail E3 Pass ❑ Fail ❑ Pass E3 Fail <br /> Is there a sensor in the sump? ❑Yes L3 No ❑Yes ❑ No ❑Yes L3 No ❑Yes E3 No <br /> Does the sensor alarm when either ❑Yes ❑ No '❑ NA ❑ Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA <br /> roduct or water is detected? <br /> Was sensor removed for testing? ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No 0 NA ❑Yes ❑ No ❑ NA <br /> Was sensor properly replaced after L3 Yes E3 No © NA ❑Yes E3 No L3 NA El Yes E3 No C3 NA EI Yes E3 No E3 NA <br /> testing? <br /> Comments— include information on repairs made prior to testing, and recommended follow u for failed fesfs <br />