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SWRCB,January 2002 • Page_of <br /> S. FILL RISER CONTAINMENT SUMP TESTING <br /> Facility is Not Equipped With Fill Riser Containment Sumps <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 D 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 /> Highest Piping Penetration: <br /> Height from Tank Top to Lowest <br /> Electrical Penetration: <br /> Condition of sump prior to <br /> testing: <br /> Portion of Sump Tested <br /> Sump Material: <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(RO: <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 ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> Is there a sensor in the sump? ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> Does the sensor alarm when <br /> either product or water is ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA <br /> detected? <br /> Was sensor removed for testing? ❑yes ❑No DNA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA <br /> Was sensor properly re laced and <br /> verified functional after testing? UlubUINONAes o es UNo ONA 777e—s =o ❑NA <br /> Comments— (include information on repairs madeprior to testing, and recommended follow-up for failed tests) <br /> NO FILL SUMPS <br /> MUM V <br /> FES 11 2014 <br /> HEALTH DEPARTMENT <br />