HomeMy WebLinkAbout12725 015060 101 02-12-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 70946.6 c LDLTTEST
DRAFTADEM
AUTOMATIC LINE LEAK DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT
Facilit Name: nif ( Owner:
Address: Address: _
City, County,Zip: City, State,Zip:
Facili I.D.#: 1- Phone#:
Tester Name: 5 Tester Phone#:
Tester Certification: 'S Certification Expiration:
rester Com an : Test Date: Z _
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: USTcomb6ance-&adeQ,ai_a lLania.pov. 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 instructors.
4. Line tightness test equipment used must be approved by ADEM. Visit the NWGLDE website at wwu.nwolde.oro to view a list of
releaselleak detection equipmenVmemods that ADEM approves for use in Alabama.
5. Automatic Line Leak Detectors are designed to be tested in-place. Do not remove arch 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
Compliance Unit at(334)270-5655.
Type of Test Performed-check all that apply: OAutomatic Line Leak Detector(ALLD) Feine Tightness Test
Reason for Test-check all that apply: XAnnual Test ONew Installation ORequired by ADEM Enforcement Action
Manufacturer of ALLD Test Equipment: Model a Version:
Manufacturer of Line Tightness Test Equipment: raok'5 Model or Version: Ezvack
ADEM Uni ue Tank#
Product Stored 14,-- — —— -- — ——--
-96%lass Wflberglass Dfiberglass Ufberglass Ofiberglass Ofberglass
Piping material Oflexible OBexible Oflexible Oflexible Oflexible Uflexible
Osteel Osteel Osteel Usteel Osteel Usteel
Approx.length of piping 30 ��
run tested nearest fool
Piping capacity
(gallons)
Automatic Line Leak Detector Test
Type of ALLD OmechanI I Umechanical Omechanical Omechanical Omechanical Omechanical
oeleclronic Clelecironic Oelectmnic Oelectronic oelectrooic Oelecronic
Line pressure
durflng ALLD lest(psi)
Measured ALLD leak rate
(gph)
Results of ALLD ten I7pass Ofall Opass olail Upass Ofail pass Ofail pass Ofall Opals Ofall
o.--lusive oinconcluslve oinconGuaive Oinconclusive oinconelmiles oinconclushe,
Line Ti htness Test
Line pressure r `
during line lest(psi) 7l/
Measured line leak rate D
Results of line -6(ass Ofall pass Ofail Opase ofail Upass olail Upass Mail Upass Owl
tightness lest Olncencluafv, Oinconclusive olnconclusive oinconGusive pinconcluaive oineonelusive
Repairs Needed Date of Repair Description of any Repairs
Tester's Signature:
ADEM Form xxxx(new form)
Quality
Cathodic,Tank&Line Testing
3101 12-St.Suite 3
Nonhpon,AL 35476
Ph: (205)345-2811
DATE: /Z w
ESTABROOK'S EZY CHEK TEST SITE: nhd rfjslo
ADDRESS: 300 llsew t /v
PRODUCT LINE TESTER m 1 p 101
TEST RESULTS TESTER NAME: f�J IiS (.✓ 066
CERTIFICATION p: 33-8/5Z
{� APPLIED PRESSURE: 50 PSI
(7 �
PRODUCTTYPE OR TANK p: ne, PRODURTYPE ORTANK p: Y✓�Pt
TIME DATA -/+ GPL RES GPH TIME DATA -/+ GPL RES GPH
.0037 Q Q I*W 6 Q .0037 C)
S 0 .0037 U O 1:I5 0 .0037 Q_ Q
.Q .0037 O _$� f (� .0037 _C O
.0037 .0037
.0037 .0037
.0037 .0037
Final Result: G-S5 Final Result: 2,55
PRODURTYPE OR TANK p: PRODURTYPE OR TANK p:
TIME DATA -/+ GPL RES GPH TIME DATA -/+ GPL RES GPH
_ .0037 .0037 _
_ .0037 .0037
.0037 .0037
.0037 .0037 -
.0037 .0037
.0037 .0037
Final Result: Final Result:
PRODUCFTYPE OR TANK W PRODUCT TYPE OR TANK p:
TIME DATA -/+ GPL RES GPH TIME DATA -/+ GPL RES GPH
.0037 .0037
_ .0037 .0037 -
_ .0037 .0037 -_
_ .0037 .0037
_ .0037 .0037
.0037 .0037 -
Final Result: Final Result: