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0 0 <br />SWRCB, January 2002 Page of , <br />Facility is Not Equipped With Fill Riser Containment Sumps ❑ <br />Fill Riser Containment Sumps are Present, but were Not Tested ❑ <br />Test Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard ❑ Professional Engineer <br />❑ Other (Specify) <br />Test Method Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br />❑ Other (Spec) <br />Test Equipment Used: <br />�Fy�_ /fYe! �•'sS' /i/%�� ..;�,, ,.., s/.' ��' ,,.. Fill Sump # Fill Sump # <br />Equipment Resolution: <br />Fi Sump # <br />Fill Sump # <br />ter:Tank <br />resiping <br />Top to Top ofg 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-Rj): <br />Pass/Fail Threshold or Criteria: <br />Test Result: <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Is there a sensor in the sump? <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Yes ❑ No- <br />11 ❑ No <br />Does the sensor alarm when <br />either product or water is <br />detected? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor removed for testing? <br />❑ Yes ❑ No ❑ NA <br />F11 Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testing? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />