HomeMy WebLinkAbout5756 006292 081 08-04-2020 LDLTTEST ALC LINE AND LEAK DETECTOR TEST 57552.98 LOLTTEST
ADEM
AUTOMATIC LINE LEAK DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT
Facility Name: rs e-- Owner:
Address: 1 Address:
City,County,Zip: ritv State Zip
Facility I.D.M 2731S - 8 t- i "L Phone#:
Tesler Name: Robert Gray I Tester Phone#: 334/745-0055
Tester Certification: 1912.LTN Certification Expiration 07 102 / 2020
Tesler Com an : Aubum Environmental-AECT Test Date: lit 7+
Instructions
1. Submit this form,attach all test data for every test performed and submit a completed copy of this form lo: Groundwater Branch,PO
Box 301463,Montgomery,AL 36130.1463,or fax to: (334)270-5631.or email to: USTconipliancedadem.alabama.go . This form
must be completed and Included with the test data or the submittal will not be accepted.
2. This form allows up l0 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
manufacturers instructions.
4. Line tightness test equipment used must be approved by ADEM. Visit the NWGLDE website at www.nwclde.om to view a list of
release leak detection equipmentimethods 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 forth should be directed to the Groundwater Branch,UST
Compliance Unit at(334)270-6655.
Type of Test Performed-check all that apply: PtAutomatic Line Leak Detector(ALLD) 01-ine Tightness Test
Reason.for Test-check all that apply: §dAnnual Test ONew Installation ORequired by ADEM Enforcement Action
Manufacturer of ALLD Test Equipment: Training and Svcs Corp Model or Version: TSC 1000
Manufacturer of Line Tightness Test Equipment: Training and Svcs Corp Model or Version: NFPA 329-87
ADEM Unique Tank# S
Product Stored tea „te
Wberglass Qfiberglass Ofiberglass Ofiberglass Ofiberglass Ofiberglass
Piping material Oflexible Oflexible Oflexible Oflexible Oflexible Oflexible
Detest Dsteel Osteel Osteel Osteel Ostael
Approx.length of piping s- O S ,
run tested nearest foot
Piping capacity $ 8
(gallons
Automatic Line Leak Detector Test
Type of ALLD jillmnec mechanical Omechanical Orms anical Omechanical Omechanical
Oelectronic Oelecbonic Oelectronic Oelectronic Oelecbonic Oelectrome
Line pressure 2-9 2 (�
during ALLD test i
Measured ALLD leak rate t
Results of ALLD test gpa¢s Dfall Ofall "Opass Efall Opals Ofail Opals Ofall Opals Ofall
IL]nconclusive Olnwnclusive Dineomclusive Oinconeluslve Dinconclusive Olnwnclusive
Line TI hlness Test
Line pressure y T r
during line test si
Measured line leak rate b O . 6 v
h
Results of line Bpass Ofall ss Ofail Opals Ofall Opals Ofail Opals Ofail Opens Ofall
tightness teat Olnconclusive Oinconclusive Dirwonclusive Einconclusive Dinconclusive Oinconclusive
Repairs Needed Date of Repair Description of any Repairs
Testae,Signature: lAl
ADEM Form 566