HomeMy WebLinkAbout12719 009495 101 12-03-2020 ATGTEST NJW AUTOMATIC TANK GAUGE TEST 51434.18 ATGTEST
ADEM ANNUAL TANK GAUGE TEST
REPORT FOR YEAR gran
Facilil Name: United Food and Fuel#5 Owner: McNeill Family
Address: 4545 Selma Hwy Address: PO Box 11
City, County,Zip: Montgomery, Montgomery, 36108 Cit , State,Zi
Facilil I.D.#: 12899-101-009495 Phone#: 334-263-9070
Tester Name: Kurtis Wailes Tester Phone#: 334-300-0984
Tester Company: Test Date: 12-3-20
Instructions
1. Submit a completed copy of this form within 30 days of performing test to: Groundwater Branch,PO Box 301463,Montgomery,AL
36130-1463,or fez to: (334)270-5631,or email to: USTcompliance(rDadernslabarni .
2. This form allows you to record up to 6 ADEM Unique Tank Numbers,assuming that the Facility ID Number remains the same.
3. Inspection and 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. 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.
5. If the probe is not used for leak detection but the console is(e.g.double walled tanks using interstitial monitoring),then it does not
need to be tested.
ADEM Unique Tank# 2
Product Stored I Gasoline Gasoline I Gasoline I Diesel
Automatic Tank Gauge Console Test
Does console test history include test ®yes ®yes ®yes ®yes ❑yes ❑yes
alarms?(Don't forget to clear test alamis ❑ no ❑no ❑no ❑no ❑no ❑ no
Does site setup agree with configuration ®yes ®yes III yes ®yes ❑yes ❑yes
shown in console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Is battery backup operational? M yes ®yes ®yes 0 yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Testing results? M pass ®pass ®pass 0 pass [3 pass 13 pass
Must meet all applicable criteria to pass. [3 fail 0 fail 0 fail 0 fail 0 fail ❑fail
Probe and Float Test
Is probe free of residual buildup? IN yes IN yes IN yes ®yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Are cables free of kinks? ®yes 10 yes ®yes 10 yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Was shaft inspected and free of damage? IN yes ®yes ®yes 09 yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Do ficats move freely? ®yes ®yes M yes ®yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Does measured product and water levels in ®yes M yes E yes ®yes ❑yes ❑yes
tank agree with console levels? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does actual product float level agree with ®yes ®yes ®yes ®yes ❑yes ❑yes
console product float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does Overfill alarm activation level agree ID yes 0 We ®yes 0 n/a ®yes 0 n/a KI yes 0 n/a ❑yes 0 n/a ❑yes 0 n/a
with console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does actual water float level agree with ®yes ®yes ®yes ®yes ❑yes ❑yes
console water float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does water alarm activation level agree with ®yes ®yes ®yes ®yes ❑yes ❑yes
console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Testing results? 0 pass 19 pass 13 pass 0 pass 13 pass ❑pass
(Must meet all applicable criteria to pass.) [3 fall 0 fail 0 fall 0 fall 0 fall ❑fail
Repairs Needed Date of Description of any Repairs
Repair
Tester's Signature: Kurtis Wastes
ADEM Form 565