HomeMy WebLinkAbout12724 009491 101 12-23-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 57668.97 LDLTTEST
DRAFTADEM
AUTOMATIC LINE LEAK.DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT
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ilit Name. Owner:
ress: of 5 • Address: _
Cou Zi : C State Zi : _
Phorre#:
Tester Name:Christopher Hod Dempsey Tester Phone#:2a5 a39J w
Tester Certification: Estabrooks Ezy Chek Certification Expiration: 03/ 31 /2021
Tester Company:Quality Tank Testing Test Date:
Instructions
'I. 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: USTmmoliance®adem.alebama.aov. This to=
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
manufacturer's instructions.
4. Line tightness test equipment used must be approved by ADEM. Visit the NWGLDE website at www.m cWe.om to view a list of
mleaWleak detection equipment/methods that ADEM approves for use in Alabama.
5. Automatic Line Leak Detectors are designed to be tested in-place. Do not remove and test outside of the tank system.
B. 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)270-5655.
Type of Test Performed-check all that apply: tomatic One Leak Detector(ALLD) OLine Tightness Test
Reason for Test-check all that apply: nual Test ONew Installation ORequired by ADEM Enforcement Action
Manufacturer of ALLD Test Equipment:VMI Model or Version:LDT890
Manufacturer of One Tightness Test Equipment Estabrooks Ely Chalk Model or Version:Manual Test
ADEM Unique Tank#
Product Stored
,WBerglass erglasstL.&D
Ofiberglass Ofiberglass Ofiberglass
Piping malarial Oflexible Oflexible Oflexible Oflexible Oflexible
Osteel Oates] Osteel Osteel Osteel
Approx.length of piping ♦Nn tested nearest toPiping capacitycapz60r Test
Type of ALLD mechanical echanical eclranicel Omechanical Omechanical Omechanical
Oelectronic Del/ectronic Oelectronic Oelecironic Delecsonic Delectronic
Line pressure /D ( (/ D
dun ALLD lest
Measured ALLD leak rate h J�7 '2 J 3
Results of ALLD teat Odell Me Ofail Opass ❑fall Opass Dfaih Opals Often
OineoncluWve Oinconelusive Olnconclusive Oineonclusive Oineoxlusiv¢ Oineencluslve
Line Ti htness Test
Line pressure
during line test(psi)
Measured line leak rate
fdDh)
Results of line I Opals Ofa1t Dpaas Ofail Opme Ofail
tightness test inconclwiv Inwneluaiv Inwncluai Oinconclusive Oineonclusive Oinconclusiva
Repeats Needed Date of Repair Description of any Repairs
Tester's Signature:
ADEM Fonts tsar(new form)
Quality
Cathodic, Tank& Line Testing
PO Box 1457
Nonhpon,AL 35476
Ph: (205)339-3535
DATE: I7_ Z3- 20
VMI LDT 890 TEST SITE: OntW sd d-Tid,#
z6y 5-- C&N-4 IV.
LEAKDETECTOR ADDRESS: If�erf9s/arv. .it
TEST RESULTS ' �T—
TESTERNAME: Christopher DempeeY
CERTIFICATION#: 69'n691
TEST REPORT INDICATES
TYPE OF LEAK DETECTOR TESTED
PUMP# MAKE MODEL SERIAL#
1
2
3 rx-1hv
4
5
6
7
8
FUNCTIONAL TEST LEAR
PRODUCT METERING ELEMENT RATE OPENING PASS
PUMPN TYPE PRESSURE HOLDINGPSI RESILIENCY MLIMIN TIME FAIL
1 O_ 2g C - 0 189m1 3 %
Z C 9' C 26-6 199 ml 3 Glk
3 'I 26 �0 1119m1 3
4 189 ml
5 189 ml
6 189 ml
7 199.1
S 199 ml