HomeMy WebLinkAbout18370 000062 101 04-22-2020 ATGTEST SLA AUTOMATIC TANK GAUGE TEST 63672.07 ATGTEST
DRAFT ADEM ANNUAL TANK GAUGE TEST
REPORT FOR YEAR 2020
Facility NameOne Stop 72 Liberty Stor2 Owner: S&S Eagle LLC
Address:1175 West wuin blva Address: P.O.Box 792
City, County, Zip: montoome[yCit , State, Zi : MillbrookAL Facility I.D. #: 2-101-62 Phone#:
Tester Name: Paul Graves Tester Phone#:205-393-4517
Tester Company: P&L Testin LLC Test Date: 04/2 20
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: USTcomoliance@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 Unit at(334)270-5655.
ADEM Unique Tank#
Product Stored E-10 E-10 Premium Premium Noeth Diesel
Is probe free of residual buildup? yes ayes ;yes &yes &yes &yes
❑no ❑no ❑no ❑ no ❑no ❑no
Are cables free of kinks? &yes ■yes 7Ces !yes •yes IS yes
❑no ❑no ❑no ❑no ❑ no ❑no
Was shaft inspected and free of damage? a nos ❑ no ❑no ❑ no 49❑ no ❑ no
Do floats move freely? &yes ■yes yes K yes /yes ■yes
❑no ❑ no ❑no ❑ no ❑no ❑no
Does measured product and water levels in &yes ayes Oyes ayes i yes &yes
tank a ree with console levels? ❑no ❑no ❑no ❑no ❑no ❑no
Does actual product Float level agree with &yes •yes t yes &yes &yes &yes
console product float level? ❑ no ❑no ❑no ❑no ❑no ❑no
Does Overfill alarm activation level agree &yes yes 0-yes ■yes !yes &yes
with console? ❑no ❑no ❑no ❑no ❑ no ❑ no
Does actual water float level agree with &yes !yes ■yes &yes &yes ®yes
console water float level? ❑no ❑ no ❑no ❑ no ❑no ❑ no
Does water alarm activation level agree with a yes &yes &yes !yes i yes It
console? ❑no ❑ no ❑no ❑no ❑no ❑no
Does console test history include test &yes &yes •yes &yes &yes &yes
alarms?(Don't forget to clear test alarms) ❑no ❑no ❑no ❑no ❑no ❑no
Does site setup agree with configuration &yes ■yes &yes IS yes i yes a yes
shown in console? ❑no ❑no ❑no ❑no ❑no ❑ no
Is battery backup operational? &yeti &yes &yes i yes ayes Oyes
❑no ❑no ❑no ❑no ❑ no ❑no
Testing results? &pass &pass a pass ■pass &pass ■pass
(Must meet all applicable criteria to pass.) ❑fail ❑fail ❑fail ❑fail ❑fail ❑fail
Repairs Needed Date of
Repair Description of any Repairs
Tester's Signature:
ADEM Form xxx(new form)