HomeMy WebLinkAbout12719 009495 101 12-23-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 53687.85 LDLTTEST
DRAFTADEM
AUTOMATIC LINE LEAK DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT
Facility Na e: Owner.
Address: Address:
C' .Count Zi : City, State Zip:
Facility I.D.#: - Phone#:
Tesler Name:Christopher Hod Dempsey Tester Phone#:20533�
Tester Certification: Estabrooks Ezy Chek Certification E iration: 031 31 12021
Tester Can rr :Quality Tank Testing _ Tesl Date: — 70
Instructions
1. Submit this form,attach all test data for every teat 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: USTcomoli2nQ8Q2dem.alabama.00v. This form
must be completed and Included with the test data or the submittal will not be accepted.
2. This form allows up to 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
manufaClURYa mshudion5.
4. Line tightness test equipment used must be approved by ADEM. Visit the NWGLDE webaite at www.nwolde.om to view a list of
releasemeak detection equipmentimethods that ADEM approves for use in Alabama.
5. Automatic Line Lade Detectors are designed to be tested in-pace. 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 form should be directed to the Groundwater Branch,UST
Compliance Unit at(334)270-6665.
Type of Test Performed-check all that apply: 72zlematic,Line Leak Detector(ALLD) OUM Tightness Test
Reason for Test-check all that apply: r ival Test []New Installation []Required by ADEM Enforcement Action
Manufacturer of ALLD Test Equipment:NMI Model or version:LDT890
Manufacturer of Line Tightness Test Equipment:Fstabrooks Ezy Chek Model or Version:Manual Test
ADEM Unique Tank#
Product Stoned rlAutfl
berg lass ZLin2k
glass []fiberglass Ofiberglass Ofderglass
Piping material Ogexible le Ofiexible Ofiexible Ofiexible
[]steel l Osteei Osteei []steel
Approrc length of piping frun tested nearest foot 6dPiping capacity
allon Dart
'to
Test
Type of ALLD echanical echaniral .rfiechanical []mechanica []m
echanical mechanical Omha ecnical
[]electronic []electronic []electronic []electronic []electronic []electronic
Line pressure D �Q during ALLD test i
Measured ALLD leak rate rj
(gii l
Results of ALLD test Oin Ofail ss Ofail Mail Opera []tail Opass Ofatl Opera Dfxil
conclushm Olnconctu dve OlnronelueWe []Inconclusive Oinwnclushm Oinwnclusive
Line Tightness Test
Line pressure
durinq line test(psi)
Measured line leak rate
(giph)
Results of line es I Innclase O as Opals Ofail Opass Oral Opals []fail
tightness test inconclwi cousive rnconclusi Oinconclurive Ginwndusive Orncanclusive
Repairs Needed Date of Repair Description of any Repairs
Testers signaW re:
ADEM Form (new,form)
Quality
Cathodic, Tank & Line Testing
PO B.1457
Northport,AL 35476
Ph: (205)339-3535
DATE:
VMI LDT 890 TEST SITE: 6 I Q/ '
LEAK DETECTOR ADDRESS:
TEST RESULTS
TESTER NAME: Chrietooh.r Demo®ev
CERTIFICATION#: 64-0691 -
TEST REPORT INDICATES
TYPE OF LEAK DETECTOR TESTED
PUMP# kE MODEL SERIAL#
1
2 -
3
4
5
6
7
8
FUNCTIONAL TEST LEAK
PRODUCT METERING ELEMENT RATE OPENING PASS
PUMP# TYPE PRESSURE HOLDING PSI RESILIENCY MLMIIN TIME FAD,
1 ` 3 260 189.1 3
2 j l 'J Nwn 5 z0O 189.1 3
3 Z 189ml 3 5
4 189 ml
5 189 ml
6 189 ml
7 199 mI
g 189 ml