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RECEIVE[ <br />SEP p 3 2015 <br />10. FTT.T, RTCF.R rnNTeTNn,Tr.NT crMM <br />------_----' ` <br />Facility is Not Equipped With Fill Riser Containment Sumps ❑ IVI <br />Fill Riser Containment Sumps are Present, but were Not Tested ❑ <br />Test Method Developed By: ❑ Sump Manufacturer 0 Industry Standard ❑ Professional Engineer <br />❑ Other (Specify) <br />"fest Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic <br />❑ Other (Speer) <br />Test Equipment Used: !neon Sump <br />' <br />Tester <br />Equipment Resolution: +1- 0.002_" <br />- — <br />Fill Sum #.lel.ti" <br />Fill Sump # <br />Fill Sump # <br />Fill Sump # <br />Sump Diameter: <br />Sump Depth: <br />Height from Tank Top to Top of <br />Highest Piping Penetration: <br />P.5. <br />Height from Tank Top to Lowest <br />Electrical Penetration: <br />Condition of sump prior to <br />testing: <br />lc7'CsJ <br />Portion of SM2 Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />30 minutes <br />30 minutes <br />30 minutes <br />30 minutes <br />Test Start Time: <br />U <br />Initial Reading (Rt): <br />t.« <br />Test End Time: <br />1�t� <br />Final Reading (RF): <br />elite.( <br />Test Duration: <br />/ <br />Change in Reading (RF-Rt):42-00141 <br />Pass/Fail Threshold or Criteria: <br />/- 0.002' <br />+/_ 0.002^ <br />+/_ <br />Test Result: <br />Vrloass ❑ Fail <br />D Pass ❑ Fail <br />❑ Pass ❑ Fail' <br />❑ Pass ❑ Fail <br />Is there a sensor in the sump? <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />Yes p No <br />/- <br />C] Yes ❑ No SNA <br />(] Yes ❑ No <br />Q Yes ❑ No ❑ NA <br />❑ Yes ❑ No <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No <br />❑ Yes ❑ No ❑ NA <br />Was sensor removed for tcsting7 <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 testing? <br />Yes ❑ No DNA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yea ❑ No ❑ NA <br />Comments —(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />ITAL <br />Kir <br />