Form SFN60640 "Ust Cathodic Protection System Evaluation Impressed Current Type" - North Dakota

What Is Form SFN60640?

This is a legal form that was released by the North Dakota Department of Health - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the North Dakota Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN60640 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN60640 "Ust Cathodic Protection System Evaluation Impressed Current Type" - North Dakota

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UST CATHODIC PROTECTION SYSTEM EVALUATION
918 East Divide Avenue, 3
Floor
Bismarck, ND 58501-1947
IMPRESSED CURRENT TYPE
Telephone: 701-328-5166
NORTH DAKOTA DEPARTMENT OF HEALTH
Fax: 701-328-5200
Clear Form
DIVISION OF WASTE MANAGEMENT
www.ndhealth.gov/wm
SFN 60640 (4-2018)
Instructions: Within 30 days, send completed form to:
North Dakota Department of Health
Division of Waste Management
918 E Divide Ave 3rd Fl
Bismarck ND 58501-1947
ND UST ID Number
All reports must be submitted regardless of results (pass, fail, or inconclusive).
Incomplete, unsigned, or illegible forms will not be accepted and will be returned.
1. UST FACILITY
2. UST OWNER/OPERATOR
Name
Name
Address
Address
City
State
ZIP Code
City
State
ZIP Code
County
Telephone Number
County
Telephone Number
Name of Contact
Telephone Number
Name of Contact
Telephone Number
3. CATHODIC PROTECTION (CP) TESTER INFORMATION AND QUALIFICATIONS
Name of Tester
Name of Company
Address
City
State
ZIP Code
Telephone Number
E-mail Address
National Association of Corrosion Engineers
Steel Tank Institute (STI) Certification Number
(NACE) International Certification Number
4. TEST REQUIREMENTS
Reason Test Was Conducted (check one)
Routine - 3 year
Routine - within 6 months of install
30-day re-survey after fail
Re-survey within 6 months of repair/modification
DATE NEXT SURVEY MUST BE CONDUCTED BY:
(required within 6 months of installation/repair and every 3 years)
5. EVALUATION
CP Tester's Evaluation (check one)
All protected structures at this facility pass the CP survey and the continuity survey indicates all protected structures are
Pass
isolated. It is judged that adequate CP has been provided to the UST system. (Complete Sections 7 and 8.)
One or more protected structures at this facility fail the CP survey, and it is judged that adequate CP has not been provided to
Fail
the UST system. (Complete Sections 7 and 8.)
The remote and the local do not both indicate the same test result on all protected structures (both pass or both fail),or the
Inconclusive
continuity survey indicates continuous or inconclusive results when compared to non-protected structures, the survey must
be evaluated by a corrosion expert. (Corrosion expert to complete Section 6.)
Date CP Test Performed:
rd
UST CATHODIC PROTECTION SYSTEM EVALUATION
918 East Divide Avenue, 3
Floor
Bismarck, ND 58501-1947
IMPRESSED CURRENT TYPE
Telephone: 701-328-5166
NORTH DAKOTA DEPARTMENT OF HEALTH
Fax: 701-328-5200
Clear Form
DIVISION OF WASTE MANAGEMENT
www.ndhealth.gov/wm
SFN 60640 (4-2018)
Instructions: Within 30 days, send completed form to:
North Dakota Department of Health
Division of Waste Management
918 E Divide Ave 3rd Fl
Bismarck ND 58501-1947
ND UST ID Number
All reports must be submitted regardless of results (pass, fail, or inconclusive).
Incomplete, unsigned, or illegible forms will not be accepted and will be returned.
1. UST FACILITY
2. UST OWNER/OPERATOR
Name
Name
Address
Address
City
State
ZIP Code
City
State
ZIP Code
County
Telephone Number
County
Telephone Number
Name of Contact
Telephone Number
Name of Contact
Telephone Number
3. CATHODIC PROTECTION (CP) TESTER INFORMATION AND QUALIFICATIONS
Name of Tester
Name of Company
Address
City
State
ZIP Code
Telephone Number
E-mail Address
National Association of Corrosion Engineers
Steel Tank Institute (STI) Certification Number
(NACE) International Certification Number
4. TEST REQUIREMENTS
Reason Test Was Conducted (check one)
Routine - 3 year
Routine - within 6 months of install
30-day re-survey after fail
Re-survey within 6 months of repair/modification
DATE NEXT SURVEY MUST BE CONDUCTED BY:
(required within 6 months of installation/repair and every 3 years)
5. EVALUATION
CP Tester's Evaluation (check one)
All protected structures at this facility pass the CP survey and the continuity survey indicates all protected structures are
Pass
isolated. It is judged that adequate CP has been provided to the UST system. (Complete Sections 7 and 8.)
One or more protected structures at this facility fail the CP survey, and it is judged that adequate CP has not been provided to
Fail
the UST system. (Complete Sections 7 and 8.)
The remote and the local do not both indicate the same test result on all protected structures (both pass or both fail),or the
Inconclusive
continuity survey indicates continuous or inconclusive results when compared to non-protected structures, the survey must
be evaluated by a corrosion expert. (Corrosion expert to complete Section 6.)
Date CP Test Performed:
SFN 60640 (4-2018)
Page 2 of 7
Name of Facility
Test Date
6. CORROSION EXPERT’S EVALUATION (if applicable)
A Corrosion Expert is needed to evaluate certain metal structures. See Appendix A at the end of this form for more information.
All protected structures at this facility have been judged that adequate CP is provided to the UST system.
Pass
One or more protected structures at this facility fail the CP survey and it is judged that adequate CP has not been provided to the UST
Fail
system.
Name of Corrosion Expert
Telephone Number
Name of Corrosion Company
NACE Int./PE Certification
NACE Int./PE Certification Number
Signature of CP Expert
Date
7. EVALUATION CRITERIA
Criteria Applicable to Evaluation (check all that apply)
Structure-to-soil potential more negative than -850 mV with the protective current momentarily interrupted. (“Instant Off”)
850 Off
Structure tested exhibits at least 100 mV of cathodic polarization.
100 mV
8. ACTION REQUIRED
Action Required as a Result of this Evaluation (check only one)
None
CP is adequate. No further action is necessary at this time. Test again by no later than the date in Section 4.
Retest
CP may not be adequate. Retest within 30 days to determine if passing results can be achieved.
(Retests may occur only if all intended protected structures are continuous with each other.)
Repair and Retest
CP is not adequate. Repair/modification is necessary within the next 60 days; or permanently close the tank
system.
9. IMPRESSED CURRENT RECTIFIER DATA
Name of Rectifier Manufacturer
Rated DC Output:
Volts
Amps
Model
Rectifier Serial Number
Amps
Volts
Rectifier output as designed or lastly recommended (if available):
Tap Settings
DC Output
Date
Event
Hour Meter
Comments
(mm/dd/yyyy)
Course
Fine
Volts
Amps
"As Found"
"As Left"
Note: If rectifier output settings are modified, a corrosion expert must be consulted first and approve the modifications by signing Section 6.
SFN 60640 (4-2018)
Page 3 of 7
Name of Facility
Test Date
10. IMPRESSED CURRENT POSITIVE AND NEGATIVE CIRCUIT MEASUREMENTS (output amperage)
Complete if the system is designed to allow such measurements (e.g., individual lead wires for each anode are installed and shunts are present).
Circuit
1
2
3
4
5
6
7
8
9
10
Total Amps
Anode (+)
Tank/Pipe (-)
11. CP SYSTEM REPAIRS AND/OR MODIFICATION INFORMATION
Date of "Failing" Test
Date of Repair
Name of Repair Company
Name of Lead Repair Technician
Telephone Number
Certification of Repair Technician (check all that apply)
Note: submit failing test results with this report
Steel Tank Institute
NACE
Description of Repairs (check all that apply)
Repairs/modifications must be designed by a
1. Anodes for an impressed current system were added or replaced
"corrosion expert". Attach corrosion expert’s
design specifications.
2. Repair or replacement of anode header cables were needed
Retests after repairs/modifications are made
3. Continuity was not established between all protected structures
must be evaluated by the corrosion expert to
assure the system is functioning properly
4. Rectifier was repaired or replaced
(Section 6 must be signed by expert.
5. Rectifier output was modified (explain in “remarks/other” below).
Remarks/Other
12. IMPRESSED CURRENT STRUCTURE TO SOIL POTENTIAL SURVEY
Half Cell Placement (testing) on frozen soil, concrete, asphalt, or other paving materials is not acceptable.
The half cell must be placed locally in the soil directly over the structure being tested. A minimum of three half cell locations per tank, and
three half cell locations per piping run are required. The three locations must be as evenly distributed over the protected structure, and as far
away from any active anode as practical.
When testing flex connectors in contact with an electrolyte, one test point is required for each flex connector with the half cell placed
locally in the soil directly over the flex connector being tested.
Both “ON” and “Instant Off” potential readings are required at each half cell placement. Each half cell location must meet the “Instant Off”
potential of-850 mV or more negative, or the 100 mV polarization criterion must be satisfied in order to pass.
Check polarity (+/-) when taking readings and be sure to record them properly.
Describe Soil Type(s) of Local Reference Cell Placements:
Number 12 continued on next page
SFN 60640 (4-2018)
Page 4 of 7
Name of Facility
Test Date
Instant
100 mV Polarization
Half Cell
On
Structure Contact
off
Pass/
Site Map
Structure Tested
2
Reference Cell Placement
4
Voltage
3
Voltage
9
Point
Fail/Inc
Ending
Voltage
1
5
Code
(mV)
6
(mV)
Voltage
7
Change
8
(example)
(example)
(example)
(example)
(example)
(example)
(example)
1
Tank 1 (premium)
Tank bottom
Soil @ Prem STP manway
-1070 mV
-875 mV
Pass
(example)
(example)
(example)
(example)
(example)
(example)
(example)
(example)
(example)
Soil @ Diesel dispenser 7/8
-810 mV
-680 mV
-575 mV
-105 mV
2
Pipe 2 (diesel)
Dispenser 7/8
Pass
Comments:
1.
Designate numerically or by code on the site drawing each local reference electrode placement (e.g.,1, 2, 3…, T-1, T-2, P-1, P-2…etc.).
2.
Describe the structure that is being tested (e.g., plus tank; diesel piping; flex connector, etc.).
3.
Describe where the structure being tested is contacted by the test lead (e.g., plus tank bottom; diesel piping @ dispenser 7/8; etc.)
4.
Describe the exact location where the reference electrode is placed for each measurement (e.g., soil @ regular tank STP manway; soil @ dispenser 2, etc.)
5.
{Applies to all tests} Record the structure-to-soil potential (voltage) observed with the current applied (e.g., –1070 mV).
6.
{Applies to all tests} Record the structure to soil potential (voltage) observed when the current is interrupted (e.g., -680 mV).
7.
{Applies to 100 mV polarization test only} Record the voltage observed at the end of the test period (e.g., -575 mV).
8.
{Applies to 100 mV polarization test only} Subtract the final voltage from the instant off voltage (e.g., -680 mV minus -575 mV equals -105 mV).
9.
Indicate if the tested structure passed or failed one of the two acceptable criteria (-850mV Instant Off or 100 mV polarization) based on your interpretation of data.
SFN 60640 (4-2018)
Page 5 of 7
Name of Facility
Test Date
13. IMPRESSED CURRENT CONTINUITY SURVEY (POINT-TO-POINT METHOD)
This section will be utilized to conduct measurements of continuity on UST systems that are protected by cathodic protection systems.
Point-to-Point: When conducting this method, the rectifier must be turned off, and it is recommended that the negative cable be
disconnected from the rectifier. The leads of the volt meter are required to contact the two structures being examined to demonstrate
isolation or continuity. A half cell is not used for this test method.
To interpret continuity data, compare the difference in voltage of the structures evaluated and use the following guidelines: 1 mV or less =
continuous, 1-10 mV= inconclusive, greater than 10 mV = isolated.
For impressed current systems, all metallic structures intended to be protected must be continuous with each other in order to “pass”.
If other approved continuity testing methods are used, alter this form or submit the data on a separate sheet.
Isolated/
Point-to-Point
2
Continuous/
Other Structure
1
Protected Structure
Voltage Difference
3
Inconclusive
4
(example)
(example)
(example)
(example)
Tank #1 (premium) tank bottom
Soil @ Prem STP manway
8 mV
Inconclusive
(example)
(example)
(example)
(example)
Rectifier Negative Cable
Plus Steel Product Line @ STP
11 mV
Isolated
Comments:
1.
Structure “A” should always be the Rectifier negative cable after disconnecting from the rectifier
2.
Describe the “other” protected structure “B” that you are attempting to demonstrate is continuous (e.g. plus steel product line @ STP, plus tank bottom, plus tank
STP, etc).
3.
Record the voltage difference observed between structure “A” and structure “B” when conducting “point-to-point” testing (e.g. 1 mV).
4.
Document whether the test indicated the protected structure was continuous (1 -5 mV), inconclusive ( 6 - 9 mV), or isolated ( > 10 mV).
Attach additional sheets as needed.
Page of 7