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SWRCB, January 2002 <br />E <br />R_ FH.1, DT.V'VD rn1V rAT7 M4VATTV OTT%AFn rV•. -- <br />Page of <br />e uit�g Vv1T_jL& <br />Facility is Not E ui ped With Fill Riser Containment Sums X <br />1L`01$L9V <br />Fill Riser Containment Sumps are Present, but were Not Tested D <br />Test Method Developed By: <br />0 Sump Manufacturer 0 Industry Standard D Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: <br />0 Pressure 0 Vacuum <br />❑ Hydrostatic <br />0 Other (Specify) <br />Test Equipment Used: <br />Equipment Resolution: <br />Fill Sum # Fill Sump # <br />Fill Sum # Fill Sum # <br />Sum Diameter: <br />Sump Depth: <br />Height from Tank Top to Top of <br />Hi hest Piping Penetration: <br />Height from Tank Top to Lowest <br />Electrical Penetration: <br />Condition of sump prior to <br />testing: <br />Portion of Sum Tested <br />Sump Material: <br />Wait time between applying <br />pressure/vacuum/water and <br />startup test: <br />Test Start Time: <br />Initial Reading (R,): <br />Test End Time: <br />Final Reading RF): <br />Test Duration: <br />Change in Readin (RF -R,): <br />40jNo <br />Pass/Fail Threshold or Criteria: <br />Test Result: <br />❑Pass ❑Fait ❑Pass ❑Fail <br />Pass 0 Fail <br />is there a sensor in the sump? <br />0 Yes ❑ No ❑ Yes D No <br />Yes 0 No <br />Does the sensor alarm when <br />either product or water is <br />0 Yes ❑ No 0 NA ❑ Yes ❑ No DNA <br />❑ Yes ❑ No D NA D Yes 0 No ❑ NA <br />detected? <br />Was sensor removed for testing? <br />D Yes D No ❑ NA ❑ Yes D No ❑ NA <br />❑ Yes ❑ No 0 NA ❑Yes 11 No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testin ? <br />❑ yes []No ❑ NA D Yes ❑ No ❑ NA <br />D Yes D No D NA ❑ Yes D No ❑ NA <br />COmments — (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />