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�� PEIIRP1200-17 Tester's Name (print) 0 peLorg Tester's Signature TANK GAUGE OPERATIONAUTOMATIC Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. #: Phone #: Testing Company: Phone #: Date: This procedure is to determine whether the automatic tank guage (ATG) is operating properly. See PEVRP1200 Section 8.2 for the inspection procedure. This procedure is applicable to tank level monitor stems that touch the bottom of the tank when in place. Tank Number Product Stored ATG Brand and Model 1. Tank Volume, gallons 2.Tank Diameter, inches 3. After removing the ATG from the tank, it has been inspected and any damaged or missing ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No parts replaced? 4. Float moves freely on the stem without []Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No binding? 5. Fuel float level agrees with the value pro- ❑ Yes ❑ No []Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No grammed into the console? 6. Water float level agrees with the value pro- ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No grammed into the console? 7. Inch level from bottom of stem when 90% alarm is triggered. 8. Inch level at which the overfill alarm activates corresponds with value programmed in the ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No gauge? 9. Inch level from the bottom when the water float first triggers an alarm. 10. Inch level at which the water float alarm acti- vates corresponds with value programmed in ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No the gauge? If any answers in Lines 3, 4, 5, or 6 are "No," the system has failed the test. Test Results ❑ Pass ❑ Fail I ❑ Pass ❑ Fail I ❑ Pass ❑ Fail I ❑ Pass ❑ Fail Comments: Tester's Name (print) 0 peLorg Tester's Signature