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SWRCB,`January 2002 <br />. FILL RISER CONTAINMENT SV171[" TESTL G <br />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: 0 Sump Manufacturer ❑ Industry Standard ❑ Professional Engineer <br />❑ Other (Specify) <br />Test Method Used; ❑ Pressure ❑ Vacuum ❑ Hydrostatic <br />❑ Other (Spec) <br />Test Equipment Used: _ Equipment Resolution: <br />- <br />K`�, Fill `Sump # Fill Sump # Fill Sump # Fill Sump # <br />Sum Diameter. <br />Sump Depth: <br />Height from Tank Top to Top of <br />Highest PipinS 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 />-- <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: <br />Initial Reading (Rj): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Readin F-Rj): <br />Pass/Faff Threshold or Criteria: <br />Test Result: <br />❑ `Pass ❑ Fail <br />D. Pass D Fail <br />' ❑ Pass ❑ Fail <br />❑ Pass . 0 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 />❑ Yes ❑ No I i NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />detected? <br />Was sensor removed for testing? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testing? . <br />Ci Yes ❑ No ❑ NA <br />❑ Yes LO -No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Comments — (include information on repairs made prior to testing w7d recommended follow-up for failed tests) <br />