HomeMy WebLinkAbout16276 015113 101 12-09-2020 SPILLT SLA SPILL BASIN TEST RESULT 52347.43 SPILLT
ADEM
3 YEAR SPILL PREVENTION EQUIPMENT (SPILL BUCKET)
INTEGRITY TEST REPORT (HYDROSTATIC AND VACUUM METHOD)
Questions on how to complete this form should be directed to the Groundwater Branch,UST Compliance Section at 334 270-5855
Facility Name: United Food and Fuel#11 Owner: McNeill Family
Address: 3801 Day St Address: PO Box 11
City, County,Zip: Montgomery, Montgomery, 36108 City, State,Zip: Montgomery,Al 36101
Facility I.D.#: 12899-101-015113 Phone#: 334-263-9070
Tester Name: Kurtis Waites Tester Phone#: 334-300-0984
Tester Com an : Major Oil Co
Instructions
1. Submit a completed copy of this form within 30 days of pedorming the test to: Groundwater Branch,PO Box 301463 Montgomery,AL
36130-1463,or fax to: (334)270-5631 or email to: USTcomolianceoadenn alabama.gov.
2. This form allows you to record up to 5 ADEM Unique Tank Numbers,assuming that the Facility ID Number and test method remain
the same.
3. Double walled spill prevention equipment does not require testing.
4. Single and double walled spill prevention equipment must also be checked every 30 days in accordance with the Walkthrough
Inspection requirements. See ADEM 30 day Walkfhrough Inspection Checklist Lag which can be found on the ADEM website at
www.adem.alabama.gov/programs/water/amundwater.cnt.
5. Testing must be performed in accordance with a nationally recognized code of practice(such as PEI RP-1200 or equivalent)or the
manufacturers instructions.
6. Keep a record copy of this testing for 3 years.
Code of Practice or Manufacturers Instructions used:
ADEM Unique Tank# 1
Product Stored Gasoline asolne Gasoline
❑vacuum ❑vacuum ❑vacuum ❑vacuum ❑vacuum
❑pressure ❑ pressure ❑pressure ❑pressure ❑pressure
Test method used ®hydrostatic M hydrostatic ®hydrostatic ❑hydrostatic ❑hydrostatic
❑manufacturer's ❑ manufacturers ❑manufacturer's ❑manufacturer's ❑manufacturer's
instructions instructions instructions instructions instructions
Basin free of cracks or holes? L9 yes 61 yes M yes ❑yes ❑yes
(it no,it fails without testing) ❑ no ❑no ❑ no ❑ no ❑ no
Water,fuel,trash&debris removed ®yes KI yes M yes ❑yes ❑yes
from basin prior to test? ❑no ❑ no ❑no ❑no ❑no
(dispose of properly) ❑ n/a ❑n/a ❑ his ❑ his ❑ me
Drain valve operational and seals ❑yes ❑yes ❑yes ❑yes ❑yes
properly? ❑no ❑ no ❑no ❑no ❑no
(where applicable) ®his 91 me Ig ma ❑me ❑n/a
Water,fuel,trash&debris removed O yes ❑yes ❑yes ❑yes ❑yes
from basin prior to test? ❑ no ❑no ❑ no ❑ no ❑ no
(dispose of properly)
KI yes ®yes ID yes ❑yes ❑yes
Fill pipe cap seals properly? ❑no ❑ no ❑no ❑no ❑no
Was enough water added to RI yes KI yes ®yes ❑yes ❑yes
completely fill the basin? ❑no ❑no ❑ no ❑ no ❑ no
H drostatictest only)
Test start time 8 :00 am 8 :00 am 8 :00 am
Test end time q --:�0.arrt
(hydrostatic test-minimum 1 hour
Measured water level drop in inches
accurate to 1/16 inch
(Hydrostatic lest) 0^ 0"
Vacuum drop in inches water column 0"
vacuum test
Results of test
(Hydrostatic test fails if level drops 118 ®pass ®pass ®pass Opass Opass
inch or more.) (Vacuum test fails I
cannot maintain 30 inches water column Ofail Ofail Ofail Ofail Ofail
or ifvamum drops more than 4 inches Oloconcluslve Olnconclusive Oinconcluslve Olnconcluslve Olnconcluslve
water column.
Testers initials and date tested KW 1?9 /20 KW 12/9 /20 Kw 1? 9/20 /
Repairs Needed Date of Repair ascription of any Repairs
ADEM Form 20 ml 7/15 m2(revised 3/18)