HomeMy WebLinkAbout8071 017333 011 06-24-2021 ATGTEST SLA AUTOMATIC TANK GAUGE TEST 67078.42 L
Passing Diesel after replacing probe
ATGTEST
ADEM ANNUAL TANK GAUGE TEST
REPORT FOR YEAR 2O9, 1
Facilil Name: .e ti Owner: A G
Address: Address: p
C County, City.
it ,State ZI
Facility I.D.#: Phone#:
Tester Name:—V'lU A Tester Phone
Tester Com an I Test Date: (e y x-
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,cr fax to: (334)2705631,or email to: USTcommiliancefraademaiabama.aov.
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 manufacturer's 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 Storetl E f
Automatic7ack Gauge Console Test
Does console test history Include test Ig yes ❑yes ❑yes ❑yes ❑yes ❑yes
alarms? Don't forget to cleartest alarms ❑no ❑no ❑no ❑no ❑no ❑no
Does site setup agree with configuration 'Q yes ❑yes ❑yes ❑yes ❑yes ❑yes
shown in console? ❑no ❑no ❑no ❑no ❑no ❑no
Is battery backup operational? byes ❑yes ❑yes ❑yes ❑yes ❑yes
❑no ❑no ❑no ❑no ❑no ❑no
Testing results? V pass ❑pass ❑pass ❑pass ❑pass ❑pass
(Must meet all amplinable criteria to pass.) ❑fail ❑fall ❑fail ❑fall ❑fail ❑fail
Probe and Float Test
Is probe free of residual buildup? la yes ❑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? 13❑no ❑no ❑no ❑no ❑no ❑no
Do floats move freely/ lf-yes ❑yes ❑yes ❑yes ❑yes ❑yes
❑no ❑no ❑no ❑no ❑no ❑no
Does measured product and water levels in yes ❑yes ❑yes ❑yes ❑yes ❑yes
tank agree wil E no ❑no ❑no ❑no ❑no ❑no
Does actual product float level agree with §fyes ❑yes ❑yes ❑yes ❑yes ❑yes
console product float lave]? ❑no ❑no ❑ne ❑no ❑no ❑no
Does Overfill alarm activation level agree ;Cyes❑n/a ❑yes❑We ❑yes❑n/a ❑yes❑We ❑yes❑n/a ❑yes❑n/a
with console? ❑no ❑no ❑no ❑no ❑no ❑no
Does actual waterfloal level agree with 10 yes ❑yes ❑yes ❑yea ❑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? (7 no ❑no ❑no ❑no ❑no ❑no
Testing results? 'pass ❑pass ❑pass ❑pass ❑pass ❑pass
(Must meet all applicable criteria 10 pass.) ❑fall ❑fall ❑fall ❑fail ❑fall ❑fail r
Repairs Needed Date of Description of any Repairs
Repair
Probe Ateeetel AeA6,ot54y- . / c n of %I.i//
Tester's Signature:
ADEM Form 565