HomeMy WebLinkAbout12727 003964 101 12-16-2020 SPILLT SLA SPILL BASIN TEST RESULT 66158.48 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 334 270-5655
Facili Name: United Food and Fuel#14 Owner: McNeill Family
Address: 1192 Western Blvd. Address: PO Box 11
City, County,Zip: Montgomery. Montoomerv. 36108 Cit , State,Zi Montgormidy At 36101
Facility I.D.#: Phone#: 334-263-9070
Tester Name: Kurt a Wa tes Tester Phone#: 334-300-0984
Tester Company:
Instructions
1. Submit a completed copy of this form within 30 days of performing the test to: Groundwater Branch,PO Box 301463 Montgomery,AL
36130-1463,or fax to: (334)270-5631 or email to: USTcomoliance(ftdem.alabama.aov.
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 Walkthrough Inspection Checklist Log which can be found on the ADEM website at
www.adem.alabama.aovloroarams/water/aroundwateccnt.
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 Manufacturer s Instructions used:
ADEM Unique Tank# 1 2 3
Product Stored Gasoline Gasoline Diesel
❑vacuum ❑vacuum ❑vacuum ❑vacuum ❑vacuum
❑pressure ❑ pressure ❑pressure ❑pressure ❑pressure
Test method used Q hydrostatic 0 hydrostatic 55 hydrostatic ❑hydrostatic ❑hydrostatic
0 manufacturers ❑ manufacturer's 0 manufacturer's ❑manufacturer's ❑manufacturer's
instructions instmctions instructions instructions instructions
Basin free of cracks or holes? M yes ®yes ®yes ❑yes ❑yes
if no,it fails without testing) ❑no ❑ no ❑ no ❑ no ❑ no
Water,fuel,trash&debris removed CO yes ®yes ®yes ❑yes ❑yes
from basin prior to test? ❑no ❑ no ❑no ❑no ❑no
(dispose of properly) ❑his ❑ n1a ❑ n/a ❑ n/a ❑ n/a
Drain valve operational and seals 0 yes E yes 91 yes ❑yes ❑yes
properly? ❑no ❑ no ❑no ❑no ❑no
(where applicable) ❑his ❑ n/a ❑n/a ❑his ❑his
Water,fuel,trash&debris removed ®yes III yes ®yes ❑yes ❑yes
from basin prior to test? ❑no ❑ no ❑ no ❑ no ❑ no
(dispose of properly)
13 yes ®yes ®yes ❑yes ❑yes
Fill pipe cap seals property? ❑no ❑ no ❑no ❑no ❑no
Was enough water added to ®yes ®yes 91 yes ❑yes ❑yes
completely fill the basin? ❑no ❑ no ❑ no ❑ no ❑ no
(Hydrostatic test only)
Test start time 9 :00am 9:00am 9:00am
Test end time 0_D0,m 10_1)0i 10pnill
h drostafic test-minimum 1 hour
Measured water level drop in inches
accurate to 1/16 inch none none none
(Hydrostatic lest)
Vacuum drop in inches water column
vacuum test
Results of test
(Hydrostatic test fails if level drops 118 ®pass ®pass ®p888 0pess 0pass
inch or more.) (Vacuum test fails if
cannot maintain 30 inches water column 0fail Ofatl 0fail 0fail 0fail
or if vacuum drops more than 4 inches Oinconclusive Oinconclueive 13inconclu8ive 13inconclu8ive Oinconclusive
watercolumn.
Testers initials and date tested KW 12/16/20 1 KW 12/16/20 1 KW 12J 16/20 1 / /
Repairs Needed Date of Re it I Description of any Repairs
ADEM Form 20 ml 7/15 m2(revised 3/18)