HomeMy WebLinkAbout12724 009491 101 12-14-2020 SUMPT SLA SUMP INTEGRITY TEST 70627.86 SUMPT
ADEM
3 YEAR CONTAINMENT SUMP INTEGRITY TEST REPORT
Questions on how to complete this form should be directed to the Groundwater Branch,UST Compliance Section al 334 2701
Facility Name: United Food and Fuel#1 Owner: McNeill Family
Address: 4521 So. Court St. Address: PO Box 11
City, County,Zip: Montgomery, Montgomery: 36105 Cit , State,Zi : Mont ome AL 36101
Facility I.D.#: 12899-101-009491 Phone#: 334-263-9070
Tester Name: Kurtis Wailes Tester Phone#: 334-300-0984
Tester Company:
Instructions
1. R a low level rest Is to be performed,do not use this form. Instead,use ADEM 3 Year Containment Sump Integrity Test
Report(Low Level Method)form to document the results which can be found on the ADEM website at
www.adem.alabama.gov/orogramstwatertgroundwater.cnt.
2. Submit a completed copy of this form within 30 days of performing the lest to: Groundwater Branch, PO Box 301463 Montgomery,
AL 36130-1463,or fax to: (334)270-5631 or by email to: USTcompliancera-adem.alabama.gov.
3. This form allows you to record up to 5 ADEM Unique Tank Numbers,assuming that the Facility ID Number and the test method
remain the same.
4. Double walled containment sumps do not require testing.
5. Single and double walled containment sumps must also be checked annually in accordance with the Walkthrough Inspection
requirements. See ADEM Annual Walkthrough Inspection Checklist Log which can be found on the ADEM website at
www.adem.alabama.gov/progmms/water/groundwater.cnt.
6. Testing must be performed in accordance with a nationally recognized mile of practice(such as PEI RP-1200 or equivalent)or the
manufacturer's instructions.
7. Keep a record copy of this testing for 3 years.
Code of Practice or Manufacturer's Instructions used:
ADEM Unique Tank# 1 2 3
or Owner's Dispenser#
Products Gasoline Gasoline Diesel
(N/A foror di tlispensenser)
®sub pump ®sub pump ®sub pump ❑sub pump ❑sub pump
Type of sump tested ❑intermediate ❑ intermediate ❑intermediate ❑intermediate ❑intermediate
❑dispenser ❑dispenser ❑dispenser ❑dispenser ❑dispenser
❑vacuum ❑vacuum ❑vacuum ❑vacuum ❑vacuum
❑pressure ❑ pressure ❑pressure ❑pressure ❑pressure
Test method used ®hydrostatic El hydrostatic ID hydrostatic ❑hydrostatic ❑hydrostatic
❑manufacturer's ❑ manufacturers ❑manufacturer's ❑manufacturer's ❑manufacturer's
instructions instructions instructions instructions instructions
Sump free of cracks, holes,and N yes ®yes ®yes ❑yes ❑yes
compromised boots? ❑ no ❑no ❑ no ❑ no ❑ no
If no,It falls without test in
Water,fuel,trash&debris removed III yes CD yes [III yes ❑yes ❑yes
from basin prior to test? ❑no ❑no ❑ no ❑ no ❑ no
dis se of properly)
Height from bottom of sump to
highest penetration in inches? 8 8 8
(hydrostatic test only)
Starting test level above bottom of
sump in inches? 12 12 12
(hydrostatic test only)
Test start time 1QQp1D 2:00Pm 1:QQpm
Test end time 200om 2:OOom 200Dm
minimum 1 hour
Measured water level drop in inches
accurate to Ill inch none none none
(hydrostatic test only)
Result of test ®pass
inch or me.. [III pass 13 pass O pass O pass
(Hydrostatic test fails if level drops 1/8 pfail fail Ofail Ofail Ofail
Testers initials and date tested KW 12/14/20 KW 12/14/20 KW 1214/20
Repairs Needed Date of Repair Description of any Repairs
ADEM Form 557 03118