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Dec 31 02 1 1 : 03a Fra n Hill 5596 467,W jj P.11 SWRCB, January- 2002''`J Page of R_ FTT.T. RTCRR ('�1NTAINMF.NT CTTNTP T �:_ I ".Cl Facility is Not Equipped With Fill Riser Containment Sumps ❑ Fill Riser Containment Sumps are Present, but were Not Tested ❑ Test Method Developed By: D Sump Manufacturer - Industry Standard Professional Engineer D Other (Spec) Test Method Used: D Pressure ❑ Vacuum D Hydrostatic D Other (Specify) Test Equipment Used: Equipment Resolution: _ Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Diameter: Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: it Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum/water and startin test: Test Start Time: Initial Reading (Rt): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF -RI): Pass/Fail Threshold or Criteria: Test Result: D Pass ❑ Fail D Pass D Fail Pass ❑ Fail D Pass D Fail Is there a sensor in the sump? 0 Yes D No D Yes 0 No ❑ Yes ❑ No E Yes ❑ No Does the sensor alarm when either product or water is detected? ❑ Yes ❑ No ❑ NA ❑ Yes D No ❑ NA ❑ Yes D No ❑ NA ❑ Yes D No ❑ NA Was sensor removed for testing? D Yes ❑ No DNA ❑ Yes D No DNA D Yes D No ❑ NA D Yes D No D NA Was sensor properly replaced and verified functional after testing? ❑ Yes ❑ No DNA ❑ Yes ❑ No DNA D Yes ❑ No D NA D Yes ❑ No D NA Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests)