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    Formato Prueba de Estanqueidad

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    nuno.aparicio93
    This document is a form for reporting the results of a line tightness test of an underground storage tank system. It requests information about the facility, tank and piping system, tester, and test method used. Sections are included to document pre-test data, line tightness test data, and test results.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Formato Prueba de Estanqueidad

    Uploaded by

    nuno.aparicio93
    9 views2 pages
    This document is a form for reporting the results of a line tightness test of an underground storage tank system. It requests information about the facility, tank and piping system, tester, and test method used. Sections are included to document pre-test data, line tightness test data, and test results.

    Original Description:

    LINE TIGHTNESS TEST FORM

    Original Title

    Formato prueba de estanqueidad

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    © © All Rights Reserved

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    This document is a form for reporting the results of a line tightness test of an underground storage tank system. It requests information about the facility, tank and piping system, tester, and test method used. Sections are included to document pre-test data, line tightness test data, and test results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views2 pages

    Formato Prueba de Estanqueidad

    Uploaded by

    nuno.aparicio93
    This document is a form for reporting the results of a line tightness test of an underground storage tank system. It requests information about the facility, tank and piping system, tester, and test method used. Sections are included to document pre-test data, line tightness test data, and test results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Iowa Department of Natural Resources

    Underground Storage Tank Section


    502 East 9th Street
    Des Moines IA 50319-0034
    LINE TIGHTNESS TEST FORM
    UST FACILITY INFORMATION
    UST Facility Registration Number:
    UST Facility Name:
    Physical Address:
    City, County, Zip:
    UST Owner:
    Owner Phone Number: Email:

    TESTER INFORMATION
    Tester Name:
    Certification # and Expiration Date:
    Tank Manufacturer
    Tester Certified By [Mark all that apply]: Pipe Manufacturer
    Test Equipment Manufacturer
    Company Name:
    Phone Number: Email:
    Tester Signature:

    PIPING INFORMATION
    Piping Material: Steel Fiberglass Thermoplastic (flexible) Thermoset (rigid)
    Piping Configuration: Single Wall Double-Wall
    Piping Manufacturer / Model:
    Delivery Type: Pressurized Suction Safer Suction
    Piping Release Detection Method: ELLD Annual Line Tightness Testing (Pressurized)
    SIR Interstitial Monitoring Tri-Annual Line Tightness Testing (Suction)
    Other:

    LINE TIGHTNESS TEST METHOD INFORMATION


    Test Method: Max. Pipe Capacity:
    Leak Threshold: 0.05 gph 0.01 gph Other:
    Recommended Test Pressure: Min. Test Duration:

    TESTING EVENT INFORMATION


    Reason(s) for Test: Routine Annual Routine Tri-Annual Repair DNR Directed
    New Installation Suspected Release
    Date of Test: Time Arrived at UST Facility:
    Date Next Test Due:
    Method of Piping Isolation During Test: Functional Element Isolation Plug
    Ball Valve Other:

    06/2018 cmc DNR Form 542-0178


    PRE-TEST DATA
    Line # / Calculated
    Product Piping Length Operating # of Connected # of Flex Measured Pretest
    Max.
    (Example: (ft) Pressure (psi) Dispensers Connectors Bleedback (gal) Duration (min)
    L1/RUL)
    Bleedback (gal)

    LINE TIGHTNESS TEST DATA


    Line # / Pressure (psi) Volume (gallons) Line Secondary
    Product Time Tightness Containment Test
    (Example: (military) Before After Before After Net Change Test Results Results (Pass / Fail /
    L1/RUL) (Pass/Fail) N/A)

    COMMENTS Note any repairs, retests, or unusual test conditions

    If you have questions on how to fill out this form or to request a review of UST facility records, please contact the UST
    Section at 515-725-8364 or through email at cara.ingle@dnr.iowa.gov
    UST SYSTEM OWNER SHALL RETAIN A COPY OF THIS COMPLETED TEST FORM FOR ONE YEAR
    06/2018 cmc DNR Form 542-0178

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