HomeMy WebLinkAbout5000 017859 097 10-12-2020 ATGTEST SLA AUTOMATIC TANK GAUGE TEST 53338.3 ATGTEST_
ADEM ANNUAL TANK GAUGE TEST
REPORT FOR YEAR 2020
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,ZI : FT.IAUDERDALE,FL 33308
Facility I.D.#: 21749.097-017859 Phone#:
Tester Name: JUSTIN LAVIOLETrE Tester Phone#: a44-e09A265
Tester Company: DURAND'$TESTING SERVICE Test Dale: 8/12/20
Instructions
1. Submit a completed copy of this form within 30 days of performing test to: Groundwater Branch,PO Box 301463,Montgomery,AL
36130-1463,or fax to: (334)270-5631,or email to: USTcomoliance(Radem.alabama.aov.
2. This form allows you to record up to 6 ADEM Unique Tank Numbers,assuming that the Facility ID Number remains the same.
3. Inspection and Testing must be performed in accordance with a nationally recognized code of practice(such as PEI RP-1200 or
equivalent)or the manufacturer's instructions.
4. Keep a copy of this testing for 3 years. Questions on how to complete this farm should be directed to the Groundwater Branch, UST
Compliance Unit at(334)270-5655.
5. If the probe is not used for leak detection but the console is(e.g.double walled tanks using interstitial monitoring),then it does not
need to be tested.
ADEM Unique Tank# 1 047019 1 047021
Product Stored UNLEADED SUPER
Automatic Tank Gauge Console Test
Does console test history include test ayes 16 yes ❑yes ❑yes ❑yes ❑yes
alarms? Don't forget to clear test alarmist ❑ no ❑no ❑no ❑no ❑no ❑ no
Does site setup agree with configuration Eff yes yes ❑yes ❑yes ❑yes ❑yes
shown in console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Is battery backup operational? 19 yes Ej yes ❑yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no El no ❑ no
Testing results? pass pass O pass ❑pass O pass ❑pass
(Must meet all applicable criteria to pass.) [3 fail 0 fail O fall 0 fall 0 fall 0 fail
Probe and Float Test
Is probe free of residual buildup? yes f6 yes ❑yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Are cables free of kinks? yes 59yes ❑yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Was shaft inspected and free of damage? Ryes yes ff yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Do floats move freely? yes ❑yes yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Does measured product and water levels in yes iiiif yes ❑yes ❑yes ❑yes ❑yes
tank agree with console levels? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does actual product float level agree with dyes i yes ❑yes ❑yes ❑yes ❑yes
console product float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does Overfill alarm activation level agree ❑yei n/a ❑yes lidni ❑yes 0 n/a ❑yes 0 n/a ❑yes 0 n/a ❑yes 0 n/a
with console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does actual water float level agree with 9'yes yes ❑yes ❑yes ❑yes ❑yes
console water float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does water alarm activation level agree with yes yes ❑yes ❑yes ❑yes ❑yes
console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Testing results? E7pass pass O pass O pass O pass O pass
(Must meet all applicable criteria to pass.) [3 fall 0 fail O fall O fail O fall [3 fail
Repairs Needed Date of Description of any Repairs
Repair
Tester's Signature:
ADEM Form xxx(new form)