DERR-2024-004618

AST ANNUAL INSPECTION
Facility Name and Site Address: Date:
Facility ID #
Purpose:Regular Reinspection Complaints Annual Inspection
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Is tank grounding strap in good condition ?
Is tank coating free of corrosion / damage ?
Is tank free of noticable distortion, denting, buckeling ?
Flanged connection bolts appear tight ?
Normal and emergency vents appear in good condition ?
Inspection Remarks:
Technician signature
Inspected By: Steven B. Martin UT121
Applied Environmental Services L.C.
HOLLOW MOUNTAIN
40 NORTH SR 95
HANKSVILLE, UTAH
2-22-2024
2000316
X
X
X
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X NO GROUND STRAPS
X SOME SMALL RUST SPOTS
X
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X
X
801-540 9258 [e-mail]
Email:
X
X
X
X
X NO OVERFILL
Fill and vapor connections in good condition ?
N/A
UTAH TESTER UT 0121, AES UTAH, 801-540-9258
OWNER NAME AND NUMBER: DONALD G LUSKO 435-542-3298
X SWS TANKS IN CONCRETE CONTTank containment structure in satisfactory condition ?
Free of tank settlement and foundation washout ?
Tank supports in satisfactory condition ?
Is water able to drain off tank pad and tank top ?
Gasoline vent has P/V valve installed where required ?
Valves / syphons / solenoids appear in good condition ?
Spill containment visable and appears in good condition
Electrical junction boxes and conduits in good condition
Tank monitor free of active alarms ?
Emergency shutoff installed ?
Tank overfill equipment installed ?
Piping sumps appear in good condition ?
COMMENTS / ACTION
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.02.25 11:17:37 -07'00'
Reason: I am the author of this document