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Home My WebLink About18156 018770 051 07-25-2024 OFINP AEPACS OVERFILL INSPECTION Digitally signed by: 3 Year Overfill Prevention Equipment AEPACS Date:2024.12.06 05:18:02-06:00 Reason:Submission Data Inspection Report Location:State of Alabama version 4.3 (Submission#: HQ8-NWSF-OY5TV,version 1) Details Submission Alias 3 Year Overfill Prevention Equipment Inspection Report(Form 559) Submission ID HQ8-NWSF-OY5TV Form Input Report Entry Submission Method for Test Results Upload PDF Copyof ADEM 3 Year Overfill Prevention Equipment Inspection Report(Form 559) Is the Submission in response to an Waming Letter/Notice of Violation/Notice of Proposed Delivery Prohibition? No Site Infomtation Permit Number(Facility ID Number) 19039-051-018770 Site Name CIRCLE K#2709068 Site Address 1167 HWY 14 MILLBROOK,AL 36054 United States Upload Test Results Test Results Tank Install Date Tank Product Tank Status Test Date Test Result 12/22/2022 54282 Unleaded gasoline Currently in Use 07/25/2024 Pass 12/22/2022 54283 Premium gasoline,Ethanol free gasoline Currently in Use 07/25/2024 Pass 12/22/2022 54284 On road diesel,Other Currently in Use 07/25/2024 Pass 12/22/2022 54284 On road diesel,DEF Currently in Use 07/25/2024 Pass Attach the PDF file of the test form 27069068-OVERFILL 07252024.odf-12/062024 05,12 AM Comment NONEPROVIDED 12/6/2024 5:18:02 AM Page 1 of 1 OFINP ADEM 3 YEAR OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT Facility Name: Circle K#2709068 Owner:Circle K Address. Address: Env ronnuental Shared SerAces Gulf Coast 1100 SIus G _GCuntV, ZIP:Millbrook ELMORE 36054 1 Stal[Eqdqll Ifgl' i INC 27606 Facility I.D.It Phone#:850-316-6673 Ins edor Name: Andrew Parnell Inspedor Phone#: 800-964-1250 tns ector Company_ Tankwloqv.Inc. Ins lion Dale_07/25/2024 Instructions 1_ Submit a completed copy of this form within 30 days of performing test to: Gran dwater Bmnch.PC Box 301463,Montgomery,AL 3613D1453,mfaxto (334)27D 563f,or email to: USTcamoliancelolademalabamanov. 2_ If two or more types or overall devices are present only complete portion ct form pertaining to he primary overnh device_ 3_ Inspection must to performed in accordance will,a nationatry recognimd cede of practice(such as PE[RP-12M or equivalent)or the manufacturers II'5hn[1bIC. 4. Keep a copy of this inspection for 3 years. Questions on how to complete this form should be directed to the Groundwater Branch, 1 T Compliance Section 9(334)270-5655_ ADEM Unique TankC Product Stored REGULAR IPREMIUM IETHANOL I Diesel Primary device,being used in each 77AUtG Shutoff Ext Auto Sol Auto Shutoff at Arm Shutoff Auto Shutoff tank to prevent ovemll(Rernrd only ❑Alarm ❑Alarm -JAlarm ❑Alarm ❑Alarm primary device ins a lion rasuhs. ❑Ball Float ❑Ball Float �Ball Float ❑Ball Float ❑Ball Float Was primary overfill device E,c yes yes yes yes yes removed for test' ❑no 7 no 7 no I ❑no ❑na Automati c Shutoff Device Inspection Drop into,and Mal free of debds? yes yes yes yes yes ❑no na ::1 no ❑no ❑no Float moves freely and poppet Z yes yes Zyes zyes Lyes moves into path of flow? ❑no __j no -J no ❑no ❑no Bypass valve free of bll yes yes yes yes yes (where applicable) O rro �no �no ❑no ❑no Na v1 nla Z1 Fla 0 War ❑wa Flapper adjusted to shut art caw at V yes al yes ol yes vyes. L yes 95%or less capacdy? ❑no 7 no 7 no ❑no ❑nit High LeveI Alarm Inspection Fell Near]fn ,,Notlnswisat Tank Monhar Overfill alarm activates in test I lyes I I yes yes yes yes mode at console? ❑no ❑no no ❑no ❑no Alarm can be heard an dlor seen U yes yes yes yes yes From wnere the tank is llle0 ❑no ❑no 7 no ❑no ❑rm All associated tests move Treely? yes U yes yes yes Lj yes ❑no ❑no ::1 no ❑no ❑no Alarmadivatesat 90%orless yes yes yes yes yes cis au ? Elmo J no ::1 no ❑ne ❑no Ball Float Valve Inspection Ball float cage free of del yes yes yes yes yes ❑no it no -J no ❑no ❑no Ball moves Treeiy in cage one is yes yes yes Lj yes Lj yes Item oT damage' ❑no 7 no 7 no ❑no Fluor Vent hale in pipe is open and near ❑yes LJ yes -J yes Elyes ❑yes the top of th a to nV ❑no ❑no ono El no El no Ball float pipe is proper length to ❑yes El yes ]yes ❑yes ❑yes activate at 90%or less rapacity? 11 no 11 no -1 no F1 no Fluor Tank top hill are vapor tight ❑yes ❑yes -jyes ❑yes Lyes and free of leaks? Elm ❑no ::1 no ❑no ❑no firespaiclon Results for Automatic Shutoff Device or High Level AMm1 or Ball Float Valve Results of Inspection: 0 pass 10 pass pas]fail s V pass ❑pass (°No'arewxr to any ilen inairatas fait) ❑fail ❑fail El ran ❑fan Re airs Needed Date of Repair Description of any Repairs Tester's Signature:'0-- P` ADEM Form 559 03/10 m2(revised 8119)