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Home My WebLink About4751 010423 097 10-24-2023 LDLTTEST AEPACS LINE AND LEAK DETECTOR TEST Digitally signed by: Automatic Line Leak Detector (ALLD) AEPACS Date:2023.11.01 11:13:36-05:00 Reason:Submission Data and/or Line Tightness Test Report Location:State of Alabama version 3.0 (Submission#: HPY-TYEK-6WEEF,version 1) Details Submission Alias Automatic Line Leak Detector(ALLD)and Line Tightness Test Report(Form 566) Submission ID HPY-TYEK-6WEEF Form Input Report Entry Submission Method for Test Results Upload PDF Copyof ADEM Automatic Line Leak Detector(ALLD)and Line Tightness Test Report(Form 566) Is the submission in response to an Waming Lefler I Notice of Violation I Notice of Proposed Delivery Prohibition? No Site Information Site Name FLETCHER SMITH SERVICE STATION Permit Number(Facility ID Number) 18027-097-010423 Site Address 19415 N 3RD ST CfIRONELLE,AL 36522 United States Upload Test Results Type of Test Performed Automatic Line Leak Detector(ALLD) Line Tightness Test Please select®Did Not Test®as the test result and provide the reason for not testing for all situations in which the specific equipment was not tested or not required to be tested. Automatic Line Leak Detector(ALLD)Test Results Tank Product Test Data Test Result 11814 On road diesel 10/242023 Did Not Test 11817 Premium gasoline 10/242023 Pass 11819 On road diesel 10/242023 Pass 11821 Mid-grade gasoline 10/242023 Pass 11822 On road diesel 10/242023 Did Not Test 43783 Unleaded gasoline 10/242023 Pass 11/11202311:13:36AM Pagel of Tank Product Test Data Test Result 49264 Unleaded gasoline 10/242023 Pass 49265 On road diesel 10242023 Pass Reason for Not Testing Temporary closed Line Tightness Test Results Tank Product Test Date Test Result 11814 On road diesel 10/242023 Did Not Test 11817 Premium gasoline 10/242023 Pass 11819 On road diesel 10/242023 Pass 11821 Mid-grade gasoline 10/242023 Pass 11822 On road diesel 10/242023 Did Not Test 43783 Unleaded gasoline 10/242023 Pass 49264 Unleaded gasoline 10/242023 Pass 49265 1 On road diesel 10/242023 Pass Reason for Not Testing temporary closed Attach the PDF file of the test form doc01398120231101110105.odf-11/012023 11:09 AM Comment NONE PROVIDED 11/11202311:13:36 AM Page 2 of 2 LDLTTEST ADEM AUTOMATIC LINE LEAK DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT Site Name: / r Owner: ` elae, 5,,A 0,'/ Address:jjq1,5Address: / /5 nl 3rj City, County,Zip, State, Country: C4fwjl, City, Country, State,Zi , Country: _365,72 Facility I.D.#:1g0 -g'J Phone#: /- Iq- 112 Tester Name: Tester Phone#: 6 - Tester Certification Type: Certification Expiration: / Z/ / Tester Com an ^j Test Date: /Q- - Site Latitude Longitude Instructions 1. Submit this form,attach all test data for every test performed,and submit a completed copy of this form to: Groundwater Branch,PO Box 301463,Montgomery,AL 36130-1463,or fax to: (334)270-5631,or email to: USTcompliance at7.adem.alabama.gov. This form must be completed and included with the test data or the submittal will not be accepted. 2. This form allows up to 6 ADEM Unique Tank Numbers,assuming that the Facility ID Number and test equipment remain the same. 3. Testing must be performed in accordance with a nationally recognized code of practice(such as PEI RP-1200 or equivalent)or the manufacturer's instructions. 4. Line tightness test equipment used must be approved by ADEM. Visit the NWGLDE website at www.nwglde.org to view a list of release/ leak detection equipment/methods that ADEM approves for use in Alabama. 5. Automatic Line Leak Detectors are designed to be tested in-place. Do not remove and test outside of the tank system. 6. Keep a copy of this testing for 3 years. Questions on how to complete this form should be directed to the Groundwater Branch, UST Type of Test Performed-check all that apply: f2fAutomatic Line Leak Detector(ALLD) Line Tightness Test Reason for Test-check all that apply: Annual Test ❑New Installation ❑Required by ADEM Enforcement Action Manufacturer of ALLD Test Equipment: t Model or Version: f7y C e Manufacturer of Line Tightness Test Equipment: F'5kk,,Li I Model or Version: ADEM Unique Tank# Nor6. .isl 66-5F ZS" 119,21 ( gY26S Product Stored Kequ ck,,Izr c;2, 100l r Q 1111berglass OfiVerglass ❑fiberglass ❑fiberglass ❑fiberglass ❑fiberglass Piping material R(flexible ,eflexible Oflexible j6flexible Pfflexible J21flexible ❑steel ❑steel ❑steel ❑steel ❑steel ❑steel Approx. length of piping O /,J� �Q J�� O run tested nearest foot 7 0 Piping capacity (gallons) dob ,taa_ 06 At x I ,�u C) 06 A4r-x C2W Milk aX A114A Automatic Line Leak Detector Test Type of ALLD mechanical gmechanical 125mechanical AmechaniGal Amechanical Zmechanical ❑electronic ❑electronic ❑electronic ❑electronic ❑electronic ❑electronic Line pressure JD D O Burin ALLD test(psi) ` Measured ALLD leak rate 2 2 n J J Results of ALLD test Pass ❑fail pass ❑fail J9pass ❑fail pass ❑fail jZpass ❑fail pass ❑fail ❑inconclusive ❑inconclusive I ❑inconclusive ❑inconclusive ❑inconclusive ❑inconclusive Line Tightness Test Line pressure d o duringline test(psi) 0 Measured line leak rate(gp /1 h LJ /1 0 (� Results of line pass ❑fail pass ❑fail pass ❑fail pass ❑fail Zpass ❑fail Opass ❑fail tightness test ❑inconclusive ❑inconclusive ❑inconclusive ❑inconclusive ❑inconclusive ❑inconclusive Repairs Needed I Date of Repair I Description of any Repairs site euntact tessrse—ownei—eunbuitant- Name Tester's Signature:kind ADEM Form 566 revised 06/2022 ml EZY CHEK SYSTEMS Q + LEAK DETECTOR TESTER Systems 8 Training DATA SHEET for the TEST DATE __ Petroleum Industry '.Test Location Information Testing Company Information Name C r 5mr Name ` ui Address I 1 rJ t Address o69 City C��ON�1 ' 3� City. Phone Phone j- 6 -M93 Contact �� S `�� Technican Information Name pjr,° k- V Cert# u 0 TYPE OF LEAK DETECTOR PUMP# MAKE MODEL SERIAL# 1 FF pro STP Mc.D+G 2 rL PCB ST -Ntc 3 � a 00 4 'P�Iro �5T &D + 6 QtD 7 8 Functional Test Leak Element Rate Opening PUMP# Product Type Metering Pressure Holding PSI Resiliency ML/MIN Time Pass/Fail 1 e / (_mil_) 189ml -3 k-55 2 1ccrC2 / ` 6 6200 189ml J 76 3 (-- _,U oCJ ;00 189m1 W55 4 !00 C 19 o. 3Q3 ` / CKC10 189m1 aSS 5 y/e- J �8 0 189ml ��$S 6 /,50 189ml �� 7 189ml 81 189ml EZY CHEK SYSTEMS TEST DATE - PRODUCT LINE TESTER `vesting Company information Systems&Training DATA SHEET Name r ' for the Petroleum Industry Address c` City Al. '56693 4 Test Location Information Phone Name ��Th 1,0 Address ,J Technican information city Lt� CYJe[/e Al, 30o&9 Name DWI,, Phone `-�l7' I1�� Cert# 73-Q , Q Contact et Applied Pressure Q 2 F; FIM Product Type: l F#2Product Type: DATA -/+ GPL RES GPH DATA -/+ GP RES GPH 0 0.0037 0.0000 0.0000 5L 0 0.0037 0.0000 0.00 00 5� �_ 0.0037 Q 5(o Q 0.0037C> 0.0037 (� 56 0.0037 d O 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 FINAL RESULT: GSS FINAL RESULT: S F3 Product Type: �- #4 Product Type:ME DATA -/+ GPL RES GPH TIME DATA 4+ GPL RES GPH Z 0 0.0037 0.0000 0.0000 0j6 0 0.0037 0.0000 0.0000 y r _� 0.0037 Q O:y5 _Q 0.0037 Q OU _74 d 0.0037 p (=G0 Q 0.0037 6 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 FINAL RESULT: 4 FINAL RESULT: c�SS #5 Product Type: j #6 Product Type: a TIME DATA -/+ GPL RES GPH TIME DATA -/+ GPL RES GPH 11:/0 0 0.0037 0.0000 0.0000 :�/ Q 0 0.0037 0.0000 0.0000 Q 0.0037 Q /0_'00 (� 0.0037 1: Q 0.0037 0. 0.0037 _� Q 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 FINAL RESULT: FINAL RESULT: ATGTEST ADEM ANNUAL TANK GAUGE TEST REPORT FOR YEAR 10�3 Site Name: S ,' Registered Owner: ; Address: Address: kf City, County,Zip, Country: o ,/ City, State,Zi : Cr'fr'wr.c llc Facility I.D.#: b -q7-•oYz3 Phone#: 5- Z! -IIZX Email: Tester Name:goJr,ck v Tester Phone#: 2 /- q Tester Company: o Test Date: /0 a`l- Instructions 1. Submit a completed copy of this form within 30 days of performing test to: Groundwater Branch,PO Box 301463, Montgomery,AL 36130-1463,or fax to: (334)270-5631,or email to: USTcompliance(aD_adem.alabama gov. 2. This form allows you to record up to 6 ADEM Unique Tank Numbers,assuming that the Facility ID Number remains the same. 3. Inspection and Testing must be performed in accordance with a nationally recognized code of practice(such as PEI RP-1200 or equivalent)or the manufacturer's instructions. 4. Keep a copy of this testing for 3 years. Questions on how to complete this form should be directed to the Groundwater Branch,UST Compliance Section at(334)270-5655. 5. If the probe is not used for leak detection but the console is(e.g.double walled tanks using interstitial monitoring),then it does not need to be tested. ADEM Unique Tank# 5763 / 9-1 a(a5 Product Stored lc r I I KuI a -kA4 1 /00% u utomatic Tank u e Console Test Does console test history include test dyes yes )dyes Xyes Oyes 0 yes alarms? Don't forget to clear test alarms ❑no ❑no ❑no ❑no ❑no ❑no Does site setup agree with configuration )Z yes yes `'yes yes yes yes shown in console? ❑no ❑no ❑no ❑no ❑no ❑no Is battery backup operational? yes yes dyes yes yes yes ❑no ❑no ❑no ❑no ❑ no ❑ no Testing results? )21 pass JM pass jff pass jZrpass I 7pass g pass (Must meet all applicable criteria to pass.) ❑� 1 ❑fail ❑fail ❑fail 0 fail ❑fail Probe and Float Test Is probe free of residual buildup? )25'yes A yes JZ yes Xyes Xyes .121'yes ❑no ❑no ❑no ❑no ❑no ❑ no Are cables free of kinks? Jdyes yes Oyes yes yes P'yes ❑no ❑no ❑no ❑ no ❑no ❑no Was shaft inspected and free of damage? ❑no JV 0 no 0 no ❑no ❑no s 0 no Do floats move freely? yes 7yes yes Oyes Oyes Feryes ❑no ❑no ❑no ❑no ❑no ❑no Does measured product and water levels in )Zyes Zyes ,la''yes eyes Zyes ;Tyes tank agree with console levels? ❑ no ❑no ❑no ❑no ❑no ❑no Does actual product float level agree with Z yes yes Xyes Xyes ,dyes Oyes console product float level? -Ono------ ❑no ono— - -no ❑no — ❑no Does Overfill alarm activation level agree ❑yesxn/a ❑yes O n/a ❑yes, n/a ❑yes PT n/a ❑yesyfn/a ❑yes Zn/a with console? ❑no ❑no ❑no ❑no ❑ no ❑no Does actual water float level agree with yes Xyes yes )I yes ;°yes ,9 yes console water float level? ❑no ❑no ❑no ❑ no ❑no ❑no Does water alarm activation level agree with yes Oyes Eyes yes 'yes Ayes console? ❑no ❑no 1 ❑no ❑no ❑ no ❑no Testing results? RI pass Opass A pass pass JZ1 pass P''pass (Must meet all applicable criteria to pass.) ❑fail ❑fail ❑fail ❑fail ❑fail ❑fail Repairs Needed Date of Description of any Repairs Repair Tester's Signature �C ADEM Form 565 06/22 m 1