The URL can be used to link to this page

Home My WebLink About18156 018770 051 07-25-2024 LDLTTEST AEPACS LINE AND LEAK DETECTOR TEST Digitally signed by: Automatic Line Leak Detector (ALLD) AEPACS Date:2024.12.06 05:22:02-06:00 Reason:Submission Data and/or Line Tightness Test Report Location:State of Alabama version 3.5 (Submission#: HQ8-NWXM-GQGBA,version 1) Details Submission Alias Automatic Line Leak Detector(ALLD)and Line Tightness Test Report(Form 566) Submission ID H08-NWXM-GQGBA Form Input Report Entry Submission Method for Test Results Upload PDF Copyof ADEM Automatic Line Leak Detector(ALLD)and Line Tightness Test Report(Form 566) Is the submission in response to an Warning Letter I Notice of Violation I Notice of Proposed Delivery Prohibition? No Site Information Site Name CIRCLE K#2709068 Permit Number(Facility ID Number) 23413-051-018770 Site Address 1167 HWY 14 MILLBROOK,AL 36054 United States Upload Test Results Type of Test Performed Automatic Line Leak Detector(ALLD) Line Tightness Test Please select®Did Not Test®as the test result and provide the reason for not testing for all situations in which the specific equipment was not tested or not required to be tested. Automatic Line Leak Detector(ALLD)Test Results Tank Install Data Tank Product Tank Status Test Data Test Result 12/22/2022 54282 Unleaded gasoline Currently in Use 0725/2024 Pass 1222/2022 54283 Premium gasoline,Etharol free gasoline Currently in Use 07252024 Pass 1222/2022 54284 On road diesel,Otter Currently in Use 07252024 Pass 1222/2022 54284 On road diesel,DEF Currently in Use 07252024 Pass Line Tightness Test Results 12/6/2024 5:22:02 AM Page 1 of 2 Tank Install Date Tank Product Tank Status Test Date Test Result NONEPROVIDED 54282 Unleaded gasoline Currently in Use 0725/2024 Pass NONEPROVIDED 54283 Premium gasoline,Ethanol free gasoline Cuneraly in Use 07252024 Pass NONEPROVIDED 54284 On road diesel,Other Cuneraly in Use 07252024 Pass Attach the PDF file of the test form 9068-LINE-LD 07252024.pdf-12/06/2024 05:18 AM Comment NONEPROVIDED 12/6/2024 5:22:02 AM Page 2 of 2 LINETT ADEM SEl-9264623 LINE TIGHTNESS TEST REPORT Questiore on hi compete this form should be directed to the Groundwater Branch UST Com lien Unit at 3341 270-561 Facifirry Name_ Circle K#2709068 Owner: Circle K Address: 1167AI-Hwyl4 Address. Environmental Shared Services Gulf Coast 1100 Si s City,County, Zip: Millbrook ELMORE 360541 City Stat9,06,11II&IIIII NC 27606 Facility I.D.#: 23413-051-018770 1 Phone# 850-316-6673 Tester Name_ Andrew Parnell I Tester Phone# 800-964-1250 Tester Certificaton_ Certficaton Expiration Tester Company_ Tanknology,Inc. Instructions 1. Complete this farm,include all the test data,and submit to: Groundwater Branch,PO Box 3C1463 Montgomery,AL 36130-1463,or facto (334)27C-5631,or email to. USTccmolance(a)adem alabamaaev. Test data must include waiting time between delivery and testing,start time,eM time,recorded volume changes and limes,correction factors and calculations,and calculated leak rate for every test performed or the submittal will not be acceofed. 2. This farm allows you to record up to 6 ADEM Unique Tank Numbers,assuming that the Faulity ID Number and the test equipment remain the same_ 3. The tightness test equipment used must be approved by ADEM. Visit the Ni w4bsile at wwwmwolde.ora to view a list of releaselleak selection equipm unilmethms that ADEM approves for use In Aabama_ 4. Testing must be performed in ad romance with the manufacturers instructions_ 5. Keep a recent copy or this testing for 3 years. Reason far Test-circle all that apply 0 (Annual Test)El (New Installation) (Required by ADEM) C(Re spouse to SIR Problem) Manufacturer of Test Equipment, Tanknology Model or Version. TLD-1 ADEM Unique Tank Tl 72 T3 T4 Product stored REGULAR PREMIUM ETHANOL Diesel fiberglass 66fiberglass 01berglass berglass benglass Ltiberglws Piping material tested ❑flexible ❑flexible ❑lemnic ❑nexlble ❑flexible [flexible Lsteel Osteel Osteel Osteel Ostend Lsteel Piping capacity 200 200 200 200 allons Line pressure during test 60 60 60 60 s Equipment threshold 0.05 0.05 0.05 0.05 h Measured leak rate 0 0 0 0 h pass _pass s I _pass Results oftest: Dial Fur itt it l Mail Utnwnclusive Lini sive ❑nconclusive L msonGusive eincundwree Linconclusive Testers initials and AP 7/25/20 P 7/25I20 P 7/25/20 AP 7/25/20 date tested Repairs Needed Date of Repair Description of any Repairs Certification 1 century under penalty of law that the lest was performed in accordance with al€regulatory requirements of ADEM administrative cote rule 335-6-15 and that the submitted information is true, accurate,and complete. Signamre of Tesler 0a1e: 0 712 5/2 0 2 4 ADEM Farm 477 mt l/10 m2(revised 3/1a) LDLTTEST r AoeM AUTOMATIC LINE LEAK DETECTOR (ALLD) and LINE TIGHTNESS TEST REPORT c Fa c lily Name_ Circle K#2709068 Owner: Circle K AUUI e5S 1167 AL H 14 Address: Environmental Shared Services Gulf Coast 1100 City,-County, Zip: Millbrook ELMORE 36054 City, State$i01s Suite 100 NC 27606 Facility I .#: 23413-051-018770 Phone#: 850-316-6673 Tester Name.- Andrew Parnell Tester Phone if 800-800-4633 Tester Certification_ 182137 Certification Expiration 06/05/2025 f Tester Company: Tanknology.Inc. Test Date: 07/25/2024 Instructions 1. Sulxnitihisform,attach all testdam far every test peolomled,and subma a eompletetl copy of this Conn to' Gledhil tel Branch,Po Bmx3m1463, Montgomery,AL361M-1463,orfaxtm: (334)2705631,memallie: USTcompliance(uladernerahamagov This Pone must W mmpleted and induded mM the test data or the submhtal vnll nM be accepted. 2. This fart,allows up to 6 ADEM Unique Tank Numbers assuming that the Facility ID Number and test equipment remain the same. 3. 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. Line tightness test equipment used must he approved by ADEM. V sit(he"GME vrehsae alwww m Me org to view a list a raleaselleak detection eq,upmenVnlethods that ADEM approves for use in Al 5. Automatic Line Leak Detectors are designed to he tested in-place Da not remove and lest outside mike tank system. 6 Keep a copy of mis Testing far 3 years ouestiom on haw to complete this form should be,diweted to the Groundwater Branch.UST Compliance Unit at(334)270-51l Type of Test Performed-check all that apply iQlAutmmahc Line Leak Detector(ALLD) ❑Line Tightness Test Reason for Test-check all that apply aAnnual Test ❑New Installation CRequired by ADEM Enforcement Action Manufacturer of ALLD Test Equipment: TANKNLOGY Ml or Version:FTA Manufacturer of Line Tightness Test Equipment Made;or Version[ ADEM tlni ue Tank a T1 T2 T3 T4 Product Stored REGULAR PREMIUM ETHANOL Diesel fiberglass Ofiffergess 011berplass kolfiberglass berglass Lifflienglass Piping material Efienble Dmekible Ed le Eloamble Dllexible Eldelune Esteet Dsteel Elsteel Meet E'eteel ❑steel Apprax_length of piping 200 200 200 200 run tested nearest foot Piping capaciry 32 32 32 32 (gallons) Automatic Line Leak Detector Test Type ei ALLD AElm2ronic mechanical mechanical mechanical mechanical Jmechanical Deleatione: Delectronic Delectionic Delectronk Eeleetronic Line pressure 10 10 10 durin ALLD test siMeasured ALLD leak rate 3.0 3.0 3.0 Results of ALLD test ss it ssails it ss it ss ail nwnclusive ncanclusive ncsnclusire nconclusive Jnconclusim Line Tightness Test Line pressure coming line test si Measured line leak race Results of line Epass Cfail Dpass 0fail C6ass Dfail Kass Dail Ds 7 mastail Li Dfail tightn m stest Linconchch. ❑inrna lusive Linconclusive Limoonclusive ,conclusive Einconcluslve Repairs Needed Date of Repair Description of any Repairs Tester's Signature: ADEM Farm 566