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ANNUAL AUTOMATIC TANK GAUGING (ATG) SUMMARY REPORT <br /> (AII-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: CALlir 14tuq AAM04- PRODUCT:_ <br /> ADDRESS: TANK NO.: <br /> CITY ZIP: ZIL CAPACITY: L200D TANK OWNER/OPERATOR J2, 4 A'�VL <br /> LAST TANK A GE CHECK': LAST LINE MONITORING EQUIPMENT CHECK': LAST METER <br /> CHECK': LAST PIPING TEST': ATG SYSTEW: .& THRESHOLD': GPH <br /> CM 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 Ouring: 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 FaiitO <br /> Variation <br /> Month Year (HRS)' (HRS I' (YIN) (Y/N) (Inches) % (GPH)' (Gallonsl <br /> 90 1e , gra, A SS <br /> 2 73.2I Ig 6 I AIS <br /> 3 G b 14 � tA,0 <br /> 4 *S S 42, S ( 'Z,-. <br /> 7 s S <br /> $ Q S <br /> s S <br /> 10a , ,rs A. <br /> 11yk i7e ( I fiS <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 (local implementing agency) <br /> der penalty of perjury, that all information listed above is correct. <br /> - / ? — 24 <br /> Sig <br /> / ? — <br /> Sig ature7onitoring <br /> y Tank Owner/Operator or Agent Date <br /> ' Enter dateequipment and pressurized lines must be checked yearly. 'Enter name and model of ATG system. ' Enter certified leak <br /> rate threshowait'time between last delivery or input and start of tank test. "Enter the number of hours between the start and the and <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 races less than the cartifted leak rate threshold. 'Inventory reconciliation calculations must be,done unless tank is 90% <br /> full or within 10% of last month's highest level. 10 Enter pass if the actual variation is less than 130 gallons + 1% of throughput. <br /> swRGB-Jun"1.1996 <br />