HomeMy WebLinkAbout12725 015060 101 12-10-2020 ATGTEST SLA AUTOMATIC TANK GAUGE TEST 62830.89 ATGTEST
ADEM ANNUAL TANK GAUGE TEST
REPORT FOR YEAR 2mn
Facilil Name: United Food and Fuel #10 Owner: McNeill Family
Address: 300 Coliseum Blvd Address: PO Box l l
City, County,Zip: Montgomery, Montgomery, 36109 City, State,Zip: Montgomery, AL 36101
Facilil I.D.#: 16918-101-015060 Phone#: 334-263-9070
Tester Name: Kurtis Wailes Tester Phone#: 334-300-0984
Tester Company: Test Date: 12-10-20
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: USTcompliancettDadernslabarni .
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#
Product Stored I Gasoline I Gasoline
Automatic Tank Gauge Console Test
Does console test history include test ®yes El yes ❑yes ❑yes ❑yes ❑yes
alarms? Donl fo et to clear test alamis ❑ no ❑no ❑no ❑no ❑no ❑ no
Does site setup agree with configuration ®yes ®yes ❑yes ❑yes ❑yes ❑yes
shown in console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Is battery backup operational? ®yes ®yes ❑yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Testing results? 0 pass 0 pass O pass 13 pass [3 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? IN yes KI yes ❑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? 0 yes 0 yes ❑yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Do floats move freely? ®yes ®yes 13yes ❑yes ❑yes ❑yes
❑ no ❑no ❑no ❑no ❑no ❑ no
Does measured product and water levels in M yes KI yes ❑yes ❑yes ❑yes ❑yes
tank agree with console levels? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does actual product float level agree with IN yes IN yes ❑yes ❑yes ❑yes ❑yes
console product float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does Overfill alarm activation level agree ID yes D Na ®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 ❑yes ❑yes ❑yes ❑yes
console water float level? ❑ no ❑no ❑no ❑no ❑no ❑ no
Does water alarm activation level agree with ®yes ®yes ❑yes ❑yes ❑yes ❑yes
console? ❑ no ❑no ❑no ❑no ❑no ❑ no
Testing results? 0 pass 19 pass O 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: Kurtis Wastes
ADEM Form 565