DERR-2024-008855

PEI/RP1200 -19
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APPENDIX C-4-A
CONTAINMENT SUMP TESTING
LOW LIQUID LEVEL TEST METHOD
Facility Name:Owner:
Address:Address:
City, State, Zip Code:City, State, Zip Code:
Facility I.D. #:Phone #:
Testing Company:Phone #:Date:
This procedure is to test containment sumps using the low liquid level method. See PEI/RP1200 Section 6.6 for the test method.
Containment Sump ID
Containment Sump
Material
Visual Inspection (No
cracks, loose parts or
separation of the con-
tainment sump.)
Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Liquid and debris were
removed from sump? * Yes No Yes No Yes No Yes No Yes No Yes No
When tested, electronic
sensor connected to
EMS, stand-alone sen-
sor or mechanical float
device shuts down
appropriate STP, dis-
penser or product as
required?
Yes No Yes No Yes No Yes No Yes No Yes No
Starting Water Level
Test Start Time
Ending Water Level
Test End Time
Test Period (Minimum
test time: 1 hour)
Water Level Change
Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Comments:
*All liquids and debris must be disposed of properly.
Tester’s Name (print) ___________________________________ Tester’s Signature _________________________________