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APPENDIX A-3: SAMPLE FORM , INSPECTION <br /> Go to www.pei.orgIRP900 for an electronic version of this form. <br /> ID#: ANNUAL "OTHER" SUMP INSPECTION CHECKLIST Date. <br /> Category IDescription Po111"00 N/A Tank I Tank 2 Tank 3 Tank <br /> Other Sump.Describe location or function(e.g.,suction piping,tank manhole)on this row: 8.6 <br /> Any water or product removed and disposed of properly 8.6.4 <br /> Visible piping and fittings show no signs of leaking 8.6.1 <br /> Piping in good condition 8.6.2 <br /> Sump free of trash and debris 8.6.5 <br /> Sump is free of cracks,holes, bulges, or other defects 8.6.6 <br /> Penetration fittings intact and secured 8.6.7 <br /> Other Sump Junction box(es)have covers, not corroded;conduit and intrinsically safe wiring in good condition 8.6.8 <br /> Flexible connectors not frayed,twisted,kinked or bent beyond manufacturer specifications 8.6.9 <br /> Piping interstitial space open to the sump(open double-walled piping system only) 8.6.20 <br /> Piping interstitial space closed to the sump (closed double-walled piping system only) 8.6.22 <br /> Sump lid,gasket and seals present and in good condition 8.6.23 <br /> Manhole cover at grade in good condition,does not touch sump cover,all bolts present, 88 24 <br /> handles and lift mechanism in good condition(as applicable) <br /> Single-Walled Single-walled sump tested for integrity every 3 years <br /> Other Sump TEST DATE: 8.6.18 <br /> Double-Walled If not continuously monitored or inspected annually,double-walled TEST DATE: 8.6.19 <br /> Other Sump sump tightness tested every 3 years <br /> DESCRIBE ANY DEFICIENCIES HERE: <br /> PEI RP 900 Annual Other Sump Inspection Checklist Page of <br />