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0 <br />SWRCB, January 2002 <br />Page of <br />Facility is Not Equipped With Fill Riser Containment Sumps X <br />Fill Riser Containment Sumps are Present, but were Not Tested ❑ <br />Test Method Developed By: <br />❑ Sump Manufacturer <br />D Other (Spec) <br />❑ Industry Standard F. Professional Engineer <br />Test Method Used: <br />❑ Pressure <br />❑ Other (Specie) <br />❑ Vacuum <br />❑ Hydrostatic <br />Test Equipment Used: <br />ONIONNEM <br />Sump Diameter: <br />Fill Sump # <br />Fill Sump # <br />Equipment Resolution: <br />Fill Sump # Fill Sump # <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 />water and starting test: <br />Test Start Time: <br />Initial Reading (Ri): <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: <br />❑ Pass ❑ Fail <br />❑ Pass ❑'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 ❑ NA <br />❑ Yes ❑ No ❑ NA <br />Was sensor removed for testing? <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No [INA <br />❑ Yes ❑ No ❑ NA <br />Was sensor properly replaced and <br />verified functional after testing? <br />❑ yes ❑ No ❑ NA <br />❑ Yes ❑ No ❑ NA <br />❑ Yes ❑ No [INA <br />❑ Yes ❑ No ❑ NA <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />