HomeMy WebLinkAbout14765 013549 101 12-21-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 57708.49 LDLTTEST
DRAFTADEM
AUTOMATIC LINE LEAK DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT
Facility Name: Owner: _
Address: Address:
Cd , Count ,Zi 3 City, State,Zip:
Facili I.D. #: - Q - Phone#:
Tester Name:Christopher Hod Dempsey Tester Plane#:201
Tester Certification: Estabrooks Ezy Chek Cedification E iration: a1 r 31 f2621
Tester Company:Quality Tank Testing Test Date: - Z - d 20 _
Instructions
1. Submit this form,attach all test data for every test performed am 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: USTcomolianceCdadem aabama cov. 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 recognirad code of practice(such as PE RP-1200 or equivalent)or the
manufacturers instructions.
4. Line lightness test equipment used must be approved by ADEM. Visit the NWGLDE websim at www.nwclde.oro to view a list of
releaselleak detection equipmentfmethods that ADEM approves for use in Alabama.
5. Automatic Line Leak Detec(om 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 Grountlwater Branch,UST
Compliance Unit at(334)270-5655.
Type of Test Performed-check all that apply: E11(utomatic Line Leak Detector(ALLD) Pkrne Tightness Test
Reason for Test-check all that apply: J39mual Test ONew Installation ORequired by ADEM Enforcement Action
Manufacturer of ALLD Test Equipment:VMI I Model or Version:LDT890
Manufacturer of Line Tightness Test Equipment Estabrooks Ezy Chek I Model or Version:Manuel Test
ADEM Unique Tank If
Product Stored
2ffberglass Sfterglass []fiberglass []fiberglass Ofiberglass []fiberglass
Piping material []flexible []flexible Oflexible []flexible Oflexible Oflwuble
Defeat Osteel []steel Osteel Osteel []steel
Approx.length of piping ��� Y,S'run tested nearest foot
Piping capacity
(gallons)
Automa c Line Leak Detector Test
Type of ALLD mechanical echanicai Omechanical []mechanical Omechanical []mechanical
Delectronic I Dele(tronic Delectronic Delectronic I Delectronic Oelechonic
Line pressure
during ALLD test(psi) U
Measured ALLD leak rate `� 7
Results of ALLD teat ss Dfall paec E fail []pass D fail []pass L fail []pass Died Dpass Ofail
Dirrconclush Clirwonclusive Dinconclusive []inconclusive Oinconclusive []inconclusive
Line Tightness Test
Limgline etest(
pssu during si) JCJ
Measured linfe leak rate O
(gp
Results of line pass stall Aafass Ofail Opass Ofall Opass Ofail Opass Ofail Opass Died
tightness test []inconclusive Oinconclusiv¢ Oincondustve Oirtcortclusive I []inconclusive Oinconcusive
Repairs Needed Data of Repair Description of any Repairs
Testers Signature:
ADEM Form xxxx(new form)
Quality
Cathodic,Tank&Line Testing
PO Boa 1457
Nonhpoi%AL 35676
Ph: (205)339-3535
DATE: l?-Z( 26
ESTABROOK'S EZY CHEK TEST SITE: i rf
ADDRESS:
PRODUCT LINE TESTER
TEST RESULTS TESTER NAME: Christopher(Hotly)Dempsey
CERTIFICATION N: AL 69-0691
APPUED PRESSURE: 50 PSI -
PRODUCE TYPE OR TANK a: PRODUCT TYPE OR TANK R:
TIME DATA -/+ GPI. RES GPM TIME DATA -/+ GPL RES GPM
0 .0037 0 0 ZN ` Q .0037 47 O
/.! (79 D .0037 Q
2:V 3 .0037 0 e5 2:3A _qL .0037
.0037 .0037
- .0037 .0037 -
-_ .0037 .0037 -_
Final Result: Final Result: tcs
PRODUCTTYPE OR TANK R: PRODUCT TYPE ORTANK R:
TIME DATA -/+ GPI. RES GPM TIME DATA -/+ GPI. RES GPM
_ .0037 .0037
_ .0037 .0037 -
_ .0037 .0037 -
_ .0037 .0037 -
_ .0037 .0037 -
.0037 .0037 -
Final Result: Final Result:
PRODU WPEORTANKR: MODUCTTYPEORTANKR:
TIME DATA -/+ GPI. RES GPM TIME DATA -/+ GPI. RES GPM
_ .0037 .0037
_ .0037 .D037 _
_ .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:
VMT LDT 890 TEST SITE: Vl4" 7
LEAK DETECTOR ADDRESS:
��irF.9cFtt�1,K-3G/
TEST RESULTS
TESTER NAME: Chriatwh.r Deamaev
CERTIFICATION#: 69-0691
TEST REPORT INDICATES
TYPE OF LEAK DETECTOR TESTED
PUMP# MAKE MODEL SERIAL#
I v-
2
3
4
5
6
7
8
FUNCTIONAL TEST LEAK
PRODUCT METERING ELEMENT RATE OPENING PASS
PUMPa TYPE PRESSURE HOLDINGP91 RESILIENCY MUMIN TIME FAIL
I Lp Z� / /5D 189 ml 3
2 Z� /0 189 m1
3 189.1
4 189 ml
5 189 ml
6 199 ml
7 189 ml
8 189.1