The URL can be used to link to this page

Home My WebLink About5000 017859 097 08-12-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 53447.46 LINETT ADEM LINE TIGHTNESS TEST REPORT Questions on how to complete this form should be directed to the Groundwater Branch,UST Compliance Unit at 334 270-5655 Facility Name: MYERS MARKET THEODORE Owner: MYERS OIL COMPANY Address: 6960 THEODORE DAWES RD I Address: 221 COMMERCIAL BLVD City, County,Zip: THEODORE,MOBILE 36582 1 City, State,Zip: FT. LAUDERDALE,FL 33308 Facility I.D. #: 21749 097 017859 Phone#: Tester Name: JUSTIN LAVIOLETTE Tester Phone* 844-809-8265 Tester Certifcatiom 09-7887 Certification Expiration: s/ 17 122 Tester Company: Durand•s Testing Service Inc Instructions 1. Complete this form,include all the lest data,and submit to: Groundwater Branch,PO Box 301463 Montgomery,AL 36130-1463,or fax to: (334)270-5631,or email to: USTcomolianceCaladem.alabama.eov. Test data must include waiting time between delivery and testing,start time,end time,recorded volume changes and times,correction factors and calculations,and calculated leak rate for every test performed or the submittal will not be accepted. 2. This form allows you to record up to 6 ADEM Unique Tank Numbers,assuming that the Facility ID Number and the test equipment remain the same. 3. The tightness test equipment used must be approved by ADEM. Visit the NWGLDE website at www.nwplde.org to view a list of release/leak detection equipment/methods that ADEM approves for use in Nabama. 4. Testing must be performed in accordance with the manufacturer's instructions. 5. Keep a ra.rd copy of this testing for 3 years. Reason for Test-circle all that apply: nnual Test (Newlnstallation) (Required by ADEM) (Response to SIR Problem) Manufacturer of Test Equipment:ESTABROOKS Model or Version: F2 CHECK LINE TESTER ADEM Unique Tank# 047019 047021 Product Stored UNLEADED SUPER fiberglass fiberglass Ofberglass Ofberglass Ofberglass Ofberglass Piping material tested Oflexible Oflexible Oflexible Oflexible Oflexible Oflexible Osteel Osteel Osteel Osteel Osteel Osteel Piping capacity 15.4 15.4 (gallons) Line pressure during test 45 45 (psi) Equipment threshold(Qp h ,050 .050 Measured leak rate 0 0 (gph) ass ass Opass "Pass Opass Opass Results of test: Ofail Ofail Ofail Ofail Ofail Ofail Olnconclusive Olnconclusive Oinconclusive Dinconelusive inconclusive inconclusive Testers initials and E// / date tested JL 81220 JL 1220 / / Repairs Needed Date of Repair Description of any Repairs Certification I certify under penalty of law that the test was performed in accordance with all regulatory requirements of ADEM administrative code rule 335-6-15 and that the submitted information is true,accurate, and complete. Signature of Tester: ? Date: 8/12/20 ADEM Form 477 mi 1/10 m2(revised 3/18) LDTEST ADEM AUTOMATIC LINE LEAK DETECTOR (ALLD) TEST REPORT Questions on how to complete this form should be directed to the Groundwater Branch,UST Compliance Unit at 334 270-5655 Facility Name: MYERS MARKET THEODORE Owner: MYERS OIL CO Address: 6960 THEODORE DAWES RD Address: 221 COMMERCIAL BLVD City, County,Zip: THEODORE,MOBILE 36582 City, State,Zip: FT.LAUDERDALE, FL 33308 Facility I.D. #: 21749 097 017859 Phone#: Tester Name: JUSTIN LAVIOLETTE Tester Phone#: 844-809-8265 Tester Certification: 09-7887 Certification Expiration: 5 / 17 Tester Company:Durand's Testing Service Inc 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: USTcomoliancefoladem.alabama.00v. This form must be completed and included with the test data or the submittal will not be accepted. 2. This form allows you to record up to 6 ADEM Unique Tank Numbers,assuming that the Facility ID Number and the 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. Automatic Line Leak Detectors are designed to be tested in-place. Do not remove and test outside the tank system. 5. Keep a record copy of this testing for 3 years. Test Method Used-circle: (PEI RP-1200) I(Manufacturer) Other(specify) Reason for Test-circle all that apply: (Annual Test)] (New Installation) (Required by ADEM) Manufacturer of Test Equipment: ESTABROOKS Model or Version:EZ CHECK LEAK DETECTOR ADEM Unique Tank# 047019 047021 Product Stored UNLEADED SUPER 0iberglass afiberglass Oflberglass Ofiberglass Oflberglass Oflberglass Piping material tested Oflexible Oflexible Oflexible Oflexible Oflexible Oflexible Detest Osteel Osteel Osteel Osteel Osteel Approximate length of piping run tested 125 125 nearest foot Type of ALLD mechanical Vmechanical Omechanical Omechanical ❑mechanical Omechanical Delectronic Delectronic Delectronic Delectronic Delectronic Delectronic Line pressure 10 10 during test(psi) Measured leak rate(gph) 3 3 apass dpass Dpass Dpass Dpass Dpass Results of test Ofail Ofail Ofail Dfail Dfail Dfail Dinconclusive Dinconclusive Dinconclusive Dinconclusive Dinconclusive Dinconclusive Testers initials and date tested JL 8112/0 JL 8/1210 / / / Repairs Needed Date of Repair Description of any Repairs Certification I certify under penalty of law that the test was performed in accordance with all regulatory requirements of ADEM administrative code rule 335-6-15 and that the submitted information is true,accurate,and complete. Signature of Tesler: �' �" Dale: 8/12/20 ADEM Form 551 ml 1/10 m2(revised 3/18)