DERR-2024-005670

Inspection Checklist
Utah DEQ
Laura Perdue
1000757
192
x Leak detector test - Annual Date
x Product line test - Annual Date
x ATG Certification - Annual Date
x Spill Bucket - Three Year Date
x Overfill - Three Year Date
x
x
x
x
x
Date Eailed:
JFS #
Facility ID #
Date of Inspection:
3/10/2022
Submitted to:
Monthly Compliance Inspections
Store Personnel Training Document
3/8/2024
Agency:
UST Testing
3/8/2024
3/8/2024
Last 12 months Inspections
Insurance declaration page & JFS listed facility
Statistical Inventory Reconciliation
Training Documents
Last 12 months SIR
Simmons third party document
Insurance
3/8/2024
Testing and Inspection Certificate
Tanknology Inc.
11000 North MoPac Expressway, Suite 500, Austin, TX 78759
800-800-4633 www.tanknology.com Page 1 of 1

Test Date 3/8/2024 Tanknology WO#NW1-2364393
Test Purpose COMPLIANCE Customer PO#

Customer Location

JACKSONS FOOD STORES
3450 COMMERCIAL COURT
MERIDIAN, ID 83642

Jackson Foods #192
1613 N. State Street
Orem, UT 84057

Attn: ANDREW MARVIN Attn:
[phone]
()

Test / Inspection Description Item Tested Date
Tested Result
Precision Line Tightness (.1 GPH) Tank 1 Line 1 RUL 3/8/2024 Pass
Precision Line Tightness (.1 GPH) Tank 2 Line 1 PREMIUM 3/8/2024 Pass

PEI RP 1200 Leak Detector See test report for details 3/8/2024 Pass

RP 1200 ATG See test report for details 3/8/2024 Pass

RP 1200 Overfill See test report for details 3/8/2024 Pass

Overfill Protection Tank 1 Overfill 1 RUL 3/8/2024 Pass
Overfill Protection Tank 2 Overfill 1 PREMIUM 3/8/2024 Pass

Tanknology Representative: David Edens Technician: David Mathie
Telephone: ()Technician Certification: (See forms)
Product Line Tightness Test Page 1 of 1
Work Order: 2364393 Date: 3/8/2024
Site Name/ID: Jackson Foods #192 / 192
Address: 1613 N. State Street
City: Orem State: UT Zip: 84057
Tank Information
Test Method
Customer Tank ID
Product Name
Delivery Type
Test Pressure (psi)
Test Start Time
Test End Time
Final Leak Rate (gph)
Test Result(P/F/I)
Test was performed per
3rd party certifications as
specified in 40 CFR parts
280 and 281
Tank # 1
Line # 1
TLD-1
1
RUL
Pressure
50
10:01
11:01
0.00
Pass
Yes
Tank # 2
Line # 1
TLD-1
2
PREMIUM
Pressure
50
10:01
11:01
0.00
Pass
Yes
Tank #
Line #

Tank #
Line #

Tank #
Line #

Tank #
Line #

Technician Comments: UT151
Technician Name:David Mathie Certification #:41442 exp:
10/20/2025
Technician Signature:

Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com
Jackson Foods #192
1613 N. State Street
Orem UT 84057
192
Tanknology, Inc.
JACKSONS FOOD STORES
3450 COMMERCIAL COURT
MERIDIAN ID 83642
208-888-6061
03/08/2024
RUL RUL
Vaporless LD-
2000
Vaporless LD-
2000
Vaporless LD-
2000FX1VLD2000LD2000
30
18
100
0
30
0
30
30
150
2
20
3
30
30
150
2
20
3
UT151
David Mathie
NW1-2364393
PREMIUM
T1:1 T1:1 T2:1
Jackson Foods #192 JACKSONS FOOD STORES
1613 N. State Street
Orem UT 84057
192
Tanknology, Inc.
3450 COMMERCIAL COURT
MERIDIAN ID 83642
208-888-6061
800-964-1250 03/08/2024
1 2
RUL PREM
VR350 VR350
20055 14975
120 92
99.25 76.25
1.5 1.5
UT151
David Mathie
Jackson Foods #192
1613 N. State Street
Orem, UT 84057
192
Tanknology, Inc.
JACKSONS FOOD STORES
208-888-6061
800-800-4633 03/08/2024
RUL
1
20055
119.375
FRANKLINE
PREM
2
14975
91.125
FRANKLINE
UT151
David Mathie
3450 COMMERCIAL COURT
MERIDIAN, ID 83642
Tank ID (product stored)
Measure Dimension "Z" Actual Depth in Tank
Upper drop tube flange to edge of upper tube
adapter. Measurements must be taken inside
the droptube.
Measure Dimension "A" Drop tube seal
surface to bottom of the tank
Enter Dimension "B" Inch Level at 95% Volume
from Tank Chart
95% Shutoff Level Offset (4.5")
Calculated Minimum Overfill Limit:
"C" = A - B - 4.5
Overfill Protection Criteria Met (95% or less
capacity of the tank) if "Z" is greater than or
equal to "C" & passed functionality inspection
of overfill device.
Tank 1 - Overfill 1 RUL
Flapper Valve PRIMARY
48.00
153.50
106.875
4.5
42.125
Pass
Tank 2 - Overfill 2
PREMIUM Flapper Valve
PRIMARY
46.25
132.25
81.75
4.5
46.00
Pass

Franklin Overfill Valve Inspection

Store Information Testing Company
Site Name:Jackson Foods #192
Address:1613 N. State Street
Orem UT 84057
Phone:
Name:TANKNOLOGY INC.
Address:11000 N.MoPac Expressway, #500
AUSTIN, TX 78759
Phone:[phone]
Comments:
Tester: David Mathie Tester Id:
Signature: Test Date: 3/8/2024
Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2364393
Site ID / Name:192 / Jackson Foods #192
Address:1613 N. State Street
City:Orem State:UT Zip:84057
W.O.# NW1-2364393
OVF
W.O.# NW1-2364393
STATUS ALARMS
W.O.# NW1-2364393
SET UP
UST Operator Inspection - Utah
YEAR _2024
FacilittyID s92

FacilityName (Cheyyron
| Primary Class B Operator Address /613_N Stole Sr Ove ta
ME(S) AND INITIALS OF PERSON(S) CONDUCTING MONTHLY INSPECTIONS:

|

NA
| Shaen Gilfnd SC
i Please respond to ALL of the following questions with a Y¥ (Yes), N(No), or NA (Not Applicable) answer.
[ Months of the Current Year| J | F [| A mi | J | J JA | s [oN |p
[ Monthly Inspection — Release Detection
| 2 Release detection equipment is operating with no alarms or other unusual ~ vir
operating conditions. ‘if
, 2, [Records of release detection (tanks and piping) are reviewed and current.
| Monthly Inspection — Spill Prevention Equipment
| 3 | Equipment is undamaged, intact and free from defects. Y ¥ Y
| 4 I Equipment is free from debris, water, or product. of Y Y ,
[5 I! Fill Pipe is-unobstructed. YI7 |e ~
| 6 | Fill cap is un-broken and is securely on the fill pipe. yy ~ Y
| 7 | Double walled spill prevention equipment - Interstitial area is free from leaks. y Y Y
| Initials of person performing Inspection. Se BC ISL
Annual Inspection — Containment Sumps Date of annual inspection
Secondary Containment Sumps Visual Inspection of sump indicates no damage and it is free from debris, water and fuel.
(STP, Dispenser and Transition) The penetration fittings for conduits and piping entering the STP Sumps are intact.
| 9 | Double Walled Sumps Interstitial area is free from leaks.
Hand-held release detection Hand-held release detection equipment (bailer, gauge stick, etc.) is serviceable and
10 . equipment operable.
I certify under penalty of law that | am the Class B Operator referenced above and that | am familiar with information on this form
and that it is true, accurate and was completed in accordance with R311-203-7.
after the last inspection of the Current Year) | Date
e of the Primary Class B Operator (Sign this document B Operator #

US
T
Op
e
r
a
t
o
r
In
s
p
e
c
t
i
o
n
-Ut
a
h

YE
A
R
29
2
3
Fa
c
i
l
i
t
y
Na
m
e
Ch
e
y
ra
)
Fa
c
i
l
i
t
y
I
D
sq
o |
Ad
d
r
e
s
s
A/
St
a
d
e
Sh
Ov
e
n
s
|P
r
i
m
a
r
y
Cl
a
s
s B
Op
e
r
a
t
o
r |
NA
M
E
(
S
)
AN
D
IN
I
T
I
A
L
S
OF
PE
R
S
O
N
(
S
)
CON
D
U
C
T
I
N
G
MO
N
T
H
L
Y
INS
P
E
C
T
I
O
N
S
:|Pl
e
a
s
e
re
s
p
o
n
d
to
AL
L of
th
e
fo
l
l
o
w
i
n
g
qu
e
s
t
i
o
n
s
wi
t
h
aY
(Y
e
s
)
,
N orNA
(N
o
t
Ap
p
l
i
c
a
b
l
e
)
an
s
w
e
r
.
Mo
n
t
h
s
of
th
e
Cu
r
r
e
n
t
Ye
a
r
|
J |F ||J |J |A |s
|o
|
N
Mo
n
t
h
l
y
In
s
p
e
c
t
i
o
n
—Re
l
e
a
s
e
De
t
e
c
t
i
o
n |
1
(R
e
l
e
a
s
e
de
t
e
c
t
i
o
n
eq
u
i
p
m
e
n
t
is
op
e
r
a
t
i
n
g
wi
t
h
noal
a
r
m
s
or
ot
h
e
r
un
u
s
u
a
l
op
e
r
a
t
i
n
g
co
n
d
i
t
i
o
n
s
.
||||||
2 |R
e
c
o
r
d
s
of
re
l
e
a
s
e
de
t
e
c
t
i
o
n
(t
a
n
k
s
an
d
pi
p
i
n
g
)
ar
e
re
v
i
e
w
e
d
an
d
cu
r
r
e
n
t
.||||||5G ||
Mo
n
t
h
l
y
In
s
p
e
c
t
i
o
n
—
Sp
i
l
l
Pr
e
v
e
n
t
i
o
n
Eq
u
i
p
m
e
n
t
3 |Eq
u
i
p
m
e
n
t
is
un
d
a
m
a
g
e
d
,
in
t
a
c
t
an
d
fr
e
e
fr
o
m
de
f
e
c
t
s
.
|||||||x ly |
4 |Eq
u
i
p
m
e
n
t
is
fr
e
e
fr
o
m
de
b
r
i
s
,
wa
t
e
r
,
or
pr
o
d
u
c
t
.
|||||%
S |Fi
l
l
Pi
p
e
is
un
o
b
s
t
r
u
c
t
e
d
.
|||||||Ke |
6 |Fi
l
l
ca
pis
un
-
b
r
o
k
e
n
an
d
is
se
c
u
r
e
l
y
onth
e
fi
l
l
pi
p
e
.
|||||||Ku
.
te ly |
7 |Do
u
b
l
e
wa
l
l
e
d
sp
i
l
l
pr
e
v
e
n
t
i
o
n
eq
u
i
p
m
e
n
t
-In
t
e
r
s
t
i
t
i
a
l
ar
e
ais
fr
e
e
fr
o
m
le
a
k
s
.||||K v ly |
In
i
t
i
a
l
s
of
pe
r
s
o
n
pe
r
f
o
r
m
i
n
g
in
s
p
e
c
t
i
o
n
.
|||||||ly ly |
An
n
u
a
l
in
s
p
e
c
t
i
o
n —Co
n
t
a
i
n
m
e
n
t
Su
m
p
s
Da
t
e of
an
n
u
a
l
In
s
p
e
c
t
i
o
n
Se
c
o
n
d
a
r
y
Co
n
t
a
i
n
m
e
n
t
Su
m
p
s
Vi
s
u
a
l
in
s
p
e
c
t
i
o
n
of
su
m
p
in
d
i
c
a
t
e
s
no
da
m
a
g
e
an
d
it is
fr
e
e
fr
o
m
de
b
r
i
s
,
wa
t
e
r
an
d
fu
e
l
.
(S
T
P
,
Di
s
p
e
n
s
e
r
an
d
Tr
a
n
s
i
t
i
o
n
)
Th
e
pe
n
e
t
r
a
t
i
o
n
fi
t
t
i
n
g
s
fo
r
co
n
d
u
i
t
s
an
d
pi
p
i
n
g
en
t
e
r
i
n
g
th
e
ST
P
Su
m
p
s
ar
e
in
t
a
c
t
.
9 |Do
u
b
l
e
Wa
l
l
e
d
Su
m
p
s
In
t
e
r
s
t
i
t
i
a
l
ar
e
ais
fr
e
e
fr
o
m
le
a
k
s
.
|
1
Ha
n
d
-
h
e
l
d
re
l
e
a
s
e
de
t
e
c
t
i
o
n ||o
Ha
n
d
-
h
e
l
d
re
l
e
a
s
e
de
t
e
c
t
i
o
n
eq
u
i
p
m
e
n
t
(b
a
i
l
e
r
,
ga
u
g
e
st
i
c
k
,
et
c
.
)
is
se
r
v
i
c
e
a
b
l
e
an
d
eq
u
i
p
m
e
n
t
op
e
r
a
b
l
e
.
Ice
r
t
i
f
y
un
d
e
r
pe
n
a
l
t
y
of
la
w
th
a
t |amth
e
Cl
a
s
s B
Op
e
r
a
t
o
r
re
f
e
r
e
n
c
e
d
ab
o
v
e
an
d
th
a
t |am
fa
m
i
l
i
a
r
an
d
th
a
t
it is
tr
u
e
,
ac
c
u
r
a
t
e
an
d
wa
s
co
m
p
l
e
t
e
d
in
ac
c
o
r
d
a
n
c
e
wi
t
h
R3
1
1
-
2
0
3
-
7
.
Si
g
n
a
t
u
r
e
of
th
e
Pr
i
m
a
r
y
Cl
a
s
s
Se
oo
t
!
Go
m
m
e
n
t
s
/
F
o
l
l
o
w
u
(1
0
°
19
.

wi
t
h
in
f
o
r
m
a
t
i
o
n
onth
i
s
fo
r
m
B
Op
e
r
a
t
o
r
(S
i
g
n
th
i
s
do
c
u
m
e
n
t
af
t
e
r
th
e
la
s
t
In
s
p
e
c
t
i
o
n
of
th
e
Cu
r
r
e
n
t
Ye
a
r
)
Da
t
e
B
Op
e
r
a
t
o
r
#21
9
7

Results of the U.S. EPA Standard Evaluation
Statistical Inventory Reconciliation
This form tells whether the statistical inventory reconciliation (SIR) method described below complies
With requirements of the federal underground storage tank regulation. The evaluation was conducted
by the vendor of the . SIR method or a consultant to the vendor according to the U.S. EPA's "Standard
Test Procedure for Evaluating Leak . Detection MethLis: Statistical Inventory Reconciliation Methods:"
The full evaluation report also included a form describing the method and a form summarizing the test
data.
Tanks owners using this leak detection method should keep this form on file to prove compliance with
the federal regulations. Tank owners should check with State and local agencies to make sure this
form satisfies their requirements.
Method Description
Name: SIR 5.7
Version: 5.7.L.M
Vendor: The Simmons Corporation
T06 East Main Street
(address)
Richardson Texas 75081
(city) (state) (zip code)
MINIWINIONIPIOWP*
Evaluation Results
[phone]
(phone)
1111n111•114

If applicable, vendor's threshold= gallons per hour
Or vendor's criterion. Statisticallysignificant continuous loss at the 1% level .
This statistical inventory reconciliation method reports results on the following basis:
(check one)
( X ) quantitative results (leak rate reported)
( ) qualitative results (pass, fail, inconclusive)
The test results are:
Reported Results

Tight Leak Inconclusive Total Not
Anal zed

Analyzed
17 0 0 17 0
0 24 0 24
17 24 0 41
Tight
Actual induced
Leak
Total
Method: SIR 5,7
Version: 5.7.1_,M
Evaluation Results
The proportions of inventory records reported inconclusive are:
0 % among tight tanks
0 % among leaking tanks
0 % among all tanks
The probability of false alarms, P(FA), based on the vendor's threshold, is 1 %.
For qualitative methods, a 95% confidence interval for P(FA) is from
NA to NA %.
The probability of detection, P(D), is 99 %. This is valid for a leak rate of: (check one)
( X ) 0.10 gallon per hour
( ) 0.20 gallon per hour
For qualitative methods, a 95% confidence interval for P(D) is from
NA to NA %,
Based on these results, the method ( X ) does ( ) does not meet the federal performance standards
established by the t,),$: Environmental Protection Agency of 0.10 gallon per hour [or 0.2 gallon per
hour] at P(D) of 95% and P(FA) of 5%.
Test Conditions during Evaluation
The data evaluation set included data from tanks of the following sizes:
*Tank Size (gallons) <5,000 5,000-10,000 10,000-15,000 >15,000 Total # of Records
Number of Records 0 0 0 41 41
The tanks had various monthly throughputs.
Percentile of Records 25 50
(median)
75
Monthly throughput allons 33,312 55,791 77,028
The data included: 21 records during hot weather months.
7 records during mild weather months.
13 records during cold weather months.
* Size of tank system
Method: SIR 5,7
Version: 5.7.L.M
Limitations on the Results
The performance estimates above are only valid when:
•The method has not been substantially changed,
•The vendor's instructions for using the method are followed.
•The tank is no larger than 60,000 gallons.
•The data records cover 27 days or more.
•"The method is based on a single (non-manifolded) tank.
•Other limitations specified by the vendor or determined during testing:
**SIR 5.7 has been tested on manifolded tank systems of two, three , and four tanks.
The performance on these rnanifolded systems exceeded the federal performance
standards.
> Safety disclaimer: This test procedure only addresses the issue of the method's
ability to detect leaks. It does not test data recording equipment
for safety hazards.
4=11111n
Certification of Results
I certify that the statistical inventory reconciliation method was applied according to the vendor's
instructions. I also certify that the evaluation was performed according to the standard EPA test
procedure for statistical inventory reconciliation and that the resultS presented above are those
obtained during the evaluation.
.Sam S. Gordji, Ph. D
(printed name)

SSC Associates
(organization performing evaluation)

Oxford, MS 38677
(signatu (city, state, zip)
September 3, 2001
(date)

[phone]
(phone number)

MERIDIAN
OREM
0192 - PWI 860
STATISTICAL INVENTORY RECONCILIATION (SIR) REPORT
SIR Provider Phone:
SIR Version Date of SIR Report:Period Covered What is the required number of usable inventory days per tank? 30Facility Name Cust Site ID:Simmons Site ID:
Tank Location Address:Phone:City:State:Zip:Fax:Tank Owner Address:Phone:City:State:Zip:Fax:
Name:
Tank Operator Name:
Simmons Richardson TX [phone]
SIR 5.7 - Version 5.7.L.M 03/22/2402/11/24 - 03/11/24 0192 NALDAOI
1613 N. STATE STREET [phone]UT84057Jackson's Food Stores3450 E. COMMERCIAL COURT ID 83642 [phone](208)888-3585Jackson's Food Stores
Simmons Tank Number Customer Tank Number Tank Contents Tank Capacity0192001UNLEADED19946NALDAOI1(gallons)
MONTHLY
Listing LeakThreshold MinimumDetectableLeak Rate CalculatedLeak Rate Pass, Fail,Inconclusive
gph gph gph P F I
ComplianceMonth/Year
gph
Data SetCalculatedLeakThreshold
0.10 0.18 0.08 *Apr 2023 0.0900.10 0.17 0.07 *May 2023 0.0850.10 0.18 0.08 *Jun 2023 0.0900.10 0.11 -0.04 *Jul 2023 0.0550.10 0.17 0.07 *Aug 2023 0.0850.10 0.19 0.08 *Sep 2023 0.0950.10 0.18 0.08 *Oct 2023 0.0900.10 0.19 0.08 *Nov 2023 0.0950.10 0.18 0.08 *Dec 2023 0.0900.10 0.19 0.08 *Jan 2024 0.0950.10 0.14 0.06 *Feb 2024 0.0700.10 0.14 0.06 *Mar 2024 0.070NOTE:N/A indicates No Analysis PerformedGindicates Gaining trend Negative Calculated Leak Rates Indicate Gainmindicates Manifolded tank
1. The tank owner is required to have a SIR report for each month.2. Monthly reports must be submitted to the local agency upon request.3. The tank owner is required to have the report by the 10th day of the following month.4. If for any reason, the test is neither "pass" nor "fail", the "inconclusive" column will be marked.5. The local agency may need to be notified of the tank that does not pass the SIR test within 24 hours of receipt of the report and the SIR report should be submitted to the local agency within 10 days of the report.6. Quantitative and Qualitative Methods: a. A leak threshold, minimum detectable leak rate, and calculated leak rate must be provided for each tank. If not, then the tank failed the SIR test. b. If the absolute value of the calculated leak rate for the tank is greater than or equal to the leak threshold and the minimum detectable leak rate is less than the certified performance standard, OR the absolute value of the calculated leak rate is greater than or equal to the minimum detectable leak rate and the minimum detectable leak rate is greater than the certified performance standard, the tank failed the SIR test. c. If the minimum detectable leak rate for the tank is greater than the certified performance standard (i.e., 0.1 or 0.2 gph) and the absolute value of the
d. Two consecutive failures and/or inconclusives may require a tank and/or piping integrity test within 15 days from the date of the second report. The local agency should be contacted.7. A conclusive result of "pass" or "fail" is required to meet monthly leak detection requirements.
Simmons Technician Date of SIR Report:Customer Service 03/22/24Person Conducting EvaluationFor Information Call
calculated leak rate is less than the minimum detectable leak rate, the test is inconclusive for that month.
MERIDIAN
OREM
0192 - PWI 860
STATISTICAL INVENTORY RECONCILIATION (SIR) REPORT
SIR Provider Phone:
SIR Version Date of SIR Report:Period Covered What is the required number of usable inventory days per tank? 30Facility Name Cust Site ID:Simmons Site ID:
Tank Location Address:Phone:City:State:Zip:Fax:Tank Owner Address:Phone:City:State:Zip:Fax:
Name:
Tank Operator Name:
Simmons Richardson TX [phone]
SIR 5.7 - Version 5.7.L.M 03/22/2402/11/24 - 03/11/24 0192 NALDAOI
1613 N. STATE STREET [phone]UT84057Jackson's Food Stores3450 E. COMMERCIAL COURT ID 83642 [phone](208)888-3585Jackson's Food Stores
Simmons Tank Number Customer Tank Number Tank Contents Tank Capacity0192002Premium14539NALDAOI2(gallons)
MONTHLY
Listing LeakThreshold MinimumDetectableLeak Rate CalculatedLeak Rate Pass, Fail,Inconclusive
gph gph gph P F I
ComplianceMonth/Year
gph
Data SetCalculatedLeakThreshold
0.10 0.17 0.07 *Apr 2023 0.0850.10 0.14 -0.06 *May 2023 0.0700.10 0.17 0.07 *Jun 2023 0.0850.10 0.17 -0.07 *Jul 2023 0.0850.10 0.18 0.08 *Aug 2023 0.0900.10 0.18 0.08 *Sep 2023 0.0900.10 0.18 0.08 *Oct 2023 0.0900.10 0.19 0.08 *Nov 2023 0.0950.10 0.04 -0.01 *Dec 2023 0.0200.10 0.18 0.08 *Jan 2024 0.0900.10 0.19 0.05 *Feb 2024 0.0950.10 0.17 0.07 *Mar 2024 0.085NOTE:N/A indicates No Analysis PerformedGindicates Gaining trend Negative Calculated Leak Rates Indicate Gainmindicates Manifolded tank
1. The tank owner is required to have a SIR report for each month.2. Monthly reports must be submitted to the local agency upon request.3. The tank owner is required to have the report by the 10th day of the following month.4. If for any reason, the test is neither "pass" nor "fail", the "inconclusive" column will be marked.5. The local agency may need to be notified of the tank that does not pass the SIR test within 24 hours of receipt of the report and the SIR report should be submitted to the local agency within 10 days of the report.6. Quantitative and Qualitative Methods: a. A leak threshold, minimum detectable leak rate, and calculated leak rate must be provided for each tank. If not, then the tank failed the SIR test. b. If the absolute value of the calculated leak rate for the tank is greater than or equal to the leak threshold and the minimum detectable leak rate is less than the certified performance standard, OR the absolute value of the calculated leak rate is greater than or equal to the minimum detectable leak rate and the minimum detectable leak rate is greater than the certified performance standard, the tank failed the SIR test. c. If the minimum detectable leak rate for the tank is greater than the certified performance standard (i.e., 0.1 or 0.2 gph) and the absolute value of the
d. Two consecutive failures and/or inconclusives may require a tank and/or piping integrity test within 15 days from the date of the second report. The local agency should be contacted.7. A conclusive result of "pass" or "fail" is required to meet monthly leak detection requirements.
Simmons Technician Date of SIR Report:Customer Service 03/22/24Person Conducting EvaluationFor Information Call
calculated leak rate is less than the minimum detectable leak rate, the test is inconclusive for that month.
Employee #First Name Last Name Job Assignment Hire Date
46009 Brian Moffett Assistant Manager 1/15/2020
70789 Jeffrey Howes Customer Service Rep 6/27/2022
71206 Kaylee Jensen Customer Service Rep 7/28/2022
72850 Laurie Adams Customer Service Rep 12/14/2022
73398 Brian Pier Customer Service Rep 2/15/2023
74410 Carl Eric Lindenlaub Customer Service Rep 5/26/2023
74833 Kaylyn Wilson Customer Service Rep 6/29/2023
74849 Daniel Van Vorous Customer Service Rep 7/1/2023
76716 Derek Brown Customer Service Rep 1/23/2024
28758 Doug White Store Manager 11/10/2015
28758 Doug White Store Manager 11/10/2015
3/27/2024 12:07 AM | 72497 | Confidential | Copyright © 2024 by Ceridian HCM, Inc. All rights reserved.1 - 3
Region District Location Status State
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
Region 3 - Utah, Nevada, Eastern Idaho District 28 192 Active UT
3/27/2024 12:07 AM | 72497 | Confidential | Copyright © 2024 by Ceridian HCM, Inc. All rights reserved.2 - 3
Course Enrollment Status Enrollment Date Completion Date
z_Safety and Fuel - Class C - ended 02222024 Completed 3/2/2020
z_Safety and Fuel - Class C - ended 02222024 Completed 7/13/2022
z_Safety and Fuel - Class C - ended 02222024 Completed 8/10/2022
JFS - Class C Fuel Center Operator Training Completed 12/14/2022 12/15/2022
JFS - Class C Fuel Center Operator Training Completed 2/15/2023 2/23/2023
JFS - Class C Fuel Center Operator Training Completed 5/26/2023 5/29/2023
JFS - Class C Fuel Center Operator Training Completed 6/29/2023 6/29/2023
JFS - Class C Fuel Center Operator Training Completed 6/30/2023 7/3/2023
JFS - Class C Fuel Center Operator Training Completed 1/23/2024 1/25/2024
z_Safety and Fuel - Class C - ended 02222024 Completed 1/28/2016
JFS - Class C Fuel Center Operator Training Completed 5/1/2023 5/23/2023
3/27/2024 12:07 AM | 72497 | Confidential | Copyright © 2024 by Ceridian HCM, Inc. All rights reserved.3 - 3