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0 Page 7 of 8 <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: See attached testing procedures <br />Equipment Resolution: <br />Fill Sump # <br />Fill Sump # <br />Fill Sump # <br />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 />Above highest <br />penetration <br />Above highest <br />penetration <br />Above highest <br />penetration <br />Above highest <br />penetration <br />Sump Material & Manufacturer: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />30 minutes <br />30 minutes <br />30 minutes <br />30 minutes <br />Test Start Time: <br />Initial Reading (RI): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />15 min <br />15 min <br />15 min <br />15 min <br />Change in Reading (RF -RI): <br />Pass/Fail Threshold or Criteria: <br />0.002 <br />0.002 <br />0.002 <br />0.002 <br />Test Result: <br />❑ Pass ❑ Fail <br />❑ Pass 'r ❑ 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 />® Yes ❑ 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 [INA <br />®Yes [-]No ❑NA <br />Was sensor removed for testing?®Yes <br />❑ No ❑NA <br />®Yes ❑ No ❑NA <br />El No El <br />NA <br />®Yes El No F-1®Yes <br />NA <br />Was sensor properly replaced and <br />verified functional after testing? <br />®Yes ❑ No ❑NA <br />®Yes El No ❑NA <br />®Yes El No ❑NA <br />®Yes E] No ❑NA <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />*********************DIRECT BURIAL******************* ***** <br />