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S'IA RCB, January 2002 Page of 6. UNDER -DISPENSER CONTAIN?viFNT (ITnC1 TF..Cfrnvr_ Test Method Developed By: ❑ UDC'Manufacturer ❑ Industry Standard v u 7 --'Professional Engineer f ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic ❑ Other (Specify) Test Equipment Used: Equipment Resolution: ,'.� } r, lt"fl! ' `fdc jY -. k!"'rxu d!F. • r }n ��n iifr' {. .i. F:teaftp. r.. .:-. ry r. n .'• .rt f�'ffiw� w��Rl.LW .. t....y, UDC # UDC # UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested Does turbine shut down when UDC sensor detects liquid (both C Yes ❑ No [INA ❑Yes ❑ No ❑ NA Q Yes ❑ No ❑ NA ❑ Yes u No u NA product and water)?' Turbine shutdown response time Is system programmed for fail- safe shutdown?" ❑ yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was fail-safe verified to be operational?* ❑ yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes G No ❑ NA ❑ Yes ❑ No ❑ NA Wait time between applying pressure/vacuum/water and starting test Test Start Time: Initial Reading ): Test End Time: Final Reading F): Test Duration: Change in Reading (RF- P4)-Pass/Fail Threshold or Criteria: Tist;Resu)li{: Q:;Eass, . 0 gam` :.Pas .:.'.C� F ii., t7? Pass'; Q Paih '0 Pass: ❑ Rsii . Was sensor removed, for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No Q NA Q Yes ❑ No ❑ NA C! Yes ❑ No ❑ NA Was sensor properly replaced and ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA verified functional after testing? , a Comments — (mclude information on repairs made prior to testing, and recommended follow-up for failed tests) If the entire depth of the UDC is not tested, specify how much was tested. If the answer to as of the questions indicated with an asterisk (*) is "NO" or "NA', the entire UDC must be tested. (See SWRCB LG -160)