HomeMy WebLinkAbout16276 015113 101 12-09-2020 ATGTEST SLA AUTOMATIC TANK GAUGE TEST 52280.94 ATGTEST
ADEM ANNUAL TANK GAUGE TEST
REPORT FOR YEAR gmn
Facility Name: Un ted Food and FUej #11 Owner: McNeill Family
Address: 3801 Day St Address: PO Box 11
City, County,Zip: City, State,Zip: Montgomery Al 36101
Facilil I.D.#: _ _ Phone#: 334-263-9070
Tester Name: Kurt a Waltes Tester Phone#: 334-300-0984
Tester Company: Me or Oil Cc Test Date: 12-9-20
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# 1 2 1 3
Product Stored I Gasoline I Gasoline I Gasoline
Automatic Tank Gauge Console Test
Does console test history include test ®yes ®yes ®yes ❑yes ❑yes ❑yes
alarms?(Don't forget to clear test alarms ❑ no ❑no ❑no ❑no ❑no ❑ no
Does site setup agree with configuration 10 yes ®yes to yes ❑yes ❑yes ❑yes
shown in console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Is battery backup operational? M yes 0 yes M yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Testing results? 0 pass ®pass III pass 13 pass 13 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? ®yes ®yes KI yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Are cables free of kinks? ®yes ®yes ®yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Was shaft inspected and free of damage? ®yes ®yes III yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Do ficats move freely? ®yes ®yes ID yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Does measured product and water levels in III yes 0 yes ®yes ❑yes ❑yes ❑yes
tank agree with console levels? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does actual product float level agree with to yes ZI yes ®yes ❑yes ❑yes ❑yes
console product float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does Overfill alarm activation level agree ID yes 0 Na ID yes 0 n/a ®yes 0 n/a ❑yes 0 n/a ❑yes 0 n/a ❑yes 0 Na
with console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does actual water float level agree with ®yes ®yes 0 yes ❑yes ❑yes ❑yes
console water float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does water alarm activation level agree with ®yes ZI yes KI yes ❑yes ❑yes ❑yes
console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Testing results? El pass 19 pass ®pass 13 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: KurtlS WaIt2S
ADEM Form 565