Release Detection Equipment Testing Form - Idaho

The Idaho Department of Environmental Quality has released this version of the "Release Detection Equipment Testing Form" on April 1, 2018.

This form may be used by all Idaho residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

ADVERTISEMENT
Idaho Department of Environmental Quality
Release Detection Equipment Testing Form
Test Date:
Release Detection Equipment Testing Form
In lieu of this form, DEQ prefers the manufacturer's testing forms be used and completed per manufacturer's instructions.
l
Probes and sensors must be removed from the tank or containment and tested in liquid.
l
Setup reports must be printed from the automatic tank gauge and attached to this form.
l
Keep a copy of each report that the ATG is programed to perform.
l
Fill in the tank number, describe the sump, and check or fill in the box information if the item has passed test.
l
UST Facility
Person Conducting the Testing
Name:
ID#:
Name:
Street Address:
Company Name:
City:
Zip Code:
Address:
Site Contact:
Phone:
Email:
Phone:
Automatic Tank Gauge (ATG) and Probes
All console lights function
Battery back-up functions
Printer functions
ATG Make and Model:
Identify tank number:
Product stored (unleaded, E-10, diesel, etc.)
Probe serial #
Tank volume, gallons
Tank diameter, inches
ATG setup meets compliance standards for this site: (Leak
min. vol. and duration 0.2 gph, 0.1 gph, alarms enabled, etc.)
Probe was inspected and any damaged or missing parts were
replaced
Float moves freely on the stem
Fuel float level on the ATG agrees with gauge stick reading
Water float level on the ATG agrees with gauge stick
reading
April 2018
Page 1 of 2
Idaho Department of Environmental Quality
Release Detection Equipment Testing Form
Test Date:
Release Detection Equipment Testing Form
In lieu of this form, DEQ prefers the manufacturer's testing forms be used and completed per manufacturer's instructions.
l
Probes and sensors must be removed from the tank or containment and tested in liquid.
l
Setup reports must be printed from the automatic tank gauge and attached to this form.
l
Keep a copy of each report that the ATG is programed to perform.
l
Fill in the tank number, describe the sump, and check or fill in the box information if the item has passed test.
l
UST Facility
Person Conducting the Testing
Name:
ID#:
Name:
Street Address:
Company Name:
City:
Zip Code:
Address:
Site Contact:
Phone:
Email:
Phone:
Automatic Tank Gauge (ATG) and Probes
All console lights function
Battery back-up functions
Printer functions
ATG Make and Model:
Identify tank number:
Product stored (unleaded, E-10, diesel, etc.)
Probe serial #
Tank volume, gallons
Tank diameter, inches
ATG setup meets compliance standards for this site: (Leak
min. vol. and duration 0.2 gph, 0.1 gph, alarms enabled, etc.)
Probe was inspected and any damaged or missing parts were
replaced
Float moves freely on the stem
Fuel float level on the ATG agrees with gauge stick reading
Water float level on the ATG agrees with gauge stick
reading
April 2018
Page 1 of 2
Idaho Department of Environmental Quality
Release Detection Equipment Testing Form
Inch level at which the water alarm activates corresponds
with value in ATG
Test Results (P = pass, F = fail)
Sensors
(liquid sensors, tank interstitial sensors, etc.)
Identify each sensor location:
(product sump or dispenser number)
Type of sensor: Make and model
ATG is clear of any active alarms: If the sensor is in alarm
and functioning, indicate why in the corrections section
Test liquid: P = product, W = water
Sensor alarm circuit is operational prior to test
(i.e., “sensor normal,” no alarms)
Sensor was inspected--It is not damaged, cables are free of
kinks and breaks, floats move freely
Installed in the proper location and position
Sensor triggers alarm when placed in test liquid
When alarm is triggered, the sensor is properly identified on
the ATG
Test Results (P = pass, F = fail)
Line Leak Detector
(3 gph and 0.2 gph)
Identify tank and pipe tested
DEQ or manufacturer's testing form is attached
Test Results (P = pass, F = fail)
Corrections/Comments
(Description of actions taken if items tested or inspected were not acceptable.)
Tester's Signature
Date
April 2018
Page 2 of 2
ADVERTISEMENT
Page of 2