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Home My WebLink About*Other - Public WorksEXEGUTIVE SUMMARY Both lines passed the test, RECOMMFENDATION,SS There are no recommendations, E-mail: jef4te'venson(p ,j..IeIgI*,tOnobrIe,n.con) .-e •':r: .:'I. ..':z4.. "'.4 r "t, 3 .1 4 SMS SUS, LLC ISetrvice Distribulors. SWE: 'Sioli..1tionss LL(*j'p TW, 263-572-3822 05/1 7/ 2024 Report U8198129 Site Grant County Public Works 124 Enterprise St SE Ephrata WA 98823 USA Test Date(s) 05/1 E312024 Reason for Test Annual Compliance EXEGUTIVE SUMMARY Both lines passed the test, RECOMMFENDATION,SS There are no recommendations, E-mail: jef4te'venson(p ,j..IeIgI*,tOnobrIe,n.con) .-e •':r: .:'I. ..':z4.. "'.4 r "t, 3 .1 4 SMS SUS, LLC ISetrvice Distribulors. SWE: 'Sioli..1tionss LL(*j'p TW, 263-572-3822 AIM To Investigate the integrity of the UPS$$ due to Annual Comp1lance METHODOLOGY An individual test was 1• were performed an the product Iii Line Was/were ested to a 0.05 gph leak rate using Leighton 0' Brien P1V12 test equipment proved ures. SUM MARY OF LIN ES RESULTS AS 11STED Product Lines Test Date Result -+A- , . VM AWN Unleaded Tank I to Dispenser (1 12) 06/16/2024 P A 816 Diesel T'ank 2 to DIspenser (3.4) 05/16/2024 PASS MM E NTSID] S C U SS 10 NS 1306`11ne—s passed ' sed the, , , tes-t,"'--, *. . " � , i C 0 M 11-t`1EN DAT 1 There are no recommenclations, FUEL SYSTEM DETAILS Fuel Operation System Tank Line Pressure Double Wall (Fiberglass/Fiberglass) Environ ['14-hrista. Grant . C Via Di',a9M,,StiC Rap.,,)tt to -16.05-2024 Page ADDENDUM Dato of Test 0,5 /16/2024 lJoan so. d 'Tester Eli Olson Report Preparod by Jeff steveelwon Lololiton 0' Brien 9 lossary of Terms Field Services P,rY LTO UPSS$b,- Underground Petrohaum Storage Phurle: +613 9804 2200 Systems. Pox,* +613 $804 2299 US EPA United States of Anoerica Enviratirnerital Protection Agency. US.A: +1 888 275 3781 The undergrOUnd pipe and tank configUrations Ernalh, info(Mleightonobri om-.Co o: contained in this report are deduced from infort-nation 111WW. I gathered attire Bite by Leighton a' Brian Field Services and by information given to I-eiglitor, 0, Brien Field Services by the client. 1'est technology used: Leighton 0' Brien wet test O'"nass based), Leighton 0' Brien ullag(a, test (pressure or vaCUUM), Quantitative Wet Line 'rest PM2 and QUailitative. Dry Une 'Fest PP42 Leighton 0' Fjf.,N.1d rvices are, prov)ded on the terms and conditions set out in the conditions of sale document, The Leighton 0' BrIenservice is warranted to the invoiced value of services performed lo accordance with section 64A of the Australian Consumcr Law (Schedule 2 of the Competition and Consurnet Act 20,10), wyW E t;ra G2 ra n t CO'c i i P) IL y ID u 1) 110 Wo r ks L 1 �S'l 98 1 2",,J D: ai g r x_m t I t ;R ; e po o r 4.4, t -,r ",, 1 11,15 - e. y,6% /, 3 of 4 LINE TESTS DETAILS Lino Tests Date Start End Cert Result 00ndition qpYhr Pal .-14. .1 - bb 4.. — 4, W.. Rowed 1 Pressure Tests Diesel Tank 2 to Dispenser (3,4)* 06/16/24 07,20 08:09 491230 PASS Wet -0-013 50.68 Unleaded 'rank Ito Dispenser (I,2}'* 05/16124 07:20 08:09 491230 PASS Wet -0-1013 50M ................... 1*4*q4j Ira 0 px4 114114 Ittodu 414 bal 66#0.04 WOVI v F1 .118VIrwheove IN r*1$44* I Nt For, I&I #mtrorI. Mq1 Is$ 1&4 1# 041 ro11ta1*b4b tj Lines tested to a 0.05 gph leek rate using Leighton 0' Brien PM2 test equipment & procedures *Lines were manifolded during testing WOW— 1. 01 -AL rLy 2 024 4 0, f 4 F'ohnM-a ("i -ant coun' F -,ti' 4; Work-,�- t I S' 19,8120 SME $0LUT IONS, LLC 10707 8, Tecoma Way 280 0 N.W. 31 St, Ave into A-2 Poltland, OR. 97210 LaKaMod.WA, 99499 (603) 9464000 (253) 672a22 Mechanical Leak Detector Test Data Sheet Site Name Grant County Public Works Date 5/16/2024 Address 124 Enterprise St SE ---------- Ephrata, WA, 98823 Test Inforrviation 2 4 Product ------ mft — -- k-ft-i*ft - 0-1* 1 Regular Diesel Manufacturer 0 � VM) VM1 Model LD -2000 LO -2000 Full Operating 24 Line Bleed Back (mi.) 60 76 Trip Tie (see) 2 2 "I O' 0" Metering Pressure (psi) I -VE Holding Pressure (1151) 23 28 Test Leak Rate (ml/mb-i)(ph) 3 OG P H - OGPH PASS or FAIL PASS PASS Com 'men ts This letter certifies that the aruival leak detector tests were performed at the above referenced facility a ccor ding, to the. equipment manD factu rers procedures and I'm ita tions and the results as listed are to iny knowledge true and correct. The mechanical leak detector test pass/ fail is determined Usilig a low flow threshold trip rate of 3 gpli a -t 10 PSI, SME Solutions, LLC Inspected By: Contractor., --- d - Technician Eli Olson 10267749 iFll Signature.....___ monnonang Syste Equipment Ceftification This form must be used to document testing and servicing of monitoring eq uIpment, A sep_qate cortification_ or rep must be,pjepared_fpr.@p -grt* M nitg�rlag _�y�te by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. A* General Information FacifityName: Grantcoy!� Yf!�q!lc Works Bldg, No.: Site Address., 124 Enterprise St CitY: Ephrata Facility Contact PersonEl : M ZIP; 98823 r Contact Phone Number Make/Model of Monitoring Sy.stern, Incon EVCS R, Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment Inspected/servicedo. Date of Testing/Servicing: 5/16/2024 Tank ID. ul r Tank IMP Diesel In - Tanl(Gauglng Probe �TM Model: LL2 In -Tank GaLlging Probe Model: Annular Space or Vault Sensor Model; FMP Annular Space or Vault Sensor Model; LL2 Modp l: Piping Sump/trench Sensor Model: ULS Piping Sump/Trench Sensor Model: LJL,3 E] Fill Sump Sensor(s) Model: Fill Sump Sensor(s) Model., Mechanical Line Leak Detector Model: L X] h4echanlcal Une Leak Detector E Model: LD2000 D Electronic Une Leak Detector Model: Electronic Line Leal(Dotector Model: Tank Overfill/High Level SLmsor Model; Tank Overfill/High Level Sensor Model; Other (Specify equipment type and model in 5ectlo n G on Page 3) 0 Other (Specify equipment type and model in Section G on Page 3) Tank IDO Tank is 0 In -Tank Gauging Probe Model; In -Tank Gauging Probe Model: El Annular Space or Vault Sensor Model; Annular Space or Vault Sensor Model: Piping Surnp/Trench Sensor Modul: E] Piping SumpfTrench Sensor model,. F1,11 $UMP sen5or(s) Modei: Ej Fill .Sump Sensor(s) Model: Mechanical Line Leak Detector Model., Mechanical Line Leak Detector Model: Electronic Line Leak Detector Model: D Electronic Line Leak Detector Model; 'El Tank Overfill/High Level Sensor M odel: [D Tank Overfill/High Level Sensor Mode[.. Other (Specify equipment type and model in .Section G on Page 3) Ej Other (Specify equipn)ent type and model in Section G on Page 3) Tank ID, Tank 11): F1 In - Tank Gauging Probe Model., El in -Tank Gauging Probe E] Annular Space or Vault Sensor Model: Annular Space or Vault Sensor Model., w.. Model., Ej Piping Sump/Trench Sensor Model., Piping Surnp/Trench Sensor Model: 1=111 -Sump Sensor(5) modoelf. 1E] Fill Sump Sensor(s) Model; Mechanical Line Leak Detector Model: Mechanical Line Leak Detector Model: El Electronic: Line Leak Detector Model: Electronic Line Leak Detector Model:. E] Tank Overfill/High Level Sensor Model: Tank Overfill/Hi h Level .Sensor E Other (Specify equipment type and madel in Section G on Page 3) 1 [] Other (Specify equipment type and model ire Section G on Page 3) "if the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. Page of Site Address-, 1124 Enterprise St SE Date of Testing/Servicing: 5/16/2024 Dispenser OT All I I Dispenser 11D: Dispenser Containment Sensor(s) Model: ShearValve(s) Dispenser Containment Float(s) and Chafn(s) Dispenser Containment Sensor(s) Model: shearvalve(s) Dispenser Containment Floatfs) and Cha In(s) Dispenser Of Dispenser Ol Disperser ContalnmentSensor(s) Model: Shear Valve(s) Dlsponw Containment Float(s) and Cha[n(s) DIspenser ID; Dispenser Containment Senwr(s) Model-, Shear Va lye (s) Dispenser Containment Float(s) and Chaln(s) Dispenser ID: Dispenser Containment Sensoos) madel: ShearValve(s) Dispenser Containment Float(s) and Chaln(s) C, Results of Testing/Servicing Software Version fnstalled: N/A Complete the following checklist., Dispenser ContalnmentSensor(s) Model: ShearValve(s) Dispenser Containment Float(s) and Chain(s) Dispenser 111 Dispenser Containment Sensor(s) model; Shear Valve(s) Dispenser Containment Float(s) and Chaln(s) Dispenser' lD: Dispenser Containment Sensor(s) Model; Shear Valve(s) Dispenser Containment Ptaat(s) and Chaln(s) Yes E3 No Is the audible alarm o' perational? Yes yes-, which sensors 11nitlate Posttive shutdown? No* Is the visual alarm op'era-flonal? Yes Did you confirm positive shutdown due to leaks and sensor fall u re/disconnection? No* Were all the sensors visually inspected, functionally tested, and confirmed operational? Yes For tank systems that utillzethe monitoring sy stern a s the e primary~ ma ry ta n k overfl I I wa rn 1 n g device (i.e. No* Were all sensors installed at lowest point of secondary contaInmen't and positioned so that other N/A at the tank fill point(s) and operating properly? If so, at what percent does the alarm trigger? equipment will not interfere w1th their proper operation? El Yes M5 any monitorIng equipment replaced? yes, Identify specific sensors, probes, or other equipment No If alarms are rela ed to a remote monitoring statio - -- ..- -- — A. i- b---- y n. is all commianications equipment (e,g. Yes* N o Was liquid found Inside any s t -a I n m ent systems d esl g n e d a s dry systems? modem) operational? Z Yes No* Was monitoring system set-up reviewed to ensure proper Ings? (Attach set-up reports, If applicable) N/A Is all monitoring equipment operational per ma�nuRa'ctwrer's specification .. s7 Q Yes N.o* For Pressudzed piping systems, does the turbine automatically shut down if the pip*ng I secondary 1containment monitoring system detects a leak, faills to operate, or is electrically disconnected? If NIA yes-, which sensors 11nitlate Posttive shutdown? (Check all thatapply) [] Sump/Trench Sensors D Dispenser Containment Sensors Did you confirm positive shutdown due to leaks and sensor fall u re/disconnection? 0 Yes El No Yes No* For tank systems that utillzethe monitoring sy stern a s the e primary~ ma ry ta n k overfl I I wa rn 1 n g device (i.e. no mechanical overfill protection valve Is installed), is the overfill warnIng alarm visible and audible N/A at the tank fill point(s) and operating properly? If so, at what percent does the alarm trigger? 90 % Yes * No M5 any monitorIng equipment replaced? yes, Identify specific sensors, probes, or other equipment . ..... replaced and list the manufacturer name and model for all replacement parts in section (3, below. Yes* N o Was liquid found Inside any s t -a I n m ent systems d esl g n e d a s dry systems? (Ch eck aft tho t apply) Product El Witter Ifyes, describe causes in Sectlan G, below, Z Yes No* Was monitoring system set-up reviewed to ensure proper Ings? (Attach set-up reports, If applicable) N Yes No* Is all monitoring equipment operational per ma�nuRa'ctwrer's specification .. s7 * In section G below, describe how and when these deficiencies were or will be corrected Monitoring System Certification - Page of Site Address: 124 Entar�plse St SE Date ofTesting/Servicing: 5/16/2024 D. In - Tank Gauging/ SIR Equipment Check this box If tank gauging Is used only for inventory control, Check this box If no tank gauging or SM equipment is installed, 0 This section must be completed if in -tank gauging equipment is used to perform leak detecti nitoring, on mo ytir Has all Input wiring been Inspected for proper ent'ry''a'n'd fer'�n_i n, Including- —_ Fs?---' ii IUD ND* testing for ground 0 Yes Ej No* Were all tank gauging probes Asually Inspected for damage and residue bulld-up? Y eNo* Was accuracy of system prod u Ef_li�v_i I readings tested? s Ej Yes No Was accuracy of system water level readings tested? Yes [I No* Yes No* Nn section G below' �,de_scj ere all probes reinstalled properly? .... .. . ere all Items on the equipment manufacturer's maintenance checklist completed? be how and when these deflclen�ie's mere o"r'will -'be corrected, E. Line Leak Detectors (LLD): Complete the following checklist; Check this box If LLD's are not Installed Yes No* For equipment start-up or annual equipment certification was a leak s I m u lated to verify LLD pe rform an ce? (Check a// that apply) Simulated leak rate: M 3 g.p,h (1a+ El 01 g.p.h. (2.); 0 0.2 gp,h. N/A Notes; 1. Required for equipment start-up certification annual certification-, 2. Unless mandated by local agency, certification required •only for electronic LLD Startup, N Yes E] No* Were all LLD's confirmed operational and accurate within regulatory re'qu'lrements? 0 Yes No* Was the testing apparatus properly calibrated? 0 YesNo* Fo r rn echa n Ica I LLD's , d oes the LL-5'-r'e stri ct product fIow is -it detects a Irak? E] N/A 0 Yes []'No* For electron LLD S_r_ does the turbine automatically shut off If the LLD detects a �ea�c� �.,.�..-: -- N/A 17 Yes No* For electronic LLD's, does the turbine automatically shut off If any portion •of the monitoring system Is ]ZVA disabled or disconnected Yes No* ,For electronic LLD's, does the turb"ne automatically shut off if any_ portion of the m0N/Amalfunctions or falls a test?unitoring system is For electronic LLD's, have ins pectec17 Yes No all accessible wiring connections been visually' N/A Yes 10 No* I 'Vere all Items on the equIpment manufacturer's maintenance checklist completed? Mn section G below, describe how and when those deficiencies were or will be corrected, Fe Certification - I certify that the equipment Identified In this docurnent was inspected/serviced In accordance with the manufacturer's 9 u Id el I ne s, Attached to th Is Certification Is Information (e,g, manufacturers' checklist) ne cessa ry to verify rify that this I s I nform atl 0 n Is correct. For any equipment capable of generating such reports, I have also attached a copyof the, (Check all that apply) G. Comments E] system set-up Alarm History Report Technician Name: Ell Olson Signature Mfg, Cert,#,- 033201 ICC# 10267749 License No.: I Testing Company Name., SME Solutions, LM Phone No,, Testing Company Address: 10107 South Tacoma Way M2 -Lakewood, WA. Mlo"Itorling SYStem Certifleation - Page of (253) 572-3822 Date of Testing/Servicing: 5/16/2024 LEAK TESTING CHECKLIST LIST ID #: 409127 FOR UNDERGROUND STORAGE TANKS (U T) County -4 Grant DEPARTMENT OF EYhis cheelclist certoes testing activi'lies con(lucted in accordance with COLOGY Stote of Washington Chapter 173-360A WAC. Read lnsti-uctons onpapaes 4-7. PASS — All Section A services performed have passing results, I FAIL — One or more components tested in Section VI require repair DATE TESTS CONDUCTED** 05/16/2024 and re -testing, 0 ug 0 L.g d 3, �_6 U -_-, N IOU t. &I �z •�0 . i � "(r- .* Facility Compliance Tag A 1244 Service Provider Name: Ell Olson USS" ICS #: 409127 Company Name:SME Solutions, LLC Site Name: Grant County Public Works Address:101 07 S, Tacoma Way -Suite #A2 Site Address: 124 Enterprise St SE City: Lakewood State: WA zip:98499 City: Ephrata Phone,'253-572-3822 E rn a I 1,,r County: Grant ICC Certification Type: U1/U3 - Site Phone: ICC Cert. #: 10267749 Exp. Date: 03/23/25 Name: Pirrone: Email; w4•: rr . . . . . . . . ... U-14 . "�47 4; 71" j y - It' w I 2i tf fir_IVOR! IM 1-9. *. Vtli R9 Ab ' � '� i I .1�,-�.s•- ,•6t,_ ,,��[[�� '-r'•*.,,. • ( M. ? �D. 1. Tank ID as registered with Ecology or identlifled on ATG 2 2. Tank Status. 0P (Operatla na 1) TC (Te rn pora ry Closure) 0 P CSP 3. Product stored, including % of alternative finis Unleaded Diesel 4, Tank or compartment capacity (gallons) 9730' 9730 5. Product pumping/flow method. Note as: P (Pressurized); NS (Non -safe P rP Suction); SS (Safe Suction); Si (Siphon); GR (Gravity Fed) 1wh- 6. Tank material and construction observed ST/DW ST/DW 7. Pipe material and construction observed FLEX/DW' FLEX/DW a i , R &;.7: .:T Lf y��iu��r!��._1`.. .`i^ :,.:J �i'> - :1r.t: .yJ.•.' •: _ -•t - r„.^f 9 '�" .. 2: .i.._tr'a1'::.,�.. ;.L]. 1t. ••l' :�-2 fY.L' fVA;� El Annual testing Test after install/repair Other (explain): 0 3 -year testing El Return USTsy5tem to operation I ECY 070-69 (Rev, May 2020) E 070-69 (Rev. May 2020) cnecked serVices tested per recommended practIces, code and/or manufacturer's require nencs, end ire accordance with state- regulations, 2. Owner/operator provided with copy of the checklist and testing results, 3. Any faulty equIpment or necessary repairs explained to owner/operator or site contact, 010,11 M.A. M -"Z ".i r 7, -7,r77W!-, 14, 77, - M, - v 7777-74 RU 05/16/2024 Date Date FW ANL�-= Signature of CertIfied Service Provider Signature Qf Tank Owner or Authorized Representative ECY 070-69 (Rev.:May 2020) Eli Olson Print or Type Name Brian Print or Type Name LEAK TESTING CHECKLIST INSTRUCTIONS Tank owner loperator: 1, Within, 24 hours, report failed tests resulting In a suspected or confirmed release to the appropriate Ecology regional office, 2. Submit signed checklist and supporting documentation to Ecology within �O days Of testing, using one of the following methods. Do not include these Instructions pages with your submittal mad PDF to TCP External Document Submittal TEDD: Use Secure Access Washington (SAW) account; Add TEDS as a new service; Contact (360) 407-7170 for more information, -4 Service providers: U lVaii WA Department of Ecology Underground Storage Tank (UST) Section PO Box 47655 Olympia, WA 98504-7600 1. Completion of this checklist Is confirmation of services performed in accordance with chapter 173-360A WAC4 2. Refer to Table 920-1 in t ' he UST regulation for a list of services and required certifications. 3, With the checklist, include the test data recorded. Include make and mode -1 number for all tanks, piping, sensors, ATGs, ALLDs, overfill devices, and spill buckets, if they can be determined, 4. The service provider must be certified to operate the equipment used for testing, Checklist sections: 1-111. UST Facility, Certified Service Provider, UST Owner/Operator: Provide the UST facility compliance tag # (small license plate) and/or UST 04; ICC -certified service provider information; and owner/operator information, IV. UST System Information: Provide site-specific information about tanks and piping only if visually verified during the site visit. To report product stored, use products listed at dispensers. Do not use Ecology records to complete this section, V. Reasons Services Performed; Check appropriate box or explain if different. V1 Services Performed: Check all that apply and detail the location and number of components tested, plus test method used. Find an example of Section V1 on page 70 ALLD: List the ALLD test method and service provider's test method certification expiration date In the space provided, If an electronic ALLD is tested, the tester must also document proof of certification on the ATG or other controller. Attach the ALLD test data (including ALLD make/model) to this checklist. Verify the ALLD is third -party certified for use with the particular piping run (volume, through -put, etc,), Per the method specified, perform the test from the furthest/highest elevation point of each piping run, If satellite dispensers are installed, perforin the test an each entire piping run from the fu rthest satell Ite dispenser. If the ALLD does not pass the function test when tested at the farthest point in the line, it is a ICY 070-69 (Rear. May 2020) 4 failed test for that piping run, Including if the malin dispenser solenoid is blocking the satellite line. In the comments, indicate the dispenser number where testing was conducted, Line Tightness Test; In the space provided, note the test method and service provider's certification expiration date for that method. If the piping run Includes satellite lines, ensure the entire piping run is tested. Follow manufacturer testling procedures, verify the test method is third -party certified for the piping run being tested, and indicate the dispenser number. Electronic Monitoring System Tests: Record the monitor make, model, and tester's certification expiration date for it. If the monitor/controller does not have tester certification by the manufacturer, leave the expiration date blank, List how many of each component was tested (e.g. probes, sensors, etc.), Test Iqgwires rq�m *.rt probe(si, Monitor/controller and probes - One-year compliance tests include verifying system configuration/pro ra rming, operation of alarms, battery backup, probes, free residual buildup, floats move freely, shafts free from damage, and cables free of kInks/breaks. Verify equipment is third -party certified for use by the particular UST system (i.e. through -put, manifold) and that components are compatible with the product stored, List the recommended practice or code followed, b) Sump Sensor Functionality - (Sump sensor, vacuum or pressure): Test sensors per manufacturer specifications or list the Recommended Practice used, Verify sensors are compatible with the product stored and monitorIng system, Ensure sensors are upright and placed in the lowest part of the sump. Note If sensors are not connected to a monitoring system. c) Tank Annular Sensor Functionality (i.e. annular sensor, brine): Test per manufacturer Instructions or list the recommended practice used. Verify the annular space does not contain product or water and monitoring equipment is functional, Verify monitoring equipment is compatible with the product stored and communicating with the controller. overfill Equipment Test: Ensure overfill prevention equipment is set to activate no higher than the required level (i.e. 95% tank capacity for automatic shutoffs; 90% tank capacity for overfill alarms; and 90% or manufacturer specifications for ball floats). Verify alarm Is audible when standing at fill ports. Remove automatic shutoff and ball float devices to confirm functionality. If the ball float device does not pass the test, it cannot be replaced; another functioning fa rm of overfill prevention M ust be Installed. Remove probes to confirm functionality of exterior alarm/float communication at calculated height, Verify conflicting equipment does not affect overfill device operability, Conflict examples: ball float device may not function with suction pumps or coaxial fills; automatic shut -offs may not function wirth ball float stern inside tare. unless the a uto m atl c shut -cuff device Is set louver than the ball float stem. If known, include the overfill device make and model and list the recommended practice or code followed. PI H/SpIll Bucket Test-, Include the make, model and whether spill bucket Is single wall (SW) or double wall (DW) construction, Note if a test falls date to visual observation only, DW Spill buckets that have both walls continuously monitored are exempt from every 3 -year testing If Inspected and documented monthly, List the Recommended Practice or code followed, Tank Top or Transition Sump Test: Required if relying on interstitially monitored piping, including any piping run installed after October 1, 2012, Describe containment sump as SW or DW. If the piping run includes transition sumps, enter those sump tests in this section. Note if a test falls due to visual observation only, DW sumps that have both walls continuously monitored are exempt from every 3 -year testing if inspected and documented annually. List the recommended practice or code followed, ECY 070-69 (Rev. May 2020) 5 UDC Sump Test: Conducted every three years and at sump installation. Required if relying on interstitially monitored piping, Describe containment sump as SW or DW, Note if a test falls due to visual I o bservaflo n. DW su mps that have both Wa I Is continuously monitored are exempt from every 3 -yea r testing if inspected and documented annually. Ust the Recommended Practice or code followed. Tank Tightness Test: The test method and service provider's test method certification expiration date must be listed. Follow manufacturers testing procedures and verify the test method is third -party certified for the tank/compartment tested. Other: Describe all tests conducted that do not fit other service types. For example,, pre -testing a tank using a non -third -party -certified method fo r a Fuel Request Farm. V11. Explanations/Problems Encountered: Describe reason for testing and any problems encountered. For failed test results, include any known details about correcting the problem(s) (e.g. how and when it will be repaired/replaced and which company will do the work). V111, UST Site and System Diagram: Include location, number, and description of tanks, piping, dispensers, and ail other UST site and system components (such as sumps, fill ports, vents, buildings, etc.). Ensure descriptions in Section IV are consistent with labels on this diagram. Include a north arrow, IX. Final Check: Mark the boxes that correctly answer the questions. X. Required Signatures: The ICC-certlfled service provider and authorized representative must sign and date the completed checklist, ExAm PWLE OF SECTION VI a See next page. ECY 070-69 (Rev. May 2020) N6 fill "I L j. T. U ZZI # REPAIRED # PASS # FAIL & PASSING D r -SCgIpTioNs REQUIND: (59f, INSTRUCT -1 ONS N 44) ALLD Test (attach data 3 Uni from 7/8; . Diesel fromb/6; on road Diesel from Test method used: satellite 4 (main solenoid not blockIng satellite); Uni ALLD replaced and Test Method cart, exp, data: tested-, Line Tightness Test {attach) data) 4 — ------------ Test method used: Un I from 7/8; Diesel from 5/6 Test method cert, exp. date: Electronic Monitoring Sy�tem Tests ........... Contra lier manufacturer/model Controller tort. exp, date Monitor/controller . _I Per RP 1200; VR TLS 350.; relolaced bulbs. Diesel Sensor Probe 4 replaced. Sump Sensor Functionality 3 Tank Annular Sensor Functlonality 4 F] Auto shutoff Overfill Equipment Test n Sall float valve Per RP VOM robe re 1200; Ppprogrammed to tank chart Overfill alarm 3 Fill/ pill Bucket Test (attach data) Uni 'Vill burket needs replacement, Tank -Top or Transition Sump Test (attach date) 4 Low level sump test with automatic shutdown of STP, UDC Sump Test (attacli data) 4 Tank Tightness Test (attach -data) -�-- .....�.�_._�.�,..��..,, �- --�. 3rd -party certified test; Test meth od'used : ' - Test method cert. exo. date: Other A -n ;;3 ; p 4-b . .'•; . ..... ki wy A, 4 ADA Accessibility To request an ADA accommodation, contact Ecology by phone at 360-407-6831 or email at qecyadacoordjnator@�! . .......gy, or visit https://ecology,wa,gov/accessibility. For Bela V Service or TTY call 711 or 877- 833-6341. EY 070-69 (Rev, May 2020) 7