Transcription of Vapor Recovery Test Result Cover Sheet - www.tceq.texas.gov
1 texas commission ON environmental QUALITYV apor Recovery Test Result Cover Sheet (NOTICE: Submit Test results to the appropriate tceq regional office, or local program with jurisdiction, within10 working days of test completion. See reverseside for addresses.) tests of the Vapor Recovery System were conducted at the following location:Facility Name:_____ Facility ID Number: _____Facility Address: _____Facility City:_____ State: _____ Zip Code: _____Facility Phone:(_____) _____ - _____Owner Name: _____ Phone Number: (_____) _____ - _____Vapor Recovery System Installed:SystemUST or ASTType of System1 Executive Order orCertification NumberTest Purpose2 Stage IN/AN/AStage II1 Coaxial or Two-point for Stage I, Balance or Assist for Stage Test Purposes are.
2 CI=Initial Compliance, CA=Annual Compliance, CM=After Major Modification, or 5Y=Five Following tests were Conducted at the Facility:Number Test Procedure NameDate TestedName of Person(s) Conducting TestPass or FailTXP-101 Vapor Space ManifoldTXP-102 Pressure DecayTXP-103 Dynamic BackpressureTXP-104 Flow Rate DeterminationTXP-105 Liquid Removal DeviceTXP-106 V/L RatioTP CARB A/L RatioTXP-107 Healy Booted NozzleOther:_____The tester arrived on-site at _____:_____ ( AM or PM ) and departed at _____:_____ ( AM or PM ).
3 There are a total of _____ pages containing test results attached to this Cover certify that the above tests , the results of which are attached to this Cover Sheet , were conducted in accordance with the testprocedures as outlined in the Vapor Recovery Test Procedures Handbook, and that the results submitted here are true and correct tothe best of my of Test Contractor Responsible Party: _____ Date: _____/_____/_____Test Company Name:_____ Phone Number: (_____) _____ -_____TCEQ-10502 (06-05-2002) Page 1 of 2 texas commission ON environmental QUALITYList of Contacts for Stage II Vapor Recovery Testing InformationSubmit Test Notifications to the Regional Office with JurisdictionTCEQ Regional OfficeJurisdictionMailing AddressPhone and FaxNumbersRegion 4 - Dallas / FortWorthCounties: Collin,Dallas, Denton, TarrantTCEQAttn: PST/Stage II Team2301 Gravel Worth, TX 76118-6951 Phone: (817) 469-6750 Fax: (817) 795-2519 Region 6 - El PasoCounty: El PasoTCEQAttn.
4 PST/Stage II Team401 E. Franklin Ave., Ste. 560El Paso, TX 79901-1206 Phone: (915) 834-4949 Fax: (915) 834-4940 Region 10 - BeaumontCounties: Hardin,Jefferson, OrangeTCEQAttn: PST/Stage II Team3870 Eastex Fwy., Ste. 110 Beaumont, TX 77703-1892 Phone: (409) 898-3838 Fax: (409) 892-2119 Region 12 - HoustonCounties: Brazoria,Chambers, Fort Bend,Galveston, Harris,Liberty, Montgomery,WallerTCEQAttn: PST/Stage II Team5425 Polk Ave., Ste. HHouston, TX 77023-1486 Phone: (713) 767-3642 Fax: (713) 767-3646** This portion of the form is provided for informational purposes only.
5 Please do not submit this page witha Stage II Vapor Recovery Pre-Test Notification. ** tceq -10502 (06-05-2002) Page 2 of 2
