HomeMy WebLinkAbout16276 015113 101 12-21-2020 LDLTTEST SLA LINE AND LEAK DETECTOR TEST 59858.02 LDLTTEST
DRAFTADEM
AUTOMATIC LINE LEAK DETECTOR(ALLD}and LINE TIGHTNESS TEST REPORT
Facility Name I- 61 Owner:
Address: Address:
Cit ,Count Zi : 0 City,State Zip:
Facility I.D.#. Phone#:
Tester Name:Christopher Hod Dempsey Tester Phone#:205-339a535
Tester Certification: Estabrooks Ezy Chalk Certification Ex iration: 03/ 31 /2 i
Tester Company:Quality Tank Testing Test Date:17.
Instructions _
1. 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 36130-1063,or fax to: (330)2705631,oremail to: USTcomoliancetfadem.alabamaaov. This form
most be completed and Included with the test data or the submittal will not be accepted.
Z 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 rationally recognized code of practice(such as PEI RP-1200 or equivalent)or the
manufacturer's instructions.
4. Line lightness test equipment used must be approved by ADEM. Visit the N GLDE websits at www.nwolde.oro to view a list of
releasedeak 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.
6. Keep a copy of his 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: utomatic Line Leak Detector(ALLD) 01[ine Tightness Test
Reason for Test-check all that apply: nnual Test ONew Installation ORequired by ADEM Enforcement Action
Manufacturer of ALLD Test Equipment VMI Model or version:LDT890
Manufacturer of Line Tightness Test Equipment Estabrooks Ezy Chalk Model or Version:Manual Test
ADEM Unique Tank#
Product Stored H
arglass erglass Ofiberglass Dfiberglass Ofiberglares Ofiberglass
Piping material Ofledme Ofiedble Oflexible Ofladble Ofiedble Flexible
Osteal Defeat Osteel Osti Dsteel Osteel
Approx. length of piping 12
run tested nearest foot
Piping capacity Z� � AO alcap G
Autionnatic Line Leak Detector Test
Type of ALLD mechanical echanical Omechanical Dmechanical Omedlanical Omechanical
Oelectronic Delectmnic Oelachonic Oelectronic Oelectronic Oelectronic
Line pressure n
during ALLD test(psi) l/
Measured ALILD leak rate l7 3
Results of ALLD test ass Otail papse, ❑fail Opals Ofail Opass Mir Opass Mill Opals Ell
Oinconclusive I Dinconclusive Otnconclusive Oinconctus-. Oinconel—We Oixoncluaive
Line Ti htness Test
Line pressure
dunm line test -10 63
Measured line leak rate O O
h
Results of line pass Oheil ss Ofail Opals Dhil Opals Ofall Disuse Dfail Dpass Wall
tightness test Oineonchedw Oinconclustve Olnconclusive Oinconclusiva I Dinconclusive Oinconclusive
Repairs Needed Date of Repair Description of any Repairs
Tester's Signature:
ADEM Form xxxx(new form)
Quality
Cathodic, Tank&Line Testing
PO Box 1457
NoMpom AL 35476
Ph: (205)339-3535
DATE:
VMI DDT TEST ADDRESS:
��Il13 ifI
LEAK DETECTOR ADDRESS: I
TEST RESULTS
TESTER NAME: Christopher Dempsev
CERTIFICATION#: 69-0693
TEST REPORT INDICATES
TYPE OF LEAK DETECTOR TESTED
PUMP# MODEL SERIAL#
I
2
3
4
5
6
7
8
FUNCTIONAL TEST LEAK
PRODUCT METERING ELEMENT RATE OPENING PASS
PUMP# TYPE PRESSURE HOLDING PSI RESILIENCY MLM/IN THE FAIL
I6C9 2-6— 8^ / 189 ml 3
2 /63 189 ml 17
3 189 ml
4 189 ml
5 189.1
6 189.1
7 189.1
$ 189.1
Quality
Cathodic,Tank&Line Testing -
PO Box 1457
Northport,AL 35476
Ph: (205)339-3535
DATE:
ESTABROOK'S EZY CHEK TEST SITE: T )�
ADDRESS:
PRODUCT LINE TESTER 3G or
TEST RESULTS TESTER NAME: Christopher(Hody)Dempsey
CERTIFICATION R: AL 69-0691
APPLIED PRESSURE: 50 PSI ��,,y��.rr
PRODUCTTYPEORTANKN: �ej PRODUCT TYPE OR TANK K: rN"r
TIME DATA -/+ GPL RES GPM TIME DATA -/+ GPL RES GPM
Y.'M & .0037 0 0 y_$0 , .0037 Q O
�yr�5 .0037 4:453F .0037
5� .0037 Q 6� .0037 U U
_ .0037 .0037 _
' .0037 .0037
- .0037 .0037
Final Result: Final Result:
PRODUCTTYPEORTANKR: PRODUCrT EORTANKR:
TIME DATA -/+ GPL RES GPM TIME DATA -/+ GPL RES GPM
_ .0037 .D037
_ .0037 .0037 -
_ .0037 .0037 -
_ .0037 .0037 -
_ .0037 .0037 -_
.0037 .0037
Final Result: Final Result:
PRODUCTTYPEORTANKR: PRODUCTTYPEORTANKR:
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: