HomeMy WebLinkAbout12730 009494 101 12-22-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 53649.69 LDLTTEST
DRAFTADEM
AUTOMATIC:LINE LEAK DETECTOR(ALLD) and LINE TIGHTNESS TEST REPORT
Facilit Name: Owner'.
Address: Address:
City,County,Zi l Y;vj '4-f 3610el Cirly, State, Zip
Facility I.D.#: Phone#:
Tester Name:Christopher Hod Dempsey Tester Phone#:205-33e-3535
Tester Certification: Estabrooks Ezy Chek Certification Expiration: 03 f 31 12021
Tester Company:Quality Tank resting Test Date: 2�
Instructions
1. Submit this form,attach all test data for every test performed,and submit a completed copy of this form tc: Groundwater Branch,PO
Box 301463,Montgomery,AL 36130-1463,or fax to: (334)270-5631,or email to: USTcomolianceQadem.alabama.cov. This form
must be completed and included with the test data or the su bent al will not be accepted
2. This form allows up to 6 ADEM Unique Tank Numbers,assuming that me Facility ID Number and test equipment remain the same.
3. Testing must be performed in accordance with a rationally recognized code of practice(such as PEI RP-1200 or equivalent)or the
manufacturers instmclions.
4. Line tightness lest equipment used must be approved by ADEM. Visit the NWGLDE website at www.nwnde.om to view a list of
releaselleak detection equipmenUmethods 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.
6. Keep a copy of this testing for 3 years. Questions on how to complete this f hm should be directed to the Groundwater Branch,UST
Compliance Unit at(334)270-5655.
Type of Test Performed-check all that apply: 124utomatic Line Leak Detector(ALLD) [Line Tightness Test
Reason for Test-check all that apply: [Annual Test [New installation [Required by ADEM Enforcement Action
Manufacturer cf ALLD Test Equipment:VMI I Model or version:LDT880
Manufacturer of Line Tightness Test Equipment Estabrooks Ery Chek I Model or Version:Manual Test
ADEM Unique Tank#
Product Stored /
rglasa rglass [fiberglass [fiberglass [fiberglass Dfiberglass,
Piping material [flexible [flexible [flexible (3flexible [flexible Oflexible
[steel [steel [steel [steel [steel [steel
Approx.length of piping i
run tested nearest foot
Piping capacity ?M
allons
Automatk;Line Leak Detector Test
Type of ALLD echemical echanical n0electonr
[mechanical [mechanical [mechanical
Oelectronic Delecbnonic [electronic [electronic Delecironic
Line pressure /V
duri ALLD test i VMeasured ALLD leak rate
(gph)Results ofALLD teat ss Dfail pass [fail Opess Dian opass Dian Opass Dfail
Dinconclusive Dinconclusive Dinconclusive Dir ....save Drncorrclusive
Line Tightness Test
Line linessu ((//t( �j1
Burin pressure
test
es
Measured line leak rate O
Results of lure 1410115us 13fail Dfail Dpass [fail Dpaas afail Dimes [fail [pass Dist
tightness test I [Inconclusive Dinconclusive [inconclusive Dinconplrffiive [inconclusive [inconclusive
Repairs Needed Date of Repair Description of any Repairs
Tester's Signature:
ADEM Form xxxo (new form)
Quality
Cathodic,Tank&Line Testing
PO Box 1457
Northport,AL 35476
Ph: (205)739-3535
DATE: I Z -Z Z- zo
ESTABROOK'S EZY CHEK TEST SITE: i
ADDRESS: 4-e ilk
PRODUCT LINE TESTER recykaT7.
TEST RESULTS TESTER NAME: Christopher'(Hody)Dempsey
CERTIFICATION R: AL 69-0691
APPUED PRESSURE: 50 PSI
PRODUCTTTPE OR TANK M MODULTTTPE OR TANK#:
TIME rA -/+ GPL RES GPM TIME DATA -/+ GPL RES GPM
ilJr O O .0037 O O 1.'157 49-5' O .0037 O O
}O �.0037 0 0 g &9 O .0037 O 0
Y �- .0037 0 0 �� _� .0037 45
.0037 .0037
- ' .0037 .0037 -
.0037 .0037 -
Final Result: !N'S Final Result:
PRODUCTTTPEORTMKR: PRODUCtT EORTANKA:
TIME DATA -/+ GPL RES GPM TIME DATA -/+ GPL RES GPM
_ .0037 .0037
_ .0037 .0037 -
_ .0037 .0037 -
_ .0037 .0037 -
_ .0037 .0037 -
.0037 .0037 -
Flrul Result: Final Result:
PRODUCTTTPE OR TANK M PRODUCTTTPE ORTANK R:
TIME DATA -/+ GPL RES GPM TIME DATA -/+ GPL RES GPM
_ .0037 .0037
_ .0037 .0037 -_
_ .0037 .0037
_ .0037 .0037
_ .0037 .0037 _
.0037 .0037
Final Result: Final Result:
Quality
Cathodic, Tank & Line Testing
PO B.1457
Northport,AL 35476
Ph: (205)339-3535
DATE: IZ—?Z—Z0
VMI LDT 890 TEST SITE: 141-k-t y
LEAK DETECTOR ADDRESS: p U
mir
TEST RESULTS yarb J� �0
TESTER NAME: Chrietooher Dempsey
CERTIFICATION#: se-neat
TEST REPORT INDICATES
TYPE OF LEAK DETECTOR TESTED
PUMP# MODEL SERIAL#
2 (4Z-
3
4
5
6
7
8
FUNCTIONAL TEST LEAK
PRODUCT METERING ELEMENT RATE OPENING PASS
PUMPH TYPE PRESSURE HOLDING PSI RESILIENCY ML/MN TIME FAIL
I e OF 2.00 189.1
2 (.v� 26 Q.y 189 ml
3 189 ml
4 189.1
$ 189.1
6 189.1
7 189 ml
8 189.1