61200 - Naval Station Great Lakes - Building 3402 - Great Lakes - IL - 7222021 - Final.pdf

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PWD GREAT LAKES

Harvey Pokorny

Building 3402

2021-07-22 Naval Station Great Lakes

NAVFAC MID ATLANTIC

cba

Thank you for choosing Protanic. We appreciate your business and will do our best to earn it every time. Below you will find a list of testing and/or inspections performed at the above mentioned location. Please review the following pages for results.

Mr. Pokorny, Great Lakes, IL 60088

Results of Work Performed

GREAT LAKES, IL 60088-2814

2021-07-28

Equipment Detail and Certifications

Alert Tank Tester Wis. Material Approval No. - 20170001

Technician Information

Respectfully submitted, Equipment Utilized

Comments

Customer Name and Address Site ID/Facility Name and Address Test Date

Product State ID Capacity Construction Volumetric Result GPH Score

Tank Tightness Test Results

Ullage Result

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P .

PO Box 80265 Saukville, WI 53080 www.protanic.com (262) 268-1150

Doug Metzker

20238113

60088-2814ILGREAT LAKES

C28777Veeder Root bea843a6ALERT

IL-1413Illinois

492105WI Tank Tester

9fc213c0Petro-Tite

Steel500Diesel AST

Steel350Diesel AST

Pass+0.0240 gphPassFiberglass DW2500Diesel

PWD GREAT LAKES

Harvey Pokorny

60088ILGreat Lakes

Building 3402 2021-07-22

Naval Station Great Lakes

NAVFAC MID ATLANTIC

Tank Product Tank Product

In-Tank Gauging Probe Model In-Tank Gauging Probe Model Fill Sump Sensor(s) Model Fill Sump Sensor(s) Model Tank Overfill/High-Level Sensor Model Tank Overfill/High-Level Sensor Model

Tank Product Tank Product

In-Tank Gauging Probe Model In-Tank Gauging Probe Model Fill Sump Sensor(s) Model Fill Sump Sensor(s) Model Tank Overfill/High-Level Sensor Model Tank Overfill/High-Level Sensor Model

Dispenser ID Dispenser ID

Dispenser Containment Sensor(s) Model Dispenser Containment Sensor(s) Model Dispenser Containment Float(s) Model Dispenser Containment Float(s) Model

Dispenser ID Dispenser ID

Dispenser Containment Sensor(s) Model Dispenser Containment Sensor(s) Model Dispenser Containment Float(s) Model Dispenser Containment Float(s) Model

Dispenser ID Dispenser ID

Dispenser Containment Sensor(s) Model Dispenser Containment Sensor(s) Model Dispenser Containment Float(s) Model Dispenser Containment Float(s) Model

Technician Name (Print): Technician Signature:

Facility Representative (Print): Facility Representative Signature:

Test DateCustomer Name and Address Site ID/Facility Name and Address

ATG Inspection

Certification

Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Make/Model of Monitoring System:

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P .

PO Box 80265 Saukville, WI 5308 www.protanic.com (262) 268-1150 0

Doug Metzker

Mag Plus✔

Diesel AST

Mag Plus✔

Diesel AST Mag One✔

Diesel

TLS-350

20238113

60088-2814ILGREAT LAKES

PWD GREAT LAKES

Harvey Pokorny

60088ILGreat Lakes

Building 3402 2021-07-22

Naval Station Great Lakes

NAVFAC MID ATLANTIC

Doug

Software Version Installed:

Yes No Is the audible alarm operational at the tank monitor?

Yes No Is the visual alarm operational at the tank monitor?

Yes No Were all sensors visually inspected, functionally tested, and confirmed operational?

Yes No If alarms are relayed to a remote monitoring system, is all communications equipment (e.g. modem) operational?

Yes No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product Water If yes, describe causes in comments, below.

Yes No Is all monitoring equipment operational per manufacturer's specifications?

* In Comments below, describe how and when these deficiencies were or will be corrected.

Yes No Was accuracy of system product level readings tested?

Yes No Were all probes reinstalled properly?

Yes No Were all items on the equipment manufacturer's maintenance checklist completed?

Comments

In-Tank Gauging / SIR Equipment

Does the ATG have a battery backup? If yes, is the battery backup functional? Tested and confirmed functional kyliek Typewritten Text N/A kyliek Typewritten Text N/A kyliek Typewritten Text N/A kyliek Typewritten Text N/A

PO Box 80265 Saukville, WI 5308 www.protanic.com (262) 268-1150

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P

Customer Name and Address

Facility ID Facility Name and Address

Test Date

Sensor Inspection/Certification

Was as system setup printed?

Sensor Location Type

Sensor in proper position when

ARRIVED?

Sensor in Alarm when

ARRIVED?

Functionality Test Result (Pass/Fail)

Sensor in proper position when LEFT site?

Sensor in Alarm when LEFT site?

Water present below sensor?

Is the sensor programmed for positive shutdown?

Did sensor shut down sub motor?

Comments

Technician Signature:

Yes

No

NoNoYesPassNoYesBrineDiesel Interstitial

NoNoYesPassNoYesTri-StateDiesel STP

20238113

60088-2814ILGREAT LAKES

PWD GREAT LAKES

Harvey Pokorny

60088ILGreat Lakes Building 3402

2021-07-22Naval Station Great Lakes

NAVFAC MID ATLANTIC

http://www.protanic.com/

Facility #: __________________

Facility Address: ____________________________________________________________

Annual Walkthrough Inspection Report: 20___ (year)

A/B Operator Signature (if applicable): _______________________________________________

Print Name of A/B Operator (if applicable): ____________________________________________

Inspections Required Annually (Inspections of piping sump areas must be performed by a certified employee of a contractor licensed in either the Install/Retrofit or Tank Tightness Testing modules.) All piping sumps areas shall be checked annually. Sump lids must be lifted and dispenser cabinets opened to inspect piping containment sump areas.

Contractor must initial and enter date of Annual Walkthrough Inspection.

Day/Month/Year of Inspection

Contractor Initials

Enter comments below corresponding to inspections listed at left.

Visual check for damage to piping containment sump areas: Check lids, covers & containment for damage & leaks.

COMMENTS & ACTIONS TAKEN:

Check sumps for the presence of regulated substances or any indication that a release may have occurred. Remove any liquid or debris if present.

COMMENTS & ACTIONS TAKEN:

Check that interstices of double wall containment sumps are free of water or product.

COMMENTS & ACTIONS TAKEN:

If applicable: Check gauge stick (manual tank gauging) or bailer (GW monitoring).

COMMENTS & ACTIONS TAKEN:

Contractor Employee Conducting Annual Inspection of Piping Containment Sump Areas:

1) Signature: _____________________________________

2) Print Name & Title: _____________________________________

Annual Test & Inspection: May be Performed by Contractor or A/B Operator Contractor or A/B Operator must initial and enter date of Annual Emergency Stops Test.

Day/Month/Year of Emergency Stop Test

Contractor or A/B Operator Initials

Enter comments below regarding Annual Emergency Stops Test. Attach OSFM Operational Testing of Emergency Stops Report to Walkthrough Inspection Report & keep at facility.

Test Emergency Stops for interconnection and STP shutdown.

Attach OSFM report form.

COMMENTS:

Contractor or A/B Operator must initial and enter date of Annual Shear Valve Inspection.

Day/Month/Year of Shear Valve Inspection

Contractor or A/B Operator Initials

Enter comments below regarding Annual Shear Valve Inspection. Attach OSFM Annual Inspection of Shear Valves Report to Walkthrough Inspection Report & keep at facility.

Check shear valves for proper height, secure mounting & free operation of trip arm & poppet.

COMMENTS:

Protanic Inc

DM07/23/2021

DM07/23/2021

DM07/23/2021

DM

07/23/2021

Doug Metzker

Doug Metzker

20238113

Great LakesBuilding 3402