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S WRCB,January 2002 Page of g <br /> S. FILL RISER CONTAINMENT SUMP TESTING <br /> F <br /> acility is Not Equipped With Fill Riser Containment Sum s <br /> ser Containment Sumps are Present,but were Not Tested ❑ <br /> Developed By: D Sump Manufacturer 0 Industry Standard ❑M Pr fessio <br /> S eco) <br /> Test Method Used: D Pressure cuum 0 Hydrostatic <br /> e'r(Spec) <br /> Tes a):qui ent Used: Equipment Resolution: —,__,,,� <br /> ill Sum # Fill Sump# Fill Sum # 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: ,a <br /> Wait time between applying <br /> pressure/vacuum/water and ... <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(111): <br /> Test End Time: <br /> Final Reading(RF): <br /> Test Duration: <br /> Chane in Reading RF-Rj : <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: ❑ Pass ❑Fail ❑ Pass ❑ Fail 0 Pass OVAll D Pass ❑Fail <br /> Is there a sensor in the sump? 0 Yes ❑N .s ❑Yes D No D Yes 0 No ❑Yes ❑No <br /> Does the sensor alarm when At. <br /> either product or water is 0 Yes ❑ ❑NA 0 Yes ❑No 0 NA D Yes D No 0 NA Yes 0 No ❑NA <br /> detected? , • <br /> Was sensor removed for testing? ❑Y ❑No ❑NA 0 Yes 0 No 0 NA ❑Yes D No 0 NA 0 Yes No 0 NA <br /> Was sensor properly replaced and yes ❑No D NA D Yes 0 No DNA D Yes D No DNA D Yes ❑No NA <br /> verified functional after testing? ,� <br /> Comments—(include Information on repairs made prior to testing, and recommended follow up for failed tests) <br />� _ J <br />