Attachment_B_ATG_Testing_Report_Form.pdf
PDF 288 KB Posted
- Attached to
- HAFE-FUEL MANAGEMENT SYSTEMS SERVICE
- Solicitation number
- 140P2125Q0140
About this file
The document is an Automatic Tank Gauge (ATG) Testing Report Form used for documenting annual functionality testing of underground storage tank monitoring systems. The form, revised on 4/3/2019, requires comprehensive documentation of tank gauge performance, including details such as ATG manufacturer, model, alarm triggers, battery backup functionality, and probe testing results. The form mandates that a WVDEP (West Virginia Department of Environmental Protection) certified worker must be present during testing, and any loss of pressure/vacuum during testing is considered a failed test. The form requires recording tank identification, product stored, manufacturer details, measured product and water levels, probe condition, and overall test results, with any "No" answer in required rows indicating a probe failure that must be immediately reported and repaired.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
REV. 4/3/2019 Attachment B
ATG Testing Report Form The applicable portions of this form must be completed and provided to the facility owner/operator within 30 days of the test date, along with written test procedures, data collection logs, and printouts from test equipment (if applicable). Facility must keep this page along with page 2 as applicable on record for submittal to the WVDEP upon request. Each page must identify the facility and contain the WVDEP certified worker’s signature. WVDEP certified worker must be present on site during testing.
When pressure/vacuum testing, any loss in pressure/vacuum during the test shall be considered a failed test, regardless of the manufacturer's criteria for declaring a passed test.
A. Facility Information WVDEP FACILITY ID#:
Facility Name: Site Address:
Facility Contact: Phone: Date of Testing:
B. Testing Contractor Information
To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements.
Company: Print Name of Tester:
WVDEP
Certification #:
Tester’s Signature: Date:
Address: City: Phone number: Email address:
E. Automatic Tank Gauge Functionality Test (Required annually if present)
AUTOMATIC TANK GAUGE Pass Fail
ATG Manufacturer: ATG Model:
Detected leak will trigger an alarm? Yes No Battery Backup Functional? Yes No
ATG software properly programmed? Yes No Is the ATG equipped with CITLDS? Yes No
TEST PROCEDURE – Briefly describe procedure(s) used to test the probes (i.e. PEI/RP1200, manufacturer’s testing procedure, etc.)
Probe and Testing information
Tank # ID: ID: ID: ID: ID: ID: ID:
Product Stored
Manufacturer
Model
Measured Product Level (in.)
ATG Product Level (in.)
ATG Testing Report Form - Page 2 of 2
Facility Name: Facility ID #:
Measured Water Level (in.)
ATG Water Level (in.)
Measured product and water levels match ATG values?
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
Is the probe in a good state of repair?
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
Is the ATG console clear of alarms? Yes No Yes No Yes No Yes No Yes No Yes No Yes No
Float(s) move freely Yes No Yes No Yes No Yes No Yes No Yes No Yes No
V. TEST RESULT Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Any “No” answer in a required row indicates the probe fails. Failed probes and ATGs must be reported to WVDEP and repaired or replaced immediately.
COMMENTS:
Tester
Signature: Date:
Name:
Phone:
Contact:
File details come from the government source that posted it. Updated .