Laserfiche WebLink
ANNUAL AUTOMATIC TANK GAUGING (ATG) SUMMARY REPORT <br /> (All.info'rmation 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: I& id PRODUCT: UAl L EA b <br /> (777 <br /> ADDRESS: Sao TafiGY L TANK NO.: <br /> CITY: / k ftc,y ZIP: f,1_37(g CAPACITY: TANK OWNER/OPERATO <br /> LAST TANK GAUGE CHECK': S rB LAST LINE MONITORING EQUIPMENT CHECK':8 /8 LAST METER <br /> CHECK': /B LAST PIPING TESTI: r ATG SYSTEMZ: Vgz&L A -A„dt 7'.4S-35-0 HRESHOL03: O. 7-GPH <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 I Teat Results Inventory <br /> Reconciliation <br /> Results' <br /> Wait Test Wait Test ProductPercent Leak Pass/ Actual' Pass/ <br /> Time Time Time Time Level' Full Rate Fail' Monthly Fail" <br /> Variation <br /> Month Year MRS 14 (HRS)' (YIN) IY/NI llnches) % IGPH)r (Gallons) <br /> 1 <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <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 /> nn / I certify under penalty of perjury, that all information <br /> - '--1listed <br /> aabove is correct. <br /> I, GG[t o/ J,itAcri_/��PA1 /�[ Yl AAv1S4 <br /> Sitgn e of Facili 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 and <br /> of the test. a 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 rate threshold. 'Inventory reconciliation calculations must be done unless tank is 90% <br /> full or within 10% of last month's highest level. 1e Enter pass if the actual variation is less than 130 gallons + 1% of throughput. <br /> ylNpCe.luir I, 1996 <br /> I <br />