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ANNUAL AUTOMATIC TANK GAUGING (ATG) SUM•RY REPORT <br /> 1, lLinfo'rmation not clearly listed on attached monthly tapes must be entered) <br /> �n1�1Annnuual summary reports are required for retail and non-retail facilities <br /> FACILITY NAME: C 11 �/ n /-J Oti1dl J ¢ LV4t CP.wC,?i1 PRODUCT: ' <br /> ADORESS: .SnZD J c Q.Cu C7 X ' TANK NO.: <br /> CITY: ZIP: r3wo CAPACITY: '000 ANK OWNER/OPERATOR <br /> LAST TANK GAUGE CHECK': B LAST LINE MONITORING EQUIPMENTCHECK'-. W PJrLAST METER <br /> CHECK': /B LAST PIPING TEST • i ' TG SYSTEM':Vu�ati-/tee 7466 _ 5'8 <br /> THRESHOLD':�GPH <br /> All morKhiy 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 /> ip 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 Inventy <br /> Reorconciliaticn <br /> Results' <br /> Wait Test Wait Test Product Percent Leak Pass/ Acual° Pass/ <br /> Time Time Time Time Level' Full Rate Fail° Monthly FaiI1O <br /> Variation <br /> Month Year IHRSI4 IHRSI' (Y/N1 IY/NI (Inches) % fGPHI' (Gallons) <br /> 1 I I I I I <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 1O <br /> 11 <br /> 12 <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 /> I certify under penalty of perjury, that all information listed above is correct. <br /> SignVuVe of FaciliVf Tank Owner/Operator or Agent f 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. 4 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 an the test <br /> report. 4 Enter pass for leak rates less than the certified leak rate threshold. °Inventory reconciliation calculations must be done unless tank is 30% <br /> full or within 10% of last month's highest level. 1"Enter pass if the actual variation is less than 130 gallons + 1% of throughput. <br /> SY cs-j.t. 1996 <br />