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FILL RISER CONTAINMENT SUMP TESTING <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 (Specify) <br /> Test Equipment Used: Equipment Resolution: <br /> Su <br /> Fill mp # Fill Sump # 1 Fill Sump # Fill Sump # <br /> Sump Diameter: <br /> Sump Depth: <br /> Height from Tank Top to Top <br /> of Highest Piping Penetration: <br /> Height from Tank Top to <br /> Lowest Electrical Penetration: <br /> Condition of sump prior to <br /> testing: <br /> Portion of Sump Tested 1 02 2018 <br /> Sump Material: <br /> Wait time between applying ENVIRONMENTAL HEALTH <br /> pressure/vacuum/water and PE MITISERMES <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 R,): <br /> Pass/Fail Threshold or Criteria: <br /> Test Result: ❑ Pass E Fail EI Pass El El Pass ❑ ❑ Pass ❑ <br /> Fail Fail Fail <br /> Is there a sensor in the sump? ❑Yes [—]No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> Does the sensor alarm when <br /> either product or water is ❑Yes ❑No [—]N/A ❑Yes ❑No ❑N/A[—]Yes ❑No ON/AF—]Yes ❑No ❑N/A <br /> detected? <br /> Was sensor removed for ❑Yes ❑No ❑N/A ❑Yes ❑No ❑N/A❑Yes [:]No ❑N/A❑Yes ❑No ❑N/A <br /> testing? <br /> Was sensor properly replaced ❑Yes ❑No ❑N/A ❑Yes ❑No ❑N/A❑Yes ❑No ❑N/A❑Yes ❑No ❑N/A <br /> and verified functional after <br /> testing? <br /> Comments — (include information on repairs made prior to testing, and recommended follow-up for <br /> failed tests) <br />