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ANNUAL AUTOMATIC TANK GAUGING (ATG) SUMMARY REPORT <br /> (All.infdrmation not clearly listed on attached monthly tapes must be entered) <br /> Annual summary reports are required for retail and non=retail facilities <br /> FACILITY NAME: 12' PRODUCT: - <br /> ADDRESS: TANK NO. <br /> CITY: ZIP: s_,✓ CAPACITY: TANK OWNER/OPERATOR a . '. <br /> LAST TANK GAUGE CHECK': LAST LINE MONITORING EQUIPMENT CHECK': ALAST METER <br /> CHECK': LAST PIPING TEST': ATG SYSTEM': z THRESHOLD': PH <br /> ❑ All monthly ATG results were "pass' or appropriate corrective actions were taken. The local agency was notified <br /> within 24 hours of receiving a failure or an ATG leak rate above the leak threshold. <br /> ❑ All monthly inventory reconciliation results were within allowable variations or appropriate actions as described in <br /> Section 2646(e) were taken. The local agency was notified within 24 hours of receiving inventory reconciliation <br /> results above the allowable variation. <br /> Complete for All Twelve Months <br /> Summary of Test Results from Monthly ATG Reports <br /> Time Periods Pumping During: Test Levels Test Results Inventory <br /> Reconciliation <br /> Results' <br /> Wait Test Wait Test Product Percent Leak Pass/ Actual° Pass/ <br /> Time Time Time Time Levels Full Rate Fail` Monthly Fail1O <br /> Variation <br /> Month Year (HRS)" (HRS)' (Y/N) (Y/N) (Inches) % (GPH)' J (Gallo/ns) <br /> 3 <br /> �s 2/ Q <br /> 6 96 Y-­� P <br /> Q q"7 2 y ( (� q 70 �� <br /> 69,Z q5 <br /> FCS <br /> FA <br /> �: �� 0,L ,4 -C <br /> 0 fl Z6_ <br /> 11 O I45 <br /> �. <br /> Submit report within 15 days following the end of the last month of the twelve-month time period covered by this <br /> summary report. Send to: . (local implementing agency) <br /> ce ' y under penalty of perjury, that all information listed above is correct. <br /> dtigrfatu—re <br /> of F cility Tank Owner/Operator or Agent Date <br /> ' Enter date. Monitoring equipment and pressurized lines must be checked yearly. 'Enter name and model of ATG system. 'Enter certified leak <br /> rate threshold. ` Enter wait'time between last delivery or input and start of tank test. °Enter the number of hours between the start and the end <br /> of the test. ° Enter the inches of product in the tank (A minimum of 36 inches is required). ' Enter the calculated leak rate as listed on-the test <br /> report. °Enter pass for leak rates less than the certified leak race threshold. 'Inventory reconciliation calculations must be done unless tank is 90% <br /> full or within 10% of last month's highest level. "Enter pass if the actual variation is less than 130 gallons + 1% of throughput. <br /> SWRCSJA.a 1.1996 <br />