HomeMy WebLinkAbout12725 015060 101 12-21-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 59825.43 LDLTTEST
DRAFTADEM
AUTOMATIC LINE LEAK DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT
Facilit Name' Owner'.
Address: Address:
City, County,Zi : City, State Zip, --
Facilit I.D.#: Phone#:
Tester Name:Christopher Hod Dempsey Tester Phone#:205-339-3535
Tester Certification: Estabrooks Ezy Chalk Cerfificdationp,thl 03/ 31 12021 _
Tester Company:Quality Tank Testing Test Date:
Instructions
1. Submit this forth,attach all test date 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. USTcomoliancefitiademelabama.cov. This torn
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
manufacturers instructions.
4. Line tightness test equipment used must be approved by ADEM. Visit the NWGLDE webstte at www.nwnlde.ont to view a list of
release/leak detection equipment/methods that ADEM approves for use in Alabama.
5. Automatic Line Leek Detectors are designed to be tested in-place. 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)270-5655.
Type of Test Performed-check all that apply 10K6mattc Line Leak Detector(ALLD) one Tightness Test
Reason for Test-check all that apply: Annual Test ❑New installation ❑Required by ADEM Enforcement Action
Manufacturer of ALLD Test Equipment:VMI I Model or Version:LDT890
Manufacturer of Line Tightness Test Equipment:Estabrooks Ezy Chalk I Model or Version:Manual Test
ADEM Unique Tank#
Product Stored
.Zlifiberglaw Effiberglaw Dfiberglass Ofiberglass Ofiberglass Ofiberglass
Piping material Oflextble Oflemble Oflexible Oflexible Oflexible Oflexible
Osteel Osteei Dsteel Osteel msteel Detest
Approx. length of piping 1 — /
run tested nearest toot)
oot VV
Piping capacity
(gallons) 200 /W 20V Automatic Line Leak Detector Test
Type of ALLD Omechanicai I Omechanical I Omechanical I Omechanical Omechanical mmechanical
Delectronic I Oelectronic I Delectronic I Delectronic I Delectronic Delectronic
Line pressure
during
ALLD test
Measured ALLD leak rate
h
Results of ALLD test i9i
ail ❑pass Ofail Opaes Ofail Open Ofail Opass Ofail Dismiss Ofail
ve Oinwncusive Dinconclusive Oinconclusive Dinconclusive Dinconclusive
Line Tightness Test
Line pressure �ijr �jt
during, line test(psi)
Measured line leak rate O
(gph)
Results of line Dfail pass Dfail Opals Dist Opass Ofall mpass Ofall Opals Ofall
tightness teat Oinconclusive Oinconclusrve Einconclusive Olnwnclusive Dinconclusive Otnconcluslve
Repairs Needed Date of Repair Description of any Repaire
Tester's Signature:
ADEM Form xxxx(new form)
Quality
Cathodic,Tank&Line Testing
PO Box 1457
Northpom AL 35476
Ph: (205)339-3535
-- DATE: /Z-Z1- Zo
ESTABROOK'S EZY CHEK TEST SITE: ��� 0
ADDRESS: SOo
PRODUCT LINE TESTER n
TEST RESULTS TESTER NAME: Christopher(Hotly)Dempsey
CERTIFICATION N: AL 69-0691
APPUED PRESSURE: 50 PSI
PRODUCrTYPE OR TANK#: PRODUCTTYPEORTANK#: �L/7
�ME DATA -/+ GPL RES GPH JJII[)RE DATA -/+ GPL R GPH
� O .0037 O O (OY/0 ES L�,� 0 .0037 O O
(y ZS .0037 Don 0 .0037 0 �-
.0037 ;�032 .0037 O �_
'0037 .0037
- . .0037 .0037 -
-_ - .0037 .0037 _
Final Result: Final Result:
PRODUCT TYPE OR TANK#: PRODUCTTYPEORTANK#:
TIME DATA -/+ GPL RES GPH TIME DATA -/+ GPL RES GPH
_ .0037 .0037 _
.0037 .0037
.0037 .0037 -
_ .OD37 .0037 -
_ .0037 .0037 -
.0037 .0037 -
Final Result: Final Result:
PRODUCT TYPE OR TANK#: PRODUCFTYPE OR TANK tl:
TIME DATA -/+ GPL RES GPH TIME DATA -/+ GPL RES GPH
_ .0037 .0037 _
_ .0037 .0037 _
_ .0037 .0037
_ .0037 .0037 _
_ .0037 .0037 _
.0037 .0037
Final Result: Final Result:
Quality
Cathodic, Tank&Line Testing
PO Box 1457
Northport,AL 35476
Ph: (205)339-3535
DATE:
VMI LDT 890 TEST SITE: fmJ �ftKl o
LEAK DETECTOR ADDRESS:
It 3
TEST RESULTS
TESTER NAME: Christo h.r D.,P..v
CERTIFICATION#: 69-0691.
TEST REPORT INDICATES
TYPE OF LEAK DETECTOR TESTED
PUMP# CL L SERIAL#
3
4
5
6
7
8
FUNCTIONAL TEBTLEAK
PRODUCT METERING ELEMENT RATE OPENING PASS
PUMP# TYPE PRESSURE HOLDING PSI RESILIENCY MVMIN TIME FAIL
1go2LP ^ 189 ml
2 189 m1
3 189 ml
4 199 ml
5 189 ml
6 189.1
7 189 ml
8 89 ml