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SWRCB.January 2002 FINAL DRAFT Page 6 of 7 <br /> . FILL RISER CONTAINMENT SUMP TESTING <br /> Facility is Not Equipped With Fill Riser Containment Sump(s) ❑ <br /> Fill Riser Containment Sumps are Present,but were Not Tested ❑ <br /> Test Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard Professional Engineer <br /> 0 Other(Specify) <br /> Test Method Used: ❑Pressure ❑Vacuum ❑Hydrostatic <br /> ❑Other(specify <br /> Test Equipment Used: Equipment Resolution: <br /> Fill Sump# Fill Sump Fill Sump# 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: <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-RI): <br /> Pass/Fad Threshold or Criteria: <br /> Tat Result OPass OFail ElPass [:[F—ail []Pass Fail Pass Fail <br /> Is there a sensor in the ? Yes No es El Elyes No Elyes No <br /> Does the sensor alarm when <br /> either product or water is ❑Yes❑No[INA ❑Yes❑No❑NA ❑Yes❑No[INA ❑Yes❑No ❑NA <br /> detected? <br /> Was sensor removed for testing? Yes No NA Elyes No EINA Elyes No NA Yes EjNo NA <br /> Was sensor properly replaced ❑yes❑No FI:N:Aj ❑Yes❑No❑NA ❑Yes❑No[INA ❑Yes❑No®NA <br /> verified functional after testin <br /> Comments—(Include information on repairs made prior to testing, and recd nded follow-up for failed tests.) <br /> No Fill Riser Containment Sump. <br />