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SWRCB, January 2002 R VH.i. DlrQrl? rnrrTA IXT141`XTIV OTTAMM mr+c mr►.r Page 'I of -- -- vva.ia 1L'U111\lI Facility is Not Equipped With fill Riser Containment Sumps Fill Riser Containment Sumps are Present, but were Not Tested X Test Method Developed By: ❑ Sump Manufacturer 0 Industry Standard Professional Engineer ❑ Other (Spec) _ Test Method Used: ❑ Pressure ❑ Vacuum Hydrostatic ❑ Other (Specify) Test Equipment Used: I Equipment Resolution: Fill Sump # Fill Sum # Fill Sump # Fill Sump # Sum Diameter: - Sump De the _ - - Height from Tank Top to Top of Hi hest Pit)inR Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testin : - Portion of Sump Tested Sump Material: Wait time between applying water and starting test: Test Start Time: -- -- -- Initial Readin (Ri): --� Test End Time: — — — - Final Reading (RF): Test Duration: Chane in Reading (RF-Rj): Pass/Fail Threshold or Criteria: -- Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Is there a sensor in the sump? Yes No Yes No Yes No Yes No Does the sensor alarm when either product or water is detected? Yes No NA Yes No NA Yes No NA Yes No NA Was sensor removed for testing ? Yes No NA Yes No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? Yes No NA Yes No NA Yes No NA Yes No NA Comments — (include information on repairs made prior to testing, and recommended follow up or failed tests)