DERR-2024-004457

Recommended Pract ices for the Testing and Verification of Spill, Overfil l, Leak Detection and Secondary Containment Equ ipment at UST Faci lities
APPENDIX C-4
Facility Name: wtl,
Address: bbO S
City, Sta t e, Zip Code:
Facility I.D . #: Ph one#:
Testing Company: Ph one#:
Th is procedure is t o test the leak i ntegrity of contai nment s u mps. See PEI/RP1200 Section 6.5 for the test method.
Containment Sump ID z. srp -4'-lm
Containment Sump F"l\f ~p Material
Liquid and debris xves □No ~es □No .)Yves □No Myes □ No □Yes □No □Yes □No removed from sump?*
Vis ual Inspection (No
cracks, loose pa rts ~ss □Fail ~ss □Fail ~s □Fail ~ss □Fail □ Pass □ Fa il □ Pass □ Fail or separation of the
containment sump.)
Containment Sump )b 'l ~6''-:3 (, "-3£'' Depth
Height From Bottom t o
Top of Highest I i It ('2. h /2 '' I 2 '' Penetration
Starting Water Level 'Z O ' " 2,0 '' ·UJ 7/J'' z,o 1/z"
Test Start Time o/j:a<J .,._. ~•~ %:*o~ ]>>cJ~
Ending Water Level ,Z,OJ-z I\ '2.,0 ~\. £ci 71>)1 l-0 Yz"
Test En d Ti me q:eio <>--q~ CC.co~ C(.CIOIIMA
Test Perio d (M in imu m 1~ I ~v--1 l,v-I ~v--test time: 1 hour)
Water Level Change -e--er ~ e--
Pass/fail criteria: Must pass visual inspection. Wate r level d rop of less than 1/8 inch.
Test Results Pass □ Fail Pass □ Fail ass □Fail □ Pass □ Fail □ Pass □ Fail
Comments:
*All liquids a nd debris mus~ispos ed of propky.
Test er's Name (print) LdV\J\ L.., ( ..f ~ester 's Signature ------,,-,..---v--~-----
____________________________________________ _, ei.org -•·----i
Recommended~Pract1ces tor the l est 1ng and Verification of Spilr,Dvert11i, Leak Detection and Secondary Conta inment tquIpment at OS I Facli1t1es
Address: 660 S"
City, State, Zip Code :
Facility I.D. #: Phone#:
Testing Company: Phone#:
This procedure is to test the leak integrity of cont a inment sumps. See PEI/RP1200 Section 6.5 for the test method.
Containment Sump ID C,
t/-10 I 1-J i -'Z
Containment Sump fj/y Material
Liquid a nd debris
;(!Yes □No Je'Yes □ No ~es □No ~Yes □No Q-¥es □ No ~Yes □No removed from sump?*
Visual Inspection {No
cracl<s, loose parts JtPass □ Fa il Pass □ Fail ~ass □Fail Pass □ Fail Pass □ Fail (rass □ Fail or separation of the
containment sump.)
Containment Sump 74' f7'l /7' I. 'T' I 7 &L '17 ,, Depth
Height From Bottom to /'l\ g ,, ? ,, s '1 Top of Highest <t /1 ?'' Penetration
Starting Water Level ')'' 13" /J ~ 1"3 ., 13"
Test Start Time g;«:) 3:-ooW\,--~,bO~ 9.!CJbAAn
End ing Water Level J "" /')1-L 1 '] I\. 1, "' 1 'J '\ JJ ,,
Test End Ti me q;ooo--Ci/.:eo ~ q.,"Ct)~ C/1:-0a,"-,
Test Period (Minimum
I~{' lt{'-'v1 test time: 1 hour)
Water Level Change -(:;f---e--e--e-
Pass/fail criteria: Must pass visua l inspection. Water l eve l drop of less than 1/8 inch.
Test Results Pass D Fail _!;{Pass D Fail ~ass D Fail Pass □ Fail ~ass □ Fail ~ Pass □ Fail
Comments:
*All liqu ids and debris mu~posep f pro~rly.
Tester's Name (prin t) e_t,; ~~\$}WMV)
Acldress: 660 s 7SO ~ Address: --Z/o ; SE 9:vvvfle_ S~r·vt)_L_Q ""lv
City, State, Zip Code : S~'~tr~ vlflc Vv}-rrVt6 City, State, Zip Code:~.Af11olflV(, j c; /h ~
Facility I.D. #: /Oooqq Ii • Pl1one #:
Testing Company: Phone#:
This procedure is to test the leak integrity of containment sumps. See PEI/RP1200 Section 6 .5 for the test method.
Conta inment Sump ID
Containment Sump
Material
Liquid a nd debris
removed from sump?* ~Yes □No □Yes □No □Yes □ No □Yes □No □Yes □No
Visual Inspection (No
cracks, loose parts
or separat ion of the
containment sump.)
~ Pass □ Fail r!j_Pass □ Fai l □ Pass □ Fail □ Pass □ Fail □ Pass □ Fail □ Pass □ Fail
Containment Sump
Depth
Height From Bottom to
Top of Highest
Penetration
Starting \/\later Level
Test Start Time
End ing Water Level
Test End Time
Test Period (M in imum
test time: 1 hour)
Water Level Change
7 ,,
~'\
1 '
f:c:o~
I \\ ,:~
l ~"'
-f)-
/7 II
!''
( 1 '\
i:oewv.
I ) I\
Cf .cOMIV'
I "'-:-
-0-
Pass/fail criteria: Must pass visual inspection. Wate r level drop of less tl1an 1/8 inch.
Test Results ;f Pass □ Fai l Pass □ Fail □ Pass □ Fa il □ Pass □ Fail □ Pass □ Fa il □ Pass □ Fail
Comments:
·"All liquids and debris m~e dispos,i-c prope~
Tester's Name (print) ~ e_ C .[ \~ )tVJ
ei.org ~
01/22/24 10 ·10 ~
885360
Walmart ff320B
660 south 1750 West
Springville UT 84663
Active Alarm Jlepor t
ID --
LADEL -
DLSCRIPTION C
A(l l V ~ C
CLEAR :a
ID --LABEL --DESCRlPrlON --ACTIVE =
CLEAR --
Ae 4
s ·rup 1
1 1 A WJ\J{N 1 NG
01 I "}/24 3:38P
01/\~/24 3 :3~P
Ae 3
SElLIP 0.1,l A WARNING
011·,~,,24 3~36P
01/1tl/24 3:36P
•
•
01/22/24 10 :19 AM
88S360
Walmart #3208
660 South 1750 West
Springville UT 84663
I -----------•• -• • -. • ... --------. -----. -------------------'
•• • TANK SETUP .. GEN l ~L ~., l:TUP ••• ----------------------------------· --•• ·----------------
CONFIGURED:
LABEL :
PRooucr CODE:
PROBE NUMBER :
PROBE OFF SET:
FULL VOLUM E:
DIAMETER :
TILT:
THERMAL COEFFICIENT :
METER DATA PRESENT:
DELIVERY DELAY:
GROSS TEST FAIL :
PERIODIC TEST FAIL :
-.. -TANK , '1 II ...
l:I~~, Lt;1·:•
T t • L 1l l !t1 de d
1
Ph 1 : lJn .. d. Tk il1 Prob e
0 , 00 ,\ !'iC(·I ES
1 ~ ... ,8 :! GAL LON S
11l .4-lN (HES
0 .. 0l) NCHES
t1.o"u ~ Jo
~N.\a Lt L1
S ~A l t~t, I' ES
ANNUAL TEST FAIL:
GOST VOLUME CORRECTION :
Al.A~M !i DISABLED
A-1-\R~~ DISABL ED
AL~.RMS DISABLED
O)'SI\Bl ~ 0
CONFIGURED:
LABEL:
PRODUCT CODE :
PROBE NUMBER:
PROBE OFFSET :
I I
---TANK --..
:NAltL EO
r2 •· lJ.~ l 1¼,q ded
2; Un, ld. Tk h .,...
..
..
• o,1 22124 10:20 AM
885360
Walmart #3208
660 South 11s0 West
Spti~gville Ui 846G
3
\
••• TANI( SETUP -L UU .,.,i •••
MAX VOLUME:
HIGH PRODUCT:
DELIV~RY OVERFILL:
DELIVERY LIMIT:
LOW PRODUCT:
HIGH WATER WARNlNG:
HIGH WATER ALARM:
WATER ALARM ~ILTER LEVEL : LEAK ALARM LIMIT :
SUDDEN LOSS LIMIT:
FUEL LOW TEMP LIMIT :
FUEL HIGH TEMP LIMIT:
---
MAX VOLUME:
HIGH PRODUCl:
DEL I VERY OVERFILL:
DEL I VERY LIMIT:
LOW PRODUCT:
HIGH W.&Ta;o l..••"~• .. ··-
TANK 1 .......
1 ,'98:? ~,ALLONS
9 !j%
90%
o ~~
53 1~ GA-.l LONS
, . ho rt.icHE s
3 .. bo l Nt:Hes
L 0 ..-
1 !. G,\l t. ONS
SQ GAL\.DNS
... 5 1\. OCU OEG F
14Ci . OOt, DEG F
TANK 2 · \_
1 ·1~-l \'2 (~AL LONS
9!,i
9,·,.,i \
,~%
S~l~ ,;Al I ntJ("
•
01122124 2:00 PM
885360
Walmart #3208
660 south 1750 West
Springville UT 84663
CURRENT INVENTORY REPORT
TANK 1: Tl -Unleaded
VOLUME • 10954 CiA L~
FUEL TC '" 11000 CiAl . '.i
100% ULLAGE a 7028 GAL S
90t ULLAGE ,. 5230 GA LS
I IE I Giff == 64, 07 INQ11 : 5
WA TER " O. 00 ll-lQfl ; WA TER VOL ,. O GA L~
TE MP ,. 54. 08 Of:,: "
WALMART #WM3208
635 S 1950 WEST
SPRINGVILLE UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE AR 72716
479-204-3407
12/20/2023
FRP
46
23
27
905
27
1005
1 HR
0
FRP
44
21
25
928
25
1028
1 HR
0
FRP
42
20
24
952
24
1052
1 HR
0
FRP
46
21
25
1020
25
1120
1 HR
0
Tank 1 STP Sump
1
Tank 2 STP Sump
1
Tank 2 STP Sump
1
Tank 4 STP Sump
1
UT151
David Mathie
NW1-2364465
Rernmmertdoo Practices for the Jesting and VertfficaU on of Sp3lt Overfill ~ Leak Detection and Secondary Contai11ment Eq uipmen t at UST Fa ci!iies
APPENDIX ,c-4
CONTAINME 1NT SUMP' INTE1GRITY TESTING
HYDRO,STATIC TESTING METHOD,
--------~ ------------------------~
Fa cil ity a m e: Own er:
Address: Add ress: 1
I
City, Stat,e Zi p Code: City, State Zip Code:
I
I Fa cil i , I.D. : p 0 e
I
Testing C mpany: Pho e Dat e:
Th is pro ce dure is to est t · e lea k integrity of co 11tai • mer t su m ps. See PE I/R P1200 Sectio n 6.5 for he t est n1 e h d. I I
I
I
Co nta i nm,ent Su p lD
I
I
Car ta i11m ,ent Su 1p
M at e ri a l I
l iquid a ndi d,ebri s 0 Yes 0 No 0 Yes removed fr m su m p? □ 0 0 Yes □ 0 0 Yres □ 0 □Yes □. 0 D ,.es □ 0
I
Vi sual ln spectio (N
cracks, I ose parts 0 Pass □Fa i l 0 Pass □Fai l 0 Pass □I Fa il or sepa ratio 11 of h,e 0 ass □ ail □Pass □ ail □ ass □Fa i l
co ntai n ment su m p.)
Conta inment Su p I
I
Depth
Hei ght Fro m 8 tt m t
"f;p f H ig es
Pe n e .ra ti 11 I
I sta Iii 11 g Water Leve l
I Tes Start Ti me I
Er d in g Wa er Leve l j
2:=,st nd Tim e
Tes e riod (Minirrmm
,est ti m e : 1 h ur)
I Water Le ve 11 Change
I
P~ss/fai l cri eria: Must pa ss v isual in spectio . Water le ve l drnp o · less thar 1/8 inc h.
Test R,esults 0 P~ss □Fa i l 0 Pass □Fai l 10 Pass □Fai l 0 ass □ ail, □Pass □Fail □P ass □Fai l
I Commemts:
I
* Al I I iq ids a d d,ebr i s must be d is posed of properly_
Teste r's Na m e (p ·nt) ______________ _ Tester s Signature _JJ_/; ____________ _
pei.org 4D
WALMART #WM3208
635 S 1950 WEST
SPRINGVILLE UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE AR 72716
479-204-3407
12/20/2023
FRP
16.5
6.5
11
1028
11
1128
1 HR
0
FRP
16.5
6.5
11
1028
11
1128
1 HR
0
FRP
16.5
6.5
11
1037
11
1137
1 HR
0
FRP
16.5
6.5
11
1037
11
1137
1 HR
0
FRP
16.5
6.5
11
1044
11
1144
1 HR
0
1/2 9/10 3/4 11/12 5/6 13/14
FRP
16.5
6.5
11
1044
11
1144
1 HR
0
UT151
David Mathie
NW1-2364465
Rernmmertdoo Practices for the Jesting and VertfficaU on of Sp3lt Overfill ~ Leak Detection and Secondary Contai11ment Eq uipmen t at UST Fac iliies
APPENDIX ,c-4
CONTAINME 1NT SUMP' INTE1GRITY TESTING
HYDRO,STATIC TESTING METHOD,
---------------------------------~
Fa cil ity a m e: Own er:
Address: Add ress: 1
I
City, Stat,e Zi p Code: City, State Zip Code:
I
I Fa cil i , I.D. ·: p 0 e
I
Testing C mpany: Pho e Date:
Th is pro ce dure is to est t · e lea k integrity of co 11tai • mer t su m ps. See PE I/R P1200 Sectio n 6.5 for he t est me h d. I I
I
I
Co nta i nm,ent Su p lD
I
I
Car ta i11m ,ent Su 1p
M at e ri a l I
l iquid a ndi d,ebri s 0 Yes 0 No 0 Yes removed fr m su m p? □ 0 0 Yes □ 0 0 Yres □ 0 0 Yes □. 0 0 ,.es □ 0
I
Vi sual ln spectio (N
cracks, I ose parts 0 Pass □Fa i l 0 Pass □Fai l 0 Pass □I Fa il or sepa ratio 11 of h,e 0 ass □ ail 0 Pass □ ail 0 ass □Fa i l
co ntai n ment su m p.)
Conta inment Su p I
I
Depth
Hei ght Fro m 8 tt m t
T-p of H ig es
Pe n e .ra ti 11 I
I sta Iii 11 g Water Leve l
I Tes Start Ti me I
Er d in g Wa er Leve l j
2:=,st nd Tim e
Tes e riod (Minirrmm
,est ti m e: 1 h ur)
I Water Le ve 11 Change
I
P~ss/fai l cri eria: Must pa ss v isual in spectio . Water le ve l drnp o · less thar 1/8 inc h.
Test R,esu lts 0 P~ss □Fa i l 0 Pass □Fai l 10 Pass □Fai l 0 ass □ ail, 0 Pass □Fail 0 Pas s □Fai l
I Commemts:
I
* Al I I iq ids a d d,ebr i s must be d is posed of properly_
Test e r's Na m e (p ·nt) ______________ _ Tester s Signature _Joi/; _____________ _
pe i.org 4D
WALMART #WM3208
635 S 1950 WEST
SPRINGVILLE UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE AR 72716
479-204-3407
12/20/2023
FRP
16..5
6.5
11
1051
11
1151
1 HR
0
FRP
16.5
6.5
11
1051
11
1151
1 HR
0
7/8 15/16
UT151
David Mathie
NW1-2364465
Rernmmertdoo Practices for the Jesting and VertfficaU on of Sp3lt Overfill ~ Leak Detection and Secondary Contai11ment Eq uipmen t at UST Fa ci!iies
APPENDIX ,c-4
CONTAINME 1NT SUMP' INTE1GRITY TESTING
HYDRO,STATIC TESTING METHOD,
--------~ ------------------------~
Fa cil ity a m e: Own er:
Address: Add ress: 1
I
City, Stat,e Zi p Code: City, State Zip Code:
I
I Fa cil i , I.D. : p 0 e
I
Testing C mpany: Pho e Dat e:
Th is pro ce dure is to est t · e lea k integrity of co 11tai • mer t su m ps. See PE I/R P1200 Sectio n 6.5 for he t est n1 e h d. I I
I
I
Co nta i nm,ent Su p lD
I
I
Car ta i11m ,ent Su 1p
M at e ri a l I
l iquid a ndi d,ebri s 0 Yes 0 No 0 Yes removed fr m su m p? □ 0 □Yes □ 0 0 Yres □ 0 □Yes □. 0 D ,.es □ 0
I
Vi sual ln spectio (N
cracks, I ose parts 0 Pass □Fa i l 0 Pass □Fai l □Pass □I Fa il or sepa ratio 11 of h,e □ ass □ ail □Pass □ ail □ ass □Fa i l
co ntai n ment su m p.)
Conta inment Su p I
I
Depth
Hei ght Fro m 8 tt m t
"f;p f H ig es
Pe n e .ra ti 11 I
I sta Iii 11 g Water Leve l
I Tes Start Ti me I
Er d in g Wa er Leve l j
2:=,st nd Tim e
Tes e riod (Minirrmm
,est ti m e : 1 h ur)
I Water Le ve 11 Change
I
P~ss/fai l cri eria: Must pa ss v isual in spectio . Water le ve l drnp o · less thar 1/8 inc h.
Test R,esults 0 P~ss □Fa i l 0 Pass □Fai l ID Pass □Fai l □ ass □ ail, □Pass □Fail □P ass □Fai l
I Commemts:
I
* Al I I iq ids a d d,ebr i s must be d is posed of properly_
Teste r's Na m e (p ·nt) ______________ _ Tester s Signature _JJ_/; ____________ _
pei.org 4D
WALMART #WM3208
635 S 1950 WEST
SPRINGVILLE, UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
479-204-3407
12/20/2023
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE, AR 72716
1
RUL
5
OPW
2
RUL2
5
OPW
3
PREM
5
OPW
4
DSL
5
OPW
958
15 WC
1003
15 WC
5 MIN
0
1005
15 WC
1010
15 WC
5 MIN
0
1013
15 WC
1018
15 WC
5 MIN
0
1022
15 WC
1027
15 WC
5 MIN
0
UT151
David Mathie
APPENDIX C-3
SPILL BUCKET INTEGRITY TESTING HYDROSTATIC TEST METHOD
S:l 1NGlE AND DOUBlE-WAllED VACUUM TEST METHOD
Fac i lity Nam e: Ow ner:
Add ress: Add ress:
j City, state , Zip Code: City, sta e. Zip Cod e :
Fac ility I D_ #: Phone#:
Testin g Comp any: Phone-": Date:
Tlli s procedure is to test the lea k integrity of sin gle-an d double-walled s pil l buckets_ See PE I/RP1200, Section 6_2 fo r nydrost atic
test method, Sectio n 6.3 for si ngl e-wal led vac uum test metllod and Sec tion 6-4 for do uble-walle d vacuum test m ethod_
Ta nk umber
Product Sto red
Spi ll Bucket
capac ity
I Manu -ac ur er
Construction □S in gl e-wa lled 0 Single-wa lle d □S in g l e-wa ll ed □S i ng l e-w a ll e d D Sin gle-wal led D Si ngl e-wal led
0 Doub le-wal led 0 Dou bl e-wa l led 0 Doubl e-walle d 0 Doub le-wa lied D Doubl e-wall ed D Dou ble -wal led
Test Typ e D Hydrostatic D Hyd rosta ti c D Hydro sta t ic D Hyd rostatic D Hydro static D Hydrost atic
0 v acuum 0 v acuu m 0 v acuum 0 v acuum □va cuum □vac uum
□s ingle-wa lled 0 Single-walled D Sin gle-wall ed □s i n g l e-wa ll e d D Sin gle-wa ll ed D Si ngle-wal led
D Doub le-wal led D Doub le-wall ed 0 Doubl e-walle d □ Doub le-wa lied D Do uble-wall ed D Dou ble -wal led
Spi ll Bucket Typ e 0 Product 0 Product 0 Product 0 Product D Product D Product
□Va por □Va p o r □Va por □Va por D vaoo r □va po r
Liquid an d debris
removed f mm 0 Yes □No 0 Yes □ 0 0 Yes □No 0 Yes □N o □Yes □No □Yes □No
s pil l bucket?*
Vi sual Ins pection
(No cracks , lo ose
parts or separa-0 Pass □Fa i l 0 Pass □Fa il 0 Pass □Fa i l 0 Pass □Fail □Pass □Fai l □Pa ss □Fai l
tion of the bucket
from the fi l l pipe _)
' □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No Ta nk ri ser cap
in clud ed in t est? 0 A 0 NA 0 NA 0 NA □NA □NA
Is drain va lv e □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No
in cluded in t est? 0 A 0 NA 0 NA 0 NA □NA □NA
sta rting Le vel
Test St art Time
Endi ng Level
I Test End Ti m e
Test Pe rio d
I Level Chan ge
Pass/fai l crite ri a: Mu st pass vi s ual ins pection_ Hydrostatic: Water level drop of less than 1/8 inch; Vacuum si ngle-wal led only:
ain tain a least 26 inch es water column ; Vacuum dou ble-wal led : maintain at least 12 i nches wate r co lum n_
Test Results 0 Pass □Fa i l 0 Pass □Fa i l 0 Pass □Fa i l 0 Pass □Fail □Pass D Fa il □Pass □Fai l
Comments:
*Al l l iq ui ds a n □ d eb ris mu st be d isposed of prop e rly_
Teste r's Nam e ________________ _ . /// Tester's Sign at ure _11,h{_-~_, ___________ _
WALMART #WM3208
635 S 1950 WEST
SPRINGVILLE, UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
479-204-3407
800-800-4633 12/20/2023
1
RUL
19782
118.375
OPW
2
RUL2
19782
118.375
OPW
3
PREM
7901
118.375
OPW
4
DSL
11904
118.375
OPW
UT151
David Mathie
2001 S.E. 10TH STREET
BENTONVILLE, AR 72716
1 . m t
II 2. ec t1a -·
nis r
3. mut
binding i nto
p tub e
I g,e (if
prese nt)?
UST OVERRU EQUIIPMENrT INSPE,CTIONI
AUTOMATI:C SHUTDFF DEVICE AJND BALL FliOAT VALVE
o ner:
Address:
alve
0 ¥es □ 0 0 Yes □ 0 0 ¥es □ 0
0 ves □No 0 ¥es D 1 0 Yes □ 0 0 lles □ 0
0 ves □No 0 ¥es □ 0 ves □ 0 ¥es □ 0
0 ves □ 0 0 ¥es □ 0 0 v es □ 0 0 Yes □, 0
□ Prese n □ t Prese11t □ t Presen t □ ot Pre.s e11t
0 Yes □No 0 ¥es D 1 0 Yes □ 0 lles □ 0
s 1-5 ind ic ates a estfai lu re.
Ta
and I ea k-free ?
4. e nt h le i pip e is open and
I near top of tank?
5. Ba l~ loat pi pe is prope r
le gtt11 to res trict I a 9
I capa i 1 _ • •
--
D ves D No
D ves D No
D ves □No
O ves 0No
□Yes □ 0
□¥es D □Yes □ D 11es □
□¥es □¥e s
□Yes □Yes □ □¥es □
1_□¥es D Dves D 0 ¥es □ 0
I
□¥es □ □Yes □ □Yes D 1 o
Valve
□Yes □
□Yes □
□Yes □
□Yes □ 0
□ t Pres ent
□Yes □
□Yes
□Yes
□¥e s
□Yes
□Yes □
J
Va lve
□Yes □
□Yes D o
D ot Prese nt
1 □Yes D o
□Yes □
□Yes □ 0
□Yes □ 0
Dves □
□Yes □ 0
l11----------·n_e_s_1_-5_. _in_o _ic_ates __ a __ .t _fa_i l_u_re_. ------------..-------------------ill
lest Resu Its,
Comm enrts ::
rer s s uggested
Jer s s uggested
l est e,r s a me _______________ _
pa
ity.
Test er 's Si1gnature _1_U/s-..,aa__ ___________ _
59.25
167.5
19782
106.25
18790
19782
95
Site ID/ Name:
Address:
WM3208 WALMART #WM3208 NW1-2364465 12/20/2023
635 S 1950 WEST, SPRINGVILLE, UT 84663
Tank ID:1(RUL)
/lp11MJdlxB
71 SO Overftll V•fw In Tlnk Shut off Level Worksheet
faporta11t: ThldtmrtMI to ba supp&e-,,ental wortshNt and not a subsUtuft to fa.Uowln, tt..f nsuiU,tion
..-..nu1I inrlructN)n-.. AH length l'WIINSI.INtnW:ntsate In in dies, Ple.se C'Ontan the Authority Hfflng Jurisdic-
tion (AHJ) ..,c1 fftitw loc.a, Sltat41tand national code$ to detennlne die riegula1otyrecplrements goi,emlngi
shut-off co pa city II\ yow reg.lol\. as w♦II as take no~ ochar <0n1khradon, Ndl u-,rtrt:me tank ta.
Takt ttle follOY.1ng MH5Mrements wflh th•••fni.-..
$1 ailed In the farlk1
Dlstanet rrom tht 71S0 Inlet tubeflainge to the ca::s1:
lug iathe 7150body (sMtlguresl,upPff tube le"9'h,
NMe: theUpperTUbc l ~n!)thmurt be'Jt least 16"to
inclUde tho p1otoC'llve .be,"ld 1n the tube,.
(I))• _____ _
Oi$tai1Cll!frotn th'" 71$0 inlt( t11be flange1c:, the top and
bottom of lo'H~r1d:-., v~._.t .len91t,.
Cllll•-----
(U>•-----
Oi,12;c;efrorr1 th1171SO fol .. lubtflange to the b::lttom
otthetant Netetf ~t&nkbottom protector is present it
may be neres$8ryto arid thts thldcness ro dmensbn
(OP'l,'6111 &6ITP mcdE'fs add 0.6*1
(81•-----
Fro.n the tank <.a!lbf m:)n chert provlded bytank.manu-
f~lu'<.1 fll'\ld the dipstick number (Y) which conespoll<ll
to the lCo;t,volume.
(VJ ; ____ _
1. TodMMNntshut-o#peree~:
SUbet~cc ui:,c:crtube length (11) from distance to rank
t,()n,,m (U)
OO •tB)-(01-2'•·-------
\l,lnt thttwlkQllln1f on d'IIM't provided by thetl.nk
manl.lfaffllr« dec.rmlne cheontcil)iSdty at th• ul•
a.1h1t:ed 00 dlMentJc:. Md !tie tOO'lbvolwn•m tank
c::apaaty.
(X)lankQ,-ityln9"lloM=-----
(Y) .. n~ap,dtylnplloo,a : ____ _
$0%;; lX)capAdtJ / (V) UJHchyx100•----
C
_ ... --.!I,,
• .J -I
iOI
Upper
T,b<
' h ,
l v.'}V81Ye
I L~t!'>,
' botlomof
"'
tB:•
T olarik
IY)
Tiln1k
!V)'.';ilV9 -o..,
lf'1;Jti , 1CO~V~-
WP of C-Jl u rru Oip-
I
~t'!\i
"
~e: ThtO\'crlilll<i~ 11"11.1~ M i l\lJ:!11!~ P#.f MU fflQIJTr•
,,.11u•1tJ.,ind ,ill appliubl• LOOI ~ ,Uli <!, &nd n.&tlooeil <odes. t
:tie overfitl •G1t"".': (I Y't :.eavr-1N' ~llow..,t,!~ ,l'lu!~ percent•
ace '1e oven'IU Yel'o'e m11n bQ mnav-:::1 ,md 1-.1:11t.iocd. fu(
refe~nc~.fOCM. part 2l0$1hp~tt B Stction 280.lOc,,,...f;tl
vet11e:s shcvld bt Soil to a m.i•irr,vmof s.-s,;.
,o
57.5
165.75
19782
106.25
18790
19782
95
Site ID/ Name:
Address:
WM3208 WALMART #WM3208 NW1-2364465 12/20/2023
635 S 1950 WEST, SPRINGVILLE, UT 84663
Tank ID:2(RUL 2)
/lp11MJdlxB
71 SO Overftll V•fw In Tlnk Shut off Level Worksheet
faporta11t: ThldtmrtMI to ba supp&e-,,ental wortshNt and not a subsUtuft to fa.Uowln, tt..f nsuiU,tion
..-..nu1I inrlructN)n-.. AH length l'WIINSI.INtnW:ntsate In in dies, Ple.se C'Ontan the Authority Hfflng Jurisdic-
tion (AHJ) ..,c1 fftitw loc.a, Sltat41tand national code$ to detennlne die riegula1otyrecplrements goi,emlngi
shut-off co pa city II\ yow reg.lol\. as w♦II as take no~ ochar <0n1khradon, Ndl u-,rtrt:me tank ta.
Takt ttle follOY.1ng MH5Mrements wflh th•••fni.-..
$1 ailed In the farlk1
Dlstanet rrom tht 71S0 Inlet tubeflainge to the ca::s1:
lug iathe 7150body (sMtlguresl,upPff tube le"9'h,
NMe: theUpperTUbc l ~n!)thmurt be'Jt least 16"to
inclUde tho p1otoC'llve .be,"ld 1n the tube,.
(I))• _____ _
Oi$tai1Cll!frotn th'" 71$0 inlt( t11be flange1c:, the top and
bottom of lo'H~r1d:-., v~._.t .len91t,.
Cllll•-----
(U>•-----
Oi,12;c;efrorr1 th1171SO fol .. lubtflange to the b::lttom
otthetant Netetf ~t&nkbottom protector is present it
may be neres$8ryto arid thts thldcness ro dmensbn
(OP'l,'6111 &6ITP mcdE'fs add 0.6*1
(81•-----
Fro.n the tank <.a!lbf m:)n chert provlded bytank.manu-
f~lu'<.1 fll'\ld the dipstick number (Y) which conespoll<ll
to the lCo;t,volume.
(VJ ; ____ _
1. TodMMNntshut-o#peree~:
SUbet~cc ui:,c:crtube length (11) from distance to rank
t,()n,,m (U)
OO •tB)-(01-2'•·-------
\l,lnt thttwlkQllln1f on d'IIM't provided by thetl.nk
manl.lfaffllr« dec.rmlne cheontcil)iSdty at th• ul•
a.1h1t:ed 00 dlMentJc:. Md !tie tOO'lbvolwn•m tank
c::apaaty.
(X)lankQ,-ityln9"lloM=-----
(Y) .. n~ap,dtylnplloo,a : ____ _
$0%;; lX)capAdtJ / (V) UJHchyx100•----
C
_ ... --.!I,,
• .J -I
iOI
Upper
T,b<
' h ,
l v.'}V81Ye
I L~t!'>,
' botlomof
"'
tB:•
T olarik
IY)
Tiln1k
!V)'.';ilV9 -o..,
lf'1;Jti , 1CO~V~-
WP of C-Jl u rru Oip-
I
~t'!\i
"
~e: ThtO\'crlilll<i~ 11"11.1~ M i l\lJ:!11!~ P#.f MU fflQIJTr•
,,.11u•1tJ.,ind ,ill appliubl• LOOI ~ ,Uli <!, &nd n.&tlooeil <odes. t
:tie overfitl •G1t"".': (I Y't :.eavr-1N' ~llow..,t,!~ ,l'lu!~ percent•
ace '1e oven'IU Yel'o'e m11n bQ mnav-:::1 ,md 1-.1:11t.iocd. fu(
refe~nc~.fOCM. part 2l0$1hp~tt B Stction 280.lOc,,,...f;tl
vet11e:s shcvld bt Soil to a m.i•irr,vmof s.-s,;.
,o
54.5
162.75
7901
106.25
7474
7901
94.6
Site ID/ Name:
Address:
WM3208 WALMART #WM3208 NW1-2364465 12/20/2023
635 S 1950 WEST, SPRINGVILLE, UT 84663
Tank ID:3(PREMIUM)
/lp11MJdlxB
71 SO Overftll V•fw In Tlnk Shut off Level Worksheet
faporta11t: ThldtmrtMI to ba supp&e-,,ental wortshNt and not a subsUtuft to fa.Uowln, tt..f nsuiU,tion
..-..nu1I inrlructN)n-.. AH length l'WIINSI.INtnW:ntsate In in dies, Ple.se C'Ontan the Authority Hfflng Jurisdic-
tion (AHJ) ..,c1 fftitw loc.a, Sltat41tand national code$ to detennlne die riegula1otyrecplrements goi,emlngi
shut-off co pa city II\ yow reg.lol\. as w♦II as take no~ ochar <0n1khradon, Ndl u-,rtrt:me tank ta.
Takt ttle follOY.1ng MH5Mrements wflh th•••fni.-..
$1 ailed In the farlk1
Dlstanet rrom tht 71S0 Inlet tubeflainge to the ca::s1:
lug iathe 7150body (sMtlguresl,upPff tube le"9'h,
NMe: theUpperTUbc l ~n!)thmurt be'Jt least 16"to
inclUde tho p1otoC'llve .be,"ld 1n the tube,.
(I))• _____ _
Oi$tai1Cll!frotn th'" 71$0 inlt( t11be flange1c:, the top and
bottom of lo'H~r1d:-., v~._.t .len91t,.
Cllll•-----
(U>•-----
Oi,12;c;efrorr1 th1171SO fol .. lubtflange to the b::lttom
otthetant Netetf ~t&nkbottom protector is present it
may be neres$8ryto arid thts thldcness ro dmensbn
(OP'l,'6111 &6ITP mcdE'fs add 0.6*1
(81•-----
Fro.n the tank <.a!lbf m:)n chert provlded bytank.manu-
f~lu'<.1 fll'\ld the dipstick number (Y) which conespoll<ll
to the lCo;t,volume.
(VJ ; ____ _
1. TodMMNntshut-o#peree~:
SUbet~cc ui:,c:crtube length (11) from distance to rank
t,()n,,m (U)
OO •tB)-(01-2'•·-------
\l,lnt thttwlkQllln1f on d'IIM't provided by thetl.nk
manl.lfaffllr« dec.rmlne cheontcil)iSdty at th• ul•
a.1h1t:ed 00 dlMentJc:. Md !tie tOO'lbvolwn•m tank
c::apaaty.
(X)lankQ,-ityln9"lloM=-----
(Y) .. n~ap,dtylnplloo,a : ____ _
$0%;; lX)capAdtJ / (V) UJHchyx100•----
C
_ ... --.!I,,
• .J -I
iOI
Upper
T,b<
' h ,
l v.'}V81Ye
I L~t!'>,
' botlomof
"'
tB:•
T olarik
IY)
Tiln1k
!V)'.';ilV9 -o..,
lf'1;Jti , 1CO~V~-
WP of C-Jl u rru Oip-
I
~t'!\i
"
~e: ThtO\'crlilll<i~ 11"11.1~ M i l\lJ:!11!~ P#.f MU fflQIJTr•
,,.11u•1tJ.,ind ,ill appliubl• LOOI ~ ,Uli <!, &nd n.&tlooeil <odes. t
:tie overfitl •G1t"".': (I Y't :.eavr-1N' ~llow..,t,!~ ,l'lu!~ percent•
ace '1e oven'IU Yel'o'e m11n bQ mnav-:::1 ,md 1-.1:11t.iocd. fu(
refe~nc~.fOCM. part 2l0$1hp~tt B Stction 280.lOc,,,...f;tl
vet11e:s shcvld bt Soil to a m.i•irr,vmof s.-s,;.
,o
56.125
164
11904
105.875
11311
11904
95
Site ID/ Name:
Address:
WM3208 WALMART #WM3208 NW1-2364465 12/20/2023
635 S 1950 WEST, SPRINGVILLE, UT 84663
Tank ID:4(Low Sulfur Diesel)
/lp11MJdlxB
71 SO Overftll V•fw In Tlnk Shut off Level Worksheet
faporta11t: ThldtmrtMI to ba supp&e-,,ental wortshNt and not a subsUtuft to fa.Uowln, tt..f nsuiU,tion
..-..nu1I inrlructN)n-.. AH length l'WIINSI.INtnW:ntsate In in dies, Ple.se C'Ontan the Authority Hfflng Jurisdic-
tion (AHJ) ..,c1 fftitw loc.a, Sltat41tand national code$ to detennlne die riegula1otyrecplrements goi,emlngi
shut-off co pa city II\ yow reg.lol\. as w♦II as take no~ ochar <0n1khradon, Ndl u-,rtrt:me tank ta.
Takt ttle follOY.1ng MH5Mrements wflh th•••fni.-..
$1 ailed In the farlk1
Dlstanet rrom tht 71S0 Inlet tubeflainge to the ca::s1:
lug iathe 7150body (sMtlguresl,upPff tube le"9'h,
NMe: theUpperTUbc l ~n!)thmurt be'Jt least 16"to
inclUde tho p1otoC'llve .be,"ld 1n the tube,.
(I))• _____ _
Oi$tai1Cll!frotn th'" 71$0 inlt( t11be flange1c:, the top and
bottom of lo'H~r1d:-., v~._.t .len91t,.
Cllll•-----
(U>•-----
Oi,12;c;efrorr1 th1171SO fol .. lubtflange to the b::lttom
otthetant Netetf ~t&nkbottom protector is present it
may be neres$8ryto arid thts thldcness ro dmensbn
(OP'l,'6111 &6ITP mcdE'fs add 0.6*1
(81•-----
Fro.n the tank <.a!lbf m:)n chert provlded bytank.manu-
f~lu'<.1 fll'\ld the dipstick number (Y) which conespoll<ll
to the lCo;t,volume.
(VJ ; ____ _
1. TodMMNntshut-o#peree~:
SUbet~cc ui:,c:crtube length (11) from distance to rank
t,()n,,m (U)
OO •tB)-(01-2'•·-------
\l,lnt thttwlkQllln1f on d'IIM't provided by thetl.nk
manl.lfaffllr« dec.rmlne cheontcil)iSdty at th• ul•
a.1h1t:ed 00 dlMentJc:. Md !tie tOO'lbvolwn•m tank
c::apaaty.
(X)lankQ,-ityln9"lloM=-----
(Y) .. n~ap,dtylnplloo,a : ____ _
$0%;; lX)capAdtJ / (V) UJHchyx100•----
C
_ ... --.!I,,
• .J -I
iOI
Upper
T,b<
' h ,
l v.'}V81Ye
I L~t!'>,
' botlomof
"'
tB:•
T olarik
IY)
Tiln1k
!V)'.';ilV9 -o..,
lf'1;Jti , 1CO~V~-
WP of C-Jl u rru Oip-
I
~t'!\i
"
~e: ThtO\'crlilll<i~ 11"11.1~ M i l\lJ:!11!~ P#.f MU fflQIJTr•
,,.11u•1tJ.,ind ,ill appliubl• LOOI ~ ,Uli <!, &nd n.&tlooeil <odes. t
:tie overfitl •G1t"".': (I Y't :.eavr-1N' ~llow..,t,!~ ,l'lu!~ percent•
ace '1e oven'IU Yel'o'e m11n bQ mnav-:::1 ,md 1-.1:11t.iocd. fu(
refe~nc~.fOCM. part 2l0$1hp~tt B Stction 280.lOc,,,...f;tl
vet11e:s shcvld bt Soil to a m.i•irr,vmof s.-s,;.
,o
Tank ID:
2, To~lowertubedlsta~froffl hlnk
bottom to bonom of cut:
SubO'aa valve length l\',?frcrn distance t<> t.lnk
lx>ttnm (8)
(\')=(8)-(W)= ___ _
NOU: Lowtrtuhecleuance m ust meet tank manu ·
fi1cturer requirement, and all AHi, bcal, state, ard na·
donal~,1. T~lclearancels.about4". ff lower
b1ber,le,;iranoels not metv.1:w mu~ be l'ffl\UVed ard
3dJu$t'ed to !'T'ICt'tt!lf,e reqvlrements.
3. To determine lowerblbedistUICII! from tlnk
bottomtotc,pofwt:
Subu;xtval-.,e length (U) from Clist:ancc to t:lnk
bottom(B)
m=(B)-(UI=----
Ncte: lower tube distancefromt3nk bottomtc top
of atl must meeta'I AHJ. loc~.st.Jte,.;,nd Mtlen~I
codes, For rt'leter1ce per 4IJ CFR 63 iubP'l,'l ((CCCC /
NESHAP thelow w tub e Q n be nu rnorli! lhan6" from
the b ottomolthetan:C.. ti' lower lubedM.inU:! CS, 1l¢l
tnE"twdve must be nitr.O\'ed .ind .xljusud to mw1 thas-e
requirements,
4. 'fo determine float alignment:
Loo long Into up~rtu~ ($tt figu~l me fbat shou ld be
.ilignedalong the length of theuink. lffloM Is ~c
aligned i:woper~~dJustmcms nttd to be made.
FI OaC d ll'Ktlon
21
Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2364465
Site ID / Name:WM3208 / WALMART #WM3208
Address:635 S 1950 WEST
City:SPRINGVILLE State:UT Zip:84663
Tanknology
~ ~ 0
(/)
-I
0
::0 m
~ ¥
~ ~
~
W.O.# NW1-2364465 Cust Ref#: 38346723
ANN TNK
APPENDIX C-1
TANK SECONDARY CONTAINMENT INTEGRITY TESTING
DRY TEST METHOD
Faci lity Name: AL MART 3208 Owner:
Address: 1635 s 1750 w I Add ress:
City, Stat e, Zip Code: !SPRINGVILLE j City, State, Zip Code:
Fac i lity I.D. #: Phon e#:
Testing Company: TANKNOLOGY Phone#: [phone] Date: 112-20-23
This d ata sheet is f or testing the integrity of the d ry secondary containment of a UST. See PEI/RP1200, Section 4 .2 for the test
proced ure .
Ta ni< Number
Tank Material
Product Stored
Tank Capa city•, gallons
Test Start Time
Ini tial Vacu u m Read i ng,
inches Hg (See Table
4-1 below.)
Specified Test Duration
(See Table 4-1 below.)
Test End Time
Final Vac uum Read ing,
inches Hg
Is the Annu lar Space
Dry A~er the Test?
Test Resu lts
Tank Type
Fi be rglass
Steel
2 1314
IFRP
PREM/DSL
~901/11 904
1847
Vacuum, Capacity,
inches Hg gallons
< 20,000
10
20,000+
< 20,000
6
20,000+
*Total tank capacity. includi ng all compartments in a multi-compart ment tank.
Comments:
Tester's Name UT151 DMATHIE Tester's
r --
r ,---
r-
C I
c:=1
□ 1 hour
~J
□No
Duration ,
hours
1
2
1
2
□ 1 hour □ 1 hou r
□ 2 hours □ 2 hou rs
□Yes □No □Yes □No
□ Pass □ Fail □ Pass □ Fail
W.O.# NW1-2364465 Cust Ref#: 38346723
LINE ANN
APPENDIX C·2
PIPING SECONDARY CONTAINMENT INTEGRITY TESTING
Facil ity Name: WAL MART 3208 Own er:
Address: 635 S 150W Add ress:
City, Stat e, Zip Code: SPRINGVILLE City, State, Zi p Code:
Faci lity I.D. II: Phon e II:
Test ing Compa ny: TANKNOLOGY Phone #:[phone] Date: 12-20-23
Tl1is proced ure is t o test the i ntegrity of the interstitial space of double-walled piping. See PEI/RP1200, Section 5 for the test
proced ure.
Tank Number 1 2 3 4 1
Pip i ng Run 1-8 9-16 1-8 & 9-16 1/27/8 9/1015/1 SYPHON
Pipi ng Material FLEX FLEX FLEX FLEX FLEX
Prod uct Stored RUL RU L PREM DSL RUL
Test Start Ti me 901 901 901 901 901
Ini tial Test Pressure, psig
(Test proced ure specifies 5 5 5 5 5
5 psig.)
Test End Ti me 1001 1001 100 1 1001 1001
Final Test Pressure, psig 5 5 5 5 5
Pressu re Change (No
reduction in pressur e 0 0 0 0 0 I
allowed fo r pass.)
Te st Results E!'l Pass □Fail C!f Pass □Fail !'.'.i Pa ss □Fa ll 01>ass □Fa il !$Pass □Fa il □ Pass □Fa il
Comm ents:
Tester's Name UT151 DAVE MA T HIE Tester's Signature
I
W.O.# NW1-2364465 Cust Ref#: 38346723
OVF
:fl Tanknology Inc.
Policy 100-29-A I 1000 N. MoPac Exp ressway, S uite 500 Austin, TX 78759 [phone]
Rev: H JOB CLEARANCE FORM & SITE SAFETY CHECKLIST -OVF Revised: 6/25/2022
Site Name/#: Street Address:
Travel nme:
Scope of Work and T asks Performed (JSA's must be available for all lasks):
Fo llow-up actions required: equipment Isolated; comments:
PE -PERSONAL PROT T/VE EQUIPMENT REQUIRED Check ✓ items used or mark -if not a licab/e
fl /Gloves (all j obs) D Splash Goggles (if needed) D Hearin g Protection (if need ed)
Safety Toe Boo ts (a ll j obs) V Saf ety Glasses (all jobs) D Hard Hat (if needed) D Other
✓ PRE-TEST PROCEDURES (Check ✓ each item completed or mark if not applicable)
1. _J Discuss safety proced ures wi th site personnel. Nearest hospital : __________________ _
2. 0 Get ATG pri ntout & check fue l/water levels. Prio r to fuel delivery t he sys tem must be placed back into working order.
3. IJ Barricade work area (cones, flags, bars/tape) and place Fire Extinguishers & "No Smo king" Signs at pe rim eter.
4. 0 Confin ed Space Entry -If requ ired comple te separate CS E Checklist. If NO CSE check the fo llowing reason :
0 No CS 's l]CS's not opened IJNo en try o nly vis ual [!No entry -used tools .[;:W ork from prone positi on w/o ri sk of fa lling in
5. IJ Implemen t Lockout/Tag out per API 1646 (whe n accessing prod uct piping during ta sks)
D Secure nozzles with "Out of Service" bags and nylon ties. 0 Secure the circuit breaker(s ) wlth lockout devices and tags.
D Close ball va lves or check valves on product pip ing.
D All a pplicable eq uipment disabled during test(s).
SIGNIN l ,
General Safety Checks:
All site personnel have been informed .
Is a fuel del ivery due today ? ~--~----
LOT O procedu res have been discussed.
Wor k areas ba rricaded to protect workers, staff & public.
U Disconnect electrical "bayonet" connector from the STP(s).
D Verify LOTO i s complete by trying to operat e pumps.
Lead Technician Name Lead T echnician Signature
Site Representative Name Site Representative Signature
1.
2,
✓ POST-TEST PROCEDURES (Check ✓ each item completed or mark -if not applicable)
:J Remove all "Lockout/Tagou t" device s and nozzle bags/ties .
,.., Run all pumps an d verify there are no leaks: :::J Impact Valve Test Ports under dispensers
11 Leak Detec to r & Ve nt Tubes □ STP Fun ctiona l El em ents & Relief Screws
3.
4.
L Get ATG printout. Confirm water leve ls same as start or explain difference: ______________ _
5.
L Check following components opera tional:
o ATG probes, senso rs, & caps
□ Ball floats, dry breaks & caps
□ Con tainment su mps are dry
U Manhole covers and sump lids
C Spi ll containers & drain val ves
I:' Drop tubes , fl apper valves, fi ll adapters & caps
Remove barri cades.
SIGN ·OUT &-0 arator-Verlflcatlon of Work OVF ·
Genera l Saf ety Checks:
Work area has been left clean & safe.
Site staff aware of work status including any remaining isolation.
Changes to equipment are documented and communicated.
All incidents, near incidents, and un safe situations reported.
Site Representative Commen!s:
LI Shear valves are o pen
n Dispensers & POS operational
U Dispe nser panels are repl aced
·: Vents & Extractors (not capped, plugged or isolated )
~I Cathodic protection operational
~1 Siphon lines and manifold va lves open
Site
COMPANY CONF ID ENTIAL © Tanknology Inc ., 2022. All Rights Reserved .
[Printed co pies of this docu men t are uncontrolled . The current ve rsio n is available in rhe Tonknol o~y On-Li ne Document Contro l Sys tem.I
Product Line Tightness Test Page 1 of 1
Work Order: 2364470 Date: 1/19/2024
Site Name/ID: WALMART #WM3208 / WM3208
Address: 635 S 1950 WEST
City: SPRINGVILLE State: UT Zip: 84663
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
60
09:51
10:51
0.00
Pass
Yes
Tank # 2
Line # 1
TLD-1
2
RUL 2
Pressure
60
09:50
10:50
0.00
Pass
Yes
Tank # 3
Line # 1
TLD-1
3
PREMIUM
Pressure
60
09:51
10:51
0.00
Pass
Yes
Tank # 3
Line # 2
TLD-1
3
PREMIUM
Pressure
60
09:50
10:50
0.00
Pass
Yes
Tank # 4
Line # 1
TLD-1
4
Low Sulfur
Diesel
Pressure
60
09:51
10:51
0.00
Pass
Yes
Tank # 4
Line # 2
TLD-1
4
Low Sulfur
Diesel
Pressure
60
09:50
10:50
0.00
Pass
Yes
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
Tanknology
J)f;-
WALMART #WM3208
635 S 1950 WEST
SPRINGVILLE UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE AR 72716
479-204-3407
01/19/2024
RUL RUL 2 Low Sulfur
DieselVeeder Root
DPLLD
Veeder Root
DPLLD
Veeder Root
DPLLD
Veeder Root
DPLLDDPLLDDPLLDDPLLDDPLLD
38
2
38
2 2
36 30
2
UT151
David Mathie
NW1-2364470
PREMIUM
T1:1 T2:1 T3:1 T4:1
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak !Detection and Sewndary Contai nment Equ ipment at UST Facilities
APPENDIX C-9
MECHANICAL AND ELECTRONIC LINE LEAK DETECTORS
PERFORMANCE TESTS
Facility Name: Ow ner:
Ad d ress: Address:
City, State, Zip Code : City, St at e, Zi p Code:
Faci lity I.D. #: Phone#:
Tes tin g Com p any: Phone#: Date :
Th is data sl1eet ca11 be used to test mechan ica l li ne leak detectors (MLLD) a ri d electron ic li ne lea k d etectors (ELL O) w ith s ubmersible
t u rlJi e p ump (STPJ systems. See PE I/RP1200 Sections 9 .1 and 9.2 fo r test p rocedures.
Li ne u m ber
Product Stored
Leak Detector Manufactu re r
Leak Detector Mo de l
Type of Lea k De ector □M L LD □MLlD □M LLD □M LLD □ML l D □M LLD
~ELLO ~ELLO ~ELLO ~ELLD LJ ELLO LJ ELLD
M U.D {AU. PRES SU RE M EAS URE M ENTS ARE MAD E IN PSI G)
STP Full Ope rating Pressure
Chec k Val ve Holding Pressure
Uri e Resil iency (ml) (li ne bleed back vo l-
ume as measured fro m cl1eck valve ho ld-
ing p ressu re to O psig)
Step Through Time in Seconds (time tl1e
MLJLD 11esitates at metering p ressure
before going to full operating pressure
as measured from O ps ig wi th 110 lea k
induced 0 11 the li ne)
Metering Pr,essure [STP pressure when
si m ulated leak rate 3 gph at 10 psigJ
Openi ng Ti me in Seconds (the time the
MLLD ope1 s to allow full pressu re after
si mulated leak is stopped )
Does the STP pressu re re m ain at or
below the metering pressu re fo r at least 0 Yes 0 No 0Yes 0 0 0 Yes 0 No 0 Yes 0 No 0Yes D 0 0 Yes 0 No 60 seco nds wl1en the simulated lea k is
induced?
Does the leak detector reset (trip) wl1 e11 0 Yes 0 No 0Yes 0 0 0 Yes 0 0 0 Yes 0 No 0 Yes 0 0 Yes O N the li ne pr essure is bled off to zero psi g?
Does the STP properl y cyc l e 011/off un der 0 Yes 0 No 0 Yes O No □Yes 0 0 0 Yes 0 No 0 Yes 0 0 0 Yes 0 No no rm al fuel system operation co nditions?
A "No" answer to either of tl1e above questions indicates tl1e MLLD fa il s the test
EL LD (ALL PRESSU R E MEASU RE M ENTS AR E MADE IN PS IG}
STP Full Operatin g Pressure
Ho w ma ny test cycles are obser ved
before a larm/shutd own occurs?
Does the sim ul ated leak cause a n ala r m? l:21Yes □No 0 Yes D No 0 Yes D No 0 ves □N o □Yes □N o □Yes □N o
A • o· answer to the aoove question i11 dif-
cates tlle ELLD fa ils the test
Does the sim ulated lea k cause a 11 STP 0 Yes 0 No 0 Yes D No @ Yes 0 0 0 Yes D No □Yes 0 0 0 Yes 0 No
shutdown? □NA □N A □NA □NA □NA □NA
Te st Results ll:'.'.i Pass UFail b::'.J Pass _I Fail b::'.l Pass UFail ~Pass UFail UPassUFai l UPass UFail
Co mments:
Teste r's Name (print) ________________ Tester 's Signature _;4_' Ji_,-_____________ _
pe i.org •
Impact Valve
Inspection
Impact Valve Operational
Inspection
Work Order:2364470 Date:1/19/2024
Site Name/ID:WALMART #WM3208
Address:635 S 1950 WEST
City:SPRINGVILLE State:UT Zip:84663
How Inspected: Line Test NFPA 30A PEI RP1200 Other
Dispenser
Number Grade
Secure
Mount?
Valve
Lock?Pass/ Fail Comments
1/2 40 Pass Fail Not Tested
1/2 85 Pass Fail Not Tested
1/2 91 Pass Fail Not Tested
3/4 85 Pass Fail Not Tested
3/4 91 Pass Fail Not Tested
5/6 85 Pass Fail Not Tested
5/6 91 Pass Fail Not Tested
7/8 40 Pass Fail Not Tested
7/8 85 Pass Fail Not Tested
7/8 91 Pass Fail Not Tested
9/10 40 Pass Fail Not Tested
9/10 85 Pass Fail Not Tested
9/10 91 Pass Fail Not Tested
11/12 85 Pass Fail Not Tested
11/12 91 Pass Fail Not Tested
13/14 85 Pass Fail Not Tested
13/14 91 Pass Fail Not Tested
15/16 40 Pass Fail Not Tested
15/16 85 Pass Fail Not Tested
15/16 91 Pass Fail Not Tested

Technician Comments:
Technician Name:David Mathie
Signature:
Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com
Tanknology
-
I
p r r r
I
I I
pi E7 p r r
~ P' p r r
E7 E7 p r r
P' P' p r r
P1 E7 p r r
P' P' p r r
P1 ~ p r r
P' P' p r r
P' P' p r r
E7 E7 p r r
~ P' p r r
E7 E7 p r r
P' P' p r r
P1 E7 p r r
P' P' p r r
~ ~ p r r
P' P' p r r
P' P' p r r
E7 E7 p r r
17 P' p r r
I I
tit
WALMART #WM3208 SAM'S CLUB
635 S 1950 WEST
SPRINGVILLE UT 84663
WM3208
Tanknology, Inc.
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE AR 72716
479-204-3407
800-964-1250 01/19/2024
1 2 3 4
RUL RUL2 PREM DSL
VR450PLUS VR450PLUS VR450PLUS VR450 PLUS
19782 19782 7901 11904
118.4 118.4 118.4 118.4
UT151
David Mathie
Fa ci :I ity ame:
M d ress:
Ci' , state Zip od e:
Faci lity I.D .. :
Tes irig • • pa ny:
Thi s proce dure is t o
TI, is p roce dlur e is ap · .. ,
Tank um e r
3 . f rom t ile ta n , ias it
APPENDIX C-7
AlITOM~TIC TANK GAUGE
OPERATION INSPECTION
0 · ner:
Address :
Di , s ate Zi p ode:
Ph ri e :
Ph ne .: Da :
P 1200 Sec tion 8 . 2 for tile 1i 11 s pecti on pmoed u re.
f t he ta k w:he in pla ce .
b ee n ins pecte d a d1 a riy d ama ge d or ,iss i ng parts D 'ires D □Yes □ 0 □Yes □ 0 □Yes □ 0
re pl'
is t ri gge red·_
vat es correspori d itll va I e pro gramm ed1 in U1e
ga . ge ?
g _ Inch level from t he bottom he n th e ~er fl1
• at
first t •
10. D t a la rm
a ·v . ,ed in
the ga uge ?
If a y ans ers i Li nes 3 , 5 , or 6 are .,
Test Results,
Com m.enrts:
□'ires D
□Vies D
□Vies D
□~es D
□Vies D , o
Tes t e r's Na me ________________ _
□Yes □ 0 □Yes D IN □Yes □ 0
□Yes D 0 D ves D □Yes D Q
□Yes □ O ves □No □Yes □ Q
□Yes D o □Yes D No
□Yes D □Yes O o □Yes O r o
0 ass D ai l 0 P ss □Fa il 0 Pass OF ll
Teste r's Si gnatu m -~-------------
635 S 1950 WEST
WALMART #WM3208
635 S 1950 WEST, SPRINGVILLE, UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE, AR 72716
479-204-3407
01/19/2024
ANNULAR ANNULAR ANNULAR STP STP STP SRP
RUL RUL2 PREM/DSL RUL RUL2 PREM DSL
UT151
David Mathie
• ete rmin e wh e
o r r ecurrin g w a rnin gs or ala r s
regar ding, t he l ea k se n~o r? h' e
a r d -unc v ning ,
rop e rly i e ntified o n he
-
□
0 cri i-
n
0 Wate r
roduc1
0 Yes □No
0 Yes □No
i cates t he sens r fails t he esl
'Te-st Res1ults ] Qi Pass D ai l
Comments:
UQllJED SENSOR FUNCllONAUlY TESllNG
Owne r:
□ ,;: rimin atin g D Disc rimina in g in atin g □D i scr imin at in g_
0 ri i -0 N n-d iscrimi-crimi-0 N n-d iscrim i-
n "i ng
0 Wa e r 110 Wate r
D Product □P roduct
!0Yes □N 0 Yes □N o li0Yes O N 0 Yes □N 0ies □N o
0 Yes O N 0 Yes □N o 0{es □N o
~Yes O N IQ]Yes 0 No IQ]Y,-c: O N IQ]"¥es [[J N 0i'es []No
!0Yes O N 0 Yes 0 Yes O N 0Yes □N o
0 Yes O N 0 Yes □N o ~Yes O N [l;Z!Yes []No
Qi Pass D Fa i l Qi ass OF ii i;z]Pass o ~ai l [J;Z]Pass □Fail
Tester 's Na e ______________ _ Teste r's Sig atur e _ J)t-_______________ _
,er
0ies Do
0'{es O o
es [J: o
0ies Do
[0Yes □N o
[Q']P ass [Ya ii
635 S 1950 WEST
WALMART #WM3208
635 S 1950 WEST, SPRINGVILLE, UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE, AR 72716
479-204-3407
01/19/2024
UDC UDC UDC UDC UDC UDC UDC
1/2 3/4 5/6 7/8 9/10 11/12 13/14
UT151
David Mathie
• ete rmin e wh e
o r r ecurrin g w a rnin gs or a la r n,s
rega r ding, t he l ea k se n~o r? h' e
a r d -unc v ning ,
rop e rly i e ntified o n he
-
□
0 cri i-
n
0 Wate r
roduc1
0 Yes □No
0 Yes □No
i cates t he sens r fa il s t he esl
'Te-st Res1ults ] Qi Pass D ai l
Comments:
UQllJED SENSOR FUNCllONAUlY TESllNG
Owne r:
□ ,;: rimin atin g D Discrimina in g in atin g □D i sc rimin at in g_
0 ri i -0 N n-d iscrimi-crimi-0 N n-d iscrim i-
n "i ng
0 Wa e r 110 Wate r
D Product □P rodu ct
!0Yes □N 0 Yes □N o li0Yes O N 0 Yes □N 0ies □N o
0 Yes O N 0 Yes □N o 0{es □N o
~Yes O N IQ]Yes 0 No IQ]y;-,;: O N IQ]"¥es [[J N 0i'es []No
!0Yes O N 0 Yes 0 Yes O N 0Yes □N o
0 Yes O N 0 Yes □N o ~Yes O N [l;Z!Yes []No
Qi Pass D Fa i l Qi ass OF i i i;z]Pass o ~ai l [J;Zj Pass □Fa il
Tester 's Na e ______________ _ Teste r's Sig atur e _ J)t-_______________ _
,er
0.'es Do
0'{es O o
es [J: o
0.'es Do
[0Yes □N o
[Q']P ass [Ya ii
635 S 1950 WEST
WALMART #WM3208
635 S 1950 WEST, SPRINGVILLE, UT 84663
WM3208
Tanknology, Inc.
SAM'S CLUB
2001 S.E. 10TH STREET DEPT. # 449562
BENTONVILLE, AR 72716
479-204-3407
01/19/2024
UDC
15/16
UT151
David Mathie
• ete rmin e wh e
o r r ecurrin g w a rnin gs or a la r n,s
rega r ding, t he l ea k se n~o r? h' e
a r d -unc v ning ,
rop e rly i e ntified o n he
-
□
0 cri i-
n
0 Wate r
roduc1
0 Yes □No
0 Yes □No
i cates t he sens r fa il s t he esl
'Te-st Res1ults ] Qi Pass D ai l
Comments:
UQllJED SENSOR FUNCllONAUlY TESllNG
Own e r:
□ ,;: rimin atin g D Discri mina in g in atin g □D i sc rimin at in g_
□ ri i -□N n-d iscrimi-crimi-O N n-d iscrim i-
n "i ng
D w a e r □Wate r
D Product □P roduct
□Yes □N □Yes □N o □Yes O N □Yes □N Dies □N o
□Yes O N □Yes □N o □Yi ,;: O N [](es □N o
0Yes O N □Yes 0 No 0 "¥es [[J N [[]Yes [[]No
□Yes O N □Yes l□N o □Yes 0 Yes O N Otes □N o
□Yes O N □Yes □N o □Yes O N Q{es []No
□Pass □Fa il 0 ass OF i i □Pass □~ai l []Pass □Fa il
Tester 's Na e ______________ _ Teste r's Sig at ur e _ J)t-_______________ _
,er
Dies Do
[]{es O o
[]{es [J: o
Dies Do
[[J'ass [Yai l
2 inch Pressure Decay Test
TP201.3

Store Information Testing Company
Site Name :WALMART #WM3208 Name :TANKNOLOGY INC.
Address :635 S 1950 WEST
SPRINGVILLE, UT 84663
Address :11000 N. MoPac Expressway Suite 500
Austin, TX 78759
Phone :-Phone :[phone]

Stage I System?DUAL
Stage II System?NONE
Total # of Nozzles :16
Products per Nozzle :3
Tanks Manifolded ?Yes
Drop-Out tank present?NO
Total # of Tanks Tested :3

Tank Information :
Product Grade :
Tank Capacity, gallons :
Gasoline, gallons :
Ullage, gallons :
Testing Information :
Start Time :
Initial Pressure, wcg :
Pressure @ 1 minute(s) :
Pressure @ 2 minutes :
Pressure @ 3 minutes :
Pressure @ 4 minutes :
Pressure @ 5 minutes :
Allowable Final Pressure :
Pass/Fail (Enter "GF" Gross Failure)
1
RUL
19782
10912
8870

2
RUL 2
19782
11155
8627

3
PREMIUM
7901
5212
2689

11:21
2.00
2.00
2.00
2.00
1.99
1.99
1.95
Pass

Total

47465
27279
20186
All
11:21
2.00
2.00
2.00
2.00
1.99
1.99
1.95
Pass
Comments:

Tester :David Mathie Test Date :1/19/2024
Signature :Work Order :2364470

WO: 2364470
Tanknology
-
14
PVVC tested ==>GAS Manifolded
Final Test Result (Pass / Fail) ==>Pass
PVVC Manuf. ==>Husky Model Number ==>5885
Is this Original or
Replacement?
Original
If this cap is being
replaced, check here:
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 12 0.0254 Pass
Low High Measured
Pos Cracking (in H2O)2.50 6.00 3.52 Pass
Neg Leak Rate (CFH)0.21 23 0.0488 Pass
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -7.68 Pass
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
11000 N. MOPAC EXPRESSWAY, SUITE 500, AUSTIN, TX 78759
[phone]
QP-08-03-FF-02 Pressure Vacuum Vent Cap TP-201.1E Field Form
Rev C 1/27/2011
Site Overall Test Results: Pass
Total +ve LR: 0.0254
Total -ve LR: 0.0488

Test Date 1/19/2024
Technician Name David Mathie
WO #2364470
Facility Name / Loc #WALMART #WM3208 WM3208
Street 635 S 1950 WEST
City, St, Zip SPRINGVILLE, UT 84663

Pressure Vacuum Vent Cap Test Form TP-201.1E

Tanknology
~ □
--
n
I I
I ~ I ~
I I
I I
r r
--
I
I ~ I
I ~
I I
I I
r □
--
I
I ~ I
I ~
I I
I I
Stage I Vapor System Survey
Survey to determine compliance with Requirements of Title 40 Part 63 National Emission Standards for Hazardous Air Pollutants for Source Categories

Survey Date 1/19/2024 Work Order 2364470
Cust Name / Location Number WM3208
Street Address 635 S 1950 WEST
City, State, ZipCode SPRINGVILLE UT 84663

Product
Stage I Type
Drop Tubes Type
Drop Tubes Max inches from tank Bottom
Fill Adapters Type
Vapor Adapters Type
NESHAP Work Required?

Vent Caps
Type
Labeled Positive Cracking Pressure
Labeled Negative Cracking Pressure
1
RUL
Dual Point
Straight w/ Flapper
6.00
Swivel
Swivel (poppet)
No

GAS
Pressure Vacuum cap
3
8
2
RUL 2
Dual Point
Straight w/ Flapper
6.00
Swivel
Swivel (poppet)
No

3
PREMIUM
Dual Point
Straight w/ Flapper
6.00
Swivel
Swivel (poppet)
No

Describe Work Required

Surveyed by Signature
Tanknology
Sam's Club Emergency Stop (E-Stop / ESO) Periodic Inspection
Facility Information Technician Information
Site #: WM3208 Date: 1/19/2024
Address: 635 S 1950 WEST Name: David Mathie
City / State: SPRINGVILLE UT Technician Signature:
SITE DATA
1 Number of E-Stop switches INSIDE the building: 1
2 Number of E-Stop switches OUTSIDE the building: 3
3 Call Alarm Central at 479-273-4600
a.Press 1 for Alarm Central
b.Then press 4 for Technician
c.Tell the operator you want the Sam's Club / Wal-Mart Gas Station account for club membership WM3208 put on test.
d.They will ask for a password which is: 9350.
e.Record the Alarm Central persons name and the time that you spoke to them(Pre Alarm) CHERLY 10:50:00
PERFORMANCE DATA Yes No NA
4 You have added or confirmed that all E-Stop locations are on the Site Diagram
5 Do all E-Stops shutdown power to ALL DISPENSERS
6 Do all E-Stops shutdown power to ALL STP's
7 Are ALL E-Stops clearly Labeled
8 Are the TURBINE BREAKERS clearly identified / labeled
POST TEST
9 All equipment secured and any access ports, lids, enclosures are closed.
10 All safety barricades and test equipment has been properly removed
11 E-Stop was reset and all dispensing functions are normal
12 Call Alarm Central at 479-273-4600
a.Ask if Alarm was Received and if Yes, advise that testing is complete
b.Record the Alarm Central persons name and the time that you spoke to them(Post Alarm) ARRON 11:59:00
E-Stop Inspection Results
PASS FAIL INCONCLUSIVE
Comments

WO: 2364470
Tanknology
14-
r. r r
r. r r
r. r r
r. r r
r. r r
r. r r
r. r r
r. r r
r. r r
r. r r
ANNUAL CONTAINMENT SUMP INSPECTION
This form may be utilized to document the inspection of containment sumps.
Date of Inspection
1/19/2024
UST Facility Person Conducting Test
Facility Name
WALMART #WM3208
Facility ID #
WM3208
Tester's Name
DMATHIE
Physical Address
635 S 1950 WEST
Company
Tanknology Inc.
City
SPRINGVILLE
County
UTAH
State
UT
Certification #
41442
Expiration Date
10/20/2025
UST Owner
SAM'S CLUB
Tester's Signature Date
1/19/2024
Containment Sump Inspection
Sump Material
of Construction Fiberglass Reinforced Plastic Thermoplastic Steel Composite
Containment Sump Inspection Procedure
1. Clean-out and properly dispose of all debris, soil and/or fluids from the containment sump.
2. Visually examine the containment sump to ensure there are no cracks, holes, deteriorated seals, deformation or other
indications that the sump is not liquid tight.
3. If the sump appears to be liquid tight and no water was in the sump, the inspection result is "pass" and no further
action is required.
4. If the sump appears to be liquid tight but water was present within the sump, the inspection result is "fail".
5. If there is visual evidence that the sump is not liquid tight, then repair or replacement (see note below) of the sump is
required.
Inspection Results for the Year 2024
Sump ID
(product stored for STP or
dispenser number)
Sump lid/gasket in good
condition (yes/no)
Sump is dry (yes/no)
All penetration fittings in
good condition (yes/no)
Sump walls/bottom in
good condition (yes/no)
Are there any leaks from
pipe components (yes/no)
Inspection Result
(Pass/Fail)
STP:1 RUL - 1
Y
Y
Y
Y
N
Pass
STP:2 RUL 2 - 1
Y
Y
Y
Y
N
Pass
STP:3 PREMIUM - 1
Y
Y
Y
Y
N
Pass
STP:4 Low Sulfur Diesel -
1
Y
Y
Y
Y
N
Pass
Comments:

WO: 2364470
□ □ □
Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2364470
Site ID / Name:WM3208 / WALMART #WM3208
Address:635 S 1950 WEST
City:SPRINGVILLE State:UT Zip:84663
Tanknology
~ ~ 0
(/)
-I
0
::0 m
~ ¥
~ ~
~
W.O.# NW1-2364470 Cust Ref#: 38346723
+AAE-
I10100
01/19/24 12:40 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
SYSTEM STATUS REPORT
ID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME
Cn 1 Contact AUTODIAL FAILURE ALARM 01-19-24 12:08PM
+AAMAAQ-
I90200
01/19/24 12:40 PM
SOFTWARE REVISION LEVEL
VERSION 33.54
SOFTWARE+ACM- 342005-010-J-
CREATED - 23.08.07.19.08
+AAMAAQ-
I20100
01/19/24 12:40 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
IN-TANK INVENTORY
TANK PRODUCT VOLUME TC-VOLUME ULLAGE HEIGHT WATER TEMP
1 T1-Unleaded 10915 10984 7067 63.89 0.00 51.01
2 T2-Unleaded 11153 11233 6829 66.78 0.00 49.72
3 T3-Premium 5213 5257 2688 74.16 0.00 47.90
4 T4-Diesel 6046 6072 5858 60.00 0.00 50.54
+AAMAAQ-
I30100
01/19/24 12:40 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
LIQUID STATUS REPORT
SENSOR LOCATION STATUS
1 Unld. T1 STP Sump Normal
2 Unld. T2 STP Sump Normal
3 Prem. T3 STP Sump Normal
4 DIE.T4 STP Sump Normal
5 Unld. T1 Int. Space Normal
6 Unld. T2 Int. Space Normal
7 Prem./DIE T3/T4 Int. Normal
8 UDC FP 1-2 Normal
9 UDC FP 3-4 Normal
10 UDC FP 5-6 Normal
11 UDC FP 7-8 Normal
12 UDC FP 9-10 Normal
13 UDC FP 11-12 Normal
14 UDC FP 13-14 Normal
15 UDC FP 15-16 Normal
+AAMAAQ-
I30200
01/19/24 12:40 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
LIQUID ALARM HISTORY REPORT
SENSOR LOCATION
1 Unld. T1 STP Sump
01/19/24 9:24 AM FUEL ALARM
2 Unld. T2 STP Sump
01/19/24 9:25 AM FUEL ALARM
3 Prem. T3 STP Sump
01/19/24 9:26 AM FUEL ALARM
4 DIE.T4 STP Sump
01/19/24 9:28 AM FUEL ALARM
5 Unld. T1 Int. Space
01/19/24 10:04 AM FUEL ALARM
6 Unld. T2 Int. Space
01/19/24 10:08 AM FUEL ALARM
7 Prem./DIE T3/T4 Int.
01/19/24 10:12 AM FUEL ALARM
8 UDC FP 1-2
01/19/24 9:50 AM FUEL ALARM
9 UDC FP 3-4
01/19/24 9:51 AM FUEL ALARM
10 UDC FP 5-6
01/19/24 9:51 AM FUEL ALARM
11 UDC FP 7-8
01/19/24 9:51 AM FUEL ALARM
12 UDC FP 9-10
01/19/24 9:52 AM FUEL ALARM
13 UDC FP 11-12
01/19/24 9:52 AM FUEL ALARM
14 UDC FP 13-14
01/19/24 9:53 AM FUEL ALARM
15 UDC FP 15-16
01/19/24 9:53 AM FUEL ALARM
+AAMAAQ-
I11F00
01/19/24 12:40 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
Selected Range:
All Records:
Sensor Status History Report - All Sensors
+ACM- Sensor Location Status Active Clear
L 1 Unld. T1 STP Sump FUEL ALARM 01/19/24 9:24A 01/19/24 9:28A
L 2 Unld. T2 STP Sump FUEL ALARM 01/19/24 9:25A 01/19/24 9:29A
L 3 Prem. T3 STP Sump FUEL ALARM 01/19/24 9:26A 01/19/24 9:30A
L 4 DIE.T4 STP Sump FUEL ALARM 01/19/24 9:28A 01/19/24 9:31A
L 5 Unld. T1 Int. Space FUEL ALARM 01/19/24 10:04A 01/19/24 10:21A
L 6 Unld. T2 Int. Space FUEL ALARM 01/19/24 10:08A 01/19/24 10:24A
L 7 Prem./DIE T3/T4 Int. FUEL ALARM 01/19/24 10:12A 01/19/24 10:25A
L 8 UDC FP 1-2 FUEL ALARM 01/19/24 9:50A 01/19/24 9:55A
L 9 UDC FP 3-4 FUEL ALARM 01/19/24 9:51A 01/19/24 9:55A
L 10 UDC FP 5-6 FUEL ALARM 01/19/24 9:51A 01/19/24 9:56A
L 11 UDC FP 7-8 FUEL ALARM 01/19/24 9:51A 01/19/24 9:57A
L 12 UDC FP 9-10 FUEL ALARM 01/19/24 9:52A 01/19/24 9:58A
L 13 UDC FP 11-12 FUEL ALARM 01/19/24 9:52A 01/19/24 9:57A
L 14 UDC FP 13-14 FUEL ALARM 01/19/24 9:53A 01/19/24 9:57A
L 15 UDC FP 15-16 FUEL ALARM 01/19/24 9:53A 01/19/24 9:57A
+AAMAAQ-
I20600
01/19/24 12:41 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
TANK ALARM HISTORY
TANK 1 T1-Unleaded
SETUP DATA WARNING 01/09/24 1:06 PM
HIGH WATER ALARM 01/19/24 10:28 AM
OVERFILL ALARM 01/19/24 10:36 AM
LOW PRODUCT ALARM 01/19/24 10:42 AM
01/09/24 1:07 PM
SUDDEN LOSS ALARM 01/18/24 10:06 AM
HIGH PRODUCT ALARM 01/19/24 10:37 AM
INVALID FUEL LEVEL 01/19/24 10:42 AM
01/19/24 10:25 AM
01/09/24 1:03 PM
HIGH WATER WARNING 01/19/24 10:28 AM
DELIVERY NEEDED 01/19/24 10:38 AM
01/19/24 10:25 AM
01/09/24 1:07 PM
MAX PRODUCT ALARM 01/19/24 10:37 AM
TANK 2 T2-Unleaded
SETUP DATA WARNING 01/09/24 1:06 PM
HIGH WATER ALARM 01/19/24 10:30 AM
OVERFILL ALARM 01/19/24 10:37 AM
LOW PRODUCT ALARM 01/19/24 10:42 AM
01/09/24 1:08 PM
SUDDEN LOSS ALARM 01/18/24 10:06 AM
HIGH PRODUCT ALARM 01/19/24 10:37 AM
INVALID FUEL LEVEL 01/19/24 10:42 AM
01/19/24 10:27 AM
01/09/24 1:04 PM
HIGH WATER WARNING 01/19/24 10:30 AM
DELIVERY NEEDED 01/19/24 10:38 AM
01/19/24 10:27 AM
01/09/24 1:08 PM
TANK 3 T3-Premium
SETUP DATA WARNING 01/09/24 1:06 PM
HIGH WATER ALARM 01/19/24 10:32 AM
OVERFILL ALARM 01/19/24 10:39 AM
LOW PRODUCT ALARM 01/19/24 10:40 AM
01/19/24 10:29 AM
01/09/24 1:09 PM
SUDDEN LOSS ALARM 01/17/24 3:19 PM
INVALID FUEL LEVEL 01/19/24 10:41 AM
01/19/24 10:29 AM
01/09/24 1:05 PM
HIGH WATER WARNING 01/19/24 10:32 AM
DELIVERY NEEDED 01/19/24 10:40 AM
01/19/24 10:29 AM
01/09/24 1:09 PM
TANK 4 T4-Diesel
SETUP DATA WARNING 01/16/24 8:31 AM
01/09/24 1:06 PM
HIGH WATER ALARM 01/19/24 10:33 AM
OVERFILL ALARM 01/19/24 10:39 AM
LOW PRODUCT ALARM 01/19/24 10:41 AM
01/19/24 10:30 AM
01/16/24 8:36 AM
SUDDEN LOSS ALARM 01/17/24 1:44 PM
INVALID FUEL LEVEL 01/16/24 8:36 AM
01/09/24 1:06 PM
HIGH WATER WARNING 01/19/24 10:33 AM
DELIVERY NEEDED 01/19/24 10:41 AM
01/19/24 10:30 AM
01/16/24 8:36 AM
+AAMAAQ-
I38200
01/19/24 12:41 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
PRESSURE LINE LEAK ALARM HISTORY REPORT
Ln 1: Unld. 1 Line
PLLD SHUTDOWN ALARM 01/19/24 11:38 AM
GROSS LINE FAIL 01/19/24 11:38 AM
Ln 2: Unld. 2 Line
PLLD SHUTDOWN ALARM 01/19/24 11:48 AM
GROSS LINE FAIL 01/19/24 11:48 AM
Ln 3: Prem. Line
PLLD SHUTDOWN ALARM 01/19/24 11:52 AM
GROSS LINE FAIL 01/19/24 11:52 AM
Ln 4: Diesel Line
GROSS LINE FAIL 01/19/24 11:58 AM
PLLD SHUTDOWN ALARM 01/19/24 11:58 AM
+AAMAAQ-
I11100
01/19/24 12:41 PM
885360
Walmart +ACM-3208
660 South 1750 West
Springville UT 84663
PRIORITY ALARM HISTORY
ID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME
Cn 1 Contact AUTODIAL FAILURE ALARM 01-19-24 12:08PM
Cn 1 Contact AUTODIAL FAILURE CLEAR 01-19-24 12:08PM
Q 4 Line Diesel Line GROSS LINE FAIL CLEAR 01-19-24 12:03PM
Ln 4 Line Diesel Line LINE OUT CLEAR 01-19-24 12:03PM
Q 4 Line Diesel Line PLLD SHUTDOWN ALARM CLEAR 01-19-24 12:03PM
Q 3 Line Prem. Line GROSS LINE FAIL CLEAR 01-19-24 11:58AM
Ln 3 Line Prem. Line LINE OUT CLEAR 01-19-24 11:58AM
Q 3 Line Prem. Line PLLD SHUTDOWN ALARM CLEAR 01-19-24 11:58AM
Ln 4 Line Diesel Line LINE OUT ALARM 01-19-24 11:58AM
Q 4 Line Diesel Line PLLD SHUTDOWN ALARM ALARM 01-19-24 11:58AM
Q 4 Line Diesel Line GROSS LINE FAIL ALARM 01-19-24 11:58AM
Cn 1 Contact AUTODIAL FAILURE ALARM 01-19-24 11:57AM
Cn 1 Contact AUTODIAL FAILURE CLEAR 01-19-24 11:57AM
Q 2 Line Unld. 2 Line GROSS LINE FAIL CLEAR 01-19-24 11:52AM
Ln 2 Line Unld. 2 Line LINE OUT CLEAR 01-19-24 11:52AM
Q 2 Line Unld. 2 Line PLLD SHUTDOWN ALARM CLEAR 01-19-24 11:52AM
Ln 3 Line Prem. Line LINE OUT ALARM 01-19-24 11:52AM
Q 3 Line Prem. Line PLLD SHUTDOWN ALARM ALARM 01-19-24 11:52AM
Q 3 Line Prem. Line GROSS LINE FAIL ALARM 01-19-24 11:52AM
Ln 2 Line Unld. 2 Line LINE OUT ALARM 01-19-24 11:48AM
Q 2 Line Unld. 2 Line PLLD SHUTDOWN ALARM ALARM 01-19-24 11:48AM
Q 2 Line Unld. 2 Line GROSS LINE FAIL ALARM 01-19-24 11:48AM
Cn 1 Contact AUTODIAL FAILURE ALARM 01-19-24 11:47AM
Cn 1 Contact AUTODIAL FAILURE CLEAR 01-19-24 11:47AM
Q 1 Line Unld. 1 Line GROSS LINE FAIL CLEAR 01-19-24 11:45AM
Ln 1 Line Unld. 1 Line LINE OUT CLEAR 01-19-24 11:45AM
Q 1 Line Unld. 1 Line PLLD SHUTDOWN ALARM CLEAR 01-19-24 11:45AM
Ln 1 Line Unld. 1 Line LINE OUT ALARM 01-19-24 11:38AM
Q 1 Line Unld. 1 Line PLLD SHUTDOWN ALARM ALARM 01-19-24 11:38AM
Q 1 Line Unld. 1 Line GROSS LINE FAIL ALARM 01-19-24 11:38AM
Cn 1 Contact AUTODIAL FAILURE ALARM 01-19-24 10:47AM
Cn 1 Contact AUTODIAL FAILURE CLEAR 01-19-24 10:47AM
T 4 Tank T4-Diesel OVERFILL ALARM CLEAR 01-19-24 10:46AM
T 4 Tank T4-Diesel LOW PRODUCT ALARM CLEAR 01-19-24 10:46AM
T 3 Tank T3-Premium OVERFILL ALARM CLEAR 01-19-24 10:45AM
T 3 Tank T3-Premium LOW PRODUCT ALARM CLEAR 01-19-24 10:45AM
T 2 Tank T2-Unleaded LOW PRODUCT ALARM CLEAR 01-19-24 10:44AM
T 1 Tank T1-Unleaded OVERFILL ALARM CLEAR 01-19-24 10:43AM
T 1 Tank T1-Unleaded LOW PRODUCT ALARM CLEAR 01-19-24 10:43AM
T 2 Tank T2-Unleaded OVERFILL ALARM CLEAR 01-19-24 10:43AM
T 2 Tank T2-Unleaded LOW PRODUCT ALARM ALARM 01-19-24 10:42AM
T 1 Tank T1-Unleaded LOW PRODUCT ALARM ALARM 01-19-24 10:42AM
T 4 Tank T4-Diesel LOW PRODUCT ALARM ALARM 01-19-24 10:41AM
T 3 Tank T3-Premium LOW PRODUCT ALARM ALARM 01-19-24 10:40AM
T 4 Tank T4-Diesel HIGH WATER ALARM CLEAR 01-19-24 10:39AM
T 3 Tank T3-Premium HIGH WATER ALARM CLEAR 01-19-24 10:39AM
T 4 Tank T4-Diesel OVERFILL ALARM ALARM 01-19-24 10:39AM
T 3 Tank T3-Premium OVERFILL ALARM ALARM 01-19-24 10:39AM
T 2 Tank T2-Unleaded HIGH WATER ALARM CLEAR 01-19-24 10:39AM
T 1 Tank T1-Unleaded HIGH WATER ALARM CLEAR 01-19-24 10:38AM
+AAMAAQ-
I6SU00
01/19/24 12:41 PM
--------------------------------------------------------
+ACoAKgAq- SETUP FOR ALL TANKS +ACoAKgAq-
--------------------------------------------------------
ULLAGE DISPLAY MODE: FULL ULLAGE
USER ULLAGE
FULL ULLAGE LABEL: 100+ACU- ULLAGE
USER ULLAGE: 90+ACU-
PRINT TC VOLUMES: ENABLED
TC REFERENCE TEMPERATURE: 60 DEG F
PERIODIC TEST NEEDED
WARNINGS: DISABLED
DAYS BEFORE PERIODIC WARNING: 25
DAYS BEFORE PERIODIC ALARM: 30
ANNUAL TEST NEEDED WARNINGS: DISABLED
DAYS BEFORE ANNUAL WARNING: 355
DAYS BEFORE ANNUAL ALARM: 365
TC DENSITY: DISABLED
STICK HEIGHT: DISABLED
LEAK TEST REPORT FORMAT: ENHANCED
LEAK TEST REGION: EPA
--------------------------------------------------------
+ACoAKgAq- TANK SETUP +ACoAKgAq-
--------------------------------------------------------
--- GENERAL SETUP - TANK 1 ---
CONFIGURED: ENABLED
LABEL: T1-Unleaded
PRODUCT CODE: 1
PROBE NUMBER: Pb 1: Unld. Tk +ACM-1 Probe
PROBE OFFSET: 0.00 INCHES
FULL VOLUME: 19782 GALLONS
DIAMETER: 118.4 INCHES
TILT: 0.00 INCHES
THERMAL COEFFICIENT: 0.000700
METER DATA PRESENT: ENABLED
DELIVERY DELAY: 5 MINUTES
GROSS TEST FAIL: ALARMS DISABLED
PERIODIC TEST FAIL: ALARMS DISABLED
ANNUAL TEST FAIL: ALARMS DISABLED
GOST VOLUME CORRECTION: DISABLED
--- LIMITS - TANK 1 ---
MAX VOLUME: 17982 GALLONS
HIGH PRODUCT: 95+ACU-
DELIVERY OVERFILL: 90+ACU-
DELIVERY LIMIT: 15+ACU-
LOW PRODUCT: 536 GALLONS
HIGH WATER WARNING: 1.00 INCHES
HIGH WATER ALARM: 3.00 INCHES
WATER ALARM FILTER LEVEL: LOW
LEAK ALARM LIMIT: 15 GALLONS
SUDDEN LOSS LIMIT: 50 GALLONS
FUEL LOW TEMP LIMIT: -58.000 DEG F
FUEL HIGH TEMP LIMIT: 140.000 DEG F
--- ENVIRONMENTAL TESTS - TANK 1 ---
TANK TEST METHOD: DISABLED
--- PROFILE - TANK 1 ---
TANK PROFILE: FOUR POINT
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 19782 003 59.2 9883
002 88.8 16039 004 29.6 3735
--- TANK 1 - CHART 1 ---
LABEL: +ACoAKgAqACoAKg-
TYPE: FOUR POINT
SOURCE: USER ENTERED
LAST CHANGE: 2024-01-16
STATUS: ACTIVE
VOLUME ENTRY: TOTAL VOLUME
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 19782 003 59.2 9883
002 88.8 16039 004 29.6 3735
--- TANK 1 ---
T1 SIPHON MANIFOLDED TO
TANKS: 2
T1 LINE MANIFOLDED TO TANKS: NONE
--- ACCUCHART - TANK 1 ---
UPDATE SCHEDULE: NEVER
CALIBRATION PERIOD: 120 DAYS
WARNINGS: DISABLED
MIN OPERATING LEVEL: 10+ACU-
MAX OPERATING LEVEL: 80+ACU-
--- HRM - TANK 1 ---
WARNING LIMIT: 1 GALLONS
ALARM LIMIT: 1 GALLONS
MAXIMUM VOLUME LIMIT: 132 GALLONS
--- GENERAL SETUP - TANK 2 ---
CONFIGURED: ENABLED
LABEL: T2-Unleaded
PRODUCT CODE: 2
PROBE NUMBER: Pb 2: Unld. Tk +ACM-2 Probe
PROBE OFFSET: 0.00 INCHES
FULL VOLUME: 19782 GALLONS
DIAMETER: 118.4 INCHES
TILT: 0.00 INCHES
THERMAL COEFFICIENT: 0.000700
METER DATA PRESENT: ENABLED
DELIVERY DELAY: 5 MINUTES
GROSS TEST FAIL: ALARMS DISABLED
PERIODIC TEST FAIL: ALARMS DISABLED
ANNUAL TEST FAIL: ALARMS DISABLED
GOST VOLUME CORRECTION: DISABLED
--- LIMITS - TANK 2 ---
MAX VOLUME: 17982 GALLONS
HIGH PRODUCT: 95+ACU-
DELIVERY OVERFILL: 90+ACU-
DELIVERY LIMIT: 15+ACU-
LOW PRODUCT: 536 GALLONS
HIGH WATER WARNING: 1.00 INCHES
HIGH WATER ALARM: 3.00 INCHES
WATER ALARM FILTER LEVEL: LOW
LEAK ALARM LIMIT: 15 GALLONS
SUDDEN LOSS LIMIT: 50 GALLONS
FUEL LOW TEMP LIMIT: -58.000 DEG F
FUEL HIGH TEMP LIMIT: 140.000 DEG F
--- ENVIRONMENTAL TESTS - TANK 2 ---
TANK TEST METHOD: DISABLED
--- PROFILE - TANK 2 ---
TANK PROFILE: FOUR POINT
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 19782 003 59.2 9883
002 88.8 15039 004 29.6 3735
--- TANK 2 - CHART 1 ---
LABEL: +ACoAKgAqACoAKg-
TYPE: FOUR POINT
SOURCE: USER ENTERED
LAST CHANGE: 2024-01-16
STATUS: ACTIVE
VOLUME ENTRY: TOTAL VOLUME
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 19782 003 59.2 9883
002 88.8 15039 004 29.6 3735
--- TANK 2 ---
T2 SIPHON MANIFOLDED TO
TANKS: 1
T2 LINE MANIFOLDED TO TANKS: NONE
--- ACCUCHART - TANK 2 ---
UPDATE SCHEDULE: NEVER
CALIBRATION PERIOD: 120 DAYS
WARNINGS: DISABLED
MIN OPERATING LEVEL: 10+ACU-
MAX OPERATING LEVEL: 80+ACU-
--- HRM - TANK 2 ---
WARNING LIMIT: 1 GALLONS
ALARM LIMIT: 1 GALLONS
MAXIMUM VOLUME LIMIT: 132 GALLONS
--- GENERAL SETUP - TANK 3 ---
CONFIGURED: ENABLED
LABEL: T3-Premium
PRODUCT CODE: 3
PROBE NUMBER: Pb 3: Prem. Tk +ACM-3 Probe
PROBE OFFSET: 0.00 INCHES
FULL VOLUME: 7901 GALLONS
DIAMETER: 118.4 INCHES
TILT: 0.00 INCHES
THERMAL COEFFICIENT: 0.000700
METER DATA PRESENT: ENABLED
DELIVERY DELAY: 5 MINUTES
GROSS TEST FAIL: ALARMS DISABLED
PERIODIC TEST FAIL: ALARMS DISABLED
ANNUAL TEST FAIL: ALARMS DISABLED
GOST VOLUME CORRECTION: DISABLED
--- LIMITS - TANK 3 ---
MAX VOLUME: 7901 GALLONS
HIGH PRODUCT: 95+ACU-
DELIVERY OVERFILL: 90+ACU-
DELIVERY LIMIT: 15+ACU-
LOW PRODUCT: 536 GALLONS
HIGH WATER WARNING: 1.00 INCHES
HIGH WATER ALARM: 3.00 INCHES
WATER ALARM FILTER LEVEL: LOW
LEAK ALARM LIMIT: 15 GALLONS
SUDDEN LOSS LIMIT: 50 GALLONS
FUEL LOW TEMP LIMIT: -58.000 DEG F
FUEL HIGH TEMP LIMIT: 140.000 DEG F
--- ENVIRONMENTAL TESTS - TANK 3 ---
TANK TEST METHOD: DISABLED
--- PROFILE - TANK 3 ---
TANK PROFILE: FOUR POINT
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 7901 003 59.2 3959
002 88.8 6358 004 29.6 1558
--- TANK 3 - CHART 1 ---
LABEL: +ACoAKgAqACoAKg-
TYPE: FOUR POINT
SOURCE: USER ENTERED
LAST CHANGE: 2024-01-16
STATUS: ACTIVE
VOLUME ENTRY: TOTAL VOLUME
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 7901 003 59.2 3959
002 88.8 6358 004 29.6 1558
--- TANK 3 ---
T3 SIPHON MANIFOLDED TO
TANKS: NONE
T3 LINE MANIFOLDED TO TANKS: NONE
--- ACCUCHART - TANK 3 ---
UPDATE SCHEDULE: NEVER
CALIBRATION PERIOD: 120 DAYS
WARNINGS: DISABLED
MIN OPERATING LEVEL: 10+ACU-
MAX OPERATING LEVEL: 80+ACU-
--- HRM - TANK 3 ---
WARNING LIMIT: 1 GALLONS
ALARM LIMIT: 1 GALLONS
MAXIMUM VOLUME LIMIT: 132 GALLONS
--- GENERAL SETUP - TANK 4 ---
CONFIGURED: ENABLED
LABEL: T4-Diesel
PRODUCT CODE: 4
PROBE NUMBER: Pb 4: Diesel Tk +ACM-3 Probe
PROBE OFFSET: 0.00 INCHES
FULL VOLUME: 11904 GALLONS
DIAMETER: 118.4 INCHES
TILT: 0.00 INCHES
THERMAL COEFFICIENT: 0.000450
METER DATA PRESENT: ENABLED
DELIVERY DELAY: 5 MINUTES
GROSS TEST FAIL: ALARMS DISABLED
PERIODIC TEST FAIL: ALARMS DISABLED
ANNUAL TEST FAIL: ALARMS DISABLED
GOST VOLUME CORRECTION: DISABLED
--- LIMITS - TANK 4 ---
MAX VOLUME: 11904 GALLONS
HIGH PRODUCT: 95+ACU-
DELIVERY OVERFILL: 90+ACU-
DELIVERY LIMIT: 15+ACU-
LOW PRODUCT: 536 GALLONS
HIGH WATER WARNING: 1.00 INCHES
HIGH WATER ALARM: 3.00 INCHES
WATER ALARM FILTER LEVEL: LOW
LEAK ALARM LIMIT: 15 GALLONS
SUDDEN LOSS LIMIT: 50 GALLONS
FUEL LOW TEMP LIMIT: -58.000 DEG F
FUEL HIGH TEMP LIMIT: 140.000 DEG F
--- ENVIRONMENTAL TESTS - TANK 4 ---
TANK TEST METHOD: DISABLED
--- PROFILE - TANK 4 ---
TANK PROFILE: FOUR POINT
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 11904 003 59.2 5936
002 88.8 9700 004 29.6 2183
--- TANK 4 - CHART 1 ---
LABEL: +ACoAKgAqACoAKg-
TYPE: FOUR POINT
SOURCE: USER ENTERED
LAST CHANGE: 2024-01-16
STATUS: ACTIVE
VOLUME ENTRY: TOTAL VOLUME
+ACM- HEIGHT VOLUME +ACM- HEIGHT VOLUME
--- ------ ------ --- ------ ------
001 118.4 11904 003 59.2 5936
002 88.8 9700 004 29.6 2183
--- TANK 4 ---
T4 SIPHON MANIFOLDED TO
TANKS: NONE
T4 LINE MANIFOLDED TO TANKS: NONE
--- ACCUCHART - TANK 4 ---
UPDATE SCHEDULE: NEVER
CALIBRATION PERIOD: 120 DAYS
WARNINGS: DISABLED
MIN OPERATING LEVEL: 10+ACU-
MAX OPERATING LEVEL: 80+ACU-
--- HRM - TANK 4 ---
WARNING LIMIT: 1 GALLONS
ALARM LIMIT: 1 GALLONS
MAXIMUM VOLUME LIMIT: 132 GALLONS
+AAMAAQ-
I70300
01/19/24 12:42 PM
LIQUID MODEL
SENSOR LABEL MODEL
1 Unld. T1 STP Sump Tri-State(Single Float)
2 Unld. T2 STP Sump Tri-State(Single Float)
3 Prem. T3 STP Sump Tri-State(Single Float)
4 DIE.T4 STP Sump Tri-State(Single Float)
5 Unld. T1 Int. Space Tri-State(Single Float)
6 Unld. T2 Int. Space Tri-State(Single Float)
7 Prem./DIE T3/T4 Int. Tri-State(Single Float)
8 UDC FP 1-2 Tri-State(Single Float)
9 UDC FP 3-4 Tri-State(Single Float)
10 UDC FP 5-6 Tri-State(Single Float)
11 UDC FP 7-8 Tri-State(Single Float)
12 UDC FP 9-10 Tri-State(Single Float)
13 UDC FP 11-12 Tri-State(Single Float)
14 UDC FP 13-14 Tri-State(Single Float)
15 UDC FP 15-16 Tri-State(Single Float)
16 Tri-State(Single Float)
17 Tri-State(Single Float)
18 Tri-State(Single Float)
19 Tri-State(Single Float)
20 Tri-State(Single Float)
21 Tri-State(Single Float)
22 Tri-State(Single Float)
23 Tri-State(Single Float)
24 Tri-State(Single Float)
25 Tri-State(Single Float)
26 Tri-State(Single Float)
27 Tri-State(Single Float)
28 Tri-State(Single Float)
29 Tri-State(Single Float)
30 Tri-State(Single Float)
31 Tri-State(Single Float)
32 Tri-State(Single Float)
33 Tri-State(Single Float)
34 Tri-State(Single Float)
35 Tri-State(Single Float)
36 Tri-State(Single Float)
37 Tri-State(Single Float)
38 Tri-State(Single Float)
39 Tri-State(Single Float)
40 Tri-State(Single Float)
41 Tri-State(Single Float)
42 Tri-State(Single Float)
43 Tri-State(Single Float)
44 Tri-State(Single Float)
45 Tri-State(Single Float)
46 Tri-State(Single Float)
47 Tri-State(Single Float)
48 Tri-State(Single Float)
49 Tri-State(Single Float)
50 Tri-State(Single Float)
51 Tri-State(Single Float)
52 Tri-State(Single Float)
53 Tri-State(Single Float)
54 Tri-State(Single Float)
55 Tri-State(Single Float)
56 Tri-State(Single Float)
57 Tri-State(Single Float)
58 Tri-State(Single Float)
59 Tri-State(Single Float)
60 Tri-State(Single Float)
61 Tri-State(Single Float)
62 Tri-State(Single Float)
63 Tri-State(Single Float)
64 Tri-State(Single Float)
65 Tri-State(Single Float)
66 Tri-State(Single Float)
67 Tri-State(Single Float)
68 Tri-State(Single Float)
69 Tri-State(Single Float)
70 Tri-State(Single Float)
71 Tri-State(Single Float)
72 Tri-State(Single Float)
73 Tri-State(Single Float)
74 Tri-State(Single Float)
75 Tri-State(Single Float)
76 Tri-State(Single Float)
77 Tri-State(Single Float)
78 Tri-State(Single Float)
79 Tri-State(Single Float)
80 Tri-State(Single Float)
81 Tri-State(Single Float)
82 Tri-State(Single Float)
83 Tri-State(Single Float)
84 Tri-State(Single Float)
85 Tri-State(Single Float)
86 Tri-State(Single Float)
87 Tri-State(Single Float)
88 Tri-State(Single Float)
89 Tri-State(Single Float)
90 Tri-State(Single Float)
91 Tri-State(Single Float)
92 Tri-State(Single Float)
93 Tri-State(Single Float)
94 Tri-State(Single Float)
95 Tri-State(Single Float)
96 Tri-State(Single Float)
97 Tri-State(Single Float)
98 Tri-State(Single Float)
99 Tri-State(Single Float)
+AAMAAQ-
I78000
01/19/24 12:42 PM
PRESSURE LINE LEAK SETUP
Q 1: Unld. 1 Line
PIPE TYPE: OPW FLEXWORKS 15
LINE LENGTH: 100 FEET
0.2 GAL/HR TEST: REPETITIVE
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: 1 - T1-Unleaded
PRESSURE OFFSET: 0.0 psi
Q 2: Unld. 2 Line
PIPE TYPE: OPW FLEXWORKS 15
LINE LENGTH: 150 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: 2 - T2-Unleaded
PRESSURE OFFSET: 0.0 psi
Q 3: Prem. Line
PIPE TYPE: OPW FLEXWORKS 15
LINE LENGTH: 220 FEET
0.2 GAL/HR TEST: REPETITIVE
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: 3 - T3-Premium
PRESSURE OFFSET: 0.0 psi
Q 4: Diesel Line
PIPE TYPE: OPW FLEXWORKS 15
LINE LENGTH: 240 FEET
0.2 GAL/HR TEST: REPETITIVE
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: 4 - T4-Diesel
PRESSURE OFFSET: 0.0 psi
Q 5:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 6:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 7:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 8:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 9:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 10:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 11:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 12:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 13:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 14:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 15:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
Q 16:
PIPE TYPE: Enviroflex PP1503/2503
LINE LENGTH: 0 FEET
0.2 GAL/HR TEST: DISABLED
0.1 GAL/HR TEST: DISABLED
SHUTDOWN RATE: 3.0 GAL/HR
LOW PRESSURE SHUTOFF: ON
LOW PRESSURE: 0.0 psi
TANK: NONE
PRESSURE OFFSET: 0.0 psi
W.O.# NW1-2364470 Cust Ref#: 38346723
OVF
Tanknology Inc.
11000 N. MoPac Expressway, Suite 500 Austin, TX 78759 (800) 964--0010
JOB CLEARANCE FORM & SITE SAFETY CHECKLIST -OVF
Polic y 100-29 -A
Rev: H
Revis ed: 6/25/2022
Foll ow-up actions re(luired; 8C1Uipmenl Isolated; commen ts:
PPE -PERSONAL PROTE
Safety Vest/Shirt (all jobs ) ~'-/Gloves (al l jo bs) D
Safety Toe Boots (all jobs) Cl' Safety Glas ses (all jobs) Hard Hat (if needed) D
Hearing Protection (if needed)
Other
✓ PRE-TEST PROCEDURES Check ✓ each item com Jeted or mark -if not a Jicable
1.
2.
3.
4.
rr gi<,cuss sa fety procedures with site personnel. Nearest hospita l: __________________ _
fGj>i1\TG pri ntout & check fu el/water levels . Prior to fuel del ivery th e system m ust be placed back into working orde r.
_VBarricade work area (cones , flags, bars/tape) and place Fir xtinguis hers~"No S oking " Signs at perimeter.
_J Con fined Space En try-If required complete separate E Checkli st. If NO check the followi ng reason:
r No CS's UCS's not opened □No en try only visua l [j o entry -used tools r~ ork from prone position w/o risk of falling in
5. r:J lm~ent Lockout/Tagout per AP! 1646 (when accessing ~piping du ring tasks )
if S~ozzles with "Oul of Service' bags and nylon ties. 0 Secu e the circuit breaker(s) wilh lockou t devices and lags.
CJP'ciose ball valves-or check valves on product piping. J o· onn ect electrical "bayonet~ connector from the STP(s).
0 All applicable equipment disabled duri ng test(s).
SIGNIN
Genera l Safety Checks:
All site personnel have been inf ormed.
Is a fu el delivery due to day? ~--~----
LOTO procedures have been discussed.
Work areas barric ed to protect workers, staff & public.
1. , , Remove al l "Lockout/Tagout" devices and nozzle bags/ti e .
2. Run all pumps and veri fy there are no lea ks : ' Impact Va lve Test Ports un·der d ispensers
IJ Leak Detector & Ven t Tubes , I STP Fun ctiona l Elements & Re lief Screws
Jicab/e
3. r, Get ATG printout. Confirm wa ter levels same as start or exp lain d ifference: ______________ _
4. ,J Checiy(ollowing components operational: ./
rf ATG probes, sensors , & caps ~ear valves are open·
IJ Bajl,floats, dry breaks & caps • ~pensers & POS .operational
~ntainmen t sumps are dry ~,. Djsj>efiser panels are replaced
lyll,'lanhole covers a nd sump lids n""iients & Extracto rs (not capped, plugged or isolated )
V Sztff conta iners & drain valves L Cathodic protection operational
rYf>~o p tubes , fl apper va lves, fil l adapters & caps f j Siphon lines and manifold va lves open
5. emove barricades.
, , SIGN'.OUT & 0 el'atbr Veilfli:aUi>ri"ofWoi1( OVF
General Safety Checks:
Work area has b een left clean & safe.
Site staff awa re of work status including any remaining isolation.
Changes to equipment are documented an·d communicated.
All incidents, near Incidents, an d unsafe situations reported.
Si le Representative Commenl s:
COMPANY CON FIDENTIAL © Tanknology Inc., .:!022. All Rights Reserved.
[Printed copies of this document are uncontrolled. The current versio n is avai labl e in lhe Tanknology On-Line Document Con trol Sys1cm.l
l _____ _