Annual Spill Bucket Integrity Test Mobile App

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  This for is used to document annual testing of shear valves, UST Spill Buckets, UST Overfill Devi...

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  All testing is done by MDEQ state certified employees of PES&R IAW MDEQ regulation.

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  All testing within this document is required by MDEQ regulations to be conducted every 12 months ...

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  Date of Inspection

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  Facility Name

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  MDEQ Facility ID#

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  Facility Physical Address To Include City, State, County

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  GPS

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  UST Owner

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  Facility Employee Verification (Name)

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  Facility Employee Sigature

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  Tester's Name

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  Tester's Signature

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  Date

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  MDEQ Certification #

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  Cert Expiration Date

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  Select Test

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  Result

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  Tester Comments

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  Phot

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  Reason For Test

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  Type of Test

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  MDEQ Hydrostatic Test Procedures

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  Clean out and properly dispose of all debris, soil and/or fluids from the spill bucket.

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  Visually examine and ensure there are no cracks, holes, or broken seals & fill cap seals properly.

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  Fill with water to within 1 1/2 inches of top & let stand 15 mins to allow water to reach ambien...

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  4. After 15 mins, carefully measure the water level to the nearest 1/6th inch

• ...and More!