HomeMy WebLinkAbout5000 017859 097 12-11-2020 OFINP SLA OVERFILL INSPECTION 60900.61 OFINP
ADEM
3 YEAR OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT
Ouestions on how to complete this form should be directed to the Groundwater Branch,UST Compliance Section at 3341 270-5655
Facility Name:MYERS MARKET THEODORE Owner:MYERS OIL CO
AddreSS:6960 THEODORE DAWES RD Address:221 COMMERCIAL BLVD
City, County,Zi :THEODORE,MOBILE 36582 City,State,Zip:FT LAUDERDALE,FL 33308
Facility I.D.#:21749097017859 Phone#:
Inspector Name:Lance Lopez I Inspector Phone#:844-809-8265
Inspector Company:Durand's Testing Service Inc
Instructions
1. Submit a completed copy of this form within 30 days of performing lest to: Groundwater Brunch,PO Box 301463 Montgomery,AL
36130-1463,or fax to: (334)2705631,or email to: USTcomplianceoadem.alabama.gov.
2. This form allows you to record up to 5 ADEM Unique Tank Numbers,assuming that the Facility ID Number remains the same.
3. Complete portion of form pertaining to type of equipment inspected for each tank.
4. Inspection must be performed in accordance with a nationally recognized code of practice(such as PEI RP-1200 or equivalent)or the
manufacturers instructions.
5. Keep a record copy of this inspection for 3 years.
ADEM Unique Tank# 047109 047021
Product Stored UNLEADED SUPER
Was Overfill Device Removed? Yes 0 yes ❑yes ❑yes ❑yes
❑no ❑ no ❑ no ❑ no ❑ no
Automatic Shutoff Device Inspection
Drop tube and float free of debris? 0 Yes ❑yes ❑yes ❑yes ❑yes
❑no ❑ no ❑ no ❑ no ❑ no
Float moves freely and poppet ❑yes ❑yes ❑yes ❑yes ❑yes
moves into path of flow? ❑no ❑ no ❑ no ❑ no ❑ no
Bypass valve free of blockage? D yes ❑yes ❑yes ❑yes ❑yes
(where applicable) D no ❑no ❑no ❑no ❑no
❑me ❑ n/a ❑ n/a ❑ n/a ❑ n/a
Flapper adjusted to shut off flow at ❑yes ❑yes ❑yes ❑yes ❑yes
95%capacity? ❑no ❑ no ❑ no ❑ no ❑ no
High Level Alarm Ins ction
Overfill alarm activate in test mode ❑yes ❑yes ❑yes ❑yes ❑yes
at console? ❑no ❑ no ❑ no ❑ no ❑ no
Alarm can be heard or seen from ❑yes ❑yes ❑yes ❑yes ❑yes
where the tank is filled? ❑no ❑no ❑ no ❑ no ❑ no
All associated floats move freely? 0 yes ❑yes ❑yes ❑yes ❑yes
❑no ❑no ❑ no ❑ no ❑ no
Alarm activates at 90 h capacity? 0 yes ❑yes ❑yes ❑yes ❑yes
❑no ❑ no ❑ no ❑ no ❑ no
Ball Float Valve Inspection
Ball float rage free of debris? 0 yes 0 yes ❑yes ❑yes ❑yes
❑no ❑ no ❑ no ❑ no ❑ no
Ball moves freely in cage and is 13 yes 0 yes ❑yes ❑yes ❑yes
free of damage? ❑no ❑no ❑ no ❑ no ❑ no
Vent hole in pipe is open and near 0 yes 0 yes ❑yes ❑yes ❑yes
the top of the tank? ❑no ❑no ❑ no ❑ no ❑ no
Ball float pipe is proper length to 0 yes 0 yes ❑yes ❑yes ❑yes
activate at 90%capacity? ❑no ❑no ❑ no ❑ no ❑ no
Tank top fittings are vapor tight 12 yes 0 yes ❑yes ❑yes ❑yes
and free of leaks? ❑no ❑ no ❑ no ❑ no ❑ no
Inspection Results for Automatic Shutoff Device or High Level Alarm or Ball Float Valve
Results of Inspection: p pass 0 pass 0 pass 0 pass 0 pass
('No answer to any item indicates 0 full O fail 0 fail 0 fail 0 fall
inspection
failure.
Inspectors initials and
Inspection date ILL 12/11/20 ILL 12/11 /20 / / / / / /
Repairs Needed Date of Repair Description of any Repairs
ADEM Forth 559 03118