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SWRCB, January 2002 <br />7. �+TF,ir, RYCF.R ('(INTdTNMTNT cTrnav r�c•rnvr <br />Page of <br />Facility is Not Equipped With Fill Riser Containment Skimps ❑' <br />Fill Riser Containment Sumps are Present, but were Not Tested 0 <br />Test Method Developed By: 0 Sump Manufacturer 0 Industry Standard !7 Professional Engineer <br />0 Other (Specify) <br />Test Method Used: 0 Pressure 0 Vacuum ❑ Hydrostatic <br />0 Other (Specify) <br />Equipment Used: <br />Equipment Resolution: <br />fTest <br />Fill Sumf , # <br />'.k?. <br />Fill Sum # <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 />Height from Tank Top to Lowest <br />Electrical Penetration: <br />Condition of sump prior to <br />testing: <br />Portion of Sump, Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: <br />Initial Reading (R;): <br />Test End Time: - <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF -RI): <br />Pass/Fail Threshold or Criteria: <br />Test Result... <br />Qi Piss Q Fail <br />fl Pass;_ Ct Fail .. <br />Q Dasa 0 Fail <br />0 Pass. Q` Fal[ _ <br />Is there a sensor in the sump? <br />❑ Yes 0 No <br />❑ Yes 0 No <br />❑ Yes 0 No <br />❑ Yes ❑ No <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />❑ Yes ❑ No 0 NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />0 Yes ❑ No 0 NA <br />Was sensor removed for testing? <br />❑ Yes ❑ No 0 NA <br />0 Yes 0 No 0 NA <br />0 Yes 0 No ❑ NA <br />❑ Yes 0 No 0 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 />0 Yes ❑ No 0 NA <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for ailed tests) <br />