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HomeMy WebLinkAboutDERR-2024-004623FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT P.O. BOX 3360 DES MOINES, IA 50316 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS WWW.SENECACO.COM STORE.SENECACO.COM 6HQHFD$FFRXQW5HS 3KRQH 'DWHRI7HVW 6FRSHRI:RUN 6HQHFD-RE &XVWRPHU32 7HFKQLFLDQ &HUWLILFDWLRQ VHHWHVWUHSRUWVDWWDFKHG 7HVWLQJ6XPPDU\ 7HVW6XPPDU\'HVFULSWLRQ &RPSRQHQW7HVWHG 'DWH7HVWHG 5HVXOW &XVWRPHU,QIRUPDWLRQ 1DPH 6WUHHW $GGUHVV &LW\ 6WDWH =LS &RQWDFW 3KRQH 1XPEHU 6LWH,QIRUPDWLRQ 6LWH1DPH Testing Summary 6WUHHW $GGUHVV &LW\ 6WDWH =LS )DFLOLW\1R 2/22/24 TLT-W24000 ATG, LD, Line, Tank Kum & Go Maverik 1459 Grand Ave Des Moines IA 50309 Jenny Carpenter 515-763-6230 KG #2516 4978 W 12600 S Herriman UT 84096 4002674 ATG - Monitoring System Certification VR TLS-450+02/22/2024 Pass ATG - PEI Monitoring 4 Probes 13 Sensors 02/22/2024 Pass LD-Leak Detector Unl PLLD 02/22/2024 Pass LD-Leak Detector Prm PLLD 02/22/2024 Pass LD-Leak Detector Dsl PLLD 02/22/2024 Pass LD-Leak Detector Clr PLLD 02/22/2024 Pass Line Test 4 Lines 02/22/2024 Pass Tank Test 4 Tanks 02/22/2024 Pass Stage I Pressure Decay UNL, PRM, Clr 02/22/2024 Pass Jenny Carpenter Garrett Herlache 515-763-6230 )LHOG1RWHV 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM Testing Summary 7HVWLQJ6XPPDU\ FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT Site Location - KG #2516 Herriman, UT Job #: TLT-W24000 Arrived on site and checked in with manager. Opened sumps and dispenser and then began testing. Dri Sump SB – n/a Dri Sump Sumps – n/a Dri Sump UDC – n/a Spill Bucket Hydro – n/a SB / Low Level – n/a Stage 1 Pressure Decay- Tested/Passed ATG/AMC – Tested/Passed, T3 Dsl was programmed as the being a 96 Inch 11959 Gal tank but was corrected to being a 92 Inch 11595 Gal tank. Tank Test- Tested/Passed Line Test- Tested/Passed Leak Detector – Tested/Passed SV/ESO – n/a OVERFILL- n/a Walk Thru Insp- n/a AST inspection- n/a UPSS Precision Test Report Date 02/28/2024 Report # US191634 Site KG 2516 4978 W 12600 S Herriman UTAH 84096 USA Test Date(s) 02/22/2024, 02/23/2024, 02/26/2024 Reason for Test Compliance E-mail: jeffstevenson@leightonobrien.com Website: www.leightonobrien.com Service Distributor: Seneca Companies, Inc. www.senecaco.com Tel. 563-332-8000 EXECUTIVE SUMMARY All tanks and lines passed the tests. RECOMMENDATIONS There are no recommendaƟons. Herriman KG 2516 US191634 Diagnostic Report to 26-02-2024 Page 2 AIM METHODOLOGY To investigate the integrity of the UPSSs due to Compliance The tank and all its associated lines/risers (i.e. vent, dip, fill) were subjected to the Leighton O̓Brien precision tank test. An individual test was / were performed on the product line(s). Line was/were tested to a 0.05 gph leak rate using Leighton O̓Brien PM2 test equipment & procedures. SUMMARY OF TANK RESULTS AS TESTED Tank Start End Test Result Rate Round 1 Regular Tank 1 (19951 Tgal) at 10418 gal. or 52.2% fill (& 0 in water) 26 Feb 2024 - Cert. No. 475079 10:55 13:41 Wet Static PASS Wet Pressure not tested Ullage not tested Premium Tank 2 (11934 Tgal) at 5423 gal. or 45.4% fill (& 0 in water) 26 Feb 2024 - Cert. No. 475072 13:53 15:09 Wet Static PASS Wet Pressure not tested Ullage not tested Diesel Tank 3 (11595 Tgal) at 7769 gal. or 67.0% fill (& 0 in water) 23 Feb 2024 - Cert. No. 475077 12:12 15:54 Wet Static PASS Wet Pressure PASS Ullage PASS Ethanol Free Tank 4 (11873 Tgal) at 4958 gal. or 41.8% fill (& 0 in water) 26 Feb 2024 - Cert. No. 475073 15:16 16:27 Wet Static PASS Wet Pressure not tested Ullage not tested Round 2 *Regular Tank 1 (19951 Tgal) at 10418 gal. or 52.2% fill (& 0 in water) 26 Feb 2024 - Cert. No. 475074 16:31 19:18 Wet Static not tested Wet Pressure not tested Ullage PASS *Premium Tank 2 (11934 Tgal) at 5423 gal. or 45.4% fill (& 0 in water) 26 Feb 2024 - Cert. No. 475074 Wet Static not tested Wet Pressure not tested Ullage PASS *Ethanol Free Tank 4 (11873 Tgal) at 4958 gal. or 41.8% fill (& 0 in water) 26 Feb 2024 - Cert. No. 475074 Wet Static not tested Wet Pressure not tested Ullage PASS Nomenclature for tables above: A 6.5 times ullage fail rate is the nitrogen decay equivalent to a liquid leak under 1.5Psi at the USEPA threshold of 0.1 gph. 0.1 gph is the PASS/FAIL criteria for a USEPA precision test. (i) indicates a liquid ingress was detected during the test at the noted rate. (e) indicates a liquid egress was detected during the test at the noted rate. INC indicates an inconclusive result was obtained. *denotes temporarily manifolded for testing. Herriman KG 2516 US191634 Diagnostic Report to 26-02-2024 Page 3 SUMMARY OF LINES RESULTS AS TESTED Product Lines Test Date Result Pressure Tests Regular Tank 1 to Dispenser (1,2) 02/22/2024 PASS Premium Tank 2 to Dispenser (1,2) 02/22/2024 PASS Diesel Tank 3 to Dispenser (1,2) 02/22/2024 pass Ethanol Free Tank 4 to Dispenser (1,2) 02/22/2024 PASS OTHER RELEVANT OBSERVATIONS All visible parts of the systems, sealed by the technician, were shown to be tight using soapy water. COMMENTS/DISCUSSIONS All tanks and lines passed the tests. T1,T2,T4 are manifolded through the vents. The tanks were tested as a combined ullage. RECOMMENDATIONS There are no recommendaƟons. FUEL SYSTEM DETAILS Fuel Operation System Pressure Tank Double Wall (Fiberglass/Fiberglass) Line Fibreglass Herriman KG 2516 US191634 Diagnostic Report to 26-02-2024 Page 4 ADDENDUM Date of Test 02/22/2024, 02/23/2024, 02/26/2024 Licensed Tester Garrett Herlache Report Prepared by Jeff Stevenson & Jafet Cifuentes Leighton O̓̓Brien Field Services PTY LTD Phone: +61 3 9804 2200 Fax: +61 3 9804 2299 USA: +1 888 275 3781 Email: info@leightonobrien.com www.leightonobrien.com Glossary of Terms UPSSs: Underground Petroleum Storage Systems. USEPA: United States of America Environmental Protection Agency. The underground pipe and tank configurations contained in this report are deduced from information gathered at the site by Leighton O̓Brien Field Services and by information given to Leighton O ̓ Brien Field Services by the client. Test technology used: Leighton O ̓Brien wet test (mass based), Leighton O̓Brien ullage test (pressure or vacuum), Quantitative Wet Line Test PM2 and Qualitative Dry Line Test PM2 Leighton O̓Brien Field Services are provided on the terms and conditions set out in the conditions of sale document. The Leighton O̓Brien service is warranted to the invoiced value of services performed in accordance with section 64A of the Australian Consumer Law (Schedule 2 of the Competition and Consumer Act 2010). Herriman KG 2516 US191634 Diagnostic Report to 26-02-2024 Page 5 LINE TESTS DETAILS Line Tests Date Start End Cert # Result Condition gal/hr Psi Round 1 Pressure Tests Ethanol Free Tank 4 to Dispenser (1,2) 02/22/24 14:42 16:42 475075 PASS Wet -0.009 51.36 Premium Tank 2 to Dispenser (1,2) 02/22/24 14:42 16:42 475075 PASS Wet -0.009 51.36 Regular Tank 1 to Dispenser (1,2) 02/22/24 14:42 16:42 475075 PASS Wet -0.009 51.36 Diesel Tank 3 to Dispenser (1,2) 02/22/24 16:43 17:43 475076 pass Wet -0.025 51.21 Lines tested to a 0.05 gph leak rate using Leighton O̓Brien PM2 test equipment & procedures *Lines were manifolded during testing He r r i m a n K G 2 5 1 6 U S 1 9 1 6 3 4 D i a g n o s t i c R e p o r t t o 2 6 - 0 2 - 2 0 2 4 Pa g e 6 TA N K T E S T S D E T A I L S Ta n k 1 - R e g u l a r / C e r t N o . 4 7 5 0 7 9 Pr o d u c t R e g u l a r Ca p a c i t y 1 9 9 5 1 G a l Te s t D a t e / S t a r t T i m e 02 / 2 6 / 2 4 1 0 : 4 5 A M Du r a t i o n 2: 4 6 : 3 1 We t t e d V o l u m e o f T a n k 10 4 1 8 G a l Ul l a g e V o l u m e o f T a n k 95 3 3 G a l Su r f a c e A r e a 33 9 . 3 8 f t t Ca l c u l a t e d T a n k L e n g t h 33 . 9 6 f t Di a m e t e r 12 0 i n Wa t e r L e v e l 0 i n Ca l c u l a t e d D e n s i t y 44 . 1 5 9 0 l b / f t u It e m Ti m e Un i t s Ma s s R e a d i n g 1 1 0 : 5 8 : 4 3 A M 1 . 5 8 8 7 Ma s s R e a d i n g 2 1 2 : 0 2 : 1 0 P M 1 . 5 8 7 2 Ma s s R e a d i n g 3 0 Ma s s R e a d i n g 4 0 He r r i m a n K G 2 5 1 6 U S 1 9 1 6 3 4 D i a g n o s t i c R e p o r t t o 2 6 - 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0 . 0 8 0 0 p s i De c a y L a s t 5 - 0 . 0 0 1 8 p s i Te s t D u r a t i o n 4 6 m 3 3 s He r r i m a n K G 2 5 1 6 U S 1 9 1 6 3 4 D i a g n o s t i c R e p o r t t o 2 6 - 0 2 - 2 0 2 4 Pa g e 9 Ta n k 4 - E t h a n o l F r e e / C e r t N o . 4 7 5 0 7 3 Pr o d u c t E t h a n o l F r e e Ca p a c i t y 1 1 8 7 3 G a l Te s t D a t e / S t a r t T i m e 02 / 2 6 / 2 4 0 3 : 1 5 P M Du r a t i o n 1: 1 0 : 3 5 We t t e d V o l u m e o f T a n k 49 5 8 G a l Ul l a g e V o l u m e o f T a n k 69 1 5 G a l Su r f a c e A r e a 20 0 . 3 8 f t t Ca l c u l a t e d T a n k L e n g t h 20 . 2 1 f t Di a m e t e r 12 0 i n Wa t e r L e v e l 0 i n Ca l c u l a t e d D e n s i t y 46 . 0 6 3 7 l b / f t u It e m Ti m e Un i t s Ma s s R e a d i n g 1 0 3 : 1 8 : 0 4 P M 1 . 3 9 4 2 Ma s s R e a d i n g 2 0 4 : 2 1 : 2 8 P M 1 . 3 9 0 9 Ma s s R e a d i n g 3 0 Ma s s R e a d i n g 4 0 He r r i m a n K G 2 5 1 6 U S 1 9 1 6 3 4 D i a g n o s t i c R e p o r t t o 2 6 - 0 2 - 2 0 2 4 Pa g e 1 0 Ta n k 1 , 2 , 4 – R e g u l a r , P r e m i u m , E t h a n o l F r e e / C e r t N o . 4 7 5 0 7 4 Pr o d u c t R e g u l a r , P r e m i u m , Et h a n o l F r e e Ca p a c i t y 4 3 7 5 8 G a l Te s t D a t e / S t a r t T i m e 02 / 2 6 / 2 4 0 4 : 2 7 P M Du r a t i o n 2: 4 6 : 5 9 We t t e d V o l u m e o f T a n k 18 2 7 3 G a l Ul l a g e V o l u m e o f T a n k 22 9 5 9 G a l Su r f a c e A r e a 73 8 . 4 9 f t t Ca l c u l a t e d T a n k L e n g t h 74 . 4 8 f t Di a m e t e r 12 0 i n Wa t e r L e v e l 0 i n Ca l c u l a t e d D e n s i t y n / a It e m Ti m e Un i t s Ma s s R e a d i n g 1 n / a n / a Ma s s R e a d i n g 2 n / a n / a Ma s s R e a d i n g 3 n / a n / a Ma s s R e a d i n g 4 n / a n / a Ul l a g e T e s t Ti m e Pr e s s u r e ( P s i ) St a r t 0 5 : 2 1 : 2 5 P M 1 . 5 0 Fi n i s h 0 7 : 1 6 : 5 1 P M 1 . 2 8 De c a y T o t a l - 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BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB )8(/6<67(06_*(1(5$/&2175$&7,1*_(19,5210(17$/6(59,&(6_:$67(62/87,216 (1(5*<62/87,216_$872027,9( &200(5&,$/(48,30(17  ATG-PEI 1 $XWRPDWLF7DQN*DXJH,QVSHFWLRQ 515-262-5000 KG #2516 Kum & Go Maverik 4978 W 12600 S 1459 Grand Ave Herriman UT 84096 Des Moines 4002674 IA 50309 Seneca Companies,Inc.515-763-6230 2/22/24 1 2 3 4 Unl Prm Dsl Clr VR TLS-450+VR TLS-450+VR TLS-450+VR TLs-450+ 19951 11934 11595 11873 120 120 92 120 ✔✔✔✔ ✔✔✔✔ ✔✔✔✔ ✔✔✔✔ 100 100 7/8 76 7/8 99 3/8 ✔✔✔✔ 2 2 3 2 ✔✔✔✔ ✔✔✔✔ Garrett Herlache Reference PEI/RP1200-19 Appendix C-8 LIQUID SENSOR FUNCTIONALITY TESTING Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. #:2ZQHUPhone #: Testing Company: Phone #: Date: This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel. See PEI/RP1200 Section 8.3 for the test procedure. Sensor Location %H9HU\6SHFLILF Product Stored Type of Sensor Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Test Liquid Water Product Water Product Water Product Water Product Water Product Water Product Water Product Is the ATG console clear of any active or recurring warnings or alarms regarding the leak sensor? If the sensor is in alarm and functioning, indicate why. Yes No Yes No Yes No Yes No Yes No Yes No Yes No Is the sensor alarm circuit operational? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Has sensor been inspected and in good operating condition? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When placed in the test liquid, does the sensor trigger an alarm? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When an alarm is triggered, is the sensor properly identified on the ATG console? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Any “No” answers indicates the sensor fails the test. Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Comments: Tester’s Signature Tester’s Name (print) /DWHVW9HUVLRQ 6HQHFD&RPSDQLHV,QF  KG #2516 Kum & Go Maverik 4978 W 12600 S 1459 Grand Ave Herriman 4002674 515-763-6230 2/22/24 Unl STP Prm STP Dsl STP Clr STP Disp 1,2 3,4 5,6 Unl Prm Dsl Clr Lines Lines Lines ■■■■■■■ ■■■■■■■ Garrett Herlache UT 84096 Des Moines IA 50309 ✔✔✔✔✔✔✔ ✔✔✔✔✔✔✔ ✔✔✔✔✔✔✔ ✔✔✔✔✔✔✔ ✔✔✔✔✔✔✔ ✔✔✔✔✔✔✔ Reference PEI/RP1200-19 Appendix C-8 LIQUID SENSOR FUNCTIONALITY TESTING Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. #:2ZQHUPhone #: Testing Company: Phone #: Date: This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel. See PEI/RP1200 Section 8.3 for the test procedure. Sensor Location %H9HU\6SHFLILF Product Stored Type of Sensor Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Test Liquid Water Product Water Product Water Product Water Product Water Product Water Product Water Product Is the ATG console clear of any active or recurring warnings or alarms regarding the leak sensor? If the sensor is in alarm and functioning, indicate why. Yes No Yes No Yes No Yes No Yes No Yes No Yes No Is the sensor alarm circuit operational? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Has sensor been inspected and in good operating condition? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When placed in the test liquid, does the sensor trigger an alarm? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When an alarm is triggered, is the sensor properly identified on the ATG console? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Any “No” answers indicates the sensor fails the test. Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Comments: Tester’s Signature Tester’s Name (print) /DWHVW9HUVLRQ 6HQHFD&RPSDQLHV,QF  KG #2516 Kum & Go Maverik 4978 W 12600 S 1459 Grand Ave Herriman 4002674 515-763-6230 2/22/24 Disp 7,8 9,10 11,12 Dsl Int Prm/clr Int Unl Int Lines Lines Lines Dsl Prm/Clr Unl ■■■ ■■■ ■■■■■■ Garrett Herlache UT 84096 Des Moines IA 50309 ✔✔✔✔✔✔ ✔✔✔✔✔✔ ✔✔✔✔✔✔ ✔✔✔✔✔✔ ✔✔✔✔✔✔ ✔✔✔✔✔✔ 'DWH -RE &RQWDFW 3KRQH 2SHUDWLRQ 3UHVVXUH 36, 6XPS&RQGLWLRQ 7DQN 3URGXFW /'0DQXIDFWXUHU /'0RGHO 'RHV/''HWHFW *3+/HDN 5DWH" /HDN5DWH/' 'HWHFWHG *3+ )XQFWLRQDO(OHPHQW +ROGLQJ3UHVVXUH 0HWHULQJ 3UHVVXUH 36, 2SHQLQJ7LPH 6HF /LFHQVH1XPEHU &RPPHQWV /'6HULDO 7HFKQLFLDQ 6LJQDWXUH 6LWH1DPH &LW\ 6LWH$GGUHVV 6WDWH=LS /HDN'HWHFWRU 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM LD 1 )8(/6<67(06_*(1(5$/&2175$&7,1*_(19,5210(17$/6(59,&(6_:$67(62/87,216 (1(5*<62/87,216_$872027,9( &200(5&,$/(48,30(17  KG #2516 2/22/24 4978 W 12600 S TLT-W24000 Herriman Jenny Carpenter UT 84096 515-763-6230 1 2 3 4 Unl Prm Dsl Clr VR VR VR VR 848480-001 848480-001 848480-001 848480-001 Dry Dry Dry Dry 31 30 43 32 17 19 23 20 3 3 3 3 Y Y Y Y 23340030 23380453 23340221 23380999 Garrett Herlache 2327 pei.org 59 Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities APPENDIX C-9 MECHANICAL AND ELECTRONIC LINE LEAK DETECTORS PERFORMANCE TESTS Facility Name:Owner: Address:Address: City, State, Zip Code:City, State, Zip Code: Facility I.D. #:Phone #: Testing Company:Phone #:Date: This data sheet can be used to test mechanical line leak detectors (MLLD) and electronic line leak detectors (ELLD) with submersible turbine pump (STP) systems. See PEI/RP1200 Sections 9.1 and 9.2 for test procedures. Line Number Product Stored Leak Detector Manufacturer Leak Detector Model Type of Leak Detector MLLD ELLD MLLD ELLD MLLD ELLD MLLD ELLD MLLD ELLD MLLD ELLD MLLD (ALL PRESSURE MEASUREMENTS ARE MADE IN PSIG) STP Full Operating Pressure Check Valve Holding Pressure Line Resiliency (ml) (line bleed back vol- ume as measured from check valve hold- ing pressure to 0 psig) Step Through Time in Seconds (time the MLLD hesitates at metering pressure before going to full operating pressure as measured from 0 psig with no leak induced on the line) Metering Pressure (STP pressure when simulated leak rate 3 gph at 10 psig) Opening Time in Seconds (the time the MLLD opens to allow full pressure after simulated leak is stopped) Does the STP pressure remain at or below the metering pressure for at least 60 seconds when the simulated leak is induced? Yes No Yes No Yes No Yes No Yes No Yes No Does the leak detector reset (trip) when the line pressure is bled off to zero psig? Yes No Yes No Yes No Yes No Yes No Yes No Does the STP properly cycle on/off under normal fuel system operation conditions? Yes No Yes No Yes No Yes No Yes No Yes No A “No” answer to either of the above questions indicates the MLLD fails the test. ELLD (ALL PRESSURE MEASUREMENTS ARE MADE IN PSIG) STP Full Operating Pressure How many test cycles are observed before alarm/shutdown occurs? Does the simulated leak cause an alarm? Yes No Yes No Yes No Yes No Yes No Yes No A “No” answer to the above question indi- cates the ELLD fails the test. Does the simulated leak cause an STP shutdown? Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Comments: Tester’s Name (print) ___________________________________ Tester’s Signature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omments: KG #2516 4978 W 12600 S Herriman UT 84096 2/22/24 Unl Prm Dsl Clr gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh Garrett Herlache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um & Go Maverik 4978 W 12600 S 1459 Grand Ave Herriman UT 84096 Des Moines IA 50309 515-763-6230 515-763-6230 Unl Prm Dsl Clr 19951 11934 11873 10503 5462 4936 9448 6472 0 6937 0 9:00 9:10 9:20 2.02 2.01 2.04 2.00 1.99 2.00 1.99 1.97 1.96 1.98 1.96 1.91 1.97 1.94 1.88 1.97 1.92 1.85 1.84 1.76 1.72 Pass Pass Pass 2/26/2024 9:00 Nitrogen Spill Bucket Garrett Herlache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ispenser/Tank Sump free of all tools, liquid & debris upon completion of work? Were any sensors replaced? Programming on Monitoring Console checked for positive shutdown? All containment & UDC sensors returned to proper placement & locked (if applicable). All containment lids & retaining bolts securely fastened (if applicable). All dispenser door panels are closed & locked. Flint Loc/security alarms activated (if applicable). All test gauges/test isolation devices were properly removed. All secondary containment boots have been pulled back/removed. All site owned keys have been returned to site manager/representative. All monitor alarms generated have been logged & responded to appropriately. Monitor is free of alarms & displaying All Functions Normal. KG #2516 4978 W 12600 S TLT-W24000 Herriman UT 84096 2/22/24 ATG, LD, Line, Tank ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Garrett Herlache Jenny Carpenter ✔