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Home My WebLink About12725 015060 101 02-12-2020 CPTEST WDB CORROSION PROTECTION TEST RESULTS 62815.68 Facility I.D.# - 10 CPTEST ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT CATHODIC PROTECTION MONITORING FORM FOR GALVANIC SYSTEMS Questions on M1ow to complete this form should be directed to the Groundwater Branch,UST Compliance Unit at 334 270-5655 1.Galvanic cathodic protection systems must be tested: a.In accordance with the latest edition code of practice established by the National Association of Corrosion Engineers(TM0101), b.By a qualified cathodic protection tester within 6 months of installation and repair of any portion of the UST system,and every 3 years. 2.Please use photocopies of the appropriate pages if you have more than 4 tanks at any one location. 3.Please remove all pages that do not apply to the site. 4.Submit a completed form for all tanks and piping using cathodic protection within 30 days of completing the test by fax to(334)210-5631, by e-mail to cdj@adem.state.al.us,or by mail to: Alabama Department of Environmental Management,Gro rndwater:Bran WUST Compliance Unit,Post Office Box 301463,Mon(gomery,AL 36130-1463. 5.The UST owner is required to keep a record of these tests for 3 years from the date of the test on a form acceptable to the Department Facili Information Reason Testiin Was Conducted(mark only itrm Facility Name:uh lh FOtY� „}' 1�Ny( #1p El Routine test within 6 months of installation Address: 300 Colis&mn.�/$1lW ,I� Routine 3- ear test City, County:M0 OyVIC✓ //'f0 ❑ Testwithin 6 months of repair Gwnerinforniatlon- `General Information Owner: Date of Testing: 2 2 Address: Temperature: 3u City, State,Zip Code. Weather Conditions: o Phone Number. Tank Backfill Material: Underground Storage Tank Facility Site Drawing 1.In the space below,sketch the important parts of the facility such as tanks,manways,fill pipes,tank monitor,vapor recovery connections,piping, vents,drilled test ports,anodes,pump islands,and buildings. 2.Indicate reference cell locations using location code"R"and sequential numbers(e.g.R1,R2)and structure contact points using the location code"S"and sequential numbers(e.g.Sl,S2)as used in the tables on the following pages. 3.For each tank,include ADEM unique tank number and/or product stored. Use the letter and number designations from the tables on the following pages to Indicate reference call locations and structure comect locations used for each measurement Ivir It S+ore Q n o Q� 9 0 (L3 f�4 O (3 �SSZ 51 R2 ADEM For#545; 1/06 Pagel -2- Facility I.D.# - & .60 CPTEST Underground Storage Tanks Continuity Test Resufts Galvanic S tams 1.The"Location Code"must be used to locate the reference cell and structure contact points on the drawing of the facility as discussed on page 1. 2.Record continuity test measurements using"Fixed Cell,Moving Ground Technique",or the structure to-structure"Potential Difference Technique". g.When using the'Fixed Cell,Moving Ground Technique",the reference cell must be placed in the soil at a location remote from the UST system (not within potential gradient of anodes or shielded by other tanks or structures)and tell undisturbed until continuity testing is completed. 4.If one continuity method fails to conclusively show proper isolation,the other method may be used to try to show proper Isolation. 5.Metallic structures are isolated when the'Voltage Potential"difference between two structures is greater Nan 10 mv,continuous when 10 my or less. G.All single and double wall metal tanks should be Isolated from all other metallic structures to maximize the life of thetank's galvanic cathodic protectionsystem . Location Reference Cell Location Voltage ResultslComments Code and Potential (Line out the one that does not apply) Structure Contact Points (negative Check all availablepoints) millivolts R 1 Tank J# I I.ADEM MOiagi ank#and/orGrade of Product Stored QA Size in Gallons S (Tank bottom $ my rneatinaeae isolated S Submersible pump isolated S Fill or.. my Isolated S Tank monitor IN isolated S Vapor recovery connection 5YJ my isolated S Vent line my confinuous isolated S Other my continuous isolated S Omer my, continuous isolated S Other my continuous isolated S Other my, continuous isolated Tank # ,ADEM Umbria,Tank If anal Grade ofPmduct Stored Size in Gallons S (Tank bosom my isolated S 0 ubmersible trump - my Wentirsuml Illated S 7 Fill my isolated S Tankmonkor my isolated S Vapor recove connection my ' olated S Vent line my continuous isolated S Other my continuous isolated S Other my continuous isolate S Other my continuous isolated S Other my continuous isolated Tank III ADEM Un" re Tank#anci Grade of Product Stored Size in Gallons S Crank bottom teat lea my continuous isolated S Submersible pump my continuous isolated S Fill pipe my continuous isolated S Tank monitor my continuous isolate S Vapor recovery connection my continuous isolated S Vent line my continuous isolated S Other my continuous (isolated) S Other my continuous isolated S Other my jidontimmul isolate S Other my continuous (isolated) Tank # J,ADEM Unique Tat"and/or Grade of d Stored Size in Gallons S (Tank bottom test lead my continuous isolated S Submersible Dump my continuous (Isolated) S Fill pipe my continuous Qssalal S Tank monitor my continuous isolated S Vapor recove connection my continuous isolated S Vent lime my continuous isolated S Other my continuous isolated S Other my continuous isolated S Other my continuous isolated S Other my continuous isolated 'Describe remote location of reference cell for"Fixetl Cell,Moving Ground Technique". WA for structure-to�saucture"Potential Difference Technprre". "Indicate base structure cooled point for both techniques.Line out all that do not apply.Make sure tank is not inremelly lined before using tank bosom. 'Descries,location of any other contact points measured. -3- Facility I.D.# / - /D - /.S"Oh0 CPTEST Underground Storage Tanks Structure-to-Soil Test Results Galvanic System) 1.The"Location Code must be used to locate the reference cell and structure contact points on the drawing of the facility as discussed on page 1. 2.A minimum of 3 tank voltage measurements must betaken:one while the reference cell is placed in the soil as close to the middle of the lank as possible and the others while the reference cell is placed in the soil as close as possible to each end of the tank(but not directly over anodes). 3.All single and double wall metal tanks using a galvanic cathodic protection system,must have all voltage measurements equal to or more ne aave than-850 my to be protected from corrosion and pass the structure-to-soil test. Location Structure Contact Point Voltage ResultsiComments Code and (negative (Line out the one that does not apply) Reference Cell Locations millivolts) Tank 1# S a0k bottom R Soil near submersible pump manwa - O my (pass)ffal R I Soil near tank monitor manes - /fY fo my (pass) R Soil near vapor recovery manwa my ss R Soil near vent riser my pass fail R Other my (pass) fail R Omer my (pass) fail R Other my ass fall R Omer my ss fail Tank # S (Tank bottom FR Soil near submersible um mamva my ass R Soil near tank monitor ther mally my ss R Soil near vapor radov manwa my ss R Soil near vent riser my (pass) fail R Omer Irw ss fall R Omer my ass fail R Other my ass fail R Other my ss fail Tank # S Crank bottom test lead R Soil near submersible pump manway my ass fail R Soil near tank monitor manwa my (pass) fail R Soil near vapor recomy manwa my (pass) fail R Soil near vent riser my ass fail R Other ' my s fail R Other my (pass) fail R Other my (pass) fall R Other my ss fail Tank S (rank bottom test lead R Soil near submersible pump manwa my ss fail R Soil near tank monitor manwa my sal fail R Soil near vapor recovery manwary my ass fail R Soil near vent riser my ass fail R Omer my ss fail R Omer my ass fail R Omer my ass fail R Other my ass fail Indicate base structure contact point. Line out all that do not apply. Make sure tank is not intemalyfineo before using tank bottom "Describe location of any other reference call location used. -a- Facility CPTEST Underground Metal Product Piping Continuity Test Results(Galvanic.S ma 1.The"Location Cade"must be used to locate the reference cell and structure contact points on the drawing of the facility as discussed on page i. 7.Repaid continuity test measurements using"Fixed Cell,Moving Ground Technique",or the structure-lo-structure"Potential Difference Technique". 3.Vital using the"Fixed Cell,Moving Ground Technique",the reference cell must be placed in the soil at a location remote from the UST system (not within potential gradient of anodes or shielded by other tanks or structures)and left undisturbed until canlinuity testing is completed. a.If one continuity method fails to conclusively show proper isolation,the other method may be used to try to show proper isolation. 5.Metallic structures are isolated when the'VoRage Potential"difference between two structures is greater than 10 nal continuous when 10 my or less. 6.All single and double wall metal piping should be isolated from all other metallic structures to maximure the life of the piping's galvanic cathodic promotion s stem. Location Reference Cell Location Voltage Results/Comments Code and Potential (Line out the one that does not apply) Structure Contact Points (negadve Check all available oinfs mi/l)volts R 1 Tank N Metal Pi !n , TvDe of Metal steel)(cachave Approximate Length of Piping in Fee S i in flez corn. at submersible Plural my contlnuca isolated S Pi in flex corl at dispenser If my continuous isolated S Pi in flex coin. at dispenser# my continuous isolated S Pi in flex cooi at dispenser# my confinuous isolated S Pi in flex coi at dispenser# my continuous isolated S Pi in flex coon. at dispenser# my conffnuous isolated S Pi in flex corm. at dispenser If my wrdinuous isolated S Pi in hex corn. at dispenser# my continuous isolated S Other my confinw us) isolated S Other my continuous isolated Tank # Metal Pylarra. Type of Metal steel C roximate Legal of Piping in Feet S Pi in fiex con I at submersible pull has, continuous isolated S Pi in flex cooi at dispenser# my continuous isolated S Pi in flex coi at dispenser# my continuous isolated S Pi in flex wren, at dispenser# has, continuous isolated S Pi in flex coon. at dispenser# my continuous isolated S Pi in Flex wren. at dispenser# my continuous isolated S Pi in Flex corn. of dispenser# my commands isolated S Pi in Flex cori of dis enser# my continuous isolated S Other my continuous isolated S Other mr, continuous isolated Tank Metal Piping, Type of Metal steel (copper Approximate Length of Piping in Fast S Pi in flex win. at submersible pump" my continuous isolated S Pi in flex corl at dispenser# my continuous Isolated S Pi in flex corn. at dispenser# my confinuous Isolated S Pi in Flex wnn. at dispenser# my continuous Isolated S Pi in flex wnn. at dis enser# my continuous isolated S Pi in flex cooi at dispenser# my continuous fine S Pi 'n flex cormi at dispenser# the continuous (isolated) S Pi ' flez coon. at dispenser#' my confinuous isolated S Other my continuous isolated S Other my continuous iwlat Tank # Metal Piping, Type of Metal steel w • r A mximate Len of Pi i in Fee S Pi m flex corn. at submersible um •• my continuous Isolated S Pi in flex win. at dispenser# my confinucus isolated S Pi in flex win. at dispenser# my continuous isolated S (Pipingi wil at dis enser# my continuous isolated S Pi in flex wnn. at dispenser# my wnfinllws isolated S (Pipinal conni at dispenser# my continuous isolated S Pi it Flex wni at dispenser# my continuous isolated S Pi in flex wnl at dis enser# may continuous iwlated S Other my continuous isolated S Other my confinuous isolated 'Describe remote location of reference cell for"Fixed Cell,Moving Ground Technique'. WA for shucfure-to-sfructure°Potential fJi%eranx Technigrre". -Indicate piping and/or Flex connector.Line out any that do not apply. "'Describe location of any other contact points measured. -6- FacilityLD.# Cf - (c) - 1504.0 CPTEST _ Cathodic-Protection Test Results(Galvanic Systems) 1.If any portion of the sysifails,the system fails,and 'Fail"should be marked below. 1 cemly that all structures at this facility pass°the structure-to-soil cathodic protection testing and in my best Pass judgement, adequate cathodic protection has been provided to the UST system. No further action is necessary at this time. 1 certify that one or more structures at this feefilty"falFthe structure-tosoil cathodic protection testing and in my bestjudgement, adequate cathodic protection has NOT been provided to the UST system. The ❑ Fail cathodic protection system must be repaired in accordance with a code of practice developed by a nationally recognized association or independent laboratory,and re-tested within 6 months following the repair. Name: Nameof Company: Certi in Organization: G Address: X / Type of Certification: City, State,Zip Code: N6dk Date of Certification: /0 ( Phone Number. 9-35 Signature: �_. Date: (Z ZO Descriptionp of Cathodic Protection System Re airs andlor Comments 1.If applicable,describe the repairs in detail below and provide a sketch of the location and depth of any new anodes. 2.If repairs are made,provide the code of practice information below such as the Steel Tank Institute Standard R-972-01 "Reoemmended Practice for the Addition of Supplemental Anodes to STl-P3 USTs'. Association or independent Laboratory: Cade of Prentice Name: Code of Practice Number. Code of Practice Date: Underground Storage Tank Protection Owner Certification 1 certify underpenalty of law that 1 am familiar with the information on this form and that based on my inquiry of those individuals immediately responsible for obtaining the information 1 believe that the information is two, accurate, and complete. Signature of Owner: Date: