"Standardized Tightness Testing Form for Usts and Product Pipelines" - Rhode Island

Standardized Tightness Testing Form for Usts and Product Pipelines is a legal document that was released by the Rhode Island Department of Environmental Management - a government authority operating within Rhode Island.

Form Details:

  • Released on April 6, 2020;
  • The latest edition currently provided by the Rhode Island Department of Environmental Management;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Environmental Management.

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Rhode Island Department of Environmental Management
Office of Land Revitalization and Sustainable Materials Management - UST Division
Standardized Tightness Testing Form for USTs and Product Pipelines
RI DEM Facility ID #:
Test Date:
Facility Profile
Facility Name:
Physical Address:
City/Town:
Primary Contact Name:
Contact Phone #:
Tank Tightness Method Used:
Equipment Calibration Date:
Piping Tightness Method Used:
Equipment Calibration Date:
If the test method used requires a worksheet (e.g., Estabrook EZY-3), you must include a copy of it with this form
Tightness Test Results
Associated DEM Tank ID #
Product Stored:
Component Being Tested:
Are components and
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
boots in good condition
without damage?
Start Time:
End Time:
Start Pressure:
(indicate units)
End Pressure:
(indicate units)
Pressure Change per Hour
Leak Rate (in gal/hr)
Test Conclusion:
Describe any actions taken to
troubleshoot or actions taken
to achieve a passing result:
1
Rhode Island Department of Environmental Management
Office of Land Revitalization and Sustainable Materials Management - UST Division
Standardized Tightness Testing Form for USTs and Product Pipelines
RI DEM Facility ID #:
Test Date:
Facility Profile
Facility Name:
Physical Address:
City/Town:
Primary Contact Name:
Contact Phone #:
Tank Tightness Method Used:
Equipment Calibration Date:
Piping Tightness Method Used:
Equipment Calibration Date:
If the test method used requires a worksheet (e.g., Estabrook EZY-3), you must include a copy of it with this form
Tightness Test Results
Associated DEM Tank ID #
Product Stored:
Component Being Tested:
Are components and
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
boots in good condition
without damage?
Start Time:
End Time:
Start Pressure:
(indicate units)
End Pressure:
(indicate units)
Pressure Change per Hour
Leak Rate (in gal/hr)
Test Conclusion:
Describe any actions taken to
troubleshoot or actions taken
to achieve a passing result:
1
The interstitial space of all double-walled pipes and USTs are required to be tested every 2 years once the component has reached 20 years of age.
A primary wall test is not a substitute for an interstitial space test and will not be accepted!
Draw a rough sketch of the UST system. Make sure that all major components are labeled and that the "Tank ID #" matches what you listed above
All failed tests must be reported to DEM within 24 hours by completing the notification form on our website at
http://www.dem.ri.gov/ust
Any interstitial tightness test failure requires the primary wall to be tested for tightness within 48 hours
Final test results must be sent to DEM by the tester within 7 days for failed tests and 30 days for passing tests
Check Here if this a re-test of a failed component after repair
If any test is inconclusive or is unable to be
Check Here if this an initial test after a new installation or replacement
tested, it is considered a FAILED test
Check here if this is a primary wall test after a interstitial space failure
FINAL RESULT:
PASS
FAIL
Testing Company:
Tester Name:
Tester Signature:
Test Date:
2
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