DERR-2024-010596

Wheeler Tank Testing Inc.

Cathodic Protection Test Report
 All cathodically protected underground storage tank (UST) system components (including buried metal flex
connectors) must be tested.
 Access to the soil must be provided.
 A site drawing depicting the UST cathodic protection system and all reference electrode placements must be
completed.
UST FACILITY UST OWNER
Name: ID #: Name:
Address: Address:
City: State: City:
Phone #: Phone #:
CATHODIC PROTECTION TESTER
Tester’s Name: Certification Type (if any):
Company Name: Cert. #: Expiration Date:
Address: Phone Number:
City: State: Email:
REASON SURVEY WAS CONDUCTED
3-year test 6 months after install (date installed / / ) Re-survey after repair/modification

SYSTEM TYPE
Impressed Current sti-P3 Galvanic (sacrificial anodes) Galvanic (sacrificial anodes)
CATHODIC PROTECTION TEST EVALUATION (INCLUDING CONTINUITY) AND CERTIFICATION
Pass All protected structures at this facility pass the cathodic protection survey, and it is judged that adequate
cathodic protection has been provided to the UST system.
Fail
One or more protected structures at this facility fail the cathodic protection survey, and it is judged that
adequate cathodic protection has not been provided to the UST system. Repair and retest.

Test standard used: (e.g., NACE, STI, etc.)

_________________________________________ ______________________________
Signature of Tester Date
IMPRESSED CURRENT RECTIFIER DATA
Rectifier Manufacturer: Rated DC Output: Volts Amps
Rectifier Model: Rectifier Serial Number:
Date Tap Settings DC Output Hour
Meter
Comments
Coarse Fine Volts Amps
“As Found”
“As Left”

UST FACILITY SITE DRAWING
In the space below, sketch the important parts of the facility (tanks, tank manway locations, vents, pump islands, buildings).
Indicate reference cell locations using the letter “R” and sequential numbers (e.g., R1, R2, R3, etc.), and structure contact
points using the letter “S” and sequential numbers (e.g., S1, S2, S3, etc). Briefly describe the location of the code letters and
numbers on the following page (e.g., S1 = structure monitoring wire, R1 = landscape). Use these letter and number
designations in the tables on the following pages to indicate reference cell locations and structure contact locations used for
each measurement. These designations can also be used to identify the 30-foot remote reading on sti-P3 systems.

STRUCTURE CONTACT LOCATIONS
 Explain where each point is located and indicate it on the map above.
S1 S11
S2 S12
S3 S13
S4 S14
S5 S15
S6 S16
S7 S17
S8 S18
S9 S19
S10 S20
REFERENCE CELL LOCATIONS
 Explain where each point is located and indicate it on the map above.
R1 R11
R2 R12
R3 R13
R4 R14
R5 R15
R6 R16
R7 R17
R8 R18
R9 R19
R10 R20

CATHODIC PROTECTION SYSTEM SURVEY RESULTS
 For galvanic systems, the off potential column and the 100 mV depolarization columns will not be filled in.
Tank/Line # Ref Cell Location

ON Potential
(mV)
OFF Potential
(mV)

100 mV Depolarization
Ending
Voltage
Voltage Change
TANKS
Tank #1

Tank #2

Tank #3

Tank #4

Tank #5

Tank #6

Tank #7

LINES
Line #1
Line #2
Line #3
Line #4
Line #5
Line #6
Line #7

CATHODIC PROTECTION SYSTEM CONTINUITY SURVEY
 When conducting a fixed cell-moving ground survey, the reference electrode must be placed in the soil at a remote
location and left undisturbed.
 Conduct point-to-point test between any two structures for which the fixed cell-moving ground survey is inconclusive or
indicates possible isolation (impressed current) or continuity (sti-P3).
 The protected structure must be continuous (impressed current) or isolated (sti-P3) with all other protected structures in
order to pass.
Structure ‘A’1

Structure ‘B’2

‘A’ Fixed 3
Remote
Instant Off mV
‘B’ Fixed 4
Remote Instant
Off mV
Voltage5
Difference

Isolated/6
Continuous/
Inconclusive

1 Describe the protected structure that you are attempting to demonstrate is continuous.
2 Describe the other protected structure that you are attempting to demonstrate is continuous.
3 Record the fixed remote instant off structure-to-soil potential of the protected structure in millivolts (mV).
4 Record the fixed remote instant off structure-to-soil potential of the other protected structure in mV.
5 Record the voltage difference between structure ‘A’ and ‘B’ when conducting point-to-point testing.
6 Document whether the test (fixed cell and/or point-to-point) indicated the structure was isolated, continuous, or
inconclusive.
REPAIRS OR MODIFICATIONS
Additional anodes for an impressed current system were added (attach corrosion expert’s design).
Additional anodes for a galvanic system were added (attach corrosion expert’s design).
Rectifier repaired or replaced (explain below).
Anode header cables repaired and/or replaced (explain below).
Other (explain below).
Comments: