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SWRCB, Jamiary 2002 page of <br />Facility is Not Equipped With Fill Riser Containment Sumps ❑ <br />Fill Riser Containment Sumps are Present, but were Not Tested D <br />Test NJtethod Developed By: Q Sump Manufacturer G Industry Standard Professional Engineer <br />❑ Other (Specify) <br />Test Method Used: D Pressure ❑ Vacuum D Hy tic <br />❑ Other (Specify) <br />Test Equipment U • I Equipment Resolution: <br />Comments — (include information on repairs made priorto testing: and reconvnended follow-up for failed tests) <br />FBI p # <br />FE Sump <br />FM Sump # <br />Pill # <br />Sump Diameter. <br />Sump Depth: <br />Height from Tank Top to Top of <br />Highest Pip'Pipmg Penetration- <br />e tion:Height <br />Heightfrom Tanis Top to Loi:est <br />Electrical Penetration: <br />Condition of sump prior to <br />testing: <br />Portion of Sump Tested <br />Sump Material: <br />Waft fine between applying <br />pressure/vact u n/water and <br />starfing test: <br />Test Start Time: <br />.Initial Reading (14): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading ( <br />Pass/Fail Threshold or Criteria: - <br />TestResult: <br />❑ Paso ❑ Fail <br />❑ Pass ❑ Fail <br />Q Pass ❑ Fail <br />a Pass ❑ Fad <br />Is thein a sensor in the sump? <br />Q Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes r No <br />❑ Yes Q No <br />Does the sensor alarm when <br />either pmduct or Rater is <br />D Yes ❑ No ❑ NA <br />❑ Yes Q No DNA <br />DYes ❑ No DNA <br />QYes QNo DNA <br />detected? <br />Was sensor removed for testing" <br />F- Yes Q No D NA <br />C Yes Q No [INA <br />Q Yes ❑ No DNA <br />Q Yes : No Q NA <br />Was sensor properly replaced and <br />Ii <br />Nenfied fcuwaonal after testing? <br />❑ Yes ❑ No Q NA❑Yes <br />Q No ❑ NA <br />Q Yes ❑ No DNA <br />Q Yes v No G NA <br />Comments — (include information on repairs made priorto testing: and reconvnended follow-up for failed tests) <br />