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SWRCB, January 2002 R_ Fii.T. RT.QT'R (PINT A 1f1U1%41-*rr orrnun mr, L,mT .r. Page -I of U Comments — (include information on repairs made prior to testing and recommendedfollow-up forfalled tests) ----- uvl•4 iLlJlll\ll Facility is Not Equipped With Fill Riser Containment Sum s Fill Riser Containment Sumps are Present, but were Not Tested Tst Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard 0 Professional Engineer D Other (Spec) Test Me d Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic D Other (Spec) fffff Test Equipment Fill Sump # Fill Sump # Sump Diameter: Equipment Resolution` Fill Sump # i Fill Sump # t Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material:. Wait time between applying pressure/vacuum/water and starting test: r Test Start Time: Initial Reading RI Test End Time. Final Reading F Test Duration: Change in Reading (RF—R,): Pass/Fail Threshold or Crite a: TestResult: ❑ Pass ❑ Fail 0 Pass D Fail '0 Pass ❑ Fail: Pass Q;Fail Is there a sensor in the ump? ❑ Yes ❑ No ❑ Yes 0 No 0 Yes 0 No ❑ 0 No when Does the sensoorater either product is detected? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No 0 NA D Yes 0 No 0 NA ❑ Yes ❑ D NA Was sensor rdmoved for testing? ❑ Yes 0 No 0 NA ❑ Yes 0 No ❑ NA D Yes ❑ No D NA 0 Yes ❑ No 0 Was sens r properly replaced and verified functional after testing? 0 Yes ❑ No ❑ NA ❑ Yes ❑ No 0 NA 0 Yes ❑ No ❑ NA ❑ Yes ❑ No 11 NA Comments — (include information on repairs made prior to testing and recommendedfollow-up forfalled tests)