COMPLIANCE INFO_2012 - 2014 - Laserfiche WebLink

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TRUCHEK DATA ILS Fill out the site location,tank information and test boxes below. Be sure to choose the correct test box according to the diame- ter of the tank being tested. Follow the test procedures on the other side of this form.A separate test form is needed for every tank. For additional copies of the form,contact the UST coordinator at the Xerxes manufacturing facility nearest you. (See back cover for information.) SITE LOCATION AND TANK INFORMATION Site Location: Tank Information: Address: Nominal Gallons: Diameter: Phone: Approximate standpipe length: Contact name: Product type: Test Date: Person Performing Test: • • • • • • DOUBLE-WALL 95% - 5% TEST 99% - 1% TEST Ia.Start level (inches in standpipe) 1b. Start level(inches in standpipe) 2a. End level after 4 hours - 2b. End level after 10 hours - 3. Difference(subtract 2a from la)= 3. Difference(subtract 2b from lb)= 4. Calibration factor x .20 4. Calibration factor x .20 5. Volume change = 5. Volume change = 6. Test hours - 4 6. Test hours - 10 7. Gallons-per-hour loss = 7. Gallons-per-hour loss = (If 0.05 gallons/hour or less, tank passed.) (If 0.05 gallons/hour or less, tank passed.) Note: maximum allowable dispensing volume Note: No product dispensing allowed. during test: 8-foot-diameter tank- 1,200 gallons maximum 6-foot-diameter tank- 500 gallons maximum 4-foot-diameter tank- 300 gallons maximum 0-FOOT-DIAMETER DOUBLE-WALL 95% - 5% TEST 99% - 1% TEST Ia.Start level (inches in standpipe) 1b. Start level (inches in standpipe) 2a. End level after 6 hours - 2b. End level after 10 hours _ 3. Difference(subtract 2a from Ia)= 3. Difference(subtract 2b from 1b) _ 4. Calibration factor x .30 4. Calibration factor x .30 5. Volume change = 5. Volume change = 6. Test hours T 6 6. Test hours _ 10 7. Gallons-per-hour loss = 7. Gallons-per-hour loss = (If 0.05 gallons/hour or less, tank passed.) (If 0.05 gallons/hour or less, tank passed.) Note: maximum allowable dispensing volume Note: No product dispensing allowed. during test: 10-foot-diameter tank-750 gallons maximum XERXES@ CORPORATION 9 eubsldiery o1 ZCL ComposRes Inc.