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0 RECEIVED <br />SWRCB, January 2002 Page of <br />9. FILL RISER CONTAINMENT SUMP TESTING ,' A''i i 201 <br />Facility is Not Equipped With Fill Riser Containment Sumps X <br />Fill Riser Containment Sumps are Present, but were Not Tested ❑ <br />Test Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard ❑ Profes g <br />❑ Other (Spec) <br />Test Method Used: ❑ Pressure ❑ Vacuum <br />❑ Other (Specify) <br />❑ Hydrostatic <br />Test Equipment Used: <br />Fill Sump # Fill Sump # <br />Sump Diameter: <br />Equipment Resolution: <br />Fill Sump:W Fill Sump # <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 />water and starting test: <br />Test Start Time: <br />Initial Reading (111): <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: ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br />❑ Pass ❑ Fail 0 Pass: 0 Fail <br />Is there a sensor in the sump? ❑ Yes ❑ No ❑ Yes ❑ No <br />❑ Yes ❑ No ❑ Yes ❑ No <br />Does the sensor alarm when <br />either product or water is ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No [INA <br />detected? <br />❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br />Was sensor removed for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA <br />Was sensor properly replaced and ❑ yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ 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 />