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S`YVRCB, January 2002 S. FILL RISER CONTAINMENT SIIMP TFCTINf_ Page __ of Facility is Not Equipped With Fill Riser Containment Sumps, Fill Riser Containment Sumps are Present, but were Not Tested ❑ - _ JTest Method Developed By: - P Stinp Manufacturer D ludusax standard -�� i_I Professional Engineer LI Other (.Spec) Test Method Used: G Pressure 0 Vacuum U hydrostatic U Other (Specify,) Fest Equipment Used ----- E Equipment Resolution: - T �- �---•-«<-� ,-• .;- T; -- � �a � .,��:a: �..�.;.: „ t4rt of uuon Fill Sum # a= Fill Sum # Fill Sump # Fill Sump # Sump Diameter: _ Sump Depth: Height from Tank Top to Top of Highest Pipits Petnetratio n: Height frotu Tank Top to Lowest Elecincal Penetration: Couditiou of svmp prior. to Portion of Sunup Tested --" -'- - Sum Malerial:--- Wait bine between apply iub — pressure/vacttuw/uater and N 1 starting test: Test Start Time: - - - - Iiddal Reading (R,): -- -- �'-- -- -" Test End Time: --` _ - - Final Reading (RF): Test Duration, -- -- - Change in Reading (RF -RI): - _ Pass/Fail Threshold or Criteria _ -- - - - — Test Result: D Pass D Fail D Pass D Fail D Pass D Fail ❑ Pass CI Fail Is there a sensor in the sump? o Yes D No D Yes D No _ D Yes D No D Yes D No Does the sensor alarnn AA-iuea _ eidter product or water is D Yes CI No O NA A Yes D No DNA D Yes U No [INA U Yes D No IJ NA detected? - Was D Yes D No DNA D Yes D No DNA U Yes D No DNA D Yes D No DNA. Was sensor properly replaced and verified Muctional after testing? U Y es D No DNA D Yes U No DNA D Yes D No [INA Q Yes 11 No 11 NA Comm eRtsi - (include it formation on repairs made prior to testing, and recommended follow -uta for failed tests)