HomeMy WebLinkAbout12727 003964 101 12-16-2020 ATGTEST SLA AUTOMATIC TANK GAUGE TEST 66052.05 ATGTEST
ADEM ANNUAL TANK GAUGE TEST
REPORT FOR YEAR gmn
Facilil Name: United Food and Fuel#14 Owner: McNeill Family
Address: 1192 Western Blvd. Address: PO Box 11
City, County,Zip: Montgomery, Montgomery, 36108 City,State,Zip: Montgomery,AL. 36101
Facili I.D. #: 12899-101-003964 Phone#: 334-263-9070
Tester Name: Kurfts Wales Tester Phone#: 334-300-0984
Tester Company: Test Date: 12-16-20
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 fax to: (334)270-5631,or email to: USTcpmpliance(aladem.alabama.gov.
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 3
Product Stored I Gasoline Gasol ne I Diesel
Automatic Tank Gauge Console Test
Does console lest history include test ®yes ®yes ®yes ❑yes ❑yes ❑yes
alarms?(Don't forget to clear test alarmist ❑ no ❑ no ❑no ❑ no ❑ no ❑ no
Does site setup agree with configuration ®yes ®yes ®yes ❑yes ❑yes ❑yes
shown in console? ❑ no ❑ no 0 no ❑ no ❑ no ❑ no
Is battery backup operational? ®yes M yes IM yes ❑yes ❑yes ❑yes
❑ no ❑ no ❑ no ❑ no ❑ no ❑ no
Testing results? W pass 0 pass IH pass 0 pass 0 pass ❑ pass
Must meet all applicable criteria to pass. ❑fail 0 fail 0 fail 0 fail 0 fail ❑fail
Probe and Float Test
Is probe free of residual buildup? D yes ®yes ®yes ❑yes ❑yes ❑yes
❑ no ❑ no Ono ❑ no ❑ no ❑ no
Are cables free of kinks? ®yes ®yes ®yes ❑yes ❑yes ❑yes
❑ no ❑ no Ono ❑ no ❑ no ❑ no
Was shaft inspected and free of damage? IN D no lz❑ no 13❑no ❑ no ❑ no s❑ no
Do floats move freely? ®yes Z yes IS yes ❑yes ❑yes ❑yes
❑ no ❑ no ❑no ❑ no ❑ no ❑ no
Does measured product and water levels in E yes 0 yes 0 yes ❑yes ❑yes ❑yes
tank agree with console levels? ❑ no ❑ no ❑no ❑ no ❑ no ❑ no
Does actual product float level agree with tg yes ®yes ®yes ❑yes ❑yes ❑yes
console product float level? ❑ no ❑ no ❑no ❑ no ❑ no ❑ no
Does Overfill alarm activation level agree IN yes 0 n/a IN yes D n/a IN yes D n/a ❑yes D n/a ❑yes D n/a ❑yes 0 me
with console? ❑ no ❑ no ❑no ❑ no ❑ no ❑ no
Does actual water float level agree with IN yes ® yes ®yes ❑yes ❑yes ❑yes
console water float level? ❑ no ❑ no ❑no ❑ no ❑ no ❑ no
Does water alarm activation level agree with ta yes ®yes (A yes ❑yes ❑yes ❑yes
console? ❑ no ❑ no ❑no ❑ no ❑ no ❑ no
Testing results? 0 pass ®pass 12 pass 0 pass 0 pass ❑ pass
(Must meet all applicable criteria to pass.) ❑fail 0 fail 0 fail 0 fail 0 fail ❑fail
Repairs Needed Date of Description of any Repairs
Repair
Tester's Signature: Kurtis Wailes
ADEM Form 565