HomeMy WebLinkAbout5756 006292 081 08-04-2020 SPILLT ALC SPILL BASIN TEST RESULT 57587.43 SPILLT
ADEM
3 YEAR SPILL PREVENTION EQUIPMENT (SPILL BUCKET)
INTEGRITY TEST REPORT (HYDROSTATIC AND VACUUM METHOD)
Questions on how fo—let,this form should be directed to the Groundwater Branch,UST Com liance Section at 334 27041
Facility Name: f w 1 Owner:
Address: s.s as.. N- Address,
City, County,Zi : 3— city, State, zip:
FacilityI.D.#: - I. L1 a- Phone M
Tester Name: R rt Gr - Bid HemW Tesler Phone#: 334n45-0055
Tester Company, um Hnvironmenta Consulting and Testing-AECT.
Instructions
1. Submit a Completed copy of this form within 30 days of performing the test to: Groundwater Branch,PO Box 301463 Montgomery,AL
36130-1463,or fax to: (334)270-5631 or email to: USTcompliancefiadem alabama oov.
2. This form allows you to record up to 5 ADEM Unique Tank Numbers,assuming that the Facility ID Number and test method remain
the same.
3. Double walled spill prevention equipment does not require testing.
4. Single and double walled spill prevention equipment must also be checked every 30 days in accordance with the Walkthrough
Inspection requirements. See ADEM 30 day Walkthrough Inspection Checklist Log which can be found on the ADEM website at
rramstwarer/qmundwater cut.
5. Testing must be pemir med in accordance with a nationally recognized code of practice(such as PEI RP-1200 or equivalent)or the
manufacturers instructions.
6. Keep a record copy of this testing for 3 years.
Code of Practice or ManufactureYs Instructions used:
ADEM Unique Tank# r1JT C. /!
Product Stored .' I- /ee. r
❑vacuum ❑vacuum ❑vacuum ❑vacuum ❑vacuum
❑pressure ❑pressure ❑pressure ❑pressure ❑pressure
Test method used $hydrostatic 3-hydrostatic ❑hydrostatic ❑hydrostatic ❑hydrostatic
❑manufacturer's 0 manufacturer's 0 manufacturer's O manufacturer's 0 manufacturer's
instructions instructions instructions instructions instructions
Basin free of cracks or holes? Ryes yes ❑yes ❑yes 0 yes
(if no.8 fails wihoul testing) ❑no 0 no ❑no ❑no ❑no
Water,fuel,trash&debris removed byes [ayes El yes ❑yes ❑yes
from basin prior to lest? d no ❑no ❑no ❑no ❑no
(dispose of properly) ❑Na ❑Na ❑Na ❑n/a ❑Na
Drain valve operational and seals ❑yes ¢t yes D yes ❑yes 0 yes
property? ❑no ❑no ❑no ❑no ❑no
(where applicable) III Na ❑ni ❑me ❑Na ❑n/a
Water,fuel,trash&debris removed �Lyes yes O yes ❑yes ❑yes
from basin prior to ti Ono Ono ❑no no ❑no
(dispose of property)
III Byes O yes D yes 0 yes
Fill pipe cap seals property? ❑no ❑no ❑no ❑no ❑no
❑Na ❑rue ❑Na ❑Na ❑n/a
Was enough water added to ,yes F yes ❑yes ❑yes O yes
completely fill the basin? ❑no ❑no ❑no ❑no ❑no
(1-1vt1rostatictesionti
Test start time x�!
Test end time
(hydrostatic test-minimum 1 hour
Measured water level drop in inche
accurate to 1116 inch O V
(Hydrostatic test)
Vacuum drop in inches water column
vacuum test
Results of test
(Hydrostatic test fails it level drops 1/8 Rlpes8 Wass Dpass Dpass Opass
inch or more.) (vacuum test fails'rf Ofail OTail Ohll Ohll Ofall
cannot maintain 30 inches water column
or if vacuum drops more than 4 inches Dinconcluelve Dinconclusive Oinconclushre Dinconcluswe DinconclwNe
water column.
Tester's initials and date tested /A Ls Q/V /%13
Reptairs Needed Date of Re air Description of any Kepi
ADEM Form 20 m17115 m2(revised 3118)