DERR-2024-004676

t00/tz0
Joseph K. Miner, M.D., M.S.P.H.
Executlve Dlrector
OF ENVIRONMENTAL HEALTH
February 8, 1999
Charlie Hjorth
1320W800N
Mapletcn, UT 84664
Re: Closure Plan approval for underground storage tanks at Charlie's, Mapleton, Utah
Facility ldentification No. 1 000120
Dear Mr. Hjorth,
The Closure Plan forthe above-referenced facility received by the Utah County Health Department on January
29,1999, has been approved subject to the noted modifications, if any. This department requires a fee of $100
pertank forthe permit to remove or install, and $50 per upgrade, including one charge each for removal and
installation of lines, which can be obtained at the above address within 72 business hours prior to closure or
installation activities. This department also requires you to schedule our inspector well in advance to be on
site at your closure or installation activities. The local fire department must be notified 72 hours before
beginning closure or installation and may have additional requirements.
The Closure Plan approval is effective for a period of one year from the date of approval. lf closure does not
take place within one year, submital of a new Closure Plan will be required, unless othenruise approved by the
Executive Secretary (UST).
Any change to an approved Closure Plan must be submitted in writing and approved by our office before
implementation. lf contamination is suspected or found during closure activities, you must report it to the
Division of Environmental Response and Remediation (DERR) at [phone] within 24 hours of discovery.
Enclosed is a copy of the "Closure Notice" form which must be completed and submitted to the Executive
Secretary PSI Kent Gray, 1950 W North Ternple, Salt t-ake City, UT 84114-4840. Please submit ihe
environmental and Unified Soil Classification (USC) sample analysis data and Chain of Custody forms with the
Closure Notice as soon as possible, but no laterthan 90 days aftertank closure.
lf you have any questions please contact Vivian Walker at370-8775.
(801) 3704525 a Fa,r (S01) 3704521
Dwight C. Hill, E.H.S. Director
drui
Director, Environmental Health
DCHA/W
enclosures
cc: Gary Harris, Utah Division of Environmental Response and Remediation
Mapleton City Fire Department
Steve Lyons, Rocky Ridge, PO Box 241,Payson, UT 84605
UNDERGROUND STORAGE TANK CLOSURE PLAN (rev.01/01/97)FAC|L]TY D#1 0001 20
Closure Plan prepared at the request of the owner/operator (identified below) by,(harles Hiorth
of (ccmpany name)C.H. Services, Inc.Phone * f801 t 491 -6025
Address 1 320 West 800 North City MapLeton State tll Zip 84664
A Contractor may prepare this Closure Plan as the owner/operato/s agent. ln preparing the Closure Plan, the Contractor must
act with the owner/operato/s knowledge and approval. The owner/operator must sign the Closure Plan.
This Closure Plan is submitted in compliance with the requirements contained in R311-202 Subpart G and R311-204 (U.A.C.)
FACILITY INFORMATION
Tank Owney Charlies Hjorth Phone#(801 ) 489-7061
[ ] sole proprietorship [)$ partnership [ ] corporation
Address 790 Iitorth 1600 West City mapleton StateUt Zip_8a66L
Facility Name Ctrarlie's Conveni-ence Store LC
Address 790 North 1500 west City Uapleton State tll Zip-846U
Corrtact person Charl ie Hiorlh Phone#( 801) 489-7061
Iotal number of regulated underground tanks at this site (Tank #5 was rennved 1-13-99)
4'r-otal number of regulated underground tanks at this site to be closed
IANKS TO BE CLOSED
te Received I
ate LHD Approved
ate mailed to State
Date lnstalled
lndicate the specific subslance stored in each tank lo be closed (regular, unleaded, diesel, wasle oil, 6tc.)
For waste oil tanks: Have
Yes (identify if known)
,tnalysis for lead or other con
your disposal facility.)
of solvents been stored or mixed with the waste oil?
Not known
TANK REMOVER Name drarles \arth /
7-1-9s 4
Cornpany C.H. Servicesrlnc.
c"rtYfr oo77 Exp. date
Phone#( 801 1491-6025
state_Ur_ zip 84664 /,,--SOI UGROUNDWATER SAMPLER Name Steve Lyons Cert. # GS 0559 Exp. date 10-1-2000
phone [phone]CompanyRocky Ridge
Address P.O. Box 241 city_Payson _ state Ut Zip 84605
Before the closure plan is submitted for approval, the local health and ,ire departnents where the facitity is tocated
must be contacted. ff the tacility is in Beaver, @tfun, Enery, Gafietd, Gnnd, tron, tGne, Sdt l-ake, &n Juan, Wasatctt, or Washington @unty @nts'ct
DEBR (UST) at (801)53641 00 instead of the local health distic| You stitt must contact the local fire deoaftment in these counties.
CONTACT LOCAL HEALTH DISTRICT Name of Dist.
Contact Vivian Walker
Utah County Health Dept.p31s 1-13-99
Title phone # [phone]
LOCAL FIRE DEPT. Name of Dept.Manle-ton Pire Dent-Date 1 -19-99
phone g 489-5655
Adcjress i 320 West 800 North City Mapleton
CONTACT
Contact Title
DISPOSAL INFORMATION
Iank(s) will be disposed at: Facility
Address 601 South l4ain
Swenson Metal Salvage
City Sfranish fork StateUI Zip 84660
Contact person JaY
Product lines will either be: X removed or _ cleaned, secured in place, and capped.
Vent lines will either be: X removed or _ cleaned and secured open.
Svrenson Metal SalvagePiping will be disposed at: Facility
phoneglB0l 1 798-3548
Address 601 South Main ciry Spanish Fork State {II Zip 846ffi
contact person Jav phone#[phone]
Tank(s) will be emptied by: company C.H. Senrices Inc.
Tank(s) will be cleaned by: company V.J. E:vironmental Inc.phone*f8011 595-8151
Contaminated water in the tanUrinsate will be disposed at: Facility V.J. Elironmental Inc.
Contact person Craiq L. Christensen Phone # ( 801 t s9s-81 51
-,/
Phone * t801 1491-6025 r'
Tank(s)willbe:xpurgedor-renderedinertbythelollowingmethod:
Residual sludges will be disposed at the following facility:
Address 1 55 North 500 West
V.J. E:vironmental Inc.
City SIC State UT Zip 84116
lonlact person Craig L. Christensen Phone #r 801 t 595-8151
FOR CLOSURE IN.PLACE ONLY
t I Facility Site Plat, Sample lnformation Table, sample results and Chain of Custody forms are included.
I I Approval for in-place closure has been granted by the Local Fire Department.
Fire Dept.Phone#Contact Date
[ ] Approval for in-place closure has been granted by the Local Health Department.
Health District Phone# Contact
t I Substance to be used to fill tanks
Date
fhe site plat must be drawn to an app'opriate identified scale. lt must show planno.r sampling locations, substances stored
in tanks, and other relevant information. Tank and sample identification numb€E must be consittent with the information given
on p. 1 and 5 of the Closure Plan.
Facility lD # 1000120 Drawn By Charles Hiorttr Date_Ja&-_?&_19,99_
$ri
N.
Ut
\tIt
.|.{{-
($
N(,\
.E
f.lf
R
U
Slate
DISPOSED AT AN ACCEPTABLE FACI Yz
v-
All materials generated from UST closures must be managed and disposed in a manner that does not place those materials
rn direct contact with the environment. On-site stockpiling of contaminated soils may be required prior to any soil management
activities. Any person providing remedial assistance for a fee, including aeration and over-excavation (of more than 50 yd),
must be a Certified UST Consultant.
Contaminated soils generated as part of tank removal are to be disposed at the following facility:
wiII deal with on site Address City
Contact person Phone # (
SIIE ASSESSMENT
.\ site assessment must be performed for all UST closures and change-in-service. Site assessments must be
performed as outlined in R311-202, Part 280.72and R311-205 (U.A.C.). lf contamination is susoected. additional
samples must be collected at the location where contamination is most likelv to be present. lf qroundwater is
encountered. a soil sample must be collected. in the unsaturated zone. in addition to each groundwater sample. Soil
and groundwater samples must be analyzed for the compounds shown in the following table, using appropriate lab
methods.
SUBSTANCE CONTAMINANT COMPOUNDS TO BE ANALY?ED ANALYTICAL IVETHODS '
soIL GROUNDWATER
oT SURFACE WATER
Gasoline Total Petroleum Hydrocarbons (TPH)
Benzene. Toluene. Ethvlbenzene. Xylencs (BTEX). and MTBE
8015 Modified 3pg!
EPA 8020 or 8240
8015 Modified aad
EPA602 or 624
Diesel Total Petroleum Hydrocarbons (TPH)
Benzene, Toluene, Ethyl benzcae, Xylencs. Naphhalene GTEXN)
8015 Modiied ud
EPA 8Ul0 or 8240
8015 modified 349!
EPA@2or624
Used Oil Oil and Grease (O&G) or Toal Rccoverable Hydrocatons (TRH)
Benzene, Toluene, Ethyl benzene, Xylenes, Naphthaleoe GTEXN)
Halosenated Voladle Orsanic Comoounds (VOC's)
EPA4l3.l or4lE.l;
aos! EPA 8020 or 8240
and EPA 8010 or 8240
EPA413.1or418.l
dEPA 602or624
and EPA ffil ot 624
New Oil Oil and Grease (O&G) or Total Recoverable Hvdrocarbons (TRH)EPA413.l or4l8.l EPA413.1 or418.l
Other or
Unknown
Total Petroleum Hydrocarbons (TPH)
Benzene, Toluene, Ethyl benzene, Xylenes, Napbthalene (BTEXN)
Halogenaed Voluile Organic Compounds (VOCS)
Or other EPA methods as aooroved bv the Exccrrtive Secretanr
8015 Modified
and EPA 8020 or 8240
etd EPA 8010 or 8240
8015 modified
@EPA 602o1624
andEPA60l or624
Complete the Facility Site Plat and Sample lnformation Table on pages 4 and 5 to provide site assessment
information.
CONTAMINATION INFOBMATION
lf contamination at the facility is suspected or confirmed. the information must be reported to the Executive Secretary (UST)
at [phone] within 24 hours. The Division of WaterQuality must be notified at [phone] if Free Product is
encountered or if surface water has been impacted. lf contamination is confirmed, any person assisting in the remediation
process for a lee must be a Certified UST Consultant
Ztp
'Alternative methods allowed for 413.1 are 1664 or 552O(b), and 418'1
metnod numbers can change or be replaced (e.g. 8240 can be replaced by 8260)'
sampler, or your analytical laboratory if you have guestions.
may also use 5520(f). Note that analytical
Check with the DERR, your certified
SAMPLE INFORMATION TABLE
Cornplete table for all samples to be raken for closure.
1 Soil (SS), Groundwater (GW), or Unlfied Soll Classlfcatlon (USC).
2 Approx. depth in feet below grade. The required manlmum sile assessnrent samplos mu6t bo tak€n al G2 leet below th6 backfilunative soil interfaco.
3 Conlaminant compounds to be analyzed lor each sample (lrom taue on p. 3).
4 A.ppropriate analysis methocls ,or contiaminant compound(s) in 6ach sample (trom table on p. 3). /
Approximate depth to groundwater in the vicinity of the tanks: 35/ feet. /
Re g ional g rou ndwater f low direction: NORITIWESI
State Ce(ified Laboratory to be used:AIT,IRTCAT{ WEST AT{ALEICAL I,AB
Sample #Analysis method(s)'
15 I4ODIFIED & EPA 8240
8015 IVTODIFIED & EPA
TPH & BIEIC.I
& MItsE
8015 MODrFrm & EPA 82
Address 463 IrIEST 3600 SO(m{City sra StatetlT Zip 84115
Contact person STEVE phone * t 801;2Q3-8686
Please explain any unusual or extenuating circumstances expected regarding the site assessment or closure:
I certity under penalty of law that I am the owner/oporator of the tank(s) relerpnced above and that I am lamiliar with
the information on this form and that it is true, accurate a,pd complete, and further, that the proccdures described
hereinwillbefollowed duringtagkcloSure. 4,. ,2il, /
Signature ol tank owner
Full Name of tank owner CHARLES TIJORITI 9316 1-20-99
1
UNDERGROUND STORAGE TANK CLOSURE PLAN (rev.01/01/97)FACIL]TY ID*1 0001 20
lDate Received-
lReriewer
1o.," r-nO appro*O
iDate mailed to State
i
!
rllosure Plan prepared at the request of the owner/operator (identified below) by Charles Hiorttr
Ji (ccmpany name ) C.H. Senrices, Inc.Phone * t801 t 491 -6025
Ac,dress 1320 West 800 North City llaPleton StatelE_ Zil 84664
i Contracror may prepare this Closure Plan as the owner/operato/s agent. ln prepaling the Closure Plan, the Contractor must
acr rsitn the owner/operato/s knowledge and approvat. The owner/operator must sign the Closure Plan.
This Closure Plan is submitred in compliance with the requirements contained in R311-202 Subpart G and R31 1-204 (U.A.C.)
FACILITY INFORMATION
Tank owner oErlieq-!1i-cElh Phone#(801 ) 489-7061
i I sole proprietorship [ ][ partnership I I corporation
Address 790 lbrtn l t9Q-ldeSE City t'lapteton Stateg!- Zrp-9@-,
Charlie's Convenience Store LC
LHO USE ONLY
Received From LHD
Facility Name
Address 790 North 1 500 West City Mapleton State UI ZaP-84664
contact person Ctrar'l ie Hiorlh Phone# ( 8011 489-7061
t-orat number of regulateci underground tanks at this site
--!-
(Tank #5 was renoved 1 -13-99 )
-crar number of regulated underground tanks at this site to be closed
|ANKS TO BE CLOSED
For waste oiltanks: Have of solvents been stored or mixed with the waste oil?
'/es (identify if known)Not known
+nalysis ior lead or other
vour disposal facility.)
. tndicate the specilic subslance stored in eaci tank to be dosed (regular, unleadod, die$|, wagto oal, elc.)
_ - .,ie,,riUiAil0N
irior to disposal contamanated soil or other material. (Check with
TANK REMOVER Name d:rarlesYjorttr
lli.::Dan'. C.H. Senricesrlnc.Phone#( 801 1491-5025
A.:cr:ss 1320 West 800 NffitI CitV hPleton__ State UI Zip 84664
SOIUGROUNDWATER SAMPLER Name Steve Lyons l/
Cert. * GS 0559 Exp. date 10-1 -2000
Comoany P.ocky Ridge phone [phone]
Adcress P.O. Box 241 Ciry Payson__ State ut Zip
Before the closure plan is submitted for approval, the local health and lire dcpartments where the facility ls locatcd
must be contacted. r he bcility is in B€av€r, cfltopn, &nery, @tfrekl, GaN, lon, l<ilD, satt l,llr,, *n Jrut, wafflbtt, ot washingbn a)nty @nEld
DERR (USTI at (801)5364100 instead ol tha lml health clhttt;l You slll must @ntect lhe lffit frn (rloafinent in these counties.
\-/ A--
Cert. # TR uu / / Exp. date
47-1-99
84605
CONTACT LOCAL HEALTH OISTRICT
Conlact Vivian Walker
CONTACT LOCAL FIRE DEPT. Name of Dept.
Conracr
ptsPosAL tNFoRMAT
Name of Dist. Utah County Healttr Dept.
lGp1eton Fire Deot-
Date 1-13-99
Title phone s 370-8700
Tirle Phone #
Date@9L
489-5655
ianx(s)will oe disposed at: Facility Spenson Metal Salvaqe
Aociress 601 South l4ain Spanish Fork StatetlT Zig 84660
Ccnract person JaY phone[phone]
Product lines will either be: X removed or
-
cleaned, secured in place, and capped.
Vent lines will either be: X removed or _ cleaned and secured open.
Piping will be disposed at: Facility
Address 601 South l4ain City Spanish Fork &ate-UT Zip_84660
Conract person Jav phone#[phone]
Tank(s) will be emptied by: company C.H. Senrices Inc.Phone s t801 t491-5025
Tank(s)willbe cleaned by: company V.J. Enviromental Inc.Phonel(801t 595-8151
Contaminated water in the tanUrinsate willbe dispooed at Facility V.J. Envirorurental, Inc.
lonract person fraiq L. christensen phone 6 t 801 t 595-8151
Tank(s) will be: x purged or
-
rendered inert by the lollowing method:
Residual sludges will be disposed at the following facillty: V.J. Ervironnrental, fnc.
\dcress 155 North 500 West C1y_-SLC State tlT Zip 84ru
lonract person Gaiq L. Christensen phone # [phone]
FOR CLOSURE IN.PLACE ONLY
, Facility Site Plat, Sample lnformation Table, sample results and Chain of Custody forms are included.
I Approvat for in-place closure has been granted by the Local Fire Department.
Fire Dept.Phone#Contact_ Date
[ ] Approval for in-place closure has been granted by the Local Health Department.
Health District
Substance to be used to fill tanks
Phone#Contact
1
.JONTAMINATED MATERIALS M.-T BE OISPOSED AT AN ACCEPTABLE }...JILITY:
rll materials generated from UST closures must be managed and disposed in a mannerthat does not place those matedals:r oirect contact with the environment. On-site stockp,iling of contaminated soils may be required prior to any soil management
activities. Any person providing remedial assistance for a fee, including aention and over-excavation (of more tnan iO yd),
'nusi i:e a Certified UST Consultant.
Jontaminated soils generated as part of tank removal are to be disposed at the lollowing facility:
will deal wittr on site Address City
srare _ zip Contact Phone # (
SIIE ASSESSII'ENI
.{ site assessment must be performed for all UST closures and changc'in'service. Site assessmenE must be
,rer{ormed as outlined in R311-20i1, Part 280.72 and R311-205 (UA.C.). ll contamination ic suspected. additional
samples must be collected at the location wherc contamination is most llkelv to be greeant. lt orounduratcr it
encountered. a soil sample must be collected. in the unsaturated zone. in additon to each grounduater samob. Soil
and groundwater samples must be analyzed forthe compounds shown in the lollowing table, using appropriate lab
methods.
SUBSTANCE CONTAMINAT.IT COMPOUNDS TO BE ANALYED ANALYTICALMETI{ODS I
soL GROUNDWATER
ar (l IDEAIT lllATED
Gasohne Toa.l Peuoleum Hydrocartoas (TPH)
Benzene. Tolrrcne. Ethylbcozcoc. Xylcms GTEX). and MTBE
8015 Modiicd gg[
FPA lat20 ar f?t0
t0l5 Modificd aad
EPA 602 or 624
Dresel Toul Petroleum Hydrocarboas (TPH)
R.raeeae Tnlrram Frhvl h.nr.m Xvlmar- Nrahthicne (BTEIN)
t0l5 Modificd rod
EPA 8(20 or t240
t0l5 modindetd
BDA Alrl * A)A
Used Oil Oil and Grcasc (O&G) orTotd Rccovcrable Hy&ocaftons (TRH)
Benzcnc. Tolrrcrr. Bhyl bcnzcae. Xylcocs. Naphhalcoc GTEXN)
Hdopenarcd Volailc Oremic Commuads NOC's)
EPA4l3.l or,llt.l:
3glEPA 8020 ot 82()
and EPA t0l0 or t24O
EPA4l3.l or4lt.l
rsrlEPA 602 or62a
aar{ EDA K\l ae A7A
New Oil Oil and Grcasc (O&G) or Tod R.ecovcrablc Hydrocarbons (TRH)EPA ttll.l or 418.1 EPA4l3.1or4l8.l
Other or
Unknown
Total Peroleum Hydrocarbons CI?H)
Bcnzenc. Tolucne. Ethyl bcnzmc. Xylcttcs. Nrphhalcoc (BTEXN)
Halogenacd Volarile Orgraic Compouods (VOCs)
Or other EPA mdhods as aDorovcd by tnc Ercafivc Sccretary
t0l5 Modincd
aglEPA 8020 or 82a0
ICEPA t0l0 or t2,O
8015 modificd
agd EPA 602 or 624
3gllPA60l or624
Complete the Facility Site Plat and Sample lnlormation Tabla on pagG3 4 and 5 to provide site assessmant
information.
CONTAMINATION INFORMATION
lf contamination at the facility is susoected or confirmed. the inlormation must be reported to the Executive Secretary (UST)
at (801 ) 536-41 00 within 24 hours. The Division of Water Quality must be notified at (801 ) 538-6146 if Free Produa is
encountered or if surface water has been impacted. lf contamination is confirmed, any pe6on assisting in the remediation
process for a fee must be a Certified UST Consultant.
a
rAlrernarive methods allowed 1or 413.1 are 1664 or 5520(bl, and 418.1
merhod numbers can change or be replac€d (e.9.8240 can be replaced by 826O1.
sarnoier, or your analytrcal laboratory if you have quegtions.
may also use 552O(l). Note that analytical
Check with tha OERR, your cenilied
\ :AClLtW Sm P1AT (CLOSURE PLA]\-, ' '
l.neSltepiatmUstbedrawnto"n"ppffiustshowplannedsamplinglocations,substancesStored
n taxks, and other relevant information. Tank and sample identification numbers must be consistent wath the information given
3n p. 1 anci 5 of the Closure Plan.
Facrlrty lD # 1000120 Drawn By Ctrarles Hiorth Date Jan. 22, 1999
\<r
x
N
s
SAMPLE INFORMATION TABLE
:,ere :acle ior all samples to be taken for closure.
4,.
Sample #
I
2
GASOLINE
Sc.t (SS). Groundwarer (GW), or Unified Soit Classificaton (USC).: Aoorox. depth in leel below grade. The r6quir€d minimum sile assessment sampl€s must be taken at G2 f€et below the backlilunative soil interlace.,'r Contaminant compounds to be analyzed lor each sample (rrom tabl6 on p. 3).: iDoropnate analysis methods ,or contaminant compound(s) in each sample (from table on p. 3).
l.csroximate depth to groundwater in the vicinig ol the tanks: 35/ 1691.
i a.l I onai q rou ndwater f low direction: NORITIIJEST
Stare Certrfied Laboratory to be AI,IRICAIII [ilEST AUAL]mfeAL LtB
Adcjress 463 WEST 3600 SOUII{City_ SLc statet/T Zip 84115
Ccnlact person SIEI/E phone#( 8011 263-8586
Please explain any unusual or exlenuating circumstances expected regarding the site assessment or closure:
: certity under penalty of law that lam the owner/operator of the tank(s) referenced above and that I am familiar with'he information on this form and that it is true, accurata 9;rd complete, and further, that the procedures describednerein will be followed during
Signature of tank owner
-)
--.
J
4
Analysis method(s)a
8015 t4oDrFrm & EPA 8240
8015 I'ODIFIED & EPA 8240
80'15 t4oplFrm & PA 8240
8015 MODIFTTD & EPA
TPH & BIE{I(
MIBE,U.S.C.8015 MODTFIm & EpA 8240
Fu1 Name ol tank owner CX{ARLES HJORITI Date 1-20-99
Fr6m : C. H. SERUICES PHONE No. : BA1 4e9 @224 Jan.85 1999 12:56PN PAz
DBq/DERN [il oor
t0// tz 0
FocrtiryDrl!@!
Bocclvod l- 6^
EntareoJ.:L
Tempon1vCIosureNottcepraprrc<latthcrcguottof1t1g9wlrr/opcrdor(idcnrifildbrlrrrr,)by
of(conqrrnyna[10)-9Ha8I4IlEffi{IIENTEN(.}.!+l(f,{nllhonc*r001r489-7051
.q6g*s 790 r{CI{rtr t 6()0 r,m;,r, .Jity IOPItrtr)N-- stdr-[!- z;p -9!993-
@
UST Owncr CIIARIIEB }ULIR'II] ... Phono * t 801 t 489- 0349
I lsolcproprlctotthio ffi gannerrhlg I Icorporoilon
nddmsr 132U W!;s'f BO0 retlTE
FudlitY Nqmu _ rh aa6.AA
tutrlrpsa 790 NoRIH t 600 y{ET cr.y iIAPLETOII Stet t{1. ZlpL
NumDcr of resulateo tsoks st tho factltry ro be tomporully clocedl 5
Nunrlror of rcgulatcd tanke at thc fae'lllr;zlQ-
ciry MAEI&JIN-..---$ucEzin. q,1661-
Atl UST s:/srcm (cmPorarity slorcd lca thrn 3 tionthe mut$
o conrinuc op.*trni o,ii n,tinu,rlnca of coroSion protcc(on (lf anyl on 11flks and linor'
g cordnue opaarlon urd mlintnnancc of rclenrl ttctccdon or cmpv lhc lhe UST system to less tltan l" 0I Eudu:L
An UST systcmlclrlPororlly tlurcl ! rnonthr ormotstllllttl
O coiltnue oertJ"" riJt*inrstuoc. of colrosion potccilon (if any) on
'"tr-l(3
and lines'
e ,onunue opotttloi ara rrior"nEncc of felttuo detrction or cn'pry tha the UST SyStcnr lo lctg thul l " of product'
o lcave vcnt llno, opcr. and fuocrioning, und cup arrd sceure all ohcr ltnee, pumPsf msnway$' und nruillrry equlpDcil
o ,.na
"
prp.iiy Jm*reatcnrporuryoosruc toflDro rhc DERMIST Section-
UST8 (tenks ano linea) withcst p'od to*tton protcetlon may rctnrln under r:rnprrrry closum ruurl lor uP to 12 unnth
E{GES dre end of thlt clcu:'r gcriodl
-o thc tanlcr rilsr bc permmmtlyclole* or
e
"
eiru *saeslii";;#;;-##d;ii ar, *tr,rlon of rhc rcrsporrlyclocuns stslut rsquecad fromthc DERR ttt
RpPlcvod-
AnUSTsysrcmrempcrrarilytlotcdfortmrc$ullzmonthsmuftbEuPErdcdwlthcorrrrslorrprorcctioaontrr*rendlincu,ult
,fiU ana or"ttirf p*-*ntini' haforc tho GnI| cstn bc Ulughl tntouse'
Fuel sras emptied. I t corroston prouctioo ia oPendnT I t Rclcssc dctlcrion cqulPmsnt le opcroting'
\
tx
Fr6m : C.H. SERUICES
0L/0a/80 lli0D
INC.
PAI 1 OOT Eler2{3
PHONE No. : 8@1
DBQ/DFPP
449 4224 Jan.96 1999 12:s?Pl'l
6oor
PA3
ffiffittcd.l' ili-L rn<' rrl tla)
rToorarlrtt l/! ltto
$or Tumporera Clooro o?t rnonthr rr !lo!!t
BoforclzmoarhsthcUst(l)willbu tXl Psrmnsnilyclo6€d 1! NsrAlpfndca I lErteasionruqurn:d
CtppctUsecurcC (Y/N)
llng
P0mor
mrnrnys
srlt,\s$lssllMEltf.
Irancrunsron of tre ll nonthtcmporEyclosu* ir rcqucrtcd.coragtcrcrhcsrtc A..*rrrintporriorsof tho oail*Gprrxlgto^ir rral
i.t..r-t Cf"run Notlce (rvrllrblc npon nquert)'
I crrhfy undcr grmr3l of rnr thrt t,rq tbo orneof trra !rdr(r) dr*ibcd aDovr and rlr* [ eo barrhr dth ihr rolormador
on rtrb foru zndtbnr itirntc,recuraErld Go;;a;;;[.;rrh*rh"proccdlrmc deccrlbcdhrrclovcrtlollowoi durlnl
itrakcloaucc-
S[mturl oIUST Omrr
oerc 1-.6:92
Frrllorosolg*rq' CIgEEitlfJRrl
Renrrn cornPletcd Tenpotrryclosulg llotiut lorn to:
iffii"'.8"H;Hf#ffi :[i$i'IlkduionuSrstction
l6t Ndllt l9!0Wrrt lar Elcor
Saltl-aloClg. Uta[ 84116
,,'
,:" DEPARTMENT OF ENVIRONMENTAL QUALITY
Z orvtsloN oF ENVIRoNMENTAL RESpoNSE AND REMEDIATIoN
Michael O. Leavitt . 168 Nonh 1950 West
Governor 7 P.O. Box 1,14840
Dianne R. Nielson, Ph.D. "L Salt Lake City, Utah 841 14-4840
Executive Director . [phone] Voice
Kent P. Gray [phone] Fax
Director ' [phone] T.D.D.
MARLENE HJORTH
L320 W 800 N
},IAPLETON
October 29,1998
ur 84664
Re: December 22,1998 upgrade deadline for Underground Storage Tanks
The Division of Environmental Response and Remediation (DERR) records show you have one or more underground storage
tanks (USTs) which have not met the December 22, 1998 UST upgrade requirements. These tanks are located at CHARLIE'S
CONVENIENCE STORE LC,79O N 1600 W, MAPLETON, facility ID# 1000120.
Under Federal regulations issued in 1988, UST owners and operators have until December 22, 1998 to upgrade, replace, or
permanently close USTs that do not meet the requirements for protection against spills, overfills, and corrosion.
This deadline will not be extended. If your tanks are not in compliance by the deadline, they will not be able to receive
deliveries of fuel.
Our information shows these requirements have not yet been met:
Tank ID Substance Tank Capacity Spill Protection Overhll Protection Corrosion Protection
I Gasoline 6000 No No No
2 Gasoline 8000 No No No
3 Gasoline 10000 No No No
4 Diesel 8000 No No No
5 Kerosene l00O No No No
Any metal flex connectors connected to fiberglass reinforced plastic (FRP) piping at the submersible pump or dispenser must be
cathodically protected or taken out of contact with the soil.
USTs filled by transfers of less than 25 gallons at a time (usually used oil tanks) are not required ro meet the spill and overfill
prevention requirements as part of the upgrade requirement.
If you have questions about which requirements you still need to meet, or would like to have someone visit your site to help assess
your needs, please call Alan Jones ar (801) 536-41 15.
I toatzo
Joseph K. Miner, M.D., M.S.P.H.
Executive Director
DIVISION OF ENVIRONMENTAL HEALTH
Phone (801 ) 37o4s25 o Fax (801) 3to4SZ1
Dwight C. Hill, E.H.S. Director
Ei^/aot*irt^t
ulll{ col,tfiY ltg,ur{ 0e RIE{T
589 South State Stseot
Provo, Utah 84606-5056
" c re ating h eal thy ammun ilies "
I
f,
h
d
II
October 15, 1998
Charlie Hjorth ,'
1320 W 800 N
Mapleton, UT 84664
Re: Closure Plan approval for underground storage tanks at Mapleton, Utah
Facility ldentification No. 1 0001 20
Dear Mr. Hjorth,
The Closure Plan for the above-referenced facility received by the Utah County Health Department on October
7, 1998, has been approved subject to the noted-modifications, if any. This department requires a fee of $100
per tank for the permit to remov-e or install, and $50 per upgrade, including one charge each for removal and
installation of liries, which can be obtained at the above address within 72 business hours prior to closure or
installation activities. This department also requires you to schedule our inspeclor well in advance to be on
site at your closure or instaliation activities. The local fire department must be notified 72 hours before
beginning closure or installation and may have additional requirements.
The Closure Plan approval is effective for a period of one year from the date of approval. lf closure does not
take place within one year, submital of a new Closure Plan will be required, unless otherwise approved by the
Executive Secretary (UST).
Any change to an approved Closure Plan must be submitted in writing and approved by our office before
imilemen[ation. lf cdntamination is suspected or found during closure activities, you must repgrt it to the
Division of Environmental Response and Remediation (DERR) at [phone] within 24 hours of discovery.
Enclosed is a copy of the "Closure Notice" form which must be completed and submitted to the Executive
Secreiary (UST) Kent Gray, i950 VV North Tempie, Sait Lake Ciiy, UT 84114-4640. Please sui:niit the
environmental and Unified Soil Classification (USC) sample analysis data and Chain of Custody forms with the
Closure Notice as soon as possible, but no later than 90 days after tank closure.
lf you have any questions please contact Vivian Walker a|370-8775.
Director, Environmental Health
DCHruW
enclosures
cc: _94[grc--Utah Division of Environmental Response and Remediation
Mapleton Fire Department
C. HiII, E.H.S.
UNDERGROUND STORAGE TANK CLOSURE PLAN (rev.01/01/97)FACILTTY lD# 1000120
LHD USE ONLY --4'
\
)ate LHD Approved
)ate mailed to State
ctosure Ptan prepar"o ",,Ljffi owner/operator (identified below)by.Charles Hjorth
of (company name) C-H. Servicesr lnc.Phone # 601 ) 491 -6025
Address '1320 West 800 North City Mapleton StateW Zip 8466q
A Contractor may prepare this Closure Plan as the owner/operato/s agent. ln preparing the Closure Plan, the Contractor must
act with the owner/operato/s knowledge and approval. The owner/operator must sign the Closure Plan.
Thts Closure Plan is submitted in compliance with the requirements contained in R311-202 Subpart G and R311-204 (U.A.C.)
FACILITY INFORMATION
Tank Owney Charlie Hjorth phonesfS0l t 489-7061
[ ] sole proprietorship [{ partnership [ ]corporation
Address 790 North 1 600 West Cit)4 Mapleton State-ur-Zip 84664
Facility 11"r" Ctrarlie's Convenience Store L.C.
Adcjress 790 t{orth 1600 West City.ll,apleton State_u Zip Ba6il
Contact person Charlie Hjorth Phone*601 t 489-7061
Total number of regulated underground tanks at this site ??
Total number of regulated underground tanks at this site to be closed 1
TANKS TO BE CLOSED
' indicate the specilic subslance stored in each tank to be closed (regular, unleaded, diesel, wasts oil, elc.)
For waste oil tanks: Have degreasing or other types of solvents been stored or mixed with the waste oil?
Yes (identify if known)No _ Not known
Analysis for lead or other contaminants may be required prior to disposal of contaminated soil or other material. (Check with
your disposal facility.) .- ' .----
Tank #5
Date lnstalled 197,3-1975
Capacity 1 000
Substance stored'(-1 Kerose IE
Date last operated In Use
TANK REMOVEH Name CItarle\djorttr
Company C.H. Services, Inc.
466r"rr i320 west 800 North city_j9pr"to"_stateut zip g4664
SOIUGROUNDWATER SAMPLER Name Steve Lvons Cert. # GS 0559 ,*r. O^ 0,
Company Rocky B.idge phone # ( 801 ) 7iB-1 B5B ,r- lgFrr,
Address P"O. Box 241 Payson State ffi zip Ba6ffi
Before the closure plan is submitted for approvat, the local health and lire departnents where the facility is tocated
must be contacted. ff the hcitity is in Beaver, @tbn, Emery, Garfreld, Gancl, lron, t.trIne, *lt Lake, $n Juan, wasatctt, or washington @unty @ntact
DERR (UST) at (801)53641 00 instead ol the locat health district You stltl must contact the local fire deoaftment ln these counties.
\-.
Cert. # fR 0077 Exp. date 7-1-99 . .
-tn
CONTACT LOCAL HEALTH
Contact Vivian lialker
DISTRICT Name of Dist. Utah County Health Dept.pssg 5-8-98
Phone #[phone]
Mapleton Fire Dept.Date 5-1-96
phone # [phone]
DISPOSAL INFORMATION
Tank(s)W
Address
wiII be cleaned, rnodified and re-used as a dump truck Iiner.
Contact person Phone # (
Product lines will either be: x removed or
-
cleaned, secured in place, and capped.
vent lines will either be: X removed or _ cleaned and secured open.
Piping will be disposed at: Facitity SWON6? ttetAk 7AL'AC€
Address A0l gourH HAnN cityqPAitvsq tuAt/ statek-t zipS_fuCo
Contact person fAy Phone# ( \ )qq'35q9
Title
CONTACT LOCAL FIRE DEPT. Name of Dept.
Contact
Tank(s) will be emptied by: company C.[i. Services, Inc.
Tank(s) will be cleaned by: company C.H. Servicesrlnc.
Contaminated water in the tanUrinsate will be disposed at: Facility EVaporated.
Contact person Phone # (
Title
State_ Zip
)
Phone n(801 1491-6025 u'/
Phone6(801t 491-6025
contact person Phone # ( )
rank(s) will be: x purged or
-
rendered inert by the foilowing method:
ilesidual sludges will be disposed at the following facility: N/A
Address City State
)-zip
FOR CLOSURE IN.PLACE ONLY
I I Facility Site Plat, Sample lnformation Table, sample results and Chain of Custody forms are included.
[ ] Approval for in-place closure has been granted by the Local Fire Department.
Fire Dept.Phone#Contact Date
I I Approval for in-place closure has been granted by the Local Health Department.
Health District Phone# Contact
t I Substance to be used to fill tanks
Date
rir materials generated lrom UST closures must'be managed and disposed in a mannerthat does not place those materials
I cirect contact with the environment. On-site stockpriling of contaminated soils may be required priorto any soil management
es- Alrypersorrffinidtnlramqlta I assistance for a fee, including aeration and over-excavation (of more than S0 yd),
re a (';rtliled USf Consultant.\
-cntaminated soils geneiaEtlFas part ol tank removal are to be disposed at the following facility:
iVill deal ivitn on site.Address City
State zip Contact person Phone # (
SITE ASSESSMENT
A site assessment must be perlormed for alt UST closures and change-tn-servic€. Site assessments muet boperformed as outlined in R311-202, Parl280.72 and 8311-205 (U.A.C.). lf contaminatlon te gusoected. addlilonal
samples must be collected at the location.wherp gontamination is most
encountered. a soil sample must be collected. In the unsaturated zone. in additlon to bach groundwatir sample.Sofl
and groundwater samples must be analyzed forthe compounds shown in the loltowing tabte, using appropiiate tab
methods.
SUBS TANCE CONTAMINANT COMPOUNDS TO BE ANALY2ED ANALYTICALMETIIODS '
SOIL GROUNDWATER
OT SURFACE WATER
Gasolirrc Total Petroleum Hydrocarbou (TPH)
Benzene. Toluene. Ethvlbenzene. Xvlenes (BTEX). and MTBE
8015 Modificd sps!
EPA 8020 or 8240
8015 Modified 3as!
EPA602 ot 624
Dresrt Total Peuoleum Hydrocarbons (TPH)
Benzene- Toluene- Erhvl bcnzenc- Xvlenas- Nanhrhelane (ETEXNI
E0l5 Modificdsn{
EFA 8U20 or 8240
8015 modifiedggd
EPA 602 or 624
Used ()il Oil and Grease (O&G) orTotal Rccoverablc Hydpcarboru (TRH)
Benzene, Tolucnc, Ethyl bcnzcnc, Xyleacs, Napbthrleoe (BTE)(N)
Ha.loeenued Voluile Orsanic Communds (VOC's)
EPA4l3.l or4t8.l;
g{EPA 8020 or E2()
and EPA 8010 or 824O
EPA413.l or418.l
!3{EPA @?ot624
urd EPA 601 or 62,1
Neu oil Oil and Crease (O&G) or Total Rccovemhle Hvdmartnns (TRll)EPA4l3.l or418.l EPA4l3.l or418.l
Otler or
Unlcrc,ri n
Total Peuoleum Hydrocadons (TPH)
Benzene, Toluene, Ethyl benzeae, Xylenes, Napbthalene (BTE)(N)
Halogenaed Voluile Organic Compounds (VOCs)
Or other EPA methods as aoproved bv the Execttivc Secretarv
8015 Modificd
eslEPA 8020 or 8240
1$EPA 8010 or tZO
8015 modified
&CEPA 602or624
g$IIPA 601 or 624
Complete the Facility Site Plat and SamPle lnlormation Table on pages 4 and 5 to provide site asssssment
information
CONTAMINATTON INFORMATION
ii contamination at the facility is susgected or confirmed. the information must be reported to the Executive Secretary (UST)
at (801) s36-4100 within 24 hours. The Division of WaterQuality must be notilied at [phone] if Free pr6OuA ii
'':ttcountered or if sudace water has been impacted. lf contamination is confirmed, any person assisting in the remediation
)rocess for a iee must be a Certified UST Consultant
rAlternative merhods allowed for 413.1 are 1664 or 5520(bl, and 418.1
method numbers can change or be replaced (e.9.8240 con be replaced by 82601.
sampler, or your analytical laboratory if you have questions.
may rlso use 5520(f). Note that analytical
Check with the DERR, your certified
'l
r..\N
>.
,!
3\$
.},.{Y
;,
I
D
nn
L]
\s
N
I
ss
r$\tr
R
t.,
I !t-i|.lliii
-I_.t._ iiiiI '' !i,rii'
i r .l
:;l
iiitliiiil'ir'liriilr
g5,47'.',
i hd:.cirii
l;,
!
I
I
I
I
!
i
l
:
1
I
I
:
I
'
:
i.
ll
E
$
z, = Sample locations (SS-#, WS+, USC+)
= I\,,lonitoring Wells (MW#,)
= Soil boring (SB-#), or Geoprobe Boring (Gp+)'{ = Water Wells (domestic, livestock, elc.)
! I ope of Su rJace Topography: (N,NW,W;SW,S,SE,E,NE)
. :r nd Use At Site: _Residential _Commercial _lndustriil,rrroLrnding Land: _Residential _CommErcial lndustrial
Site Plat Must lndlcate Approximate Locations Of:y' Current & formertanls, piping & dispensers/ Location of allsamples to be taken
r/ Buildings, fenc€e, & property boundariesl/ Utility condulte (sewers, gas, water, storm drains,
electrical, etc.)
I ,r lirt:l'.,r," ,ol. all samples to be taken r"
ii
ii
it
i'
,ril
Substance
stored in
tank
ll
i;
il
il
ii
il
Ir
1 Soil (SS), Groundwater (GW), or Unified Soil Classification (USC).
2 Approx. depth in feel below grade. The rsquired minimum sito ass€ssmont sampl€s must be taken at G2 l€6t below th6 bacKilunative soil interfac€.3 contaminant compounds to be analyzed tor each sampl€ (rrom tablo on p. 3).
,1 Appropriaie analysis methods lor contaminant compound(s) in each sample (lrom table on p. 3).
Approximate depth to groundwater in the vicinig of the tanks:35f feet.
Y
1 e g ro nal g rou ndwate r f low di recti6n' Norttr!'Iest
Analysis method(s)a
8015 l4odified & EPA 8020
8015 l4odified & EPA 8020
80i 5 l4odified & EPA 8020
State Ce(ified Laboratory to be
Address 463 West 3600 South City Src State_tlT Zip 84115
person Steve Phone#(80'l t 263-8686
explain any unusual or extenuating circumstances expected regarding the site assessment or closure:
:" )ontact
)lease
i certify under penalty of law that I am the owner/operator ol the tank(s) relerencgd above and that I am familiar with
the information on this form and that it is true, accurate and comptete, and further, that the procedures described
herein will be folfowed during tank closure - , ,/
Signature of tank owner
cull Name of tank owner Charles Hjorttr Date 9-9-98
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
I c)oo 12C
Mrchacl O. Leavrtt l6tl Norrh 1950 Wesrc.vcrrt.r P.o. Box 144840
Dranne R ,Y:ill:l ,,1P.; Salr Lake Ciry. Urah tt4lt4-4840
(801)536-4tfi) Voice
Kcnt P Cral' [phone] Faxl)ircctor (gol) 536-4414 T.D.D.
luly 27,1998
TO: Marlene and Charles Hjorth
Charlie's Service
790 North 1600 West
Mapleton, UT 84664
Enc losecl is infbrrnation re-eardin-e:
'['ank Notification Form
Tank Closure Plan
Tank Closure Norice
Certified Tank Installers
Certified Tank Removers
Certified Tank Testers
Certified Groundwater & Soil Sarnplcrs
State Certified Labs
X Other: Underground Stora-cr- Tank Tae
Utah UST Administrative Rules R3l I
Utah UST Act
EPA UST Regulations 40 CFR 280
PST Fund Information
Release/Leak Informarion
MUSTS for USTs
Billing Information
Leak Detection Intbrrnation
(17l27l98 9:.l6arn
lIy'ou huVe qucsttons concerninc tlti. lltilltcr or nccrl ;rsrisr;.rrrcc. plclrc c()ntact me at (801)536-410g.
Sincerelv.7^W
PaLrl l{trdins
LjST Scction/L.lrlh DERR
s-::/
".1
1
i.^ i' ; , , .......: - :. "; ,,,.
,_,
DEPARTMENT OF E}.IVIRONMENTAL QUALITY
rILE COPY
la ta /22
Michael O. Leavia
Coracmor
Dianne R. Nielson, Ph.D.
ErccutiE DirEcior
Kent P. Gray
Dilccttr
DTVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
l6E North 1950 West
P.O. Box l,{4840
Salt Lake Ciry, Utah 8411448.s0
(801) 5364100
(E0l) 359-8853 Fax
(801) 536-+414 T.D.D.
www.deq.starc.ut.us Web
ERRU-393-98
June 30, 1998
Charlie's Convenience Store L.C.
1320 West 800 North
Mapleton, Utatr 84664
RE: Underground Storage Tanks (USTs)
Located at Charlie's Convenience Store
Facility ID No. 1000120
Dear Mr. Hjorth:
According to the provisions of the Utah Underground Storage Tank Act (Act), Utah Code
Annotated (UCA). Section 19-6-412, all owners and operators of petroleum underground storage tanks
must have a Certificate of Compliance by July 1, 1991. Any peroleum disributor who delivers to a tank
that does not have a Certificate of Compliance will be subject to a civil penalty of up to $500 per
occurence (19 -6-416, UCA).
The Division of Environmental Response and Remediation (DERR) has received your request
to receive one delivery of fuel to test your tanks at the above reference facility. This letter is NOT a
Certificate of Compliance but allows you to obtain petroleum products for testing your tanks.
This letter applies to fuel being delivered from Maetex Supply on or behpeen July 2 through
July 8, 1998. A Certificate of Compliance cannot be issued for the non-complying tanks. If after our
review, your tanks are found not to be in substantial compliance with federal and state rules and
regulations, a certificate cannot be issued.
If you require further assistance, please contact Gary Harris at [phone].
Sincerely,
@c,fuu*
5i#3;f.i?;iffi*ff.:$ffi":1'J,Board
KPG/GIVjs
cc: Robert Resendes, M.B.A., M.T., Director, Central Utah Public Health Deparfinent
Roger Foisy, District Engineer, Department of Environmental Quality
FACILITY ID. IOOO I2.O
PsT PROCESSI}IG CHBCRLIST
Year qq usrs+ 8,4, lO
n^q$
Non-Market,er Discount
Not
Unacceptable Acceptable Applicable
\,-
Previous Pollution fncidents
- LUST File
- Form Included
Y/@-
@* L/
+l ,?lqg
- Verify cank/lines
vs registered.
- Documentation ok?
- Rate ok?
9N
@z*
QN -r/
?ttHq(
Fund Paid
- FY 91 Q1_Q2-Q3-Q4-
- FY 92 Q1_Q2_Q3-Q4-
- FY 93 Q1_Q2_Q3_Q4-- FY 94 Q1_Q2-Q3-Q4-- FY 9s Q1_Q2-Q3-Q4-- FY 95 Q1-Q2-Q3-Q4-- FY 9? Q1_Q2_Q3-Q4-
oe\qo
@wFees Paid
-FY88-FY89.FY90.FY91
-FY92
FY 93
FY 94
FY 95
FY 95
FY 97
r\ qq lqtu Podd. b /fi!1/
Compliance t-/
- Compliance Outstanding? Y@- Leak det,ection required? @m \
- ipirf /overfill re{uired? @N @- Corrosion protection required? SryN u^-.1+ rFf/
- Notification up to date a complece? qglN t/
Application submitted? qflm -4
.+PPT? ,, '+
>kF_
iSv.a .zra
4 [tol,
Date QualifiedDate Issued
-7-2"^q
( a:tt ,-4b*-,r s .-aJ ,
Review completed and certificate issued by A Tl,lrOf
pRooucr CoxrrtillrEltr Svsrex Ixteenlty Evelurrtox Dern Cxnnr
:Loclrtox :
a
a
a. aa aa aa a. aa a!
:fixen :
:
REESOT FOR TEST :
:Pensox :
Rreuesrlfic TEsr :
:
I
aTrnr(s) INVOLVED:
REGULATIONS
6rqlrhfe
CTpTcITY Gnroe Tesreo rr Aee
? N. /r@ u,
aaaaaaaaaaaaar
l.lnrentri
?AA?
rr]
[[E -
Locrrtox
3
Coven F r r-r-s/Vexrs Puttps Svpnoxe
ir" ?"
t'1" /,"
ilt, Lrt
.enr DerEcroR Tesr 1 pASq ' pru ' rr* u
.NDERGROUXD IIATER
Resuurs
Acconorxa ro
ID
AVAILABLE SOURCES, MORE THAN
Resuurs Rlre
fo reer ,
Drrr
1
2
3
45-SreEEoxsHoRren EZY 3
Nor VoUUIIETR I c
TnHx Trenrxess
Tesren
32q01t352---
Co-0001ui-ooi4 , I
In-9114029
UTT-1038
$JL \1ES
R€IC( RIDGE, TNL.
P TRO E}ryIRO
P.o. BG 51365
Provo, ft,ah 84605
Phone 80O 657 2844
)lq
^
PETROLETJM STORAGE TAI\IK
FINAI\CIAL RESPONSIBILITY DECLARATION
FACILITY ID# | ooo tzo
FACIUTY OWNER
FACILITYNAI\,IE
FACILITYADDRESS
CheckOnly Otu
fr ,choose to participate in the PST Trust Fund.
O Submit this Financial Responsibility Declaration fonn and obtain a Certificate of Compliance
before the tanks are put into service.
O All petroleum storage tanks located at the facility, including unregulated underground tanks
and above-ground tanks, may be required to participate in the PST Trust Fund.
O Indicate the number of above-ground petroleum tanks located at this facility O
O Indicate the number of unregulated underground petroleum tanks located at this facility O
n I choose another Financial Responsibility Mechanism
The financial rcsponsibility mechanism to be used is
Submit acceptable financial rcsponsibility documents using the format and exact wording
specified in 40 CFR Paft 280 Subpart H for the chosen mechanism and include a processing
fee of $420 for each mechanism used; or if this mechanism has already been approved for
other facilities and the processing fee for the current year has been paid, submit an amended
list of the facilities covercd by this method and check herc: E
Submit this Financial Responsibility Declaration form and obtain a Certificate of Compliance
before the tanks are put into service.
krdicarc your Company's Fiscal Year ending date
Name of person authorized by owner or operator to demonstrate financial responsibility as
required by Utatr Admin. Code R3l l-206-2(d).
Namc of person authorized by owncr or opcrator
I
'l40lt, l6fiO l't,'cqlat , tr ?tt('6c{
o
o
o
o
I ', i' 4io' =,'
Print name of owner/operator or authorizcd
ir,t
I
\\
represcntative
Jt lIs
l _ Facility lD # rooorzo
This lsfrar, or an quivalant, mnt b sigtrld aN nd@ with yanr apliaion aN t#.
PRET'IOUS POLUJNON NCIDENTS
To: Mr.lGnt P. Gny
EreartiYs Socrctary (UST)
t tah SdH & Flazardoug Wagb Contol Boad
Dear Me Gny
As raquf€d by paragraph 19!6..019 of fie utah UndaErourd S-bnage Iattk Act l hars perfuincd a tmk atd
[ne tdtfit€ssi*n oi€idr rrrde€round srago rnr ai nry fadllty, atd basf qr thb tlst' tlsc hi3 tEt beal
a nfLsa of petobum. Addito;aily, basl on 'arstornary busineas imrenbry praclicas star&ds' I am @
aflara ol arry rebase of pafohum fiom rry tanl.B.
9E
I have had ha blowing raleasas of pemohum (detaibd below; also mention atry adion yor.r bolt to dean up
fio rolease).
1
Facitity lD #
PETROLEUM STORAGE TANK FUND APPUCATION
LOCATION OF TANKS
1 0001 20
Address 1320 [{EST 800 }ffiIII
Fadlrty Name cmnr.mrs mlvErrrrm sqrhn rn
Address 790 lmIII 1600 t'JESr
City IIAPLEIU{
County
State T}:NAII Zp Code -A!ssA-Phone [phone]
Contact person CHARLEI EilRItI
TYPE OF OWNER
I x] Marketer, or non-marketer with facility averagts monthly thrcughput greaEr Utan 10,(n0 gaflons.
[ ] Norrrnail<ebr wih fadlity average monhly thmughput less ttran 10,(X)O gallons (mu* verin.
DESCRIPT|ON OF UNDERGROUND STORAGE TANKS
Tank #
Age
Capacity
Substance
City MAPI.,EiEN nf,Nr 84664
County_EAE
state trrNl zp codle _-31651_
Pnon
ConAA Person CHeRtEfi ITTGWI
8
-9- -Lo-NEN
12n<
-DIEIEIJ-
12< 1z(',
GES GAS
TANK TIGHTNESS TEST
Tank #
Pass/Fail
I
PASS
910
PASS PASS
EERTIFICATE OF REGISTRATION
Ix I All Underground Storage Tanks (USTs) at this facility have been registered.
I x ] All tank regisfiation fees have been paid.
COMPUANCE wlTH UST REGULATIONS
ls the applicant qlr€nty in compliance wtth all Federal, Stiate, and Local UST regulations?
I x I Yes I I No lf 'No'please dessibe iEm(s) of non-compliance:
PREI'IOUS POLLIMON NCIDENTS
Has a pollution incident ewr ocqrned at )lour facility?
I I Yes lf Yes'pleasa prcvitle LUST (Lealdng Underground Storage Tank) information:
Ix I llo ll'llo'please afiach a leter stating that under g*$aaU hnllesslnveq9qRracticeestandards
you af€ not awarc of any raleasa .ttiq facifrty. The PREVIOUS POUUflON
INCIDENTS form may be used.
1ns
I I I have met the financial responsibility
mehod:
lor tre ftrs1$25,000 per release by the folloring
I I Self lnsurance [ ] Guarantee rr i6rtdfrA?,illtn*ran " I IsuretyBondi i nisr Retention Group i i t-etter of Credit 'i-jo65r
I etuty under paalty of law tlrrt ilE abw represrlntsrtiorc made by ma are f,ue ard ama.
r
t_
oumer/operator signrau n e 4'Z(, Data signed .rn.Y 16- lqqn
PEIRUjUM STORAGE TAI{K FUND cHE/ JsT}'
1. CERTIFICATE OF REGlffiAfl9N,,,==,,
==::: l::: :::i=:=:: =;; ;;; iEi6:i iE;E;; d6ii-
t
t t,I*"lJglo;il'n-;;";#E;-p"id. nscar years-.1e8&8e= $2sltankr!r., Fiscal years leeq-e2-
$45/t""t 4/t., Subsequent fiscal yeats $60 or $139tank4n'
deEaion requirements'
t I I am in **iii*." mn
"rr
other Federal, Stiate, and Local UST ragulations'
t tGuarurbe [lgmmercial lnsurance [lSretyBold
i t Umr of Credit I I Other
3. PETROLEUm sroRAGE TANO r:uND FEES
@harnbeenPaid.t I Fiscal years 1 gg1 €3= $:250/tank{p. or 01 2s/tanldyr. (wiilr non-marketer discount') plus applicable
Process fees.
t I Fiscal year 1994= $lsotantsyr. or $7s/tankyr. (wth non-marketer discounf) plus applicable
Process fees.
t I Subseqnentfiscalyears= Based on tacility trroughput S5o' S150 or $l7utanlal6 plus applitxble
Process fees.
' For non'marketer discount
t I r ama non-marketer with facility averagelnonthly ttPryllul less than 10,000 gallons'
t I r have comptered ne nipicinou Fon uonlueaxH:ea DtscouNrrorm(s).
4. TANK AND UNE TlGtlTI,'lE?S TFFT : : , : ::@ tank and line tightnes: tesls:
t I I am submm[ng 6i".rG or tni an-r and line tightress tests and a copy of the field repoil
t I Alltanks do not meet tre requirements set by rule regarding ank tighhess testing'
t I I have.onAa.,a ur" sar ubi omce and wifi submit-evidenca of a plan for review'
s. pHEVTOUS poLLU[!9N !!99E?{rs= = , , , ,==:: :::: ,
t I I have compteteO fr e PR6/|OU s whether under customary
business irfintor, practices standads I am awarc of any release trrom the tank
6.tNpEPENDENTFNlNclflA?9pRl!\$rcE :r:::: , : ''' 't I I have me se bY the tollowing
method:
I I Self lnsunnce
I I nsr Reention GrouP
"See elplanations under'Hour do I get started?'
%services, rnc.
1320 West 8(X) Norlh
Mapkrlorr, Utah 846fi4
June 20, 1998
TO WHOM IT MAY CONCERN:
BECAUSE OF TANK EXCAVATION SLUFFING WE COI]LD NOT GET T}IE TANK
AT CHARLIE'S CONVENIENCE STORE DEEP ENOUGH TO ALLOW TTM, PRODUCT
LINES TO HA\.{E I/8- SLOPE BACK TO TIIE'T'ANKS.
TTIEREFORE, TIIE PREMIUM, PLUS AND NOLEAD LINES TIEADING NORTTI
SLOPE FROM THE TANKS DOWN TO THE POINT OF CONNECTION TO Tt{E, EX-
ISTING LINES. TI{E DilSTING LINES SLOPE UP TO EACH DISPENSER CONNECTION
FROM THERE.
CH,{RLES HJORTH
O\rtr$lER
CITqRLE' S CONVENIENCE STORE
1n':4
r^--1 l't<lu-'.l- '' (
,/ u7z1{"e4 11:19 FAX 80aSg ggsg DMNY RESP Ra
usT lnsEallation/UPgrade Pw'mlt @ ooz
txt N€yE!r81E t I Dnrmltlaodlllar?loE
hserrr.cioE eoDDrsy - Rockv Ridqe, Inc. t'ttatE *"' ,; .4,18;3=5-2
o46'"'" P.O. -Bo* 5 atlcc Utahs'rp-94505
Pbono#r800 r 617-2844
Cerllllad tErE,lllrr's on Frojectt
NamE charles Hiorth cert-
CGTE.
ccrg.
x rr, 00?6 se.
*!!-Er39.*EL-se'
aace 7-1 -99
dagc-
daCe
93gs work rrlll commenee lst @
IIEuEu.l OE .vEl0Urclag clrcrrnrErEe.a orDrsErdt
(Xl Nertrn3lallaEion ( 1 USrg'rede
Togar rDsEEIIarion TeDk Fee/D.rntt -"999*gg-
Frellrry x-r Cknrliq's Convenience Stgre IL ,
^""rr"r'
- -z- "t"" scece-!@[ uir-9!55L
co[tact Pergon
atDl3s tat€l'vad t"u lalBallrtslos / urerrltl-
fanh #2 3
InerBu./upgrBde TnstaIl TnstaIl Tnst-a11
cspacity (gallone)12r.12K 12K
q/pe (FRE, steel , egc.)SteeI Steel SteeI
Substanca Eo be Stgred iasoline Iasoline Diesel
giPlng lfpe (PreE6.'
SucElon, GrevlEy)kessure Pressure Pressure
Tyrc ol ltllcruqqle8llrDgtql.--
Daecrlptlot -.:€--:"1=-lSt !b.a
Tnsta].l New Tanks 1..*,o^rrr.fu l'.! I ?
RECEIVED
IAPR Z U '*.i
I I
I
:r+.lil#I
r6al1 coraDl.t.d tor Eo!UErh DeDartuent of EnvirourEngal Quauty
Divtrsloa of Envtronoent,al RctPonse aad Rcmcdlation
::i.-ffi.leso
r{G'!' :'at rloor
sraEe uec onry: DaEe Approv "u
r-Ldilkr"n lllt"' a/>- D.c. ps'rir Maued *l*lq{,el+ 177.<
Michecl O. Lcavia
Got€[!d
Diannc R. Niclson, Ph.D.
Erccrdva Dirccior
I(cot P. Gny
Dil€c(r
l.
DEPARTMENT OF ENVIRONMEMAL QUALITY
DTVISION OF ENTVIRONMENTAL RESPONSE AND REMEDIATION
168 Nort 1950 W6t
P.O. Box l4lt{0
Salt lalc City, Uteh t4l 14-4840
(t0l) 536.{l$ Voicc
(801) 359{t53 Far
(8Ol) 53G4414 T.D.D.
4 -zt-?(Date:
From:L) , l/l^",,o
2.
3.
Dear Underground Storage Tank Owner/Operator:
The Division of Environmental Response and Remediation has received notification that one or morc
underground stomge tanks (USTs) (tanks / associarcd lines upgraded) at
Utah, facility
ID# I O@1ZO . Before regulated USTs cin rcceive deliveries of fuel and 6e put into operation, they
must qua[ry for the Petnoleum Storage Tank (PST) Fund and rcceive a Certificate of Compliance. To quatiff
the tanks for the Fund and receive a Certificarc of Compliance or maintain your currcnt Certificate of
Compliance, you must do the following:
Register the changes in the tanks using EPA fomr 7530-1, Notification for Underground Storage Tanks
(Enclosed). Tanks installed after December 1988 must have the following in place when installed: leak
detection on tanks and piping (including automatic line leak dercctors on all prcssurized piping), spill and
overfill deviccs, and conosion protection. Ihe Utah Certifred Tank Installer must sign page 5 of the fom
to certify e proper installation.
New Tanks or Systems participating in Utah's PST fund Only: Complete the PST Application (yellow) and
Previous Pollution Incidents (green) forms from the enclosed PST Fund application packet. You must
indicate on the PST Application form the gpe of financial assurance you will use for your share of eligible
cleanup costs for each release covercd by the Fund, and declare your Financial Responsibility type(s).
Conduc{ a tank and line tightness test and send a complete copy of the results to the DERR. The tightness
test must be conducted by a Utatr certified UST Tester for any new tanh line or system installed.. A list of
certified UST Testers is included in the PST Fund application packet. All portions of the tank and piping
system which could contain product must be tested. To rcceive a delivery of fuel for testing, you must
contect DERR for authorization of a one-time delivery for testing purposes for new USTs. Contact the
DERR office at (801) 53641A0,24 hours in advance, to ilrrange for this authorization.
New Tanks or Systems Only: Pay UST regisration fees. In addition tanks participating in Utah's PST Fund
must pay new ank PST fees for all new tanks installed. These are: registration fee- $150 per tank; New tank
PST Fund fee- $250 per tank. These fees must be paid before a Certificarc of Compliance can be issued.
l5lRlll lrnsElailruoqcas {uBI atsrols punoJtJapun
'suoqsanb (uu arreq nof gt 661p9€g (I08) lB acIJUo ISn )ruAq aql IIBc aseald
'asn olu tnd aru farp arogaq $lur1 ,rlau roJ pans$ aq acuugdtuoCJo e1ucgpreC 3 1utp sannbar ('bas n tOFg-6I
'uuv apoJ r{u1n) lcy 4rul aEerolg punorErapun qz1n aql 's{ustrno{;o asn atpJo ssol pIo^B no{ dlaq ptru
ssacord aql alsllllc?J IIr^\ sluauarmbar raqlo prrB suuoJ pepeau arggo uopaldutoc {1arut1 'a1qec11ddu uaq,nt
acuuqduo3 Jo alucgruaC B anssr nl/r\ lptrIC aql 'palraoar sI uopeutroJur frssacau eql uaqrtyssappo a^oqs
ae ls mIgO eql ol sluau(ud aag (uz pnu'sllnsar lsal'snf,roJ atp puas 'palalduoc aJ" sluall e^og aql uaqrtl
I
./-tJ1 ++":':r.c----^ .\-; rni,-
!-j l;i- ,-f -Q 1 J l;Cl.!.-i
Michel O. Lcavin
CrOttrUC
Diannc R. Nielson. Ph.D.
ErGcutivc DirEta
Kcnt P. Gray
DiEai.r
DEPARTMENT OF ENVIRONIVIENTAL QUALITY
DwISION OF EI.wIRONMENTAL RESPONSE AND REMEDIATION
l6t Nonh 1950 wcst
P.O. Bor 144E40
Salt blc City, Utah t4t144840
(t0l) 5364100 Voicc
[phone] Fax
(801) 5364414 T.D.D.
Facility ID. #Lbo 12o(lo.tcr Ri.4< r. .
P.O.' Bov t-(zl
?ctf .^^ , c ^T €l'/6ll
oae: 1f ztlqfl
From: lt tlil'z*
Enclosed is the information you have requested regarding:
Utah UST Administrative Rules
UtAh UST ACt
EPA UST Regulations 40 CFR 280
Billing lnformation
Release/l-eak Information
Musts for USTs
Dollars and Sense
[-eak Detection Information( PST Fund
)<- other
Message:
k. Tank Notification Form
Tank Closure Plan
Tank Closure Notice
Certified Tank Installers and Removers
State Certified Labs
Cenified Tank Testers
Ccrtified Groundwater & Soil Samplers
If you have any questions, please contact me at (801) 5364121.
Underground Storage Tank Section
Prinl€d on recycled paper
F:\ERRSUPFORT\UST\FORMS\BIANKf RITASPMEMO
MARLENE HJORTH
L320 W 800 N
I4APLETON
March 17, 1998
ur 84664
Re: December 22,l99t upgrade deadline for Underground Storage Tanks
Division of Environmental Response and Remediation (DERR) records show you have one or more underground storage tanks
(USTs) which have not mer the December 22, 1998 UST upgrade requirements. These tanks are located at CHARLIE'S
CONVENIENCE STORE LC, 790 N 1600 W, Mapleton, facility ID# 1000120.
Under Federal regulations issued in 1988, UST owners and operators have until December 22, 1998 to upgrade, replace, or
permanently close USTs that do not meet the requirements for protection against spills, overfills, and corrosion.
This deadline will not be extended. If your tanks are not in compliance by the deadline, they will not be able to receive
deliveries of fuel.
The DERR encourages owners and operators to meet the 1998 upgrade requirements ils soon as possible before the December 22,
1998 deadline. It can take several months to upgrade, close or replace an UST system. Delays are not unusual, and contractors
may not be available if you wait. Start planning now!
Our information shows these requirements have not yet been met:
Tank tD Substance Tank Capacity Spill Protection Overfill Protection Corrosion Protection
I Gasoline 6000 No No No
2 Gasoline 8000 No No No
3 Casoline 10000 No No No
4 Diesel 8000 No No No
5 Kerosene 1000 No No No
Any metal flex connectors connected to fiberglass reinforced plastic (FRP) piping at the submersible pump or dispenser must be
cathodically protected or taken out of contact with the soil.
USTs filled by transfers of less than 25 gallons at a time (usually used oil tanks) are not required to meet the spill and overfill
prevention requirements as part of the upgrade requirement.
If you have questions about which requirements you still need to meet, or would like to have someone visit your site to help assess
your needs, please call Alan Jones at (801) 536-41 15.
l0@12-o
.- lrST lnstallation/Upgrade Notificatir.rt
The Utah Underground Storage Tank (UST) rules (Utah Administrative Code R311.20g-g) require that UST lnstalters notifythe Executive secretary, Utah Solid and Hazardous waste Control B.oard, 30 days be10r; rnstaflinl or ,fgooing .nyregulated UST system. This lorm has been prepared to assist you in providing ihis intormation. ielore instattiig orupgrading an UST systam, please complete this form and retum it to th6 Oivision of Environm6ntal Response andRemediation at the address below. ll any tanks or lines are removed or replaced, a Closure plan lor those tanks or linesmust be submitted and approved, and a site assessment must be performed at closure.
Facility lD# (if not a new facilig)1 0001 20 1 xt Newlnstaltation I I Upgrade
Date work will commence Aori 1
Tank Owner Phone#(801 ) 489-034q
Address 1320 West 800 North City Mapleton State_Ur Zip_84664
Contact Person in charge of tanks Charles Hi orth
Facility Name
Address 790 North 1600 Weht City ltapfef-on State ur Z\qJASSA-
Contact person Charles Hiorth phone # ( not) anq_.l nrr
Certified Tank lnstaller Name Ced. # TL 0025 . Exp. date_7-l;!!
Company C. H. Services, Inc .Co'fl*at 7 Phone # L8O1 ) 4Bg-6025
Address i 320 West 800 North City uapleton Stare UT Zp_9.3.!.!.1__
lnstallatiory'Upgrade lnf ormatlon
Tank #
lnstall/upgrade
Capacity (gallons)
Type (FRP, Steel, etc.)
Substance to be stored
Piping Type (Press., Suction. Gravig)
Tank Leak Detection method
Line leak detection method
Form o{ Corrosion Protection
Spill device to be installed (YN)
Sqto
InstaII Install fns.tal.l
't 2R 12R 12K
Steel Steel Steel
Gasoline qaggllne Diesel
Pressure Pressure- Pressure
Autcrnatic Tark GauqinqannGfilne]iffiAutcrnatic Line Leak Detector
STI P3
Yes
smP3
YeS
Yes
STIP3
Ovedill device to be installed (Y/N) yes Yes
Unusual or extenuating circumstances
i
I
i
tUtah Department ol Environmental Ouality
Division ol Environmental Response and Remediation
168 North 1950 West. lst Floor
Salt Lake Clty, Utah 84116 D xaivo oELIVERED
State Use onry: Date a""'03/2cl/?< Radday h/ > Noilco sent To o/o i,u.Llnn tzug!
State Zip Code
Area Code Phone Number
Contest Pereon At UST Location
4gq - \ab?no""
r
r-""it.,rv
:t'-" Llrr*r[*h (-0rutr,saJLa^r:L,
"o""'ooo'"""tlqo N, lboo w.
i'" tta-#r*mn
uouily 1;m k(
Certificate of Compliance on site? (e{No Expiration data
tv [Av1 certify that I have inspected the above-named facility on{qlntml
lnspector's
Signature of Owner or Owner's Representative present During
Oistribution: White-DERR, Yellow-lnspeaor, pink-Facility/Owner
Automatic Flow Restrictor (if yee, indicate model in comments soctaonl
Automatic Shut-off Device (if yes, indicEte model in commont6 soctionl )
Continuous Alarm System (if yes, indicate model in comments section)
Records of last Line Leak Detector performance test aro available on-site
Date of last Line Leak Deteaor
Result of last Line Loak Dotoctor
Rocords of last Line Tiohtness Tost ar6 available on-site
Date of last Line Ti
Result of lact Line Ti
Name and company of certified tester:Testor Certificstion Numbor: UT
Groundwater Monitoring (if yes, use Groundwater Menitoring checklistl
lnterstitial Monitoring (if yes, use lnt8rstitial Monitoring checklistl
Statistical lnventory Reconciliation ISIRI {if yes, us€ SIR checklist}
Other approved method (if yes, use other method checklistl
Records of last Line Tishtness Test are available on-site
Dato of last Lino Tiqhtness T6st
Rosult of last Lino Tiqhtness Test
(if yes, use Vapor Monitoring checklistl
Groundwater Monitoring (if yes, use Groundwater Monitoring checklistl
lnterstitial Monitoring (if yes, use lnterstitial Monitorins checklistl
Statistical lnventory Reconciliation ISIRI (if yos, use SIR checklist)
Other approved method (if yes, use 6ther mothod checklistl
Slope of piping will allow ALL product to drain into tank when suction is
released
Has only Ol{E check valve, locatod dir€ctly under pump
All above information on suction piping is VERIFIABLE, use comm€nts
soction below to document how it is verifiable.
Signature of Owner or Ownsr's Representative Present During
Distribution: White-DERR, Y Plnk-Facility/Owner
This method of leak detection requires both monthly inventory control reconciliation and tank tightness testing. lf the UST has not been upgraded
(upgraded means that the tank and piping are protected from corrosion and that spill and overfill prevention devices have been installed) the tank
needs to be tightness tested annually. lf the UST is upgraded the tank needs to be tested every five years. lnventory records must be kept for
each operating day.
Record of last Tank Tightness Test available on-site
Date of last Tank Tightness Test
Result of last Tank Tightness Test. lf fail, specify in comments section what
actions have been taken to correct the problem. Has DERR been notified?
Type / Brand of test equipment used:
Name and company of tank tightness tester:Utah Tester Certification Number: UT
Documentation of performance claims for the Tank Tightness-Test method is available and shows the ability to detect leaks of
0.1 gph with 957o or greater probability of detection and 5% or less probability of false alarm (3rd party certificationl
lnventory volume measurements for regulated substance inputs, withdrawals,
and the amount still remaining in the tank are recorded each operating day
lnventory is reconciled monthly (sum of daily over and short for each month
is compared lo 1o/o ol tank's flow through volume + 130 gallons)
Which months exceed the allowable over-short? (specify month and year)
lnventory Control records are maintained and available for the past 1 2
months for each tank
Records include monthly water monitoring to the nearest 1/8"
Monthly water readings are used to adjust monthly inventory balances
Appropriate calibration chart is used for converting product level
measurement to gallons and is available for review
Dispenser pump has a current calibration sticker or appropriate
documentation
A drop tube is present and it extends to within one foot of tank bottom
Owner/operator can explain inventory control methods and demonstrate acceptable gauging techniques
The volume of product in the tank is measured using a:
lf a gauge stick is used, it is long enough to reach the bottom of the tank
lf a gauge stick is used, the bottem of the gauge stick is:
lf a gauge stick is used, it is marked legibly and the product level can be determined to the nearest 1/8 of an
inch over the full range of the tank's internal height
Signature of Owner or Owner's Representative Present During
Distribution: White-DERR, Y lnspector, Pink-Facility/Owner
'liirilllllriirir::1.!r:rrrr: lrr !r. : !:. ! ! lrlllr !,lr ! !,,,,,1,,1: i:liiiiiliiiill;ir iiilii i
!!!!!!:!!i!!!!iiiiii:llllll:illll:l::ll:llil:lllllllliilliilllilirllfillli:lr a
txriiiffi riIiiiiiiii*+#ffi]ffi
iiii{$i+lff-,ffi.ffi'
S.H,iilfilff,i
;iffiitffisi fi,lffiil*s1ffiff#ffi.jfitriffiiiiilrs**iffi}tr[li,#ffi*iti* #l#if;ffifii$jftit.fffiliiftflliirilillxililliiif,l
r$PlffiHffifilhLii#H.EtlH H+,,,'.:,:l:.,':i:::i:.:::..il::::::::rililliiiii$
Tank 1 Tenk 2 Trnk a Tank d
The UST system is filled by transfers of 25 gallons or less. lf yes, spill
and overfill prevention is not required.
Yes 6:i Yes No Yes No Yes- No
ls there a spill containment bucket or another device that will prevent
release of product into the environment?
Yes Ko )
\--l(
Yes No Yes No Yes . No
----l>
ls there an overfill prevention device installed on the tank? lf yes,Yes e,Yes No Yes No Yes :!l,lo
rr rvrgq(s u rs ryPg vr usvru9. 9a[ [var 1[
(in fill pipe), Alarm, or Other (specify)
For overfill alarm only: ls the alarm located where it can be easily
seen and heard by the delivery driver?
Yes No Yes No Yes No Yes No
For overfill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?
Yes No Yes No Yes No Yes No
Tank I Tank 2 Tank I Tank 4
lndicate the type of corrosion protection: Noncorrodible material (FRP),
Composite steel (CS), lnternal lining (lL), lmpressed Cunent (lC),
Sacrificial Anode (SA), or Not protected (NP). lf FRP or CS do not
complete the remainder ol this section.^JP
Tank Tmk Tmk_>
^/P
Llm Ltre
FdT2
lf the UST is not protected, was the tanMine installed before May 7,
1985? ll yes, corrosion protection is not required until Dec. 22,
1998; do not complete the remainder of this section.
G", No Yes No Yes No Yes Not'
The results of the last two cathodic protection tests are available.
(within 6 months of installation and every 3 years thereafter).
Yes No Yes No Yes No Yes No
Results of the most recent cathodic protection test.
Name of tester:
Test Date:
Tah*
volts
Tail
volts
Tar*
volts
Tank
volts
Llm
volls
UM
volts
Llm
volts
Um
volts
For impressed current system: The results of the last three
equipment operation checks are available. (Equip. check required every
60 days.)
Yes No Yes No Yes No Yes No
lf the tank has been retrofit (lined or cathodically protected), indicate
the date the retrolit was completed.
tllii+:6,a*l+iiiliiriliiiiiiirriwiliiiIiiiliiiiiiiffi ixiliniiffi fi
l|nqfffiH.Eillll$tlHl. ffiIultl
r\ (/!Qn/,€-c' !##;fr '[*tr
'
understand that the folowins marked items must o" "orr,"ffi
December 22, 1 998 in order to meet the '1998 upgrade requirements: ffipitl prevention tor tank(s) * I - 5
fiuertiltprevention tor. tant (.)* i - f y'Corrosion protection for tank(s) *--l- -5/-
/Conodonprotectionforpipingassoc.with tanillsl* 17r3, 5 ! Facititymeets lgggupgradersquirements.
iignature of Owner or Owner's Representative present During lnspectionY_:(22Signature of Owner or Owner's Representative present During lnspectioni
-FDistribution:White-DERB, Yellow-lnspector, Pink-Facility/Owner
FACILIW SITE PI.AT FacllitylD No. IOOO lh
gDD N
\sf,
. ,l 4llE4,
-t-' _+ 1Oor l-l
'.;ola
I
I
*(
Ltsgtyr1c .El r
'I]
Ar
'12-*-L
vrnt
ot a[ buitdings. streets. tanks. pipi(E and dispenser istands. lndicate location and degth ol all samples collecled by lhe sampler and th6 lnspedor. AIso indicate
re location ol any reponed PID or FID readings.
'otential Receptors- lndicate distance (in feet) to tho nearest: Residences Buildings Buded utilities
A,ctive water well Surlace water
)omments:
rrte: fZe76
50t 38 t'acilitv Number: I 0001>0
INSTALI"ATION INSPECTIO N
QProperry ! Business only gf",* -rtv
Owncr Name rCorporarion. Individual. I\.rblic Agency, oi oth".
"r,titv)
i37u r,D ?ao ru
c 'fhz+lltnr- - -
t tT Sl b; 4-
! Business onlv ! Tank only Seme as Scaion I:
-Facilitv. Name3g CogCanl Site ldentifier,, as applicable
C/La4.ll)b /nt u<-tt,tl-rtcx-
'74 c Pr i laod k) 48q'
City (nearestr state
-
Iio cae
UST TNSTALLER:Company: CH ?.w,ie4 Cert#: TLclO,)b
D I
TankNo. b, TankNo. TankNo. TankNo. TenkNo.
l. Estimated Total Capacity (ga[ons; I fl<
2. Type: FRP. Steel. Composite I 5f
3. Substance Stored 4 K H.Aw De:e
New or Used (must bc recertified)
5. Type of leak detection
QVapor Monitoring
Automatic Tank Guaging fl Tightness Test and Inventory Control
! Manual Tank Guaging E Other
E GW lflonitoring
. Type: FRP, Coated Steel, Composite
Typc: Suction, Pressure, Gravity
3. Type of leak detection ! Automatic Tank Guaging ness Test and Inventorv Control E] cMrlonitoringE [nterstitual Monitoring flManual Tank Guaging E Other
1. Spill device installed (Typet
2. Overfill device installed (Ttpe)
SPECTFICATIONS
Distance from tank(s) to nearest property line (5' minimum) _ fJ.Distancefromtanktoneareststructure(5'plrrs45fromsurfacetotank)-ft.
Estimated depth to groundwater ) ZO I
Do tanks have at least lt" spacing between tanks (stable conditions)?
If unstable walls, are tanks spaced at least l/2 times the diameter of the tanks from each other?
can groundwater raise into the bottom of the tank excavation (must anchor)?
Does depth of installation conform to planned Anchoring, Surface and TraIIic conditions.
groundwater conditions and piping run slope requirements?
Has Tank and Piping Cathodic Protection systems been checked to verify they are working
properly?
Does the amount of Tank Deflection meet specifications?
r-l:
lt
{l
U
Show locations ot all butldings, streets. tanks, prping and oaspenser rsranOs.
the location of any reponed Plo or FIO readings.
Potential Receptors- lndicate distance (in feet) to the nearest: Residences
Active water well Surlace water Other
c, trl
Ag
,".,*,"LL""t?,c
Facllity lO No. I O OO t JO
*.^{
k$
depth ol all samples collected by the sampler and the inspector. Also indicate
Buildings Buried utilities
FACILIW SITE PI.AT
NORTH ilZ€a?o----)--
lt-ur-
\.'r I I
--lttr-T
N t-.-J
T[I !+!
l-1,
l-9
,16
,^, i
Li 3
-t_c&
a
$(.
"(
cA
rIlit(.
ct
Comments:
V Crv lwi*that I inspected the above-named lacitity on a{nf*(**r!r.A{b
7=-" '^ | ,
"en*
TT c)i)ge, oate, /t //,,.1 /eh
,o(al urcl
lnspector's Signature:--/.
PST PROCESSIITG CEECKI.IST
Year 1 < usrs
FACTLTTY -u. If v\l>?
#d-l
Non-Marketer Discount
unacceprable Acceprable eppl?!.ur",,-/D/
Previous Pollution Incidents
- LUST File
- Form Included
Y/N
@,
TTT
- Verify tank/linesvs registered Y/N
- Documentation ok? Y/N
,/
,-/7
Fund
-FY-FY-FY-FY-FY-FY-FY
Paide1 Q1_Q2_Q3_Q4_e2 Q1_Q2_Q3_Q4_e3 Q1_Q2_Q3_Q4_e4 Q1_Q2_Q3_Q4_es Q1_Q2_Q3_Q4_96 Q1_Q2_Q3_Q4_e7 Q1_Q2_Q3_Q4_
Fees Paid
-FY88-FY89-FY90-FY91-FY92
-FY93-FY94-FY95
FY 96
-FY97
Compliance
- Compliance Outstanding?
- Leak detection required?
- Spi1l/overfill required?- Corrosion protection required?- Notification up to date & complete?- Application submitted?
Date QualifiedDate Issued
-/'
l-/7T-
=T7
-
Y/N
&il
8l
@t't
psEproc. frm 05/L8/95
Review completed and certificate issued by
PRODUcT CoxTIINMENT Sysreu Inreenrrv EvnluATloil Drre Cnrnr
P. A. REGULATIoNS
Locrr rox
aaaaaaaaaa
Owxen
a
a
a
a
a
a
a
Rerson FoR TEST :
:PEnsot :
ReouEsrrNG TEsr :
:
a
Tmr(s) rxvolvEot Gnnoe Tesreo trwd a€#n
E.
Crprcrrysffi $t{/1t/Aoe ilrreRrrl
a l a a aa a a a a a t a t a a a a a a a a a a aa aa a a a a t a a a a
I
,I
Locrrtox CovEn Frr-r-s/VEilrs Puttps Sypxoxe
L
1
2
3
4
Tesr
EAK DErecroR Tesr , y,n , pA"^ ,
NDERGRoUxo }lnrrn Acconorxe
D
TO AVAILABLE SOURCES,
Results
I.IORE THAi{ ZQ FEET ,aRrre Drre
D Hervo o..,r."ri
Honnen EZY 5
Nox VoI.UMETRIcInnx Trenrness
Tesren
TEVE LYO}IS
,24011 52
Co-0001
uT-o054
Io-9114029
UTT-10'8
Rocky Ridse, *.. 9l[YE*hU8[i*inofEt[,
P. o. bx 241
Payson Ut.
Pnooucr CoxrrtNHENT Svsreu
a
aLocrrtox :
a
a
.. .a aa aa aa .a a! aa
a0wxen :
a
Rersox FoR TEST ;
a
a_ Pensox :ReoursrrilG TEsr :
:
a
Trxr(s) TNVoLvED;
InreenTTY EVALUATIoN Drrr Cnnnr
aa aa aa aa aa aa aa aa
A. REoULATIoNSE.
Crprcrryw$knf Gnroe Tesreo rrtw ?&ca Aoe ihrenrrl
I
II
Coven Frr-us/VENrs Puups Svpxoxe
xe Tesr
Acconorx6 To
TD
1
AVATLABLE SOURCES,
Resulrs
I.IORE THAN ZQ FEET ,oRrre Drre
2
3
enx DerEcroR Tesr , run 2
NDERcRouxo tlnren
Resulrs
4
5Honxen EZY 3
Nox VoI.UMETRIc
TeHx Trenrxess
Tesren
Sreve fvoxs
3240t1352
Co-0001 Rocky Ridge, Inc.
P. O. bo:( 241
Payson Ut.
uT-0054
Io-9114029
UTT-10'8
r Facility lD #
PCTNbT.CUM STORAGE TANK FUND APPUCATION
Address 790 iI. 1600 r?.
i'la-:tleton
County
1 0001 20
OWNER OF TANKS LOCATION OF TANKS
Address
City
County
City
DESCRIffiON OF UNDERGROUND STORAGE TAltlKS
Age
Capacity
Substance
1320 1.r. 800 i{.
State
Phone 1A-o-7461 Phone [phone]
bori"a
TYPE OF OWNEH
I x I Marl<eter, or nonflarketer with facility a\rerage monthly througtitput greaEr than 10dD gaflons.
[ ] Nonmailt&r with facilig avoragts monthly throughput less than 1O,(X)0 gallons (muS vedfy).
C'7(r^\uEI. nir',fr
ZD Me State utah Zp Code 84664
TANK NGHINESS TEST
fanr * 7
-
Pass/Fail Pass
CERNHCATE OF REGISTRATION
e Tanks (USTs) at this facility have been registered-
1 x I Alltank regisffation fees have been paid.
CoMPUANCE Wm{ UST REGULATTONS ,, - - , -
all Federal, Stiata. and Local UST regulatons?
I x ] Yes t I No lf'No'pleasa dascribe item(s) of non'compllance:
PRE\/IOUS POLLTMON NCIDENGi
Xas a pollution incident ever occuned at lour facility? tb
t I Ves I Yes'please provide LUST (Lealdng Underground Storage Tank) informaton:
[>r ] No ll'No'please attacfi a lefier stating that under customary business invenbry pracfrces standards
you arr not awarB of any release from any tank(s) at this facility. The PREIIIOUS POUUflON
INCIDENTS lom may be used.
a I I have met the financial responsibility requirement for the first per release by the folloring
method:
lHf?'lrPY9lr_I lGuarantee I lCommerciallnsurance I lSuretyBond
1r 1 Rist< Retention Group I I LetEr of Credit I I Other
I eftrfy utfur pnltY ol bw illrlt he abw made by me ate tua aN @fiec/'
Ouuner/Opeator signafirtc Datesigned#
nETR Ltu sroRAGE TANK FUND cHEcr-sr
1. CERTIFICATE OF REG!STR4TI9N,, :== : : : ,
t I All Underground Storage fanXs rm 7530'1 (Revised A92l'
t I Tank regisfiarion fees-have oedn p"il- Fi.4 v"ari 198&89= $25ltanklYr, Fiscal years 199q92' i
0A5/tank7!r., Subsequent fiscal years $60 or $135/tanldyr.
z CoMPLIANCE WrH UST REGULATIgNF . ,
rebaPe deEaion requircments' ,^.!-r
i I I am in .otiti*." with allother Federal, State, and Local UST regulations'
3. PETROLEUM STORAGE TAND r:uND FEES
IT PST Fund lees harre bean Paid.t I riscaivears ig91-9d=$2softantolr. or$l2Vtank{r. Oith non-marketerdiscount') plusapplicable
Process fees.
t I 'F.*t-y*rJgg= $lsutantsyr. or gs/Enkrlp. (wiur non-matketer discounf) pltls appli:able
procecs bes.
t I bubsequent liscal |€3ls= Based on facility throughput $50, S150 or $lTVtanklyr plus applicable
Process fees.
' For non-marlreter discount
t I I am a non.marketer with facilig averagernonthly througlq{ less than 10,000 gallons.
t I I have compteted he ApPUCinON rba uou-ueRKEiER DtSCOUNTform(s).
4. TANK ANO UNE TIGHTNESS TEp, T , , ,
t I Aii systems pass the tank and line tightness tests.
i i I am submittfng ne resutts of the anr and line tightsress tests and a copy ol the field report
t I All tanks do not meet tle requirements sel by rule regading ank tighhess testing.
i i I have contastd the state Uif omce and will submit evidence of a plan for review.
5. PREVTOUS POLLtmoN =lEcJqEtqfE= =, .: :==:: :::= ,
wnicn states whether under anstomary
business inventory pacticcs standads I am aware of any release from ure Ank
6. TNDEPENDEim m{^Ncw AssuR+ltgE .
t I l have met tle frnancial ,ssP6
methocl:
t I Self lnsurane I lGuaranbe I lcommercial lnsuranca t lstr]atyBond
I i nisr Reention Group I I Letbr of Credit I I Ofrter
-See explanations under'Hor do I get started?'
To:
O FacilityD#i999139
Tlils terer, ot an equivabnl mwt M si$ed aN ndtM wifi- pur aplietioli aN f€/sF,.
PREI/IOUS POLLUNON NCIDENTS
Mr. Kent P. Gray
Ersaiiva Sacrcary (USf)
t tah Solid & Hazardqte Wasb Contol Boad
Daar Mr. Gnf
As rcquired by pangraph i96".+19 of tre pbh Uncter€rcgnd Storage Tank Act, I harc Pedonlt+ a tank and
h. iiffi:iir --dC, rrynlergrountl songe tank anw laamty, atd b8+ ah ttb b.L hm h.l nd bcan
;a;iledh.nrtr iicteily, b.dsr'emnrefo h*rlr itllco0oryedqF S4{!lr' |.rtES
aware of arry pbasa d pefrd€tm lrcm my tanl6.
OR
I harra had x1o lolloring teleases of petroleum (&tailecl below; also mention any adion yog bok to dean up
tha nlease).
signatrn of outq/opentor
Fafin A @ofi p@forE re@ aN ffi iw aaan uffi ftp MnSAaf Tail( Rr',f,
FTDII gIgD'
,\
FILE C*FY
DEPARTMENT OF ENVIRONMENTAL QUALTTY
DwISION OF EI\N{RONMENTAL RESPONSE AND REMEDIATION
Michael O. Leavin
Gomor
Dianne R. Nielson, Ph.D.
Erccltivc Dirccor
Kent P. GrayDieor
KPG/GKA/em
l6E Nonh 1950 West
P.O. Box 1,148,()
Salt Lake City. Utah 841144840
(801) 5364100 Voice
[phone] Fax
(801) 5364414 T.D.D.
Sincerely,{jew
Kent P. Gray, Elecutive Secretary (UST)
Utah Solid and Hazardous Waste Control Board
/00o/zo
ERRU-342-97
July09,1997
Marlene Hjorth
1320 W. 800 N.
Mapleton, Utah 84664
RE: Underground Storage Tanks (USTs) at Charlies's Convenience Store,
790 N. 1600 W., Mapleton, Utah
Facility ID #1000120
Dear Ms. Hjorth:
According to the provisions of the Utah Underground Storage Tank Act (Act), Utah Code
Unannotated (UCA)- Section 194-412, all owners and operators of petroleum underground storage tanks must
have a Certificare of Compliance by July l, 1991. Any petroleum distributor who delivers to a tank that does
not have a Certificate of Compliance will be subject to a civil penalty of up to $500 per occunence (tg-OqtO,
ucA).
The Division of Environmental Response and Remediation (DERR) has received your rcquest to
receive one delivery of fuel to test your tanks at the above reference facility. This letter is NOT a Certificate
of Compliance but allows you to obtain petroleum products for testing your tanks.
This letter applies to fuel being delivered by Maetex Supply on or about July 10, 1997, through
July 16, 1997 . A Certificate of Compliance cannot be issued for the non-complying tanls. If after our review,
your tanks are found not to be in substantial compliance with federal and state rules and regulations, a
certificate cannot be issued.
lf you require further assistance, please contact Gary Astin at [phone].
Joseph K. Miner, M.D., M.S.P.H., Director, Utah County Health Department
FA)( COVER SHEET
STATE OF UTAH
UTAH DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDI,ATION
168 North 1950 West
Salt Lake City, Utah 84116
(80r) s364100
Mailing Address:
P.O. Box L4484/u.
Salt Lake City, Utah 8411214840
FA)( NUMBER (801) 359-88s3
AGENCY/FIRM: 4har\( cs Cczn I evae,.v., e, -SL*r-
C8r,)
F61(NUMBER: {qt -eoz<
PAGES TO FOLLOW:
iocol2o
I
COMMENTS:
t.
I XI N.t,Pcnal,t t I Pcraittlodlf,Lcatloa
UST Installation/Upgrad.e Permit
| ,o""..r..ion co.Daay c''II; 'senricesr' rnc' pcr',oir *", , Ll'l1 - 4
l ;;;;-Tg2o -weFr
""""lrooo.*(801 ) 491-6025
Ccrtifl,cd IDattll.r'a on Project.:
IrDusual or cxteDuatLag cl,rcuustaDcca e:rDcct64:
Name Charles Hjorth certs. * tr, 0015 x*p. a"x" lvlAf lG /??/
Cerc. #
Cert. *
Exp. da
Exp. date-
Date work will commence
Facility rD* (if nor a new faciliEy) 1000120 f X: rnstsall/Replace t I upsrade
EaDtE orrrrGr Marlene O- lljorth
eaa.."" citv Mapleton state Utdh zip-W--
.or,.".. *."o Phone * tS01 1+E-OgZylXT'r*,
raciliry 01"r. Charlie's Convenience Store LC
edd.ess ciEy Mapleton state Ut6.tI zip-;!@l-.:
EaEks lDvolvcd Ln lDstallatioa IIDqradc
Tank *dr
rnstsa11/upgrade InstalI Flarr DEQ
Capacity (gallons)8, 000
r^L nr{arrvflJE c fitn
PFlrBvEn
:DlAIl0N
Tt4)e (FRP, Steef, etc.)Steel (ST P3)
substance Eo be stored lieseU'|0(Octane MIY f,mr
Piping 1\4)e (Press.
Suction, GraviEy)Press.I I
InsEall/Upgrade What,?
(Tank, Lines, C.P., . .
tank/r,ine
TyD. of lastallatLoa/IrElgEd..ffi;}H.ffiiiiiiii{,4.,Ji'*Eir$$i$i.i
DescriptloD lilunbcr
Install New Tank I saffi
ry
ffi lffi Bi:i::i ! ! ! ! !! ii\l:+,:Xii*;ffi * ! l/iil4ir'.nlw?.ifii?W. | | i. I ll I ill I i.iffi jii*:il: illnuiirr jri#i:tSsiiRrUlty-+r iCrMIffiIffi ir : iir* r!
lw"niwfi.nn|,:llii+ii*tffihe:+rii ffi ##ffiffi*#,tsmirrr,
ToEaI rnstsarlar.ion Tank Fee/pe r r, {Zg4aZ
uaLl c6lrl.tcd forr to! UEah Department of Environment,al Quality
Division of Envirorunental Response and Remediation
168 North 1950 WesE., 1st Floor
srare use only: Dare ryeros;e,i
'"Tr"'Ylr*l4i ttln
. ,o h2- Dare permj-r Mailed 5lzg ',
cx* 21O 6
Michrcl O. L.avin
C.ortnr
Dianne R. Nielson, Ph.D.
E.crlilc DirEcror
Kent P. Grav
Dircctri
^
1; DEPARTMENT OF ENVIRONMENTAL QUALITY, DTVISION OF ETWIRONMENTAL RESPONSE AND REMEDIATION
.i: 168 Nonh 1950 West
,,, P.O.Box l,l4t4o
,,: Salt Lakc City, Utah E41144840
:i (Eol) 536-{1fi) voice
:: [phone] Fax
ii [phone] T.D.D.
t.
Date:=-2?^7)From,l, l./ll*_*
Dear Underground Storage Tank Owner/Operator:
The Division of Environmental Response and Remediation (DERR) has received notification that one or more
undergroun{.st93setanks(USTs),(qnts/associatedtines@@)willbe@pgraded)at
?ao t,. 16& h) . , W<pkt,,^, - , Utah, facifiry fO* -tMtZO
Before regulated USTs ian receive deliveries of fuel and be put into operation, they must qualify for the
Petroleum Storage Tank (PST) Fund and receive a Certificate of Compliance. To qualify the tanks for the
Fund and receive a Certificate of Compliance or maintain your current Certificate of Compliance, you must
do the following:
Register the changes in the tanks using EPA form 7530-1, Notification for Underground Storage Tanks
(Enclosed). Tanks installed after December 1988 must have the following in place when installed: leak
detection on tanks and piping (including automatic line leak detectors on all pressurized piping), spill and
overfill devices, and corrosion protection. The Utah Certified Tank Installer must sign page 5 of the form
to certify a proper installation
New Tanks or Syst€ms Only: Complete the PST Application (yellow) and Previous Pollution Incidents
(green) forms from the enclosed PST Fund application packet. You must indicate on the PST Application
form the type of financial assurance you will use for your share of eligible cleanup costs for each release
covered by the Fund.
Conduc{ a tank and line tighhress test and send a complete copy of the results to the DERR. The tightness
test must be conducted by a Utatr certified UST Tester for any new tank, line or system installed.. A list of
certified UST Testers is included in the PST Fund application packet. All portions of the tank and piping
system which could contain product must be tested. To receive a delivery of fuel for testing, you must
contac{ DERR for authorization of a one.time delivery for testing purposes for new USTs. Contact the
DERR office at [phone],24 hours in advance, to iurange for this authorization.
New Tanks or Systems Only: Pay UST registration fees and PST Fund fees for all new tanks installed. These
are: registration fee- $135 per tank; PST Fund fee- $250 per tank. These fees must be paid before a
Certificate of Compliance can be issued.
3.
4.
\,\-
a6rtut0 arnsutf{uoncas {uBI eEHols PunofraPun :2ru"
'suoqsenb fue a,ruq no1(Jl o0l?-9€s (t08) lB acuJo Isn u)IgC aql llsc assald
.asn olu, lnd ar, faql ato;aq ${usl t\au JoJ panssiaq acuerduroCJo apc$pral B lst$ sarmh ('has n t0?9-61
.uuv apo, rln,n) lcv TmI at,rors punortrapun q,,n aql 'qu,, rnoi Jo asn aql Jo ssol pIo^B no( dlaq pue
ssaco1d aql elqltlcgJ III^\ slua1rlallnbal laqlo pllB sqIJoJ papaau aql Jo u;nelduoc '(latull 'alq?cflddB ueq^\
muB[druoJ Jo al?cg$al B anssl mlv\ u)Igc aql 'pa^rac.u sI uogBuuoJur frssacau a$ uaq'/u\ 'ssalppB a^oqs
aql lB UUAO aql ol slua;[Bd eal ftre pus 'sllnsar lsel 'struoJ aql puas 'l,leld.,oc aru suell a^oqs aql uaqr^
+
FACILXTY W IOOOI\O
PETROLET]M STORAGE TANK
FINANCIAL RESPONSIBILITY DECLARATION; - --*
;i .*--Completeonefomforeachfacility i I
:i
; l-- -.
FACILITYNAI\IE CHAflECG @PVCA*TIre OBE 'C .. _.,:-
FACILITYADDRESS 7AT N, //OO U,
PAPAaTaN U* At/ ( I
Checkonlv One
E[ I choose to continue to participate in the PST Trust Fund.
O Submit this Financial Responsibility Declaration form by May 1, 1997.
O Submit the Fiscal Year 1998 Facility Throughput Declaration @lue form) by May 1,1997.
O All tanks including aboveground stor4ge taoks (ASTs) located at this facility may be required
to participate in the PST Trust Fund.
O Indicate number of ASTs, il-y,locarcd at this facility hbfle,
tr I choose another Financial Assurance Responsibility Mechanism(s)
O Submit this Financial Responsibility Declaration form by May 1, 1997.
O By June 15, 1997, submit acceptable financial assurance documents and $1000 processing fee
per mechanism (Use the exact format required by federal regulation, 40 CFR Part 280,
Subpart H.).
O Lrdicate your Company's " Fiscal Yeat''ending darc
r t/4A\qs pwArr/
Print name of owner/operator or
authorized rcprcsentative
5 -z- ?7
DateSignature
* SEITID NO PAYMENT AT THIS IIME *
5o t38
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner
This method of lsak detection requires both monthly invontory control reconciliation and tank tightness testing. lf the UST has not been upgraded
(upgraded means that the tank and piping are protected from corrosion and that spill and overfill prevention devices have been installed) the lank needs
to be tightness tested annually. lf the UST is upgraded the tank needs to be tested every five years. lnventory records must be kept for each operating
day.
llllllllllilll.,r r,.: r r n. : :,, ,,,,r:i :'i' .r...::i:...:.'...'.............
Ctahii gpqilon..br eadr,.,tank i
r.iri,ri;,iIfi *,2iiiii1iiiii irrilir#sitd-itiiit,ffirfr#,*ffi
Record of last Tank Tightness Test available on-site ' ,t''(v".) ruo 6A No [""d No -l)v""D*o
Date of last Tank Tightness Test +l>l ,ts _>
Result of lasl Tank Tightness Test. lf fail, specify in comments section what
actions have besn taken to correct the problem. Has DERR been notified?@ Fair €g Fair @ Fair ?,*'n,
Tank Tightness Testing method: A A-f M r EV-'L VA-c-ttt wyt - .z t
Name and company of tank tightsress tester: @ Ro C-Lq V'drU-TrL -'t;fu";7cffii"tio. r'.r,,r"u",, ur oO ;4
Documentation of performance claims for the Tank Tightness Test method is available and shows the ability to detect leaks of 0.1 gph
with 95% or greater probability of detection and 5% or less probability of false alarm (3rd party certification)
Yesl No
lnventory volume measurements for regulated substance inputs, withdrawals,
and the amount still remaining in the tank are recorded each operating day f9 No (9No @No ,6.)[ff.&"
lnvenlory is reconciled monthly (sum of daily overages and shortages for each
month is less than 1% of tank's llow through volume + 130 gallons) ry"11r( 6la @ No
/^- i jyv\ -/v\\ I t ,Ho,:"@No t,El,"
lf no, which months were not? (specify month and year)
lnventory Control records are maintained and available for the past 12 months
for each tank @No @No @No @ 60"
Records include monthly water monitoring to the nearest 1/8"6d No f",No (w) No G \lo
Monthly water readings are used to adiust monthly inventory balances (E No Ye$ No Yes/ No G Y{o
Appropriate calibration chart is used for converting product level measuremenl to
gallons and is available for review !e No @No @No Qrw"
l
Dispenser pump has a current calibration sticker or appropriate documentation ..tl{83 ) No G) No GD No [*] I *"
The drop tube in the fill pipe extends to within one foot of tank bottom Yes No Yes No Yes No Yes No
Owner/operator can explain inventory control methods and figures recorded 7e. )No
Books appear used and evidence of recent entries is apparent /ae No
Owner can demonstrate acceptable gauging techniques ,"" )No
-The gauge stick is long enough to reach the bottom ol tho tank Yes No
The ends ol the gauge stick are flat and not worn down Yes No
The gauge stick is marked legibly and the product level can be determined to the nearest 1/8 of an inch over the full
range of the tank's intemal height
Yes No
|:
Comments:
Distribution: White-DERR, Yellow-lnspector, pink-Facility/Owner
,n
(1t$its1!:iilitil!
m,&,ffi
iiiiinElij}:L::jiiii!-lii[}if.,-5liit$Sll
tS.H'l'Etlf"S.ttrfi ijilil#f.tijx;iiiljrlifll41,lf;i1i1i11ll li:,,:t,iii.,rj..,j.,rr,:,iirri ,,ii,i.iiili.',,..iiiiilli.rl
Tank I Tank 2 Tank ?4-r^
'k t{
The UST system is filled by transfors of no more than 25 gallons at one
time. lf yes, spill and overrill prsvention is not required.
Yes @")Yes (9 Yes (9 @"'@
ls there a spill containment bucket or another device that will prevent
release of product into the environment?
Yes (9 Yes @ Yes (9 8}"'6/
An overfill prevention device is installed on the tank. lf yes, indicate
the type ol device in the space below.
Yes (9 Yes (9 Yes O 9"'(!,
Ball float valve (in vant line)
Aulomatic Shuioff valve /in fill ninal
Overfill Alarm
Other Svstem (soecifu tuoe)
For overfill alarm only: ls the alarm located whers it can be easily
seen and heard by the delivery driver?
Yes No Yes No Yes No Yes No
For overfill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?
Yes No Yes No Yes No Yes No
Tank I Tank 2 Tank 3 /\ lt rk4
Tanks and/or lines are made of a noncorrodible material (such as
fiberglass) or are made of steel clad with a nonconodible material. lf
yes, cathodic protection is not requlred.""r'*6[),"r
t*
O Yes K)v
Yes (No)
UE^
Yes K)
,* ,..Yes (Ns),"r
t'*fr)u".6)
Tanks and/or lines are made of unprotected bare steel and were
installed prior to May 7, 1985. lf yes, cathodic protection is required
on or by December 22, 1998.
f$* *o
/4\ Tdkd No G) No G m,"
(G* *o
z-\ Um(rA No
,z\ Lrm(v"+) No G '(yJ"
lndicate type of cathodic protection: lmpressed Cunent (lC) or
Sacrificial Anode (SA)ilm^t \7
The results of the last two cathodic protection tests are available.
(Tests are required within six months of installation and ev6ry three
years thereafter).
Yes No Yes No Yes No Yes No
Results (in volts) of most recent cathodic protection test.
Name of person who performed test:
T&*
volts
Tar*
volts
Tar*
volts
n
volts
Lim
volts
Um
volts
Llm
volts
re
volts
For impressed current system: The results of the last three
equipment operation checks are available. (Equip. check required every 1
Yes No
o &"tts)
Yes No Yes No vesl No
Comments:
lnspector's Signature:
signature of owner or owne/s Representative pr.sent During lnspect irn, (-' ,d fu-irz
Distribution: White-DERR, Ye[ow-lnspector, pink-Facility/Own€r
Automatic Flow Restrictor (if yes, indicate model in comments
Automatic Shut-off Device (if yes, indicate model in comments section below)
Conlinuous Alarm System (if yes, indicate model in comments section below)
Records of last Line Leak Detector peformance test available on-site
Date of last Line Leak Detector
Result of last Line Leak Detector performance test
Records of last Line Tightness Test available on-site
Date of last Line Tightness Test
Result of last Line Tighhess Test
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lnterstitial
Statistical lnventory Reconciliation ISIRI (if yes, use SIR checklist)
Other approved method (if yes, uso other method checklist)
Records of last Line Tightness Test available on-site
Date of last Line Tightness Tesl
Result of last Line Tiohtness Test
Vapor (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lnterstitial
Statistical lnventory Reconciliation tslRl (if yes, use SIR checklist)
Other approved method (if yes, use other method checklist)
ffi$
at less than atmospheric
slope of piping will allow ALL product to drain into tank when suction released
Has only ONE check valve, located directly under
All above inlormation on suction piping is VERIFIABLE, use comrnents soction
Signature of Owner or Owner's Representative present During
Distribution: White-DERR, yellow-tnspector, pink-Facitity/Owner
lP { tooo t}oI
\),s-))
oO
r- I t-trtlli_,1 L/
4.aq*{\'1 )v
0I
l.lA
fl
'-/ dx
Facility rD
CLOST.'RE INSPECTION
No.
DateInspector
Inspector
Ovrner
Name:
Screet:
City:
Tank Location
Narne:
Street:
City:
Phone:
E ranx nly Eranr/property f]r"on"rty onry
State t,tT-
_county L\f zip_Latitude Longitude
leq -<.atq
Certified Tank Handler
llame:
Compa
l.lame:
Company:
TvDe of Closure i r.^oorary
Ito \^L1,,-cerr.# TR - oo'1'-/
Cert. #(a" bog')
Substance stored for Change-in-service
Tank Information
-,
6rioinal #Tank l.9
Permanent
- .Removed Tanks t + New Tanksl"
t-l| 'change-In-Service
o = current 5original #Tank
No.
.\ge of Tank
Capacity
Type: FRP, SteeI,
Compos ite
Substance
Date Last used
Date Closed
How Closed?
Emptied?
Sludge Removed?
Cleaned?
Certif ied Soil /Groundwater Sarnnler
t*r ucL
Purged or fnerted?
Temporarv Closure
New or Upgraded:
Greater than 3 months:
Are Vent Lines open?
Are Lines, pumps and Manways Capped
Over 12 months:
Has a Site Assessnent been done?
v
Facility fD No.looo tzo
and Secured?
N
Is Corrosion protection System maintained?
rs the Leak Detection system stirr being monitored?..
Has the O/O applied for an extention?.If yes, Expiration Date:
Has the tank been upgraded to new corrosion and LeakDetection standards?.
General:
Does O/O have an approved Closure plan?....
Has the Fire Department been Notified of Closure?..:......
Has Fire oepartment given approval to Close in place?.....
Has Fire Department been notified for change-in-service...
Were Product Lines: Renoved Secured/Capped in place ,/
Site Assessment:
Were SoiI and Ground Water
What Methodology was used8015 modified
were unified Soir crassification sanpres Taken?
Name of State Certified LabNarne A*uctcavt
Street
State
/sanples taken? L/
for Sampl9 Analysis?418.1 '/ Other
"^Ma
L
r\/
Ies were taken:
t+ OC Lgorc)
1
Faciliry rD No . L1oo tzo
Was the Excavation scanned with a pfD or FfD meter?If Yes, What lrere the Readings, Make of Meter,Gain or Span setting, and Calibratj.on Specs.
v
Are there Any signs that indicate contamination to soilsor Ground Water?
was Bureau of Sotid & Hazardous Waste Notified ofContarnination?
was Bureau of Air euality Notified of Contaninated Soilif emission from the contaminant is to take place?
was Bureau of Water PoIlution Control Notified ofGround Water Contanination?.{
Contractors:
Narne of Individual who renoved product:
Name Conpany E^cl
Street
State city
zLp Phone
Name of Individual who Cleaned Tank:
Name
Street
Stace
courpany C. b{ , 2.rvLc/-scity
Phone
Place where Tank was Disposed:
Name conpany ?LuYarvJtrtr.Company -) ln'uvv,tr7r
cLry
zip
Phone
Place where Product was Disposed:N"..
-
"-- ---'- company N/A-i -r..---
-
rrss vadrrv-Es.
corupany N
Street
Place where Pipinq was Disposed:
Name
Street
State
Street
State
Place where Sludoe was Disposed:
Name
Street
State
zip
company Nl^city
cityZfp ----lf,one
Company
2ip city
Phone
Facility ID No.loooon
where Contaninated Soils were Disposed:N/A
Conpany
City3rp--
where Contaminated lfater was Disposed: NI h
Comoanv
Citv_zrF-- '
Place
Name
Street
State
Place
Name
Street
State
-
rf any of the above is different than indicated on the closure pran, preaseexplain why:
UNDEBGROT ND SITORAGE TAI{K CLOSURE NOTTCE (turrts.d BrOt/B)
Closure Notlca prcpared attho roquost ol the ownorroporator (tsed[ied bolorrl5y Ctnrles Htonttr
ol (corpany natnol c.H. sewioes, rrrc. phone # ( 801 I 489-0224
Address 1320 West 800 t{ont}r Cty Mapleton Stab tT Zb 94664
FACILITY INFORiMNON
Tank Owner !{arlene O. HJorttr Phone#(801 ) 489-4285
t ldba (individual do[tg buslness as) t I sola prcpdator]rh t I pailrorhb [xl corporagon
Acldress 1320 W. 800 lbrttr Cty Mapfeton Stata_l&_?{,JL6SA_
Faclllty
eoor.g 790 W 1600 v0e"t fiy__Dbplglgg $de tll b 84664
Contact pnrson Charles Hjorth phonall 801 1376-0417
Numberol rcgutated tatts dthelac&y b€iosa do$rc: 5
Number ol rcgrrlated tanb d tho laclty dler dosle: 5
TYPE oF cLosuRE El penranen t I Tecporary t t ctranodn€endce
Petmanent or ctunoe{n€etuop D{ Rrol was engled D0 gtJ{o ryas ranrrrcd [{ Tankwas deamd.
Tarkwas: t4PuEed I lltEiled Mo&odusae purged lnith ocrpressed air un,til belo$, lot I,E[,
Locationot Closure Records 1320 lfest 800 t\Iorth !,tapletonrUtah 94664
For injlace dosura: tanls llll€d
Substance to be stoEd for Clurpo.ln€en lco
Tamgonru [ l rua was erqiled. il conoslon protecilon b operdn& il tuloaso &t€auon eqlpmert b operating.
Residue depth rcmalnlng ln tank-hdp8. 0r_.96 bywolelt ol btal capacry ol iJSf.
3months: I I ven[finesopen caflgoqrr€: t tlnes, I tnrms t tnnnnrya
12 rpnttts: I t Pernanedly clos€d I I Newrupgraded I t Edemlon loqtl€d
TANKS CLOSED
-
Tank# 6
-
_
Ageoftank 33 _ _
-
-
Capacrty
Subs. stored' 0II-
ode last used -$II*I
Date closed 7-15-94 --
--
---
Rnld/ln placo@'Indicatettresffis r.E5dacJ
Fadey D *- 10001.20

TANK REMOVER Name Charles H.iorttr corr. # TR 0077 Exp.ctatesg5
Company C.H. SeIviqes, Inc.phonaXtS0l t 489-0224
Address 1320 West 800 tikolttr state [rt ziD 84664
SOIUGROUNDWATERSAMPLERNAMA CtrArlES HJOrtTr Cert. # GS 0087 Exp. date 7-ffi _Company Phone #( 801t qAg-0224
Address 1320 West 800 tlorttr _ CitV Uapfebn State UT Zp_glSS!
DISPOSAL SITES USED:
Tank: shrenson Metal Salvaqe
Contaminated Water:
Contaminated Soil:
Product lrom Tank: _.Qdvanced Petroleun Recycling Date 7-14-94
Contaminated water lrom tank cleaning: Adv. petroleum Recy. g31g 7-14-94
Sludge: Oae 7-1 4-94
D31e 8-3-94 Number 1
Amount 45 Gallons
Arpunt 20 Gallons
Amount 10 Gallons
Data
Date Aflrount
-
ls any contaminated soilwhich was overexcavded silllon site? _ yes No L Not appticabte
SITE ASSESSMENT
complete the Facility Sito Plat (Closure Notlca) anrl Sanple ldornation Table (Closur€ Nodco) on pag6g B and 4 to strowthe locations, depths, and othor infornation dn d! soiUircundwaer sarnples'hkan lgr dosure. -nl
sampres must beconsistently identitied by sampte tD #on the site plat. EEh. and lab n.ry.s,ipori. -
lxl Comeleted Facitity Stta ptat (Ctosure Notce! ls afiached.
Ix] completed sampte tntorndion Table (cbsure ].lotbe) b attachad.
I x] cedilied lab analyticat emionmedal sarnple resutts arc afracfred.
Ixl Unilied soil crassil&:ation (usc) sanple rcsutts arc anachod.
I X] Chain ot Custody lorm is atached.
samples were property: t { co[ected tx I Laboled [x !packaged g I Trarcported
[;] Samples were in sigtrt ol tho p€6on ln @stody d all times or in a securad lod(od placo.
I certlfy under p€nalty ol law tt6 tne dosun slte assssernem at thls tadllty was conduciled tn aaoodance wlthR311'202 (parts 2805_2 and.N.7'i2l and Rlll-205 uAC., ano'tna any aootitonit eamptes rcqulred by R311.202parrs 28052 anct 2@.72and R311.20$2(axl) rue]e plopsrty colleaed.-
Stgnature of Cerufted Groundryarer/Sou Samp o. C / 1: t .tr
Full name ol Cedlllecl Sampter Ctrarles Hjorth Date Sept. 21, 1994
.\
The site plat mst strow locath* r , pping. tlispensor blands. anc
undetlround utflitlos. The ste Cat m,tst bo dtam to an appaoprbto ldontllod 8calo. li ml1 shfl aGilJd sanpling;
locatbns. substancos sitol€d h tad6, and drer rcbvail lnforinalon. Tad( and sarple ldemilbdlon run6ers musl be
consistent with the inlormilon gfuen on p. 1 8nd 4 ol the dosure notca.
Facility lD #JQ09129_ Dravn AV Gar1es Hjorth Darta Septenrber 21 , 1994
X - Sample locatiors (SS+, WS+, USC+)
@ = Monitodng Wells (MW+,)
O = SoitbodrE (B+)o = water wells (domas{ic, livestod( etc.)
\
sA.
comptete tabre tor a[ sampres thd wo't.k.nm lD numbers on tha tabls must be conslstent
wtth the sample lD numbers glven on tha ![a pht lnd ln the larb-analyclr rcpo]t
Sampte #/L8b lD#
s.s. #1
s.s. #2
u.s.c.
Sub. sioltd
Used Oil
Used Oil
Spl. typer
SoiI
Soil
Dertf
101
101
-
101
CompoundC
g'roor/rpH/Hoc
EI'IEO{/TRH/HOC 8020/ 418.1 /801 0
Anatfls method(sf
80201 418.1 /801 0
-
Used O11 U.S.C.
I
2
3
a
Soil (SS), Groundrater (GW), or Uniled Soll Classllcdlon (USC).
Final depth (in leet) behrv grad6 d u,hlch samphs werc Aien.
contaminant compound(s) analr:od lor each samplo (IpH. BTEXN, o&G. otc).
Appropdate analysis mdhods lor contanrlnafl conpound(s) ln eacfi sample (gb15 mod.. g020. 413.1, etc).
State Certiliod Laboratory us€d: arrErican rlest Analytlcal Iab
Address 453 t{est 3600 South c[y salt rake citv slare& zp_94,1_!5__
Contact person Steve Getz Phone#(801 ) 253-8685
Please explain arry unusual or extolUating clrcunstarrces encountercd during tha sih assessmant or cbsure:
I certlty under penatty ol law tlut I am the omrer ol thc unro descdberl above and thd I am tamlltar wtth thelniormatlon on thls lotm and thsl lt 18 tnr, aocuralo anO coir-ptdo and lurthor, thd the prcoedur€s descrlberl
hereln wem followed dudng tank closuso.
Slgnature ol UST Ownar
Fullname ol Owner
Retum completed Closuo Notlce form. Faclllty S[e Pld and Sample ldomd6n Table, SolUGrounctrvater sample tab
analysis results, USC sample rosulE, and Chaln ol Cusorly lorm wilhln g0 days ol UST Closure to:
State ol utah Dept. ol Environmerild Arafity
Division ol EnvironmentalRosponse and Remadlation UST soction
150 North 1950 W6st 2nd Fbor
Satt lake city, utah 94116
9.
i
=
a
;
qv
=
v
!
9
32
9
,
E
a
I
s
-'
l
a
9\
E6 ?,o 3 E G
U,Et-EI
t
A
?r

6N
!l

u)
F
FE
E
T

,
AS
E
T

E
=E
g
H
e
E
E
o,l
tl LzcTl oeaJc
-EE+\\-\h\
=!Fx 66oo
tr
)

t\
)
6CUl

i.
r
ca
o
o\
a
6A
rl

6
{vz vo zot3(l
l U,
ooZ
q=
=
-
Er
r
r
r
r
r
r
S
cr
:
*
.
1
;
'
s
9
EE
3

E:
;
rr
E
:
..
t
tt
t
t\\(r
j
,N \N Nrs N
&"
.N
I 2 !,
1
u z z z E
;2.{z ?Flt T (t 4j
t.tr
?
l.it
iqi(
iq
I
J=
D
G=r'
i
"0+.
V v
LOGTN CHAlll OF CUSIODY REP0RT (tn01)
Jut 15 1994, 05:36 Pn
Login i{r-nber: 119146
l"iorniiiisroo c.H. serYices, lncorporated
SitE : HARTS fOOOS I.IAPLETON
,iii:iiiii::iilli:i:::iiiiiii::.i:i
" !!rr.i::::l:11:i'tSocatocy,:,,,,,,:,:,
St{Pl"B:,tlurEan
share Sampte / Contact: chartie tliorth -a;Ii;" s o&G'lR oil' & Gr'ase bY IR
ioiia" s vox/BTx vox & BrExtl by purge GC/l'ls
119146-2 ss #2 UEST EllD, OF TAllx ExcAvATto[ a 10'
Share Sampl.e / contact: Char(ie Hjorth
iolia" s o&G'lR cit & Grease bY lR
iotia. s vox/BTx vox & BTExll by prge Gc/Hs
119146- 1
r19146-3
Contact: chartie Hiorth
Sot ids S USC
ss #1 EAST EllD ot TAIIK EXCAVATIoI a 10'
usc SAHPLE a 10',
Uniform Soi t Ctassif ication
l5-JUL-94 15'JUL-94
Exoi res:29'JUL'94
Exiires:29-,tUt-'94 jerrY
15'JUL:94,15'JUL-94
Exoi res:29'JUL-94
Exiires:29-.lut-'94 jerrY
15-JUL-94 t5-JUL-94
29-J 4
1 Contain
29-JU.-94
1 Contain
29-JUL-94
1 Contain
Page 1
Si gnaturc:
0ate:
AMERICAI'{
WEST
ANALYTICAL
LABORATORIES
Client: C.H. Serviccs
Date Sampled: July 15, 1994
Date Received: July 15, 1994
Set Desctiption: Ilrec 5o1i6 $amPles
Set Idcntification ft 19146
Conacu Charlcs Hjontt
Received By: Rldie Richoond
flaaExtraned:
July 27, 1994Analysis Requested:
Total Rccovcrablc Pctrolcum
Hydrocarbons
463 west 3600 South kb SamDle ID. Numbcr:
Salr lake City. Ua]r l9l4GMethod Blank
84115
Analvtical Results
[phone]
Fax [phone]
Field Sarnple ID. Numbcn
MettrodBlank
Detcction
Litris
s.0
Total Recoverable Petroleum rocarbons
Compound:
Toal Recoverable Perolcum Hydraarbons
Arnount
Deacted:
<5.0
<Value = Nonc dctccted abovc tlc spccified method detection limit, a a valuc tlut reflccts a reasonablc lim[ drc
o interfercnccs.
Releascd by:
Rcport Darr7ng94 lofl
Method Ref. Numbcr:
EPA4t8.1 (Extraction
InfrilcdAbsorPtion)
bboratory Supervisor
TI|ls NEP(TftT ls PR,OYTDED FOR THE EXO,USIVE USE OP TrE ADDRNSSEG. NTIViLEGES OF SUESEOUEI\T US8 O? THE NA'IIE OPTHIS COMP^T{Y OR ANY
MEMBEn o? tts srAF?. oR REpRoDUcrroN op ntts nEx)nr rr-iiniicn6iwnrr na roveiiiseverr. PRoMortoN oR s^LE oF
^NY
Pnoouct oR
pRocEsrs oR u{ coNNgcnoN yrrH THE RE.RrBuc^Tror oerriiilii6liibr riv mnnoss-Tlrex PonflB
^DoREssEE
wllJ- BE GRANTED ot{LY oN
corarRlcr. r{rs coMpANy AclEprs No REsttoNsr.rutv r:cet io-i-riirr. ou:e .enrotverci 6ir"-specnoN ^I{Don
Ar&Y'rs N oooD F^lrlt ^l\D
^c\coRolNc
ro:fllF. Rtrlrs (tF fllli ln^oe AND OF SCIENCE.
vA
AMERICA}.{
WEST
ANALYTICAL
LABORATORIES
[phone]
Fax [phone]
Client: C.H. Services
Date Srmpled: July 15, 1994
Date RecCived: Iuly 15, 1994
Set Description: Ttirec Solid Samples
AnalysisReguested: @ffimoleum EPe+tg.t (Exqcti.on
HyAroc.tUons Infrard AbsorPtion)
Sct Identification #: 19145
Contp.^r Charlcs Hjorth
RccavcdBy: Eddie Richr 'd
Dctcction
Lioir
5.0
Darc Extr
July 27,
Arnount
Detected:
13.
-di)4
Datc fuialyzcd.
luly 27, L994
Total Recoverable Petroleum H rocarbons
<Value = None detcctcd above rhe spccified mctrod &rection limit' or a valuc rtW rcflecS a reasonable limit due
o interferenccs.
Released by:
Report Datciltllgi' I of I
:e;il;lilis ciri.rirxv rcceprs No Rcsr)NsrslurYrrc
;:'ilffi ;i; i; n I n-iuiris or n m' maDE
^
r..D oF s crENcE'
,3 West 3600 South Lab Sample ID. Number:
alt Lake City, Utatr 19146-01
84115
Anal ical Results
nlts =
Compound:
Total Recoverablc Peroleum Hydrmubons
Field Sanrple ID. Numben
Han's Foods - MaPleon
SS #1 EastEndof Tank
Excavation @ 10'
,\\
A
eGntcoN
WEST
ANALYTICAL
ABORATORIES
[phone]
rx [phone]
Client: C.H. Services
Date Samplcd: July 15, 1994
Darc Reciived: Iuly 15, 1994
Set Description: thrcc Solid Samptes
Analvsis Requested:
Toal Recoverable Peuoleum
Hydrocarbons
Sct Idcntification * 19145
Contacc Charlcs Hjontt
RcccivedBy: Eddic Richmond
DarcExtracted:
laly Tl,l9,4
Total Recoverable Petroleum H rocarbons
Dctcction
LiEi$
5.0
Anount
Detgedl
6.0
<value = None detcctcd above thc spcciEcd method detcction limit or a ralue that rcflccs a reasonablc limit drc
n incrfcrences.
Releascd by:
R@rt DarrAUg4 l of I
TtlE nEFORt ls pRoYtDED FOR. TtG EXCLUSryE USE OP TIG ADORnSSEE. nrlvrLEGESOF SU.ESEQUEI\T US8 OP TH8', NAM-E OF THIS COMPA]IY oR ANY
MEMBE. oF ns srAF. on nEpRoDUcrtoN o? r*ls RExrr rr-i&rii6rbiJuimina rov-e-#islidrr. proncnrox-o-Rs^Le oF
^NY
PRoolrcr ot
procEss oR rN @NNEcrror{ wrr* rH! na.n Buc^.ox op nriii'aiiiili'6n ^ii n4roso iirl-r-iri-i,g eoonrssE. YllJ' 8E cR^NrED ol{LY oN
cp'rR^cr. r*rs coMp^l{y ^crEp*
No resrcxsran rw axdt idn-riiiiou'-e pairorvrxci Ji:iiJpiiiioi
^xD/oR
A}l^,.Ysls lN oooo F^ml ^iD
icbidixc to ntc Rulls oF Tl G TRAoB Ai-D oP sclENcE'
PPn ltg.t (Extraction
Infrarcd AbsorPtion)
West 3600 South lab Sarnplc ID. Nurnbcr:
It hkeCity. Utah 19146.02
84115
Anal tical Results
nlts =
Compound:
Total Recoverable Peuoleum Hydraarbons
Field Samplc ID. Number
Han's Foods'MaPlcon
SS f,lWestEndof Tank
Excavation @ 10'
AMERICAI{
WEST
ANALYTICAL
LABORATORIES
Client: C.H. Serviccs
Date Rcccivcd: July 15, 1994
Set ldentification Nirmbcn 19146
Analvsis Requesrcd:
Uniform Soil Classification
Contacu Charlcs Hjorttt
Rcccivcd BY: Bldic Richmond
Method Rcf. Numbcr:.
2488-84, X4.2
463 West 3600 South
Salt Lake CitY. Utah
84115
[phone]
Fax [phone]
Released by:
Lab Sample ID. #:
1914603
EcldSanolc-D*t
Ilart's Foods - MaPleon
U.S.C. SamPlc @ 10'
Classfication:
Silt with Sand (ML)
Laboraory
Rcport Dar-7f29B4 I of I
Trtls R,EP.RT ls PR.,IDED FoR T}G ExcLustvE usE q! !1E .|9- DRfissEE. I{rlvlLEG€s_oF su,BsEQUG,rrT Us8 oP THE 'N^xE oF THls coMPA!{Y oR
^:tY
frl*::1T,irf"*1"1ffi?Hl'$.sJt1'^fffi[[x?,t{ilh"*ixH,"-si$[q$ffi;*qffi]"il#*f1tffi":^:#^ii
AMERICA}{
wEsr Client: C.H. Serviccs
ANALYTICAL Date Received: July 15, 1994
LABoRAToRIEs Set ldentification Numbcn 19146
Sct Dcscription: Threc Solid Samptcs
Analysis Requested:
Halogcnatcd Compormds
Conucr Charlcs Hjontt
Received By: Eddie Richmond
Dae fuialyzcd:
Iuly 20, 1994
Method Ref. Number:
EPA Mctttod 8260
(Prrge & Trap GCA,!S)
Ficld SanrDle ID. Numbcn
McthodBlank
[phone]
Fax [phone]
Comgound:
Bcnzyl chloridc
bis (2-Chlorocthoxy) mcthanc
bis (2-Ctttoroisopropyt) cther
Bromobcnzenc
Bromodichloromcthanc
Bromoform
Bromometrane
Carbon terachloride
Chloroaceuldehydc
Chlorobcnzenc
l-Chlorohexanc
Ctrlorocftanc
2- Chlorathylvinyl ether
Chloroform
Chloromethane
Ciloro methyl methyl cther
Ctrlorotoluene
Dibromochloromethane
Dibromomethane
l2-Dichlorobcrzene
1,3-Dichlorobcruzcnc
1,4-Dichlorobcwtane
Dichlorodifl uoroocthane
1,l-Dichlorocthanc
1,2-Dichlorocttranc
Anount
Detccted:
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
463 wesr 3600 South Lab Sample ID. Number:
Sah l-ake City. Utalr 1914,6Method Blank
84115
Analvtical Results IIALOGENAIED-QWPOUNDS
Unis = trlkg (ppb)
Dctcction
Lini$
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.4
2.0
2.0
2.0
2.0
2.0
2.0
2.0
RcPort DatD'7ngD4 t of 2
NrrS NEPORT ls PN.OYIDED FOR T}G EXCLUSIVE USE O? TIE ADORIiSSEE. PIIIVTLEGSS OF SUBSEQUENT T'S8 O? tHE N^ME OF THIS OOMP^}IY ON'
^SY
MEMTER o? rrs srAF?. on REmoDucnor op nfls naptorr rx-i6ixian6r wmr te rov_uirtriEvErT. PRouotror oR sxl oP
^xY
PRooL'cr oR
pnocEss oR rN clNNEcnox wrrxTHB ng-puaucenox oenn-s-i'di6iiiibr rrrv nnposanlrx eornn AmRrssEE wru' 88 GRANTED o\LY or
coxrn^cr. rurs coMplriy
^crEpr!
No REsR)NsrBrury axceii r'bntiiioua penrorvurcn opl.-specltoil rD/oi ArALYsls lN oc'oo F^ml
^\D
rmghl\n ?a fl lG glil ia alc?1fr E lhC . {6 6G c't'UA
v
Affiffi
Analvtical Results HAL!)GENATED COMPOUNDS
nffi -- lrslkg (pPb)
AMERICA]'{
WEST
ANALYTICAL
LABORATORIES
Comgound:
1,l-Dichlorocthcnc
trans- 1,2-Dictrlorathene
12-DichloroprcPane
163 west 36,00 South cis-1,3-Dichloropropcnc
SatrLakeCiry,uah trans-1,3-Dichloropropcnc
84115
Mettrvlcnc chloridc
1 . 1,2,2-Tetrachlorathane
1 ,1 , I ,2-Tetrachlorocthute
TetracNorocthene
1, 1, 1 -Trichlorocthane
[phone]
rr* iaoti 263-868? 1,1,2-Trichlorocfiane
Trichlorrethenc
Tric trlorofl uoromethanc
TrichloroproPane
Vinyl chloride
Benzcne
Toluene
Ethylbcnzcnc
Total Xylcne
Naphthalene
Releascd by:
Deaction
tisi$
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
4.0
Anount
Deacted:
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 4.0
<value = None dctected above tre spocified merhod detcction limit or a ralue thatrcflccs a rcasonable limit dttc
to intcrferenccs.
RePon Dars7t2g9a 2of 2
rl*s REpc,Rr rs pRovrDED rt R nG ExcLUsrvE usE oF nrE lDo$ssEG' mrvrLEGEsJl lY.Ss#?.1EJ;#:3fJrHlJ$I[."1T:?:",i1?i.tP-?HII
HSn:."r3n:ul"*mp,*ur6..i.liffi!,i,"IsFilifilffiS^iiit)*"iii'i,i-^oonasse.vr..iiioi^NrEDoNLyor{
co*r?Acr. ?rrs coMpANy rccLrrriio nespoxs,.,umxd,Iiiloiiir,. ou'a penron-*^rH'Jliii&drox-rrro'oR AN^Lysts tN GooD F^lrtl
^ND
::ilffiii;i;ittn nr" ' 'rFrrlG rt^on
^r-ooFSCIENCE'
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt hke City. Utatt
84n5
Clienr C.H. Services
Date Received: July 15, 1994
Set Identification Nnmbcn 19146
Set Desctiption: Threc Solid Samplcs
Analysis Requested:
Halogenatcd Compounds
Contacc Charles Hjontt
Rcceivcd By: Eddic Richmond
Method Ref. Nuglber:
EPA Method 8260
(hrgc & Trap GC/I\'iS)
1914G01
Detcction
Lini$
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
Anount
Derccted:
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
<2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
Lab Sample ID. Numbcr:Field Sample ID. NUmbcn
Han's Foods - lvlaPleon
SF#i East End of-Tank Excavation @ 10'
Analvtical Results HAILOGENATED COMPOUNDS
Unis = Fgkg (ppb) t
[phone] Cqsggund:
Fax (801) 263'868?
Benzyl chloride
bis (2-Chlorocthoxy) methanc
bis (2-ChloroisoproPYl) cther
Bromobcnzcne
B romodictrloromcthanc
Bromoform
Bromomcthanc
Carbon tetrachloride
Ctrloroaceuldehyde
Chlorobenzene
1-Ctrlorohexanc
Ctrlorocthane
2- Chlorocttrylvinyl ether
Chloroform
Chloromethane
Chloro mettryl methYl ether
Ctrlorotoluene
Dibromochloromethane
Dibromomethane
1,2-Dichlorobcnzene
1,3-Dichlorobcnzene
1,4-Dichlorobcnzene
Dichlorodifluoromethanc
1,1-Dichlorocthane
1,2-Dictrlorathane
RcPort Dart7f2994 I of 2
tltls REPORT |s PN,OVIDED Ft'R THE EXCLUSIVE USE OPTIG ADORTISSEE'' PTIVILECE_OF SU.BSEQUEIT I'S8 O? N|E NA}'IB OP T}IIS COMPAI{Y ON' ANY
MEMBEn oF ms srAF?. oR RErRoDUcrroN oe ru! nExtlr rr?&i';.ariii ilmina- rov-a-lrtiseiENT' PtoMonoN ot srlr oP ANY PRoDUcr oR
procEss on tlr coNNEcrroN wtrH tHE RE.R Buclrlox oF niii'iiii"i6e riiy1u1q91.c-iiiri rce iro roonassEE wlll BB ol'ANrtD oNLY oN
co11TRAcr. THrs coMpANy
^ccEprs
No rEsroNsr.tury rxcrfi i]o-n-iir.. o]ie peironv'rci 5i-iispecnox
^xD/oR ^rr^LYsls
tl{ oooD F^ml
^ND
ici6idnio to tttr. nutls ttt'tttt tneoe ,r.-oor soelcl'
\
Lab Sample ID. Numbcn
19l4G0l
Comgound:
1,1-Dichloroethene
trans- 1,2-Dichlorocthene
463 west 3600 South 12-DichloroproPanc
SaltLakeCiry,Utatr cis-1,3-Dichloropropcnc841t5 trans-l,3-Dichloropropcnc
Field Sample IT\ Numbcn
Han's Foods ' MaPlcton
SS #i East End of Tark Excavadon @ 10'
WEST
LABoRATORIES Unis = Fgkg (PPb) t
A
ATVIERICAN
[phone]
Fax (801) 163'8687
Dctcction
Lisis
2.0
2.0
2.O
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
4.0
Amunt
Deactcd:
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 4.0
Mettrylenc ctrlori&
t, 1,2,2-Tetrachlorocthanc
1, 1, I 2-Tetrachlorocthanc
Tcuachlorocthenc
1, l, 1 -Trichlorocthane
l, 1,2-Trichloroctranc
Trichloroethene
Tric hlorofl uoromethane
Trichloropropanc
Vinyt chloride
Benzcnc
Toluenc
Ethylbcnzcne
Total Xylene
Naphthalene
<Valuc = Nonc detected abovc thc slccificd mcrhod &tcction limiq 6 a value that rcflecs a reasonablc limit drc
to interfercnccs.
wcightbasis.
kboraory Supcwisor
RcPort DarZngP4 2of 2
TTIIS REFORT IS PR,OYTDED FOR TTG EXCLUSIVE USE, OPTIG
^DDRf'SSEE'
PRIYILEGES_OF SU.BSEOUEI\T USB OP THE NAIiIE OP TI{IS COMPATY OR ANY
\{EM8En oF rTs sT^F?. oR REfnooufitoN o? Tlus n"po.r r.{iJ*ii6r6x v;minc-r-or-n-rn]sl'vErfi' PRoMoTloN ot s^LE oF
^NY
PnoDUcr oR
pno6(s oR tN coNNEcrroN w.rH rHB RE.R BLrcAroN o? nrii-i',ffi#i'dn riii runrosa iiilN--poi im
^oDREssEE
wrr 8E GRANTED ot{LY oN
coNTn^cr. rHrs co*rprxv rcrerrs No RssrroNsrBrr.rnt:crfi idn-dir'. o.r-e peirorvexci. 6'p iiipectrox ^r,o'o. ^N^LYsrs
lN GooD F^lrtl ^\1)
iimanrrn ra tttF e I tt F( .tG tlm ?c ^nE
a!l\ at ('tEx..F
Method Ref. Number:
EPA Mcttrod 8260
(Purgc &Trap GC^{S)
Contact Charlcs Hjontt
Rcccived By: Eddie Richmond
Dar tuialyzcd:
Iuly 20, 1994
A
AMERICAT.{
wEsr Client: C.H. Services
ANALYTICAL Date Reccivcd: Iuly 15, 1994
LABORATORIES Set Identifrcation Numbcn 19146
Set Desctiption: Tlrcc Solid Sanplcs
Anal:rsis Requested:
Halogenated Compounds
[phone]
Fax [phone]
463 Wesr 3600 Sourh Lab Sample ID. Number:
Salt l-ake City, Utatr 19146-02
84115
Field Samplc ID. Numbcn
flart's Foods - lvlaplcon
SS #2 West End oi Tank Excavation @ 10
Dcaction
Litris
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.O
Amunt
Emedi
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
2.0
2.O
2.0
2.0
2.0
< 2.0
< 2.0
< 2.0
< 2.0
<2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
Analvtical Results HALOGENATED-QQ!ilPOUNDI
Units = *gkeQpb) t
ComDound:
Bcnzyl chloride
bis (2-Chlorocthoxy) mcthanc
bis (2-Chloroisopropyl) ether
Bromobcnzenc
Bromodichloromcthanc
Bromoform
Bromomehanc
Carbon tetrachloridc
Chloroacctaldehydc
Ctrlorobcnzcnc
t-Ctrlorohexanc
Chlorocthanc
2-Chlorocthylvinyl cthcr
Chloroform
Chloromethanc
Ciloro methyl mcthyl cthcr
Chlorotoluenc
Dibromochloromcthanc
Dibromomethane
12-Dichlorobcnizenc
1,3-Dichlorobcnzenc
l,4.Dichlorobenzcne
Dichlorodifluoromethane
1,l-Dictrlorocthane
1,2-Dictrloroethane
Rcport Dat '7n984 I of 2
TlIIs REporr rs pR.ovrDED FoR THE EJ(CLUSIVE USE Op TrE ADOnTSSEG. pflrvrLEGES OF SUBSeQUENT qsl-ot !!q-t!l!! oe nrts colrprnY oR
^NY
MEMBET o? rrs srAFF. oR REpRoDucrtoN op rlils REIoRT rx-i6i-iictror wru fla rovernsevert PRoMonoN oa srll oP
^NY
PRoDUcr oR
pnocass on tx clNx8crrolr wtrx THB nE.pt BLrcArroN o? flnsidporr noe
^Ny
?t RxEB Tttrrr ?oR ttlB ADol8ssEt wlla 8e GRAllrEo otlLY oN
coNTnA6.THls coMpANy AccEprs ltotEst{trsrltury axeFionnin oue penrcnrmrcn oPh-s?EcrloN ArD/on Ax^LYrls lNoooo P^ltll
^l\D
^
l.nnaltllta ?n ?llF al ll Gl alF ?l lt: ?D a t'lF l lar ne aalBlra3
Affi
AMERICAN
ComPound:
1,1-Dictrlqathcnc
nans- 1,2-Dichlorocthene
' wesr 3600 Sourh 1,2-DichloroprcPanc
. Lake ciry. Uuh cis-1,3-Dichloropropcnc841t5 trans-1,3-Diciloroprropcne
Field SamDle lTr. Numben
Hant Foods - MaPlcon
SF#2 West End oita* Excavation @ 10'
WEST
LABoRATORIES Unis = *gkg (PPb) T
[phone]
Fax [phone]?
Dccction
Lltrls
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
ArDount
Deacted:
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 2.0
< 4.0
Methvlcnc chloridc
1, 1,22-Terachlorocthanc
I , I , 1,2-Tetracilorocthanc
Tctrachlorocthcnc
I ,I , 1-Trichlorocthanc
1, 1,2-Trichlorocthanc
Trichlorocthene
TricNorofluoromethane
Trichloropropanc
Vinyl chloridc
Bcnzcnc
Toluene
Ethylbcnzcnc
Total Xylcne
Naphttralene
2.0
2.0
2.0
2.0
4.0
<value = Nonc &tectcd abovc rhc spccified mahod &tcction limiq a a vzluc trat rcflecs a rcasonablc limit dttc
to interferenccs.
t
Released by:
Rcport Darc7l299a 2of 2
ilLE C0PY
To:
MEMORANDUM
Kent Gray, Executive Secretary S tT
I
Through: Bryan Whitaker, UST Branch Manager 6LU'
Dale Manr, UST Section Uanaeer pt4
Therron Blatter, UST Scien rlrr"4b
Date: July 28, 1994
Re: PST Fund Wavier for Facility #1000120
Charles Hjorth recently purchased a facility in Mapleton. This facility had notified on 5 tanks
and all 5 tanks were in compliance. As Mr. Hjorth was inspecting the site he found a waste
oil tank which the previous owner had not reported. This tank had not been used since the
1980's (he facility has been a convince store and has not done service work since then).
Upon discovering the tank, Mr. Hjorth immediately notified our office, submitted a closure
plan, and paid the registration fee for all past years. He has request that the PST Fund
assessment be waived. Since the sinration meets the requirements set forth by the legislature
and the tank has been removed; I recommend that the PST Fund assessment for FY 91,92,
93, and 94 b, waived. The aftached sheet indicates the amount owing.
TKB
Pf
l
n
t
e
d

on

rr
y
c
l
e
o

ca
c
e
r
:
Io,
F
3S
8
6
S
8
t
8
xx
lt't*,
.+:
I
.to.o\)2-o
rnl\6.t0ao\'6ooJI8t
t
g
3
E
$
t
d.
;
d
d
:
$
t
,
;
aa

tt

l,
t

l
a6
d
)
9
t
88
8
t
t
t
t
t
6d
l
J
l
g
l
c
l
9
a
u
l
tU
0r
f
oa
r
!
-Lo,
9roF.
a
!LfBt
..
a
t
o
eO
-
Eo
c
3
.t
ti

o,
)a
r2!
'a
c
(
o
j:

6
E
<o
F
=
o
co
OF
-c
i

!
6-

'6
q
A>

ET
E
H=

5,
i
J
(,

lJ
2<=*

!
d
'-
a
r
-c
0
)
tr

lB
..
i
IAUCH
ob
2L
'co
.
tE
OL
I
l-ct
-
C
t
).
-
0
OB
t
s
.-
>
c
r
o-
o

o
qr
a
e
oIt
+
L.
-

O
AG
E
.l

4
s
ac
c
!c6

cr
6.
(
J
ts
4
4
eA
l
I
.
|
\
t
|
.
.
r
\
O
.
dv
/
W/
^
HEALTH DEPARTMENT
OF UTAH COUNTY
589 SOUTH STATE STREET PROVO, UTAH 8,1506
July 13, 1994
PHONE (801) 37s.8100
Madene Hiorilr
1320 Wcst 8OO No.fi
Maplcton, t tah 84664
Re: Closure Plan approval for undcrgro-md stotagc tanks at Madetm. tltah
Facility ldcntification No. !0OO12O
Dear Ms. Hjorth:
The Ooswc Plan for tp abovc*cfercncad facility rcccivcd by thc City{or.rrty Hcatth Dcpt. ol t tah County on July 12, 1994
has bcen approved suUca to fic noted modificatims, if any. This dcpartmcnt ?cquircs a fee of $1OO per tank for the pemit
to remove or install, whicfi can bc obtained at t te abovc address within 72 hrsiness hqrrs prior to dosure or installation
activitics. This dcpartment also rcquircs you to schedule o.rr inspcctor well in advance to be on she at yar closure or
installatim activities. Thc local firc dcpartment must bc notificd 72 hanrs before beginning dosure or installation and may trave
additional rcquircmcnts.
The Oosrre plan approval is effeaive for a period of ou year frorn ttre date of approval. lf dosure does not take dace within
d1g ycar, subrnittai of a new Closwc Plan will bc required, unlcss odrcrwisc approved by ttre Executive Secretary (USTI.
Any ctrangc to an sppfoved ooswe Plan must bc sl,brnincd in writing and apgrovcd by our office before implementation. lf
contamination b 3uspcctcd or fonrd dwing dcurc activities, you must repoft it to fic Divisim of Environmental Response and
Remcdation (DERRI at (8O11 5364100 within 24 horrs of discovery.
Endoscd is a copy of drc .Ooowc Noticc' form whicfi must bc cornplacd and suhnittcd to trc Exccutivc Sccreary (USTI Kent
Gray, 1g5O W NoAr remprc. Salt takc city, uT g4l t4484O. Plcasc subnit ttrc envirorrncrtal and unified soil classification
(USdl sam4c analysis data and Ctrain of Cr.rstody lams with thc Oocurc Noticc as soon as possiUe, h-rt no later fian 9O days
after tank dosure.
!f yor havc any qucstions Ccase cortact Mvian Walkcr at 370€775.
Director, Envirmnrcntal Hcatth
DCHA/Wiip
enclosures
Thcnm Blattcr, tltah Divisim ol Environmcntal Responsc and Remediatim
Duranc Faxton, Maplcton City Firc Dcpartmcnt
Chadcs Hiorfr, 1320 Wcst 8OO Nortl. MaCcton, t tah 846il
JOSEPH K. MINER M.D., M.S.PH., DIRECTOR
Duranc Faxton, Maplcton
BOARD OF HEALTH
MARY ELLEN EOMUNDS, R NRAYMONIJ C JOHNSON, CHAIRMAN MALCOLM H BECK LEONARD H, FOOTE. M O
(rey. og/oltrg)FACTUTY Dr 1000120
ClosurePlanpreparedattherequesloltheowner/opordor(ldentl,ledbelow)by
Address 1320 w. Bo0 N. Frrr rrrapr,r..rr, ^^_^ ffi-Cry IqAPEIoII State_$$Lb 84664
A contraclor may prepare this closure Ptan as the owner/operators agent. tn preparing the ctosure plan, the contradormust act with the owner/operatofs knowledge and +provai.- rre owner/operator must sign tho closure plan.
This closure Plan is submitted in compliance with the requiremefis contained in BO11-202 subpail G anct R311-204(u.A.c.)
FACILITY INFORMATION
Tank Ownet phone 6 ( g01 t 489_4285
[ ] dba (individualdoing business as) [ t sote proprietorship I t partneahlp l corporation
Faclllty Name HARTS FTOODS
Address 790 N. 1600 W.cftv-r4Algq
Contact person{JARLES HJORTII
Totat number of regutated underground tianks at thls slte 6
Total number ol regulated undergrouncl tanks at thls site to be closod
ga, wM zo unu*
phone6( 801 t 376-04i7
TANKS TO BE CLOSED
Tank # 6
Capacity 500
Date last used r qnr
-----------' lndicate the specific substance stored ln each tank to be closed (regular, unleaded, diesal, waste ott, etc.)
For wasle oil tanks: Have degreasing or other qpos ol sotvents been stored or mhed with the waste oil?
Yes (identify il known)No X Not known
Analysis for lead may be requlred prior to dlsposal of contamlnated soil or other material.
-
-
-
-
TANK REMOVER Name Charles Hiorth cea*@LExp.daeE/
Company C-H- Seryices. Inc.Phoner( 801 | 489-0224
Addte.s 1320 9{"=t 800 Nortt . C1V-$g}g@ stae_L zb 84664
soluGRouNDwATER SAMPLER Nane charres Hjorth cen. tq99fl- Exp. dae-L]9I
Company C.H. Senrices, Inc.Phonell 801 1 489-0224
Address 1320 9ilest 800 North cry--Yaglgtog State-[- Z,O 846il
Belore the closullo Plan E submlted lor apprcval, thc local hcE[h and llre dapanmonts whela the laclltty ls located
musil bo contacted.
CONTACT LOCAL HEALM DETR| T Nama oI DIst.Utah County Date-@
3zo-8770 /Contact Vivian Walker Tltle
CONTACT LOCAL FIRE DEPT. Name ol Dept.
Contact DUAI{E PA,\CnCIil
Phone #
MAPLEIIOT.I CITY FIRE Date 7-12-94
TlUa INSPECIOR Phone #489-55s5
DISPOSAL INFORMATION ,/Tank(s)will be dlsposed at Facilrty
601 Souttr llain Cltv SPanish Fork Slde tlT Zo 84660
Contaa person Jay Phone* ( 801 t798-3548
Produc't llnes will eilher be:_ rerpved or_!_chaned, saqrred ln place. and cappod.
vent llnes will either Uri: x rerpved or-deanad and seatrcd open.
Plplng willbe crsposed at: Faclttty S'renson t{etal Salvaqe
Address 601 South l4ain cltv@ state& zp-9,4999-
Contact pemon Phone#( 801) 798-3548
Tank(s)will be €mptlod by: company
Tank(s) will be cleaned by: company
contamlnated ryater generated by cleanlng wlll bo dlsposed at faciltty Advanced
Mvanced Petroleum RecYcling Phone *!-991-189331- /
Mvanced Petroleurn Recyclinq Phone#(801 | 364-9444
Petroleum Recycling
Contaa person
Tank(s) will be: x purgod or_ nndered lnen by fie lollowirU
Resldual sludgos wlll be dlsposed at the loltowlrE facllry:@
aaot.. cnv sl@ stdogzp-9311!-
Contact pecon Phone*t 801 t 364-9444
For Closure ln.olace:
[ ] Facilig Site Pld, Sample lnlormdon Table. sanple resulls and Chaln ol Custody loms ara lrctuded.
I I Appovallor ln4lace closre has bean granilod by the tocd Ftra Dopattmont.
Fire oept.-Date
[ ] Approvallor ln-place closure has been grartod by the Local Healh Depanmaril.
Phone *
[ ] Substance to be used to fill
Phone#- contacl- Date-
THE FOLLOWING MATERIALS MUSf, BE OISPOSED AT,AN ACCEPTABLE FACIL]IY:
All materlals genelatod lrcm UST channc must be msnsgad and dlspos.d h a msnnerthd do.s not ptaoo those
materlals ln ctlrect contact s,tth thc anylrcnmenl On€ttc stodpltlng ol contsmlnded rollr may be requlred prlor
to any soll management actlyltles. ll acratbn ol confanhdcd soll ls prcpoge4 prlor apprcval wlll be requlred by
the Executlve Secrstaty as part o, tho'Comectlve Acilon Plan mqulremom8. Botoro the closure plan ls submttted,
tha DERR LUST Sectlon must bc contactod at (801) 5tl$4100lor aetalon and pcmlttlng rcqulrements. ll aeratlon
ts not planned, lncllcate the soll rllsposal lacl$ below.
I I Contaminated Soils willbefinh*. Remediated in Stu
DERR LUST Section contacl lor aerdlon: Name - Date
Contamlnated solls are to be disposed d the lollowlng taciliU: E.T. tlechnoloqies, Inc.
Address 3656 Viest 2100 Souttt Cry salt Iake ciW State_[ Ae_84120
Contact person Philio Phona#( 801 ) 973-206s
Contamlnated water is to be disposed at the lollowhg tacillty: E.T. Technolqies. Inc.
Address 3656 West 21 00 Souttt cttv@stdogzte-W
contacl person PhiIio Phonef ( 801 | 973.?o55
SITE ASSESSMENT
A slre assessmont multt be perlomed lor.atl USf clogurct and ctrangelncerlca Slte asges$nonts must b0
pertormsd as outllnsd ln R311.202, Peil2m.Vi2and R1111.205 (U.Ac.). I contamlnatlon ls +tlDsct4. addltlonal
samptes must Ue colleded a the locatlon when Gontamlnailon lg most llkelv to !o DFton!. SOlt^anO-Opundwater
llowlng table, ljslng the apprcpflde lab methods.
Complete the Factltty Slte Pld and Samph lnlormatlon Tabh on pages 4 and 5 to prcvlcle slte assessment
lnlormatlon.
CONTAMINANON INFORMATION
or@!@! tho lntornathn must be repodedto the Exealive secretary (UST)
al [phone] within 24 nouE. -fie Otv$bl ol Water Quallty mrst bo mtilled at (801) 538€146 il contaminated
ground\,vatororsurlacewat6rislound.llcorrtamlnatbnlscorilirmed.ashouldassist
in the remediation process.
tn the event that contaminatlon ls lound. the envlronmental consultant will be:
C.H. Senrices, Inc.
CONTAMNAI{T CIMFOI'NDS rc BE A{ALY:ZE)
Tcd Eadm Hyfmrhr (I?lt) .
Bcaa. Tolnq Etylb.rEA Xltnrr GIZX)
$15 Etdfi.dlgq
EPA6/n2orCt?/
Tcrl Pamlcm Hydrurbr (I?lD
B.aro. Tdra E tylbaa. X),!ro .. l{rpLthdcoo (B[EO[)
EPA 413.1 or{lt.l grd
*AODq624
Oil rod Grtrr (O&0) c Tcrl Rssrtb Hydtpcttbor GRII)
Bcara, TdE " EUloni Xytnlq NAUdrar G|TPO{)
EPA al3.l or 4tt.lEPA al3.l or{lt lOil rod Gresc (@0) c Tad Rsumblr Hydtqto GRII)
l0l5 Modfdlg4
EPA,tltrl or{lt.l
g4EPA tUoc
o&
Ol5 ottdficd rnd
EPA al3.l or alt.l lgl
EPA 644
Tcrl Earclan HytmrUr (I?lt)
Oilrd Ggra (O&O) cTcdR*owot{o Hyltutor (IRII)
VolrdL orUlic Ccgoo& (VOC'r)
Orch..EPA aabcdr l rpondbythl Froodn Sottty
Company
Address 1320 West 800 Norttr ctty@state-[zp aqau
Contact person Ctrarles Hjorth phonept 801 t 489-0224
I Fc,LnY srrE PL4r
The slte p,"t mu$ slow .calb, oldt bullrlhga,-g1? p.p.r,, oo,ncarrc+ ."no, phhg, rlapcnrr tsrands,and unctergrcund uq[h& no-;[e nra ry 5.-gr.*r, 6in 8pgioprldo Egffi!fo scato. tt-mrd's]ur proposedsampling locauons' substanoes slortA fi'qF; and dud;laftfibradtton. Tarr( and samplo rdenrucahn must beconsist.nt wnh rhe hromitonrgrron on b;i:'IhtTi,ffi'Jffi pran
Facilitv lD # 1000120 Drmn By O*.r.244
- 9lrpt.locathns (SS+, WS+, USC+)
= Monitodng Wells (MW*,l
- Sol ooang (B{)
= Water Wells (dorrstlc. ltvosbd(, ob.)
x
a
o
o
1
comprere tabh rora[ eamprcrto bctsi.nm
Sample I Sub. gtorort Sp[ typcr Dnttht
s.s. #1
ln Enk.
USED OIL SOIL 7'
---
s.s. # 2 ll 7l
. Compoundt'
sflEor/rr[r/Hoc
Anrtyslr memoolel'
418.1 I 80201 8010
u.s.c.
' Soit (ss), Grounduvder (Gvo, or uniled solt classilcatlon (USC).
I Appror. depth ln leet below grade. AI samplas 8n b Oe taton i Oe leot below the bactrfltUnattve soll lntertace.s contaminanr compourds to oe anatrzeo bi eadr sarpto tt om talte o;p: ai.
- -
' ApPropriate analysls methods torcoitamlnan qrpouirad h eafi samire ftrom uo6 on p.3).
Approxirnate depth to gtounduvdor h the vldnlty ol the tanks: ttoRg rrIAN 20 Feet /
Regional groundwater llow diredion: __UEL
State Certi,iod Ubofidory to bo
Address 463 West 3600 Souttr
Contaa pe6on SIETTE @fZ
c@$arel4_zp_g3LLg__
Phone#( 801 I 263-8686
Please explain any urusual or exteruatlng dnJnEames ergedad rcgardlng th6 sits assossmant or clogrre:
I cettlty und* Fnalty ol law that I am the owmr/oporator ol the tan(s) ntcrcrcod abore and that I am lamuarwlth the lnlormatlon on thb lonn and thd lt h trua, aacurat anrl ciirpl.tq and fuither, thst the procodur€s
descrlbed heraln wlll be lollowod rludng tank clogun
Slgnature o, tank owner
Full Name o, tank owlt€l___t4ARtmn: o- nroR.r'r '
'W'1gZ ptte '(q) (e)tt'OgZ $ 'UUC 0, aas 'V?j1Z-l[€U 'epoC qupy qan fq pa4nbar
s? '866I 'zII ,(ul^l uo cctnlflruoc-uou ul punoJ s+m eU JoJ $V arp ro spaua4nhar
em ql!,h
"rrftprffn"
q pesroJrad TrB1 lesem uolpt 000'8 ettl roJ lyal ssauqBp rya
puu (reptu uoll?t 000'0I prn papBepm 000'8 ?opEapm qopt 000'9) quq ftryro1oJ
-+ rt rY' fqr ror slsa rotcatap ryal pur ssarqqBp srtll pu? {ugl udlspud r go Idoc E lFqns
:Eqtrollog eW op rcnu nor( ccutgdutoc erragtm o;, 'pa{o^u aq (ew erwlpuo3 Jo amgprao
rnof prre pun{ (JSd 1uu1 a8a$S wnelo$ad et{l roJ Ruauc4ttbu &nnflta et{t 8trpu1o1l aru nof
'qcns sV 'aaru1(morJo nuauulnbor il$ Fgsgso rcu eltq no,{ serucSpul /tollar ecuupdruoc aqa
'(srSd s{rrul aEuros ptmort:cpm
e^ll surBluoc llnpel sFLL 'OASSOI s! raqumr uogacgpuapt ,gntcuJ Famutlmp ar11, 'qe6 'uopldup
'lse6 gggl rluoN 061r8 pffi301 s1 ,$gmJ sgl'(no,$ uo uBqauttm [q pasado ro pilr^\o &illmJ e
ot panss! Sg0II 'o61 acuegduoC Jo amgsra3 JoJ mal^il acuqlduoc u paulogal (UUSO) uoFBIpeEeU
puu awodsaE lzlucmlotlAlql ro uols$lq ee 'OSn) Irgralces e^Smaxg eql Io tsanbu oln ty
'?fi61 'g1Iuli 1o sB rcalJo ul 082 5 'u'{'C 0r, ail.IaraJar [q saturodrocug
qtFt/r\ I-zoz-IIEU epoD 'ultrpv tlEln Eugpnlcul suopuptar pue sclru 'salrusls prepal pu? elsN IIB Inl^\
ecrngduoc ltlrrslsqns ra4nbu tcv erll 'efi'(Z)ZW9-6I $$ rluv apoo rtslo ul paglca& suanrarlnbar
aql lur{l sa{ruralep s! ll Jl cow;1dmo3 Jo fficgpreC ? s{oleJ Iuu 656i ,ftBarcas e^Uncar-a
a!0 lBqf sapprord nlfig$t $ 'url epsJ q4n '(lcv) llv {rI?I otuots prmorErapun qBln eq.L
:ua$af '{AI &09
ssor'oN srNvrrd,ror do s,rvrr.ilruae nlroa'du or u,?f:ffif"1jlTfi :au
t0048 qgln 'IroJ u?cucuv
toarlS als|s l5"g 989
llo lIutlcqnru
uasual ifura1
g66I '82,(tnf
66-89€o-nrrulr
7
tfifit h z ]lv!d
"lT' i rui':ll#il t'# ili'
'q c J. ,Irrf69 (108)
rrf 6r8n.65€ (ron)
00r4t5 (108)
9llr8 rttlo
"(t5
e1y11p5
rooll plz $ar[ 0t6t $toN osr
sll.4q
f,GlC .d lurlt
,oHJVl a^ftt$ta
'q'qc'uolplti'u auurKl
!6Ai^40
8l^r'.1 'o Prqrg^{
Ii:0I 86zC?;TI
.t
Ad0c I ltJ
roo @
NOIJVICAI^IInI OIW ASNOdStrU'IVJNTII{NOuIA.T.IEI JO NOISIAICI
,LLT.IVNO TVJ.NIIITNOUIANE JO JN!II^iIWdAO
:
c988 6S8 T08 XYI ngu dsau ANg AI0
1
_ Faciliry rD# 1000i2t)
'Page 2
$ubmit documentatjon that pmperlnventory Contrcl is completerl on the following USTs
(6,000 gallon unlesded, 8,000 gallon unleaded, 10,000 gallon regular and 8,000 gallon
diesel), as required by Utah Adnin. Code, R31l-20?-l and 40 C.F.R. $ 280.43(a). by
docrrmenring you are now property performing the following:
Document thu daily measuremcnts are taken of thp liquid volumc in the USTs,
to within one-eighth inch, the total sales from the tark rrt ttre time of
measufeftent, including measurcment before and after cach delivery, to within
one-eighth inch are maintained and available.
Document inventory records are reconciledoonthly to determine the total overage
or short+ge for each UST each rtonth, and the variance comparcd ta the
calculued allowable of 130 gallons plus one perccnt of each UST's monthly
throughpuL
Docurrent the irutallatiorr of drop tubes ilr ths 8,000 gallon unleadetl UST.
Documcnt that you have obhined a gauge stick whictr is not worn on the ends,
legible, and capa.ble of measuring one-eighth insh increments.
Document thu the water is mcasured to within one-eighth inch in cach UST, u
least once per month, and tlte water measuremgnts, converted to galloru. ars used
to corrBct the monthly fuel reconciliations.
p66,nm6p[ that you have obtained a callbrafion chart eapable of converting
measursments t0 gallons in one-eighth inch incrcments.
3. Document that you uaintain UST records in accordance with Utah Adfiin. Code,
R31l-202-l entl 40 C.F,R. $ 280,34 arrd 280.45 by dosumenting you uaintain fie
You have 60 days l'ollowing the receipt of this letcr to demonsuate compliance with rtre
requirements of the Act or your Cenificatc of Compliance will be rcvokcd artd you will be inetigibte ro
receive deliveries of fuel and receivc payment tbr claims against tlre pST F1grd.
If you fail m resolve the compliance problems described above within 60 days of receipt of rhis
Ietter, yeu will be notified by a Notice of Agcncy Action and Norice of Hearing. The prrrpose of the
hearing will be to detemrine if thcre is any teason your Certificae of Compliance shoutd not Ue revokert.
@-
o'
/vd.
@-.
/
following:
V &. ,Document fiat you maintain copies of all written pdrformance claims, incluciing
/ tlre EPA third-party evaluilion flrrnmary sheets, pertaining to all tighfress resrs
. / used, all iltomatic linc teak dctectors ur use, and all othermonitoring equipment
a/Rt v being used.-WO. Document thar you maintaln the results of all samphng, testing and monitoring.
lI,':J,tlJ 1u;id r1.\ oul ,rt.r(u,'? \ 1. . ..
a . /'
Focitiry tD# 1000120
Page 3
Please contact Therron Blatter $ [phone] to discus$ this noticc at your earliest convenience.
Sinccrcly.
,/1p,M" fcgdP. Cray, Executive Secrcary ruSf)
Utah Solid and Hazardor-r.t Wote Conrol Boud
I(PG/IIG/mw
cc: Frerl Nelsort, Attomey General's Officc
Joseph K. Mirrcr, M.D.. M.SP.H., Dirsctor, City/Counry Health Department of Utah County
A - fc,oe, l2<.,
Dec. 6o 1993
Rhinehart OiI t't t,Facitity ID#1 OOOb#
Location:
790 North 1 600 West
Mapleton, Utah 84664
Results of inspection and response to DERR letter datedJuly 28, 1993.
ERRU-0368-93 Compliance #1 1 085
rtem 1 copies of most recent tank and line tests enclosed.
Item 2c Drop tube installed in 8100 9a11on unleaded USTon Dec. 6, 1993.
Item 2d Gauge stick was present at time of inspection.
Item 2f Calibration charts have been delivered with inspectionpacket.
fter;t1 3a Documentati.on enclosed
Item 3b Documentation enclosed.
A.
]RoDucT CoUTnINMENT
0wruen
0penRtoR
Renson FoR TEST
PeRsott
ReouesrlNo IEST
Inrux(s) TNVoLVED
'.IDERGROUND Wnren
F I r_l-up
Resulrs
Sysreu lxreonrrv Evnrulrron Dnrn Cxanr
Cn r/a-, f{iort/,',|'l'L,'.U'.iiu irY' ' 'frtbp'/b'h',') '/t'
;;^;';,';t
't" '-" " " " " '
E. P. A. REGULATIoNs t
aaaaat
(f,*/as_.i--
I: CApIcrry GRnoe'€t{
Coven F t r-r-s/Venrs
4' 2"
AccohorNc To
TRurs ro BE
AVAI LABLE
FILLED AT
souRcES/ MoRE THAN 3!f reEt.
ID
1
2
3
4
Resul
Sreve Lvotts
3240t1352
Co-0001
uT-0054
Io-9_114029
Aae
Puups
a
SYpnorue
7R15
LocRttoru
Senson #
lHrenuouNTIAN Lenr DerecrroH
Results of U.S. EPA Standard Evaruatlon
Nonvolumetric Tank Tightness Testing Method
This form tells whe:her the tank dghtness testing merhod described below complies wirh rhe
cerformance requiremenr of the tideral under[roundirorage tank regularion.'Ihe evaluarion rv.as
conducted bv the equipment manufacturer or a consultant torhe manulacrurer accordine ro rhe
U.S. EP.{'s 'istandaid Test Procedure for Evaluating l*ak Detecdon vretoJi, sunroirri,r,.Trr* Tighmess Tesdng Methods." The full evaluadon repon also includes a form describing rhe
ne:nod and a tbrm sumrnarizing the.test dara.
Tenli owners using this leak detection system should keep this form on file to prove comoiiance
rvith the tederal reguladons. Tar* o*nirs should check with Stare and local a{encies ro make sure
:his torm satisfies rheir requiremenr. I
Narne
Versrcn
Vendcr
deteetion
Torner Creaii"-e ?rciucts
2L2 .Vorion St
1ay City
(sreer aooress)
)lichigan 48?06 ( 51? ) 893-3360
(stare)(zrp)
Evaluation Results
This method, which declares a tank to be leaking when unden a negatiue presaur?, the
-0?essuredee@aLcuLatedthreehoLdoalueperhouy.
(c:ly1
has an estimareC orobability of false alarrns [P(FA)I of 0 o/o based on the test
results ol 0 false alarms our of 21; i6sts.lAffiifidence intervat for p(FA)
iS :rom,) tO , i3.3 !o.
The :crresoonding probability of detection [P(D)] of a .0r,6 gallon per hour teax rs;00 96 based on the test results of er dEtealons out of zt
srmuratec reak tests. A 95o/o confidence interval for P(D) is from 100 1s 86. ?
The ground-water level was 72 inches above the bottom of the tank.
Nc:rvotumetric iTf Mqrhoct - Results Form
oL.
additional evaluation results on page 3'of this form.
Based on the results above, and on page 3 if applicable, this method E Ooes f does not
meet the federal performance stendards establiahed bythe U.S. Environmental protection
Aoency (0.10 gallon per hour at P(D) of 95o/o and p(FA)'ot So/o).
Does this method use additional modes of leak deteaion? EIyes E ruo. tf Yes, complete
Test Conditions Quring Evaluatlon
The evaluation testing was condu.cted in a 8021 -gallon E steet E Rbergtass tank
that was- . e6 . inches in diameter_and zw --inches lohg, installed ii
aand anci zrauel baCkfill.
f ana ' ri I
A.
Nonvclumetrlc TTT n'€th'J llormen Ezu '3 ' ' - '
- t,- --'-'tta nnooor,* t^k Leak detection tCailn2-VerSrOn llegati
E;t conditionE otrrrng EvAGtlon (continuecl)
The tesrs were conducted with the tank ?0 to 90 percent full'
Theternperatureditferencebetweenryod}ct3sdediofillthetankandprocuct
alreadv in the ,rn['rJn6.;ltom ttot A99i.,. aF to oF'
*t,ilii.nJiro oeviati5n of Not, AooL oF.
The product used in the evaluation was aasoline / diesel fuel'
This merhod may be atfeaed by other sources of intenerence. List these intenerenc€S bel*v
ano give the ranges of conditions ,noei *hich the evaruation was done. (check None rf ncr
accticaole.)
[ ruo.e
lnterferences Range of Test Conditions
Linutations on the Results
The cerformance estimates above are only valid when:
o The rnethod has not been substantially changed'
.Thevendor,sinstructionsforusingthemethodarefollowed.
. The tank contains a product identified on the method description form'
o The tant( capacity is 50.000 gallons or smaller ' \ee note belou
o The ditference between added and in'tank produa temperatures
is no greater th;n r or' ii - degre'es Fahrenheit'
Temperature is not a factor because
tion is at reast t tlz rrsurD' L:;gr '":;iez?ZZ"z'i,euxrr!"t*n\y;"lx:J?f;i..,"n otr. *tll9jil?^b:X^'fjlffllo,3i;t?3f;^nn?Trri?
|tn *d,olil: tank is not topp
. The total data collection time for the test is at least 1 1/2 hours'
. The product volume in the tank during testing is zo -.ig2o/otull. ZaZ"?,?u,^,[2?*1:, '.
o This method E can E cannot be used if the grouncr-water revel is -abbve the bottom of
the tank.
other timitations specified by the vendor or determined during testing:
=enk sYsten eualuation'
. -arrir : lilethOCt . ReSultS FCrm
T Cnecx if aPPlicable:
lr'
:.Results of U.S. EPA Standard Evaluailon
Nonvolumetric Tank rightness Testing Method
This form tells whe:her the mr* dehtness testing merhod described below complies with rhe
cerformance requiremenr of the fideral underfroundi,or.g. mr* regulation. Ihe evaluarion ruas
conducted bv the equipment manufacrurer or a consultant to rhe manulacrurer accordins ro rheu.s. Ep.{'s 'israndaid resr procedure for Evaluaring Lat Derecdon ,v.,loJi,f;;;;i;;;,;,.
T:n-! Tightness Testrrlg Methods." The full evaluadon reporr also includes a form describing rhe
ne:nod and a torm summarizing rhe.test dara.
T;rnii ow11615 using this leak detection svstem should keep rhis form on file to prove compliance
rv tth the tederal reguladons. TanJi o*nirs should check with Srate and local a{encies io ,iroi. ,rr.
:hrs torm sarisfies their requiremenr.
Methoct Description
Narne lorner
Versrcn
Vendcr lor.ner Creacite ?nciucts
212 .Vorion St
1ay Cit:4
(sreer aooress)
)lichigan 48706 ( 517 ) 893-3360
(c:ty,;(stare)(zrp)m
Evaluation Results
Thrs merhod. which dEclares a tank to be teaking when under d neoat;.tc n?es:4.1t1 a:.rkc
e"essure deeeu nate exeeeds a calculated threshold ualue per hour.
has an estimareC orobability of false alarms [P(FA)] of
resirits of 0 false alarms out of 21 . tests.
is :rcm
"' to i3.3 o/o.
0 7o based on the test
A95o/o confidence interval for P(FA)
The :crresponding probability of detection [P(D)l of a .086 gallon per hour leax rs:00 96 based on the test results of er detections out of 21
srmuratec reak tests. A 957o conficience interval for P(D) is from 100 ls 86. 7 o/o.
additronal evaluation results on page 3'of this form.
Based on the results above, and on page 3 if applicable, this method E Ooes E does not
meer the fed_eral performance standards established by the U,s. Environmental Protection
Aaency (0.10 gallon p6r hour at P(D) of g5% and P(FA)-of Syo).
Ooes this method use additional modes of leak detection? E Yes E ruo. I Yes, complete
Test Conditions During Evaluatlon
The evaluation testing has conducted in 2 8021 -gallon E steel E Rbergtass tank
that was e6 ihches in diameter and 25s - inches lohg, installed in
scnci tui zruuei backfill.
Tne cround-water level was 72 inches above the bottom of the tant(.
\c:rvolumerr;c ]Tf Merhocl - Results Form aace ' :i i
ff6N rz.jj;.x\O TC'llF c)
7IL M GOA Qt Mt
sag,/,
:.,o u^.. Stil& -o.. dz i
=
. aa^taa. rca nt?
,:id;:l4l
'i ti
hl -i \l:il! I it-l
I ltt rl@atno tll
opi
a t7tc4 riafrc6n9[:--
, corrtra?or o. cb"r.., gfla irf?
rtCrer€ltl Uf t,t[ P*
{ral tltl n.r! Urt ntl n rurt s sE "-:; lJ r.o ca'r.h.( A rrrmlgn 3 { ',
.r.un r3!{."r..^nr.n ru.ara- otffi,,
rt roo o, llr? ioctaraaa
^ratar? ilrraalluaaraltraa alB
oarn
GOaCll,lETa ll,...l 40 cou'il|il roainnlrai ura.a tllllo
J t//
Liarc; l,7lt
t ,.us
line test
ndards.
tyt' t
leak detector
. ,'.C
lur r.r
:l;rff flJti:f '":J,'|".il11 ^, ^
Cooductcd Ac<
PiPtline ii}fi|cctio
n SYstem
Line Tigtttness lcsl
rhis rorm summarizes rhe resurts or an ev'aruation
l? l'::1ffi:'YitFi:'1t1$1"'LX'l
g;,pff3,p,$g#,*e*,-*i*n:'gffi 'jtri"
on r ef:[.t'ffi;il1'.'.-;'!it!:i*]t#T:',',:'fl: i3;jiT"'
:i;;';t; tocal ageniies to make sure
System Evaluated
S1'stem Name: Pe'tro Tite Line Tes-ter
Version of SYstem: -----
Manufacturer Name:
(s';crt addicss)
frry. surc. zi? *)'"6iti;A^l;Pa
(lclcPhone nurnbci)
Evaluation Results
1. Thc Performance of this slstem
^' [j i.ttt or exceeds
i')'do*. not meet ' rn for houriy tcsts'
ihe federal 'oilt'o'
esublished oy the EPA regurattc
rh e Ep A i egu r ati on ror .an !9u r rr test r equ i re1'l:I|ff
11:f.I ! ; U^::i:ir*i:ti ii fr'"t
leak as small
j:'b:i e1n;lto a probabilitv of detect
iriil.r.ttn (P;J of ,57o' . i - ,--'' --''
STaTEMENT oF CorvrPLrANCE
with EPA Regulation
by Red Jacket Line
40 CFR, Part 280
Leak Detectors
Posruvp SHur-DowN TypB
The Red Jacket PPM 4000 line leak detector, when properly installed and operated, is in compliance with
EPA Regulation 40CFR, Part 280.41(b) (1) (i) and (ii), the technical standards for automatic line leak
detectors covered in Part 280.44 (a), for line tightness testing under Part 280.44 (b), and release
recordkeeping and reporting under 280.45 (b) and 280.50 (c).
claims of compliance with lec.280.44 (a) are substantiated by the following:
1. Laboratory Tests:
Under a three-year period at The Marley Pump Company Engineering Lab in Merriam, Kansas, a rest
system capable of developing thermal conditions resulting in product contraction was used to
establish the capability of the PPM 4000 to detect leaks of .3 gph at 30 psi (.05 gph ar rest pressure
of 7.5 psi). The standard required by EPA is 3 gph ar t0 psi.
2. Field Tests:
A. Tests at a fully instrumented test station in Pennsylvania verified the above performance;
B. Additional verification of stated performance was provided by data gathered during daily com-
munication with PPM 4000 systems in operation at test stations in California, Pennsylvalia ancl
Kansas.
3. Performance at Working Installations:
Since introduction, the PPM 4000 has detected leaks much smaller than the EPA standards in initial
starr-ups and existing fuel operations.
LlNr TrcsrNEss TESTTNG Rr.p,npNCE 2g0.44 (n)
C laims,of comp liance are substanilated, by ttte fctllowirtg :
1. Laboratory Tests:
Performartce tests on a piping systenl ilt'l'ho Marley Purrrp Conrpany Engineering Lab prove rhat thePPM 4000 will verify line tightness down ro a lcrLk lcvel of .03 gph at 30 psi.
2. Field Tests:
A. Conoboration of subject lab tests by tests at an instrumented test station in Pennsylvania verify
the above performance;
B. Additional verification of stated performance was provided by data gathered during daily com-
munibation with PPM 4000 systems in operation at test stations in California, Pennsylvania and
Kansas.
3. Performance at Working Installations:
Monitoring of installations by owners verified that line tightness tests are performed satisfactorily
at nrrrch higher frequency than the annual requirement covered in 280.41 (b) (l) (ii).
4. EPA Letter of Confirmation:
EPA has confirmed in writing the validity of the performance utilized by the PPM 4000 to meet the
requirements of line tightness testing under Parts 280.41 (b) (1) (ii) and 280.44 (b).
RnsrnrcrrvE Fr,ow Tvpn LtNn LBar DnrBcroRs
RedJacketModelsNo. 116-030-5andllo. 116-034-5(pistonleakdetectors),andNo. 116-012,No.116-
017, No. 116-018, No. 116-019, No.ll6-020 and No. 116-021 (diaphragm leak detectors), when
properly instaHed and operated in conrpliance with EPA Regulation 40CFR, Parts 280.44 (b). The
atttomatic line leak dctection claims covered in 280.44 (b) are substantiated by the following:
1. Laboratory Tests:
Lab tests of these units over a period of more than 20 years verify that the Red Jacket mechanical leak
detector can detect leaks equivalent to 3 gph at 10 psi.
2. Field Tests:
Field tests of these leak detectors performed over 23 years verify the above.
3. Performance at Working Installations:
Red Jacket mechanical leak detectors have been operating successfully for over 23 years.
4. Independent Tests:
Results contained in the American Petroleum Institute report, "A lrak Detection Performance
Evaluationof AutomaticTankGauging Systems and Product Line LeakDetectors atRetail Stations"
verify the above performance claims.
RED JAC}<ET'
ELECitONiC)
A MARLEY PUMP COMPANYa
s800 FoxRtDGE DRTVE . MISSION, KS 56202 . 913/831-5700
RJE-s1 4t89
COMP
I NSt DE UTAH 1 -800-437-1 1 06
NYINC.
ouTst DE UTAH 1 -800-633-3039
To trhon tt nay concern:
l{e have enclosed the lnventory reports for the various stores forthe past 2 nonths-Oct & Nov. In the past stick readlngs have notbeen taken conslstently at the sane tlnes etc.r So the varlancesnay be larger than the actual dlfference. In the futurer w€ willrnake every effort to lnsure that the stlck readlngs are done atthe sane tine as welr as being lnore accurate. r hope thisexplanatlon ls clear to you. If you have any further questloneplease call
W.y,rL#Lynn W. Ruff
Contro I 1 erHarts Convenience SLures
Ex)N
-
RHINEHART OIL COMPANY
BOX 418 AMERICAN FORK, UTAHP.O.84003
,{{,.,t\,.i.,''L\/\" i
l'l-T-o tst)f.lx d r3T Icr( INVENTDRy
( uslNG s'r I cK )
.oo 3?e. oo ss1(r.oo aes.oo-46a?.oo ?.oo.OO t47O.OO 6r.)r}.OO 46a5.OO-trlS9.OO g5O.OO
tsH0tr: OCT 1 , 1993 L!ri. ' C
TO: OCT 31, l9e3
t.l
t;;
i,., l
Unlorct.d tAeO.OO .OO ra34.OO ?gg6 OO 26,t4 OO ApA OO ea€.OOK.rot.re -oo oo rrlll oo -roo r'trl .oo ioo.ut 1oo.oo i,. l
--l
rsup.r r.rrrl..6.d .OU :..OO ,gO -UO .OO .OO .OO t.,Diesol tl ,-- :._.._:..oO :,r.Bo . .Oo .go . .o{, .oO ... .oo j,; f
_ rt fi;[,
to/o2/93 Ergulrr sast. oo . oo 6tr0 . oo sag9. oo sase. oo 5oo . oo 4696. oo l;d l
l,.i: .. - unl..d.d---- ,. :.,,74,11i€g .,,:,!F{q€g-:. .r6eklg .- er??;go ,, .?at-1,r8 ,,:',Korormo....;,,i1:i,;'.oo:'.-'.';.ooc+.oo-ri4.ot,,...''.'.go.,.,.}..o'E.}.ocor...r .€ $gi.a.oo '-:: ','[- r#.ii oiil.Ii si*e.Ii r;.ii "i;.il r ,. ']l:lr
- .;; : -,;; ",:',Eo ..Be
---- l,nCrlorol *t .Oo ,Ol) .OU .OO .oo .oo .oo \ ?,i
unl..ct.d Plu. . oo . oo . oo . oo . oo o0 . oo lfi r
--__-- rtt'lOrO3/93 R.gutrr
Unl.rd.d saa?. oo
76r4. OO
Oieg.l te
Sqp€r Unl.rdad
Oi€]l +l
Un I erdad IJ lu.
5348t . OO
.oo- .oo
.oo
.ou.,.--ioo
.oo
--oo sAs OO
oo 157 00 5r8t.OO 4ao4 0() -377.oo -34.oo
otl .oo .oo .oo .oo
tA/O4/93, RcgulF*. ....A€g.OO
Un l.tded 4,585 . OU
Kcroaan. OO
O r -re I *a .4t]0r+ . OU
Supar Uhlead.d . OO
Or.iot {t .Oll
U6lHd+d Flu. - .. .- OO
108??.rlo 166,;,r.\)t) 13t79:J.Otl -?6t4.oo-4e-?\r.oo_59e9.ou
oo .oo .oo oo 264 COf31.rtu 447.3.r1o 5348.o{J 8?5.oo 8r+1 .oo
oLr
.uo
oo
.ou
.oo
,b
Foo
rl rl
oo
oo
u0
oo
oo oo .oo
rl
1O/o!./93 R.gul.r 5aa9.UU .Ou ,g6,?.00 SZeo.Ou SAag.OO 669.r,tt 6l3e.uo !: f
- --" -----{rfr}..c.{l*-*-*--764&Oo*- - --90.----}+lt€ro{F-5aac-.-og*--76.}:oe-tlr,oo-spct"oo, ,, -. , ,, . .- .- .. l.l
. K.ro!.n , .oo .oo s6.oo -06.00 I : .;; -. ;.;; -Gi.ii r'. , -j . r. , TI'c
Ol.3al te 334a.oo .oo ea6.oo srao.Oo SB4€.OO aaA.oo 1069.0(, l; f
Btpf l.i!.la.d3,--, Or) : OO 'r OOOlar.l tt OO
Unlcidad Plur .ou
oo no oo oor-lrl . r'Jrl . ltlt . oo tlu . oo
oo
1O/06/93 F.gul.r
un t.rdad. ITotE.
Ora..l {€g(.par Uh I oactG(,
O r-.. L a l
t nl..6.d plut
58189. Oo
7614. OO-. oo
5.34.1 . UU
oo
-. oo
.oo
.oo
.oo-oo
.ou
.oo
.oo
.oo
s57. OO
t 55.5 . OO..oo
e59.00
oo
. ot)
.oo
5332 . OO
6059. OO- {ro
.:o89. OO
.oo
.oo
.oo
t
;.1 I
-,, r
",4
e34e. oo-e9to. oo 3rra . oo
7534.OO t.r?5.OO-e5(r6.OO
- ---,-,oo- -.--.-.-oe , see.os-"..,-,
3734. OO- 1.iss.OO -aA6. OO
a
a
a
lt-T-O EIOE}( I STICK INUENTORY
(uatNe 8T1cr)
FFiOrl: OCT 1 , t?93 LlrH
TO: OCT 31, t993.-(
pRot)rrcT TNVEI{ToRY !'ELII'€RIES 8eLE. lr{uF:taToFY rxu€ilroRY (61{rET)" (a}ftfilr) n€FEREI{CEIGEDTENT \' (
ij'
1li/O"/93 R.gulrr
Unl, aa6od
Dl...l ae
ara." t 7rl..d.d
lrnl.aded Plu.
' gnlsd.d
i:: : t(arotm.
lO./ lL1/93 Rfgul tr
Uh I ead€d
Kerclmo -'
Ot.r.L {2
t al..dad t,lu.
tO/71/9:l R.gql.r
UnlGadcd
Krrotma
Otaatl o€
Supar Unlaidad
Ol.3el tl
.-.--Unladfllut---
tO/t?/93 R.gulrr
- tir l aidar, --- " *
l\ ar o as.
Orar.I ae
- ri.rp.r UF I a.ded
O taa. L al
egrJ?.rlo 525.UO 4624.OO 5AE9.OO le65.Ou 44(]7.Ou 6e432
57Or-OO l47e.OO ll763.OO 76t4.OO-{}l49 00-6555.OO
oo .oooo .oo
-.' r,qj.!. IOtr
.oo
.oo .oo.ou .uu
-.,'eles,.9Eh.|t esrF ,. - .- 584?:oo i-:Et -,733;€o -1199-:!P??=99-]==9?-AT,9I_-*:-
.oo .oo
, o.l
.oo
.oo
t-.
I
|:. (761 .9. OO
,..oo
'.:;16.:ia.oo 59?6.oo ;.?614..oo l63a.oo-5o1?.oo :r.oo -r.oo .oo ,tf.oo 3ar.oo
. .,,1'1i' . Oirir. aA +'i ' - JErg:OO ,,06 ,r' ,t!6,OC
Sup.r Unl.r.lod .OO
Oa-r.I lt -OO
o0
oo
oo
oo
----** -- - - Unl.rord-J}tut. '----*- TOt,- -- ----OO
1O/O9/93 R.gulrr 5Aa9.OO .OO 614.0(l
- ....-ufrl ndarF -
--
-
?6t+- €€- ------ ---a€; - .'-+ 7e3 oo
K.ro3.no . OU . UO oo
Oi.r.l te 5344. OO OO lst O0
.6r.pe-gil-.d.d =-- -€$ -'- -.OU -' .OO
OlGrol it .gO .OO OO
Unla.ded PluE . Oo O1l OU
5e75.OO 56a9.(,0
5e3r.oo -7614.OO
.ou .oo
51e7. oo 534€. OO-.oo -.oo
.oo .oo
.orl .oo
614.OO 5?54.OO
1763:OO-3a3ri-
"(
(
tluP.r tnlsdod .OO .OO .Oo 'oo 'OO 'gO 'OO
58Ae OO
7614.OU
'-..,--.';oo
!134A. OO
.oo
3{J44. ou
5€.[7 00
. ot)
eee9 l:|(,
. otl
.oo.-.- .oo
5AA? . OO
?r*r4:or!
no
534{r. U{)
.oo
. otl
OO :l8i llo 5604:lC 3Ot34 OO-CSI'O OO 3e34 O0
UO 1al.5.CU .53ui:.ijll 6e4?-Ctl 459.UO-L775.OO
oo - .oo .oo .o() - .oo '38!.oo
oo 16.oo 533e.OO eee9.Oo-aso3.oo -6?3.oo
.ou 32 1.Url
r5i . oo 1a30 . oo
- .O€ --.OO.oo .oo
.(,t] . o'l
.oo .oo i.1i:(
.{trt 54a.oo - a536.OO
8e.52 no 16a4 oo r4te5 oo
ou e9g oo -e9f, . oo
e9e.. r-ro soc oo 55r.7 u(,
. ou . rlll . oal
oo oo .oo
---'.oo --:r}0-- -- -' ;tNl
653.OO 5e36.OO
t39?.OO ,3er7.OO
ro0 00 -too no
4rt1.Uu .r9s7.tto
.oo .oo.ot .oo
5€€9. O{} 3353: AO- 6'5€"-. tnl -69? 19-
76r4 00-65r t .oo-e2e6.oo 6()
. ot) 29a.oo 6r9.oo
- 53.l{t OO- -t6t-36'--{r.}e-:O0.oo ou .oo
gaae.oo 65s.oo 7e40.oo
-?6r 4.. OO l3?". OO-7869. OO
oo loo oo 7t9 00
534lt.OO 4rt1.OO -44t.OO
.OO :OO .OO.oo .oo .oo
\
.(
oo
o(l
(.l0
or)
oo
oo
:1 (
:C
o
lt-T -o clctox /8 tiT tcr ttsr€N
( ugrNri srlcr, )rO,ocT 31.te93
OAILY fi.T.O
T oerE PFlrrrcT :: ' - tnruo1;fir dl'. rrryrrE3 ' i''- :lelEit'rirlerrp1v
tO/'13/93 FcAulrr SAire. oo
1 -,:- :
:Ir', tllrttnT )"; icf 6ienoE/@rEile,-l .,3
'5ou 53'7 . u(, 535a . uO :Jac's . oo- l4€7 . oo 5733 . oo
Kro3s. .OO .OO .OO. .OO ..OO .EO Z|?.OOOtc..l ae s!i4e.Oo 'i,::,. , '.OO ' .:!rff,.Oo. nae?€.Oo .g,i6t*.Og. 5,llz.OGl.: IOa.AO ',:3_-'- !up.r Urrtttdrd ''.. r ;OG ':-n*!.!:J-'rriOO 'i:.: ..-:nac :::L- .OO*-- -:. :!t . - - BO - ____ i,:
Dte..l ll .Oo .Oo .Oo .Oo .O(, .Ou .OO l;; -ttnlc.ct.rl plur .OO .OO .OO .OO ,OO .Bo .OO ';3
' lo/14/93 F.grit.r !865.90 ,'.::?ZOE.OO . .: a63.Og ' tltl.r..oo Seer.oo ??9:oo 65gt.oo 6aoo? l.o -(lrl.rcrict r. O663.O0 .,, ceor.oo loeo.Oo taoTe.oo ,?Ot+.oo-6ota.O-ir,ZS5.OO . i,r G
Offi€n-
l,rr1l..d.d Plur .oo .oo .oo .oo
Uh leadad ?,314. DD oo 1,599.OO 5915.OO 76t4.OO 1t599.{J- 1t]1156.OO
Olo..l *8 5619.0(,
Sup.r tlhal,e.d.d . OO
gup.r thll..dod
Ot.r.l lt
LHcrd.tt !>fur'
.oo .oo oo .oo t{t .oo
oo 3(,2.oo 3317.oO 33rl€.OO 3l .OO r37.OO
.oo .oo -oo
ic
,.- ?{
i:,
,.- t
:'coo 73(}.oo"-- - Oi6at- ae - -'- -- 53.a€,,OO - --- - =OO -3.3.3;OO -- 56r&;OO -t3ratf;OO 333.;OO--'rt?O;Oo
Krr oloo OO OO oo .oo .oo
.oo .oo.otl .oo_._-.._.:oo- _.. _-,. -.oo
5fJL19. OU Orl
'7614 OO .OO.uo .uu
s34€1. oo oo:or1 - oo
.oo .oo
.o(} .oo
.oo
. orl"'oe
.oo
.oo
oo
.oo
.oo
:6(}
.oo .oo.oo .oo- .(x) - oo
,;,r,3
_._1,
'3
.5
ai /-
ln rD
!d
1tl/'|.6,/'?:! H.gqlar
Unl aacla6
l(ar otahc
O1.r.l te
''-- 6up+r U?rl€d.d
01er.l tl
Unl{d.d Plut
.59;l .UO 5le?.rl0
t767. OO 5A4'7 00
5? . OO -5?. OO
6e . oo 3ea6. oo. .oo .oll.oo .oo.ou .ou
5449. OU 692.OtJ ?834. UU
7614. OO 1767. 80-ile89.OO
. OO 57 . tlo ?8? . llt]
5344. OO 5e. OO 53e .00- .oo .oo .oo.oo .oo .oo.oo .oo .oo
lO/17/93 Fcgulrr
trnt.adad
- l(rorw
Orca.l *2
Sup.r Uhlaadad
Or€al tl
lJalaaded olur
1O/1e/9:t- legvlrr - --
Un l.r6od
Kar otaha
Dlfcl ii!
Sup.r Unl.rd.d
. oo 4rro . oo.oo i ta6.oooo eo oo.
. uu 5-i. rJrJ
lro . OO
.oo . ..lto
oo oo
t6.rs.oo .. ??rr,oo-
6654 00 ls','a . oo
. r)r, . Ot)
oo a3 00.oo .oo
504€ . OO- t446. OO-??35 . OO
- . oo Po., o0 . oo?. oo
4533. UO - ?.5e . O|J -e3U . rlu
.o0 .oo .oo
.t tD
.
66A0.00 tA3t.OO '063.0(, H5649. OO
?.5 l4 . OO
oo
5.-f drJ . UU
oo
.oo
OQ
66fr{}. Or,
304I OO
. or,
4S.t:I. OO
. orl
5449. OO
6444. UO
-eo. oo
5ev5. tru
.oo
.uo
.oo
"?/r?,oolore4.oo
.ou
rul50. oo
.oo oo .oo
.uo -. OU -- -.rJO.oo .otl .oo
Sfxre- oo-r€!t€-,oo-'r€{}" (x, 6ilr.r3- -- --76r4 00-e5ro.o-!e245 00
. oo . oo 80? .00
slco.oo 99e.oo..6a.oo
.ou
c
-
;;;;.rr",..nr.nro*" tsnoi'l: ilcr 1, 1'??i LtrA'
(USIH6 STICI() TO: ocT 3t, t9e3 n,C
Pl.r.t 11
---1y-74pgtf$H*ai-1:--1-7T:::r:;7I:'r-i:--:CiEtltG--*W .
*- l**--._l---]-[
Uhlo.dod Plut .oo
Sup.r ti,t l..d.d . OU . UU
Dlo..l lt .OO ,OO
rol}le.go
:.!fu:a.tE
.oo
.oo ;ii e
ill c
Karoaaha
Olor.l *2
.oo
53/a€. OO
.oo r88.oo -raa.oo .oo l8€.oo lste.oo
.oo 1t4.oo 5e34.OO 4405.OO -Ae9.OO -6il.OO
I21ltAc
:{
Oi.rot tl .. .OO .OO .0O 'OO 'OO 'Oo 'OO
u6l.rdcd plu. .OO .OO OO 'OO 'OO 'OO 'OO
::t
lzr
32 12 . O['
r rO27 OO
- --- .- ---. l(-.ffi---'. - *--.-o{r-
1!0/?-1/93 Rcgulrr
Un I a.d.d
Ol.r.l ta
sup.r (.ha l..d.d
- Dios.l *l - - --
Unlaacjad fJI'rg
tO/e?/rs t{ogulrr
Uh l.rdod
. oD .69e . OO 25:O . OO
oo 190'7 00 9reo . oo
- . ou -ilr;otF ---68 . Otl
. oo 35e . OO 4053. OO
.ou .ot .otl
oo oo oo
.0u rlo o0
ou l:38.CO 4651 oo
saa".oo 336v.oO 9:313.UU
7514. OO- r506 00-7et4. oo
.OO 68;{Nl 1-38i1-;tlt}
534€.OO lets.OO 1e35.00
:'(
4405. OO
.ou, .oo
.oo
s8tir OO
.oo
oo
.oo
.oo
.uo
.oo .url
-.. OO --:OO
t:(
-,i
.(uu
58e9. OO t83e.(]Ot{-155r . OO
?61 4. OO -6885 . O- I 343t . OO.oo 8a.oo r40e.oo
'- !'ltlar 6tt*{rtHtH't3G:OO-
.oo .oo
657'-{c
?6r4.Orl 83t9.OU 2e94.O0 l3a39.OU
K.rotm. . OO . Oo aA ' OO -e8 ' OO
1€'-----.33r16t:OtF '---4(}3;(X} .-.Y74S.OO
9r.por Unl,.rdocl
Ot.:.t ll
- --*--*--{Jnl6d.d- Plr
lO/a3/91 Rrgultr
t n l.rd?6
Karolana
Oto..l te
SArp-.-rJclffd.d
Or,...l ll
Unlaeded Plr/r
.oo .oo.or! .oo
--.-.-oo '- - --' .ao
58tf,</. Oo . oD'7614 0(, - oo
. or! . 0t)
s34A OO OO
.-.€t}. .----..oo
. oo .oo.oo .oo
.oo .oo.oo .Ou .oo .oo
,.1
[lc
L{
.oo
960 rro
r.16l oo
.UU
190 0()- -.oo-
.oo
.oo
4e29 ott saae. oo 96tl . oo I l5'l t . oo
6t5? OO ?614 0(, t.l6e.o-it977.oo
.uO .OO .UU 14Oa.OO
s I 38 CO 534€ OO r90 . OO l8aa. OO
:(
'(
;OO-
.o0
.oo
.oo
.oo
.oo .oo :.(.oo .oo
lO/?4/93 R.gulrr
un I.rdad
Kard6a
Ot.a.l le
5A89 00
,6td l)l)
.oo
5,,4€. Or)
oo 4re oo 5477 00
r)r'l t247 OO 636? OO
,oo .oo .oo
.o{] 79. OO 596?. OO
3865. OO- l6la. OO e899. OO
ase7.oo €t6i,.oo-941?.uo
' '-;OO*----.OO tll0t.OO
e956. OO-83I3.OO -4€s.oO
i(
,:,C
,::
i;l 3
t-
o
J,"r. : :.-& i F t,i., tlca...is.,!," + rr?" t
gl- - 'fPrtq:E'tq_[E
f't-T-O tsOOK 6 5T ICK INUE-NIORY f-Hull I Oc r 1 . 1i*:! LUH
e3 (U51NG STICK) TC: OCT .31, lee:J
OA ILY I,'. T -D o
(g,toET),
t'vEft-8'---:::_---:-.-=-'="-_ -----.r.
(ErEGlTr.g&snsxcszercnr ' 'i,
------".:-.--------;+;-------- It
OO-..,.-,-.---- ' l' :.' -**-" . i' r
Dlo!.1 *l
Unla.d.d ,,tur
.oo
.o0
.oo
.oo
. ut)
.oo
:OO
.oo
.oo
oo
rt{t
oo
oo
oo
oo
5
a
lJhl..d.d .i8Sa7.oo te(Pt.og";, ilHrs,8{l iJf?g"3.oo ,7614.8-. .*.- 'i Rtr olrrtr ' ' -:€6---.--_.-1E6l!El,:--tmO-zId:r:itO--EO1a,;,;OO.
,40 i;#Egt3.oo ,7614.8-il4-r?.G:814?6.OO
t9/23/93 $a.gul.r
Oi.{.1 aagup.r Unl.rd.d
lO/?7/93 Flegular' Unl.rtr
. Karotana
Or...l ae
-' - *---.-gqpar !lnlEElet,-
Orrtal *1
Ullaad.d Plqg
1t1ril8/9j R.g'Jlar
Un I c.dcc,
llJ/;\O/93 Ragu Iar
u6 l o.d.d
Ka. o3ana
!865.0I] .Ug 7t}l}
i8sa7.oo te(,zt.og,,;, ilHrs
iJo .:::,tso.Co' 5aE9.OO a733-OOta63a.80 657+t
i:t o
l,r ,.
i,i 15
,1d
2956. OU .oo t6!?.rlo 534a.oo 3"3t.oo ?a46.oo
.oo .oo .oo .oo .oooo .oo
Seae.oo .oo 72a.oo s16'r.oo
- ?6-f .|- OO - -- - --. Ot - --{6rar}: U€--- - 5PO : tlt}
.oo .oo asa oo -esB.oo
534A.OO .OO l8t.O(, 516".OO- .o0 .oo .oo oo
. ur', . u(l . uu . utl
oD oo no 00
7196. OO aO35. OO 15307 00
1t}1 1.7-ioo rrtrl*rl-t 5{38 :t}t} ----
. oo asa. oo 1570 . oo
r?a5.oo-3r9e.tl(, -6?9.oo- -----.,:OO - -G$ --.CO
. oo .otl . rl0
clo .co .oo
.{t
,, rf
?3
,l
- tole<}'.93 Rcgrl11p 5aa9 oO
(.rn | -Acr.d ?A 14 Oll
K.ro.€h6 OO
' lJleta l *t ' 5346-. Ou
Supor Uhl..6od .OO
O1...[ at .OO
- uat..ctaci Dltra -* -:OO
? 1'/6 .lJt!
10119 00
5r?t,9 . (rU
76 t.l OO
.ou
'-- -.- ---OO - '-ta'7 OO ''-t9r}e'OO- sA€tt- OO -?e-7:6Gt!?t}&3D-€!7ra-..- rir
l
31tl4,OO 175e.U(] 8966.oO 7614.OO-135e.0-1?56A.OO
Oo :Ia6.OO -326 OO .OO 3e6.OO 1996.00 ' 3
5{l9.OO a74.OO lU4'r3.OO 534A.OO-5145.OU'8353.oO-----''-
uD 84r.OO 6:J5.5.UO 58A9.OrJ -rr,56.OO14B41.OU
oo r72.l no tl3eB o0 7514 00 -'7rl4.o-162 16 0()
.oo .oo.oo .oo-"-.oo----'-oo
.oo .oo .oo.0I, .uu .ou.oo-oo''oc--'
.oo
,oo-'oo
i
;,o
.,b
. OU 9ll4 . OO 4985 . (lO 5AA? . {lO 9O4 . Ull 1669e . OO
rOO gO55.OO - 33cl .OO '--7Glr}:OO aO53':O.-lt515;Ot)-.olt 15t.oo -r5r.oo .oo tcr.oo er4?.oo
1'lillr
!
I'iir-.-" h
t
,.\ n 1/a
FHOtt! OCT 1 r l??3 LUfr
?g: €lGT 3r, t{t?3
c
t
gcrl.Y lt-T-O lr
lle.
i5l
r;i.
Ie.rp.r tlrl.acLd
O1...1 ll t,
.oo i
.oo
ao.oo
t.la. oo
':':aair..iE
ItEOt.oo
; - ':frr: ':l;o.o'). atgir'oa
?ar7o.oe u366.oo lat'oo
3
3
C
C
C
,:t
tilc
!i
i-- 'i r'Jri.' r ''
li+ :.;:rtcFi!:', Al i,r j:fiI yri$;l:ilflii
a
a
{
t
BEEiNliiiriil
:iiiVEl{TERY 0ELir'ir{ii;
THEE. +J
IiAPLE iiAfti '5lii i?, i?.;3
STORE SiiiFT DATE PRNDIJCT
!l-T-0 B00K & STirii( ii\iUEiiTilfrY
iii5iN6 5ri*:;
ifiCrl: ilfiV i i l99l LIfi
iii: lriur; 30, i ??I
IAIL'r il-i-J
EHliiiE s;iit lvEii A 0'ljEfi &
SALES ilivEx-iiRi ii{ViliiciY isiiEr{Ti isiicriii nEFEftEricEi[fi{HEl{i
iilti l?3 -neqular
lini eariec
(ercseire
iiesei 12
Super iinieadeo
!iesei *i
iinieaderi Flus
i:lii:i93 Eeguiar.
iin i eaded
(erotene
uiesei li
Super.ijnieaeei
liesei it
iinieadet Piu..
iiiuS/i3 Reguiai
iii'ii eaded
]{etosene
liesei Ii
Super" rjni eaoel
Diesei ii
ilnleaded Fius
ii1'l)4i93 fieguiar.
u'n i eaded
iercsene
iiesei 12
Super ijnieass:
liesei ll
irnieaoed Fiirs
iiln=ri+7.leguiar..
iin i eaoed
iierosene
liesel 12
5uper,.;nieadeo
Biesei li
unleadei tlus
i11061?3 fieguiar.
,iri i eadeti
Kerosene
liesei *i
Super.ijniearieri
0iesei S1
iirrieaoec Fius
. ii{J .,10
75ii. *i i4i:.CC
. ii ?tJ. C0
.0ti i63..iii
. $u ,n!i
.ei .rJ0
diul. uu aJi. iri.)
.00 . ru
. i+ i5d3. ,i0
. tj+ i:. iiG
.ilO ilii.00
.uii .$l
.00 .00
, uu 485. iril
. +c .,)0
. iu i 156. uu
.'i+ 4. ii0
. rJ',l i30,0r:
. ti.j . ilu
!.!, r.iIUU TUU
.iii {I?.';'J
.0u . ii*
. ij0 1123.,j,j
.!V n.ru
.0ri 20?.,J0
.'ii .'di
r uv r'lV.*,; 3ia.u0
.;ii .0ii
' iil i Tu=. 0u
. rlii i. iU
.0u :4(i.0u
, 00 .,;,1
. uu .0ii
.;ii 468. iiO
.0u .0u
.00 !S44.0,j
.00 i3.50
.00 ?3. u0
,00 .0s
.0.1 .00
. UU {ir. ilu
. il0-3865. ii0-386s. .,JlJ 6EtEj
?uil, +i-6it;5. iu-6irr3. ;i
. r0 ?;. +u ?*. irii
?:iii. r]0 i03.,l,i i63,.,i,i
, +il . uu ,.iir
.0.i . ij,j .0,;
JUot..\ru luii. ilu luY1..iu
.00 .0,r-3863.00
?,J5?. rit i:$3.,,,lt}-{Si?. ;r.i
. vri i i , uu Et. ui.r
?3iu. JrJ iiii.0u 3i3.,i0
.0t] .$G .iii,0u . $i .,10
3965. uii 4e:. .iu i3it. ,;ri
. rlu . {(i-iuai, ru
??El. tjt 2uE6 . urJ-i412. .;i
. i}0 {. 'Ji} 86.0+
iiJOU.ljli -Jr'a. Ut, .. iJt
.0+ . r}u .0,r.00 . u0 .00
4Et;4.;i ii56,ili, 3t36.u0
. UL, . L,U-i6c:. Uii
iti9. il,i 399. $0-;r.:{3. r,l+
.+i 3.:ii Et.ii
;3?0.0* 7l,r{. it,.t ?ri=. +ri
. U[t . 'Jij . Ui.j.0+ .ii0 .+,,
JEOJ. uU -0e1. i,iU iJil. U0
.'Jii . ']rj-Jo6l. ilil
?0:?.0u i?S:. iir; -3i4.0*
. Url i . tti y6. l.J
i570.0i !4il. ut t4S. ut
.0C . iiO .,10
. {iC .00 . tu
3865. n0 46E.,r,; 3?.33. +0
.00 .0i-3863. t0
703i.00 i:{4.'i0 l.'06.0+
.uu li.3U 1u7.6{.,
?570.0i ?3.ij,i i"r3E.0C
.0U .00 .00,00 , ++ .0r)
3465.00 4??.0rr 42iC. irir
3865. r.,0
?,.)5?, u0
?5?0. 00
. i)0
,0$
tJiu.uu
. ii[
3E65. +t
.,JU
?I?0,0(:
"tij
.UU
??El. +0
?0i;. +,j
4804. 0ir
?'i5t. t'C
1865. $0
.00
?r)St.00
.0u
?5?ii. 0t]
.uu
3865. Ct
3465.,i0
13i04. xt;
;4u?. iij
I ??rl. i.i0
3{?6. il0
?360.00
.00
t38u.00
-4. r10
?440. {j0
.00
r{4i. s$
66oii. 00
.0{j
4484. 'iri
.0ij
E?E' NI,r.J.J't. uu
-?. ljrj
?130. u*
.00
3l??.0+
.0i
5515.00
-i3.50
7{?7. t0
.s0
. urj
5436.00
tc
aE6iriliiri6
iiIvEliT0RY 0iLiv;rriEE
1
.EAEE
41
IIAPi.E iiART'5
0E[ i?, i?t3
STORE Sii:F; IAT: I,iODUCT
ll-T-i 308( & Siii,i ii{VEitTuft,i. iiisiilE STICi(i
Ffrllh iti0U i, ii?3 iilR
Ti;l li0v 3ir, itil
0A i iY :t-;-c
EtaDitiE STIiii ;vEn & 0vEn' &
SttLES iiiVEii?iftY iltVEli?DRY iSilii!iTi iSii0RT) fiiFir{i!{CE/iCl,lIiiiT
EO i i I u?lil ,legrii ar
iin i eaoeo
(er05ene
iiesei i2
Super ijnl eaoed
!iesei ii
i;nieaoed iirls
iituEilS Reguiar
iin i eaded
i,ercsene
iiesei 12
Super r.:nieadel
iiesei li
unieadec Frus
iliC?/?3 ieguiar
iin i eaoeri
{erosene
iiesei l?
Super iinieaoed
Iiesei *i
iinieacied Pius
i1iiul93 Reguiar
iln i ealed
iierosene
rti esei l2
o.i{Er L,ilieade0
0iesei $i
'unieaoee Fiiis
ll/l1i?3 iegular.
.Jni eaoeri
(erosene
liesei I!
Sriper iJni eaOeo
liesei li
iinieaoeo 3i iis
iili2ii?t freguiar.
iin i eades
i(er.osene
Diesel ii
iuper. iinieadea
0iesei il
. +u .00
?u:i . 0u ,;tit
1i -i:r iiU til')
?.q?u. iC . ui
r v, .qq
.0u . ufj
3;6=. ilrl . urj
: i. .'-i. UU . \,1u
I 16?3.00 , i,.0u . uu
i610. ',)0 . +u
irl'
. i+ .0l.,
6!;3. uir . utj
.'..1 a.'.. +.1 . ,Ju
?iSt. iit . uu
r?V ruu
,:i?ii. i;ii . iru
. i,it] . u0
. u$ .0!
3865. 'i0 . ,i,j
. rJo . iiu
-r-h r.
i UJY. 'lU i AUE i . Uu
.00 .ri0
?i7ii.00 .;i0
.0ii . uC
,'ii . i0
It63. u0 0004.0(,
. VV t ttt,
ilSui. uu .0u
.*0 .u$
4?40.00 .0i
.iu .,i0.0t .0r
94:1.'uii .i,r
.0ii .00
7i3?.0i . iu
. rlii .00
?570. u0 . u0
.0{, . iJ{l,+'/ .r0
t ttv t .lV
tsSt.tu 0200.(i0
L.!V A.JV
a?, 00 748r. ,"1c
.url .vu
. UU . Vtj
3i;.e$ 35{i.iu
.0u .l,lJ
i4?t.00 i0it6. il0
63. iu -o:. iC
t!3. t)0 ?4;;.00
.UU .?s
,i," i'r. vrt . rtt)
162. t'0 556i.0u
.u0 .u0
i444. ut, 56i:.0u
ti.,t0 -l?.{0
lsi:.ti+ ?iii.0i
.uu .ili
rlrf rVV
2A{.C0 i6,.il.+,r
Ai. ii.u'; .uu
i{3i.ii0 ;i?i3.i,j
23.40 -23.8(J
43.'.00 ii i8. riu
.0ii . u0
. ilti . i,i0
30 i . uur ?564. iru
'r.1 .'Ar riU r UtJ
i i ?8. 00 i ?453. uu
.,i0 .00
i3i. u0 4bC?.00
.+0 .$0
.00 . fJli
;68.';ii ?l5l. rjij
. trir ,*n
!i?8.r0 SEEi.li)
.00 .0ii
i6?.0t) 740i.0ri
.00 . iir,
. \r0 .,J0
..ri . ;;-3865.,)i,
i16i5.'Ji 54?:.00 668i.00
li + tn ril t'.uU i.lU iil.lU
?Ei',i. '/u 32:.00 i36t. uu
.uii .'i0 .u0
.0u ,,ii .0u
o+2l.,Jit 11?6. iid 6666.urj
. u0 . ui-Juo5. t0
?r:t.'i0-il3?. iu I:{1. +u
. uu ol. it i?:.:i
?570. r+ ri. uri l{43. irO
. rir .00 ..iu
.,10 .)0 .uil
386i. u0-i6i6. i0 4??ir.,iij
. f,fi . ii-io6S.0u
Tt;Si.tiU :44{.uit 4;88.00
. C0 i?. ri,i ir?.60
?571.00 45o.?0 i?0i.ii
.,;il .r0 ,{t0
.00 .iiij .i,;
3E65.U0 2b4.r0 i254.;+
.0(' .0i-3E68.0u 6E:o?,68?6i
i 354I . il.j-E134. ,r0-3 i .16. .10
.00 2-1.8f] 2i i.40
{t40. t $-ii?8.0{i -i??.00
.0u .00 . ii0
.i, .00 .u0
?4:i.0i -r4?.0i 5i0?.0+
. iiO , i)0-1863. u0
?05t . 'u0-i3t4. 0c-a5{0. cu
. i)0 .00 il l. {0
?SiC. 00 ;?!i.t,u :484.00
.'JC .iti .ii0
.Cu .r;t, .00
J663. iu-3iuu. iil -lul.,.),J
.00 .00-3t63.0|;
{ i,lY. iiu i I f u. UU- rJ6i. rJ{].fio .0c 211.40
i"i?,]..r,) 16?. 0,,1 if3i. J,)
. trC .00 .0ii
.,i0 .,J; .'i0
80
'qA6E 45
ilAPLE iiAriT'S
irLL ilt i7!J
STCRE li'iiFl $Aii r''Rii0iiCi
x-T-D !0ti( & STicK il\iuEi|iToRY
'iisiti6 STicKi
tsEbiltlltll{E EN[ii{E lTl[ii
iIIIVENTORYDEiIVEfriES SALESii{tjETTURYiI{vEIITuftY
1
IAiLY il-i-i
CvEfi & uUEn I
iSHEi;i iSii0RT) iiEFEREliCEiC0llllEliT
ift0lt: ltiilV ir i??3 LfiR'li: NEV 30, !?93
ini eaoed r'i ds 386i. 0U
iiiiSi;3.iegrriar .u'v
i;ni eaoed i0:?. rl0
iieiosene . +[
0iesei ii iS?t.t,j
Sirper ilnieaceo . it"
Jiesei li . +',r
unieacec iirrs 3i65.riu
illl{itl Reguiar .'ri
iinieacei ?ust.0i(eeosene . i0
triesei *2 i57t.0ir
3rrper unl eaoed . ii0
[resei il .0C
unieaoeo Plus 3065.+,i
iii i5i$3 Requia:' .$u
rinieatied t5i!. r+
i.er.osene .e0
Diesel 12 {;bl.iii
Super linleaoeo .00
0iesei ll .;+
I*ieaoeo'tius ti6i.'JC
iiil6l93,1eguiar ,',r,j
iinieaieo ?05?.0ii
i{erosene . +0
liesei i2 7570.0t;
Suier' ,inieaoeo . '10
Diesei li .0C
iinieaded lius 3403. r;u
iiiiiliS Reguiar .i'u'inleaded ?l{{.
',t,i(erosene ,'r0
Siesei 12 3865.C0
Super iinieacei .uC
0iesei tl .i,i,
iinieaoes Fius i6t0. ut;
i i i isi 53 riegular .00
iinieariec ili{?.00
;.ercsene . i0
Diesei ii ?323,0t;
Super ijniearied .00
.',lu {;6.0u 3{:?. +ii
. ii'v . ti .00
. ulu i lgi . iu :6?E. riO
.0c i6.uir -i6.00
r;ij iijVr:Jt/ I tl U.,rV
.ii .i$ .u0
. riti r UV . tJU
. 0t I'i6. lii lSE?. uli:
.,i0 . i'i ...ri,
. ut iE3. 00 62io , iru
.00 . tj'ii .'j'').00 66.c6 iSi{.0t
.00 .,itf .0i)
.l;0 .00 ,titt
. u$ 2?i]. ',r0 35?5. iiO
.00 .0{/ .0C
.00 i:4?. it,, 83{?. irO
. 'Jtr i2. t0 -1i. i0.+,i ii9.00 {i04.0c
. {.l0 .00 .00.u0 .u0 .uu
.0r,i {{?.'10 7?ib.ti{r
.,)rj . J0 .00
. Ul i;0I.00 5850.0',
.ri0 i{.i,,, -i4.lC
.0t, iEi.00 ?3Ei.0u
.,)0 .i{, .ii0
.0k .0u . u0
. iu i?u, +ti 36?5.,10
.0i .iv .t,u
50;E. u0 ilE. i0 i{3:4. ij,j
. u0 :. i',. -2. 0x
3'i04. riu i6:. r0 670?. .;0
. uC .0C .'it,
.i0 .il0 .i0
. ui,1 3Ei. riu ?l0i . uu
.,jti .00 .00
. iC i +?1. uu i 26T{. ili
.00 ?iE.67 -7iu.67
. uu 30u.0'i 7t.i3,0+
. ilO .00 .'".ti
186:.';i} {36. ru 255. t0
.0rr . ii0-3t63. Cu
?ri5?. 0u i381. iji:-3tSi.',i'i
.'r,'ir i6.li i27.1u
alar nl r.'..'1 '1.'. ia:: ..ilrlri.iri.r i.lurvu il.iJ. vu
.',ri: .ii .iii
. J0 .,i+ . i,t
3t6:. Ci 308.0C 561.0(;
. tjii . +0-la6=. ,t
?S?ts. i0 l3!2. ii0-i65t. uu
..lu . Cri i2?.,10
1263. C$-324i. 0C -48b.i10
. ii} . iii . Jrj
.00 .fit .'ii
Elo7.,i0 {3?2.r0 5i55.,iu
.Sil .$u-346S.00
?ii5i. ir)- I :9il. ii0-l?4i.,1u
,0c i2.0i :3r.1i
?5iu. S0 3{46.00 29?8. ii',j
.01 . ur, .0t
. u0 .00 . rl0
346:.00-3e53, 00 i302.00
.'i0 . iri-3;65. ;+
??44. 0i 1384. ri0-?56i. 0u
.0i i4, t0 i53.:0
3465. t0-33i6. 00 -338. iiri
. 00 . +iJ .,i0
. ui . uii .'.,,i,
iriu.,lu 4il:3. ;ri :3i?, rjtj
.0C .,r0-3ts65.00 6El6:
lI?17. rC -3??. 0t-3136. i]0
ti a i!. -Et =r. Ul,r /.. Uij jJi . f,ti
i3:1.0u 6i6.r,i 78.,i0
. -il0 . i,i, . C0
.00 .ii,i .i)0
76t0.0r, 3Et,0i, 5?06.00
. ilrr . ii0-386s. ,Jt]
i059. 0fi -t6i:. iu-A?:3. fi 0
.00 ?16.6i t74. t7
i57t,. ,,i+ :{?. uC o?5. 00
, +0 .0il .',]0
t.
";ASE 46
I{AFL! iiART I5
t3
ST$RE iiili: DAii FRODi,:i?
I-T-0 iluli(. & SIii,t :i\a'.-,EITli,f iftuik ilnv ir i??l Lili
BEE: iiii i rir:
Tt: lri8r:3u, i?i3
,AiLl i,t-T-J
ENDilib STiiii I i & uVER t
:ltVElii0nY 0Ei-lVERiEr SAiES iliVEi{iiriY :iiuEltiTlrtY iSiiuR:} iSi:0r;i REFEitEI|i/CirilttEi{i
!Eit7, i?
d0
liesei li .;0
rin i earieo t i i.is ?6i0. 0ii
iiiltl?3 leguiar .riO
:rnieaced ?+"ri. i,u
[erosene . i]C
Eiesei 12 ?5?t.00
Super unl eaoeo . i,,r
iiesei ii .'r,i
ilnieaoeo Fius 386:.+ii
iii2il9i Reguiar .Cu
rinieadeo ?0:?. tiO
i(erssene . ilu
liesai l2 ?5?u.iij
SriPer unieadec . '.,,.,,
[iesei ll .ri0
iinieadeo Fir:s ;a[3.uu
lil2iiiS rteguiar ,ru
iinieaiieu ?ist. irtj(erosene .,lii
uleSel td. al/ir.uiJ
Super iini earied . ,i0
Diesei li . ri0
iini eaded Fi rrs ;ao:.,Jii
'tii22iq3 Reguiar .00
rnleaded i004{.00
fierosene .0u
Di esei 12 6550. iiO
Super Unieaced . iu
Di ese; ll . ,iv:
tinieaoes Fius 5t8t.0f;
ili23i?3 ieguiar .00
iirrieaded ?ilS?. uC
derosene .,r+
liesei f! ?i70.0t
lrrper ijn i eared . 00
Diesei fi .0t;
riaieaderi Fii.r $65. iit
iii:4;i3 fiegular.
iin i eadeti
terosene
0iesei 12
. +f, ,0,j
50i. eu ii8t.Otr
.iic .*0
i:76.00 5?83. t;0
4?,}.33 -490.3.j
245.0c ??E:.00.u0 .+0.00 .0u
4??. i0 3{3E.ii{)
.0C .00 .tr0
.00 iC{0.0t] 601?.0u
. 0ir 44;. 0C -41:. i:u
. tjc ;4. r0 ?{86. ilc
.ii0 ruv .ti,
,,ii} .+0 .ilu
. iiO 4ii.0S l3?5.0t
.'Jti . ii0 .0*
lEb=. u,J-3i:4. 0ii 23!:. uC
. il0 . 10-3865. r0
?*5t.'iu ii?E. u,.r-?{??.uu
.i$ 4t0.3t l{6{.:0
?570.0u 245. fir ?iu.0&
. +0 .00 . ir.r
.CC .it .riu
3865. ri0 {i?.,r0 i8(jt.;$
. t0 .'ii0-3865.0C
?$5?. t}0 iS4,,,. +0-f43?. iji.l
.00 {42.0(; i?*o."Ri;
iS?ii.0C 84.,ii it4.00
.0(j .0c . $u
. r0 . iu .,iU
3to3.0rl 47C. ui, 3:?t. .;tu
. iii .0u . $v . ;ir . i;-1865. iri
. ri+ 6;4. ,Jij 6:3 i . 00 1Cfi44. ',ru 3A i 3. ii0-:a:1. irj
.ilr .;0 .iiii .00 .ilO i?06.3i1
.00 ?i.ilir ?4t6.00 655u.ii -tli.00 40.i0
. \ru . ,i0 . ir1, .,JU . r,.] . i0
.'iiii . $t . S0 .0r] . u0 . uu
.00 i3i.';ri l3l{.00 :;E?.00 2555. iiO 3b34.00
EC .0ii
. iitj
.i*
.u{
. rl0
. Gir
?00. u0
. ,j!.;
.0i
.00
,iii ,{tti
litj?.;'", 8635. i)$
60.c0 -6u.0u
156. ri0 6394. ilrl
. ,10 , ut,
.C0 .u0
104.0i 546i.00
.i,i .C0
iliC.(ii 5t4?.ii0
.00 ?$+.00
i4I.,Ju ?{2;. uu
. 00 .,,i0
.YV rUU
445.00 3380.00
.Oti . t;t;-34b3.00
j,r59.,r0- I 5?6. u0-4iC0. i0
. uri 6t;. ii0 i ?06. Sti
i370.r0 ll?6.00 l2l2.t0
.0C .0.; . iifr
.u0 ,ii .u0
386:. 00-i616. ut 42i4. 0u
.00 .00-386i,c0 73?6:
f ui7. uu ltlri. rj'r-itrti. vu
. ,jt -t',,0. C0 i 066. 5ri
?S?ri.00 i4i.00 i365.0fj
.lj0 .u0 .ii$
. +',r .0c . ,ul;
38bi.u0 485.u'i {?t3.u0
.';r .ii .ui .0u .uC .00-IE6S.u$ 6829:
?*3?.1'i0 3El?.,10 i564..J0 ii3ii.,iu 715t.ti0-4i:3.tlij-?243.t$
.00 .0C 3:;.0C -32;.u0 .ij0 32:.0u il;8.50?5;0.ilu .uu ;15.+; ?355.ut ?:?,i.;; it:.i, it8u.ri;
rHEE tr
I(AFLE fiAfrT'S
r!hi
SICRE SHIF; CATE I'R0Diii;
it-:-! E0rri( I :TiiK iltviN:0frY ift0ltr tl0U i r i??3 iilft
ii;: liuV 3C, ii?3
0AILY ;1-i-DiEuillli:lib liau:liE i;i;i, ;vER & liVEi &
ii{vEililfiI oEL:vEi{ii5 SAtiS ii\iuEliTl]flY ilivilITEfiY iSii0RT} iSii0RTi iEiinEiiijEiC0ilHEl\.I
EO
Srrper r.rni eaoei
liesei li
ijnieaoeo Fius
i:i!3ii3 fteguiar
unl ealea
|.er.csene
Siesei i2
Srrper iin i eaoeo
Jiesei li
iini eaaed Fi us
lllzilq3 xeguiar
in i eadeo
iierosene
iiiesei l!
Super iJn i eaaeri
liesei li
iinieatied F':us
i ii:?/9r- fieguiar
iin i eaded
it,erosene
Diesei 12
Super ijnieatec
0iesei ll
iinieaoec Fiiis
il/26191 Reguiar
iini eacied
iierosene
Diesei 12
Super ilnieaieo
!re:ei i1
rini eaoec ii u:
ii/:i19: ieguiar.
un i eaiao
iierosene
liesei t2
Super i.inieaoeo
0iesel *i
,;nieaoei Pirrs
il/3iii93 ieguiar
Un i eaded
ir.erosene
. ++ .;+
. tii, .0tj
1865. i0 i7ilfi. il0
. ulj
IJIV.VU
. {JU
3863.0i
.",}0 .,)u
.0u . iji
5i3. 00 5?5i.,J0
.00 . cc
dl?.00 62{4'. r0i0.ic -iG.20
ri 1.! ?lrr 1...l.j.uu (.I"j,J.vu
.00 .0t
.;i . tiu
{a?.0ii 33?4. $.i
. +0 .0c
i3l3.0u i04it.0C
i,,,1.u0 -iui.,ili
i?6.0t: 0551.0C
. i0 .00
.cc .fj0
598.00 30il.00
.,lt . uir
t08.00 ii:i.ilU
3 ii7. 00 -l i ?. 0u
IOi.UU dJil,.UU.u0 ,u+
,,,10 . t u
1?6. ue 136;. t;[
.i,$ .u0
65? . 0u 6{ii?. 00
?6. C0 -i6. ilil
iE.0C i4B:.0u
r{V ruu
..ii, . ui.l
ii i. r,u 36=4.;u
,';ut . tli
i540. ri$ 6363. 00
i;. lrJ - i E. 3U
i4I. ilu ldo3. rlu
.0ii . t(,
. u0 .0ri
484. i)u 4S?2.0t;
.C0 .ii0
i:5A.Oii 13?1u.00
::. iJ0 - i 5. 00
, itu . 'lii . riu
.0ii .0i, , tt;
It65.,10-t087. t0 i6i6. ilij
. Cr . $i,-3865. ri
i 1742. ilu 5500. 00-i?.11. 0u
. cc i,;.20 i394. Tt
i63C.,ril -b?3.uii iui. i,0
.0c ,ol,i . i0
. u0 .0i .00
Siit,uu !;41.00 495?.tu
.0,J .0r'-3863.+ii
?u5?. 00-:3i,i. 00-5iu3. i0
.i),1 i01.,)0 i{9?.?i
75?0.00 i016.Cri i?21.00
.00 .00 .00
.lrG .iC .ut
JE63.C0-i i56. i0 3?i)1. utj
.00 .00-3EiE. ti0
?05?. i)0 ?08. 00-4 i 9:. u0
.00 3i?.00 i8io.70
?i?ii.iu 26i.C0 i?t2.,ru
.0C .ilu .tr.
.0, .i)0 .u0
.1603.UU ti6.iJU +if i.Lih
. u0 .,J0-3865. u0
?9ii3. 00 :Sl.l:.+'i-2694.u0
.0,1 96.r0 i?i:.iu
52i;, i',-ii?u. i.r0 -:Ee. $t
. iiil . iitJ . tt
.ui .ii; .i;
-v76.'it] i{i1.0l] 5lii.,ru
.0C ,,10-3845. iiO o?ir(r
i03r. UU 6?6.vrl-il?.5. i,.j
. UU IE. JU iYJl. Ui;
iif U. il') -Jil. Uti -oij.j. rril
.uu .uu .ii
. irC .00 . uU
Jooi.uu -/.i.vL 4tiil.uu
.0i; . v,J-l86S, r"j 6d3ili
i tEDi. uli- i ui I . tJu-JUZ3. t,f
.i0 i5.00 ii{o.iu
,00 . ti'/
i i i4:. uii . tr..r
.,ii . r,.i
60ts0.00 .0i
.0ii . +0
. tj,, . iJ(i
;6 i ?. 0ii . ii$
.01 .0u
?+5t. ilu . +u
.0i . tju
i:?+. L'+ . i}C.ut: .00.00 . u0
384:. t,i . i'ir
.,;0 ..,1u
I,l5i. u'i . uij
.;u . il0
?S?r. ru . ir
.Us rVV
i .'.r.Jr* . utj
1665. t0 . u+
,A'i .0t
??u3. i0 .0u
. i0 .00
:aal ".i.l .:. +il rEilU. Url,OL . ut
.uil .0,j
5076.0C .,,i0
.00 .00
?05?.00 800i. U(J
.'J,J . uil
-rAEE 4i
i{AFLi ;iArii '5
cEC 1?, i??l
5iu-rtE SiilFi lfiTi :ftu0ii[T
,l-;-, g00ii & STiiii :iaVil{i0il-Y "
iu5!ti6 5?iii.)
EEaii\iti:ti; ltiEii\aE i'iiii.
iiiViitiT0rtt }EtiVErt:ri SAL:S :NVEltIur(T ilVtitiErry
ii0il: i{0V i, :913 tilR
?Cr tiv J;, i?ij
0Ai"{ il-i-D
UVER & ivii &
iSHE,if ; iSii0Rii ftEainEi{tiiCilll{El{I
Jlesei *l flr'il.+v
Super rini eacee . ,ru
Diesei ll .uu
iirrieased iiur 3865. t.i0
.uu ii3-.t0 ?4l5.ij,J
. iti .00 ,t;i
.,i; .;0 .i,C
ItJiii. ii 435. u& 6416. iti
4263. il0 EiE.;,; *s, vs
.00 . ui,r .0t
. iii . i;u .,1r,
i3!3. ,'ri 38?. ,ri 5?5?. Cu
1
FIL E COPY
Michael O. havia
Gcyartor
Diannc R. Nielson, /h.D,
Braudvc DiEtor
Kcnt P. Gray
Diro<ror
DEPARTMENT OF ENVIRONMENTAL QUALTTY
DTVTSTON OF ETWIRONMENTAL RESPONSE AND REMEDTATION
150 Nonh 1950 Wcst 2od Floor
Selt lakc City, Uteh t4ll6
(t0l) 536-{tm
(801) 359-tt53 Fax
(801) 5364414 T.D.D.
ERRU-0368-93
CERTTFIED MAIL
RETTJRN RECEIFT REOTJESTED
July 28, 1993
Jerry Jensen
Rhinehart Oil
585 East State Street
American Fork, Uatr 84003
RE: NOTICE OF INTENT TO REVOKE CERTIFICATE OF COMPLTANCE NO. I IO85Facility ID #1000120
Dear Mr. Jensen:
The Utah underyround Storage Tank Act (Act), utalr Code Ann. g 19-6414 prcvides that theExecutive Secrctary (UsT) may revoke a Certificate of Compliance ii it is determines that thercquirements specified in utatr code Ann $S 19-6412Q),413. The Act rcquircs substantial complianc€with all state and federal statutes, rules and regulations including Utah Admin. Code R3tl-212-twhichincorporates by rcference ,$0 c.F.R. $ 2g0 in effect as of May 26, 1992.
At the request of the Executive Secretary (UsT), the Division of Environmental Response andRemediation (DERR) performed a compliance review for Certiflcare of Compliance No. ll0g5 issued toa facility owned or operated by Rtrinehart oil (you). This facility is locarcd atTq0 North 1600 west,Mapleton' utah. The designated facility identifiLation rurmber iJ toootzo. This facility contains fiveunderground storage tanks (USTs).
The compliancereview indicates you have not satisfied the requircments of compliance. As such,you arc violuing the eligibility requirements for the Petroleum Storage Tank (psT) Fund and yourCertificate of Compliance may be revoked- To achieve compliance you must do the following:
1' Submit a copy of a precision tank and line tightrress and leak detector tests for thefollowing tanks (6,000 gallon unleaded, 8,000 uileaded and 10,000 gallon regular) andtank tighnre.r l"T for the g,000 ga[on diesel ank performed in ac]cordance with therequirements of the Act' for the tanks found in non-iompliance on May ll2, 1993, urequired by utah Admin code, R3ll-202-r. see 40 c.F.R. g 2g0.4r(a)
-(u), *o 2go.M.
" a:ed on recvcleJ oaoer
4
DATE SUBMITTED:
C-l? -oz
MAILED OUT. DATE AND INITIAL:
v
ASSTGNMENT''N*.O'F SHEET
AurHoR's NAME ahnrn^^ Bln{/<r
SECRETARY
DRAFT APPROVAL . DATE A}ID TNTIIAL:
', ', t'i
A ,r',, -) -1 - 13
l4ott )-) - 79
',i-1-??, YK6
^0
r "^ Zi? o/ts
k l 1-'S -77
AUTI{OR
SECTION MANAGER
BRAI{CH MANAGER
DIVISION SECRETARY
AUTHOR
SECTION MANAGER
BRANCH MA}IAGER
DIVISION SECRETARY
FINAL APPROVAL . DATE AND INITIAL:
CORRESPONDENCE #:
,-lh ' ^7 'q<
/A1
Facility ID# 1000120
Page 2
submit documentationttru proper Inven0orycgntrol is completed on the following usTs(6'000 gallon unleaded, 8,000 gaflon unleaded, 10,000 gatLn rcgular and g,000 galondiesel), as rcquircd by utalr Admin. code, R31l-202-l-and40 c.F.R. g 2g0.43(a), bydocumenting you arc now properly performing the following:
a. Document that daily measurcments are taken of the liquid yolrrms in the USTs,to within one-eighth irrch, the total sales from the tank aI the time ofmeasurement' including measurcment beforc and after each delivery, to within- one-eighth inch arc mainAined and available.b' Document inventory rccords arc rcconciled monthly to determine the toat overageor short4ge for each UST each month, and the variance comparea-to-mecalculated allowable of 130 gallons phs one percent of each u*T,s monthlythroughpur
Document the installation of drop tubes in the g,000 galron unleaded usr.pogument that you have obtaineo a ga.ge stick whicf, is not wom on the ends,legible, and capabre of measuring oni-.fitrn inch increments.
Document that the water is measured to iritr,ir, one-eighth in t, in each usr, atleast once per month, and the wat€r measurcments, converted to gallons, are usedto corrcct the monttrly fuel reconciliations.
Document that you have obtained a caribration chart capabre of convertingmeasurcments to gallons in one_eightr inch increments.
!9um9nt that you maintain usr rccords in accordance with utah Admin. code,R3ll-202-l and 4o c.F.R. $ 2g0.34 and 2g0.45 by documenting you maintain thefollowing:
a' Document that you maintain copies of all written performance claims, includingthe EPA third-party evaruation summary sheets, p.rt ining to a1 tightrer, *roused, all automuic line leak detectors iruse, ano u other monitoring equipmentbeing used.b' Document thu you maintain the rcsults of all sampling, testing and monitoring.
You have 60 days following the rcceipt of this letter to demonstrate compliance with therequircments of the Act or your certihcate of compliance wil ue revoked and you will be ineligible torcceive deliveries of fuer and receive payment for ciaims against the pST Fund.
If you fail to rcsolve the compliance problems described above within 60 days of rcceipt of thisletter' you will be notified by a Notiie of Agency Action -o ttoti." of Hearing. The purpose of thehearing will be to detennine if therc is any rcason your certificaie of compliance should not be rcvoked.
c.
d.
e.
q v
Faciliry tD# 1000120
Page 3
Please contact Therron Blatter at [phone] to discuss this notice at your earliest convenience.
Sincerely,
heL,)-- Kept P. Gray, Executive Secretary GST)
Utah Solid and Hazardous Waste Control Board
KPG/TKB/mw
cc: Fred Nelson, Aftomey General's Office
Joseph K. Miner, M.D., M.S.P.H., Director, City/County Health Deparunent of Utah County
d
.9
oo
CL
ooo
E,
E
5
oG
o
.go,
o
o
!troE
oB.o
oo
o
o
,0,,.C.
o
'1'o
-9CLIEo'o
arrlol. u.tlEIalol
<t
zl!clflFIurlEI,,
o
,o
DENIJEI{:i Completejtems 1 andafor additional services. Complete items 3, an, .& b.. Print your name and adoress on the reverse of this form so that we can
return this card to you.. Attach this form to the front of the mailpiece, or on the back if space
does not permit.
. Write "Return Receipt Requested" on the mailpiece below the article
I also th to receive the
following .vices (for an extra
fee):
1. D Addressee's Address
2. E Restricted Delivery. The Return Receiot will show to whom thB article was delivered and the date
detivered. TKB,/mw
3. Article Addressed to:
JERRY JENSEN
RHINEHART OIL
585 E STATE ST
AMERICAN FORK UT .8400}
4a. Article Number
P 301 688 592
4b. Eervice Type
E fegistered
dCertified
E Express Mail
n lnsured
E coo
Tl Return Receiot for" Merchandise'
,. ::r' -:ut
#lqooraq
7. Date of Delivery
8. Addressee's Address (Only if requested
and fee is paid)
PS Form , December 1991 *U.s.GPo:1e0F32&4o2 DOMESTIC RETURN RECEIPT
UNITED STATES PO'
\./
Official Business
lll\/L SERVICE
, tr
I ilt
PENALTY FOR PRIVATE
USE TO AVOID PAYMENT. OF POSTAGE. $3OO
Print your name, address and ZIP Code here
a
DEPARTMENT OF ENVIRONMENTAL QUALITY
DERR UST BRANCH
150 NORTH 1950 WEST
SALT LAKE CITY, UT 84116
P
*
301 h88 Ela
Receipt for
Certified Mail
No lnsurance Coverage Provided
Do not use for lnternational Mail
(See Beverse) TKQ,/mwr-
o)o,
oc3-
oo
@
0a
E
oI
a(L
Senl to /
JERRY JENSEN
Streel and No
585 E STATE ST
P O, Srare and ZIP Code
AMERICAN FORK UT 84003
Postase #1ooo12o $
Speoa De rvery Fee
Reslftated De rveru Fee
Relurn aece nl Showrng
lo Whom & Date Delivered
Beiurn Recerpt Showing to Whom,
Date ard Addressee's Address
TOTAL Posrage
& Fees $
Postmark or Date
.
(a
s
a
^
e
u
l

[6
6
[

au
n
l
'
0
0
8
8

ur
o
J

sd
Eg
i
Z

5
;E
E

g:

B
ui
E
E
;

gE
H

€
E
?
ff
g

El

Ei
E

EE
:

1
E3

i;

=,
E

EE
E

fl
E

B+

i
EE
E
E
'
E
i
;
E
E
A
i
E
E
E
i
*=

EE
E

:i

EE
H
E

EE

CA

t
,
>9
i

-(

-c
=
i

Zc

6
\z
:
E
a

:E

:E
€
E

TE

:E

3
@l
Ir,lid..lO. trrr"l
coml
Dimac R- XUfm. nr.O.fgrcmoi*l
Kcor P. Grey
DiEd
;\t
State of Utah
DEPARTMENT OF EI{VIRONMENTAL QUALITYDIVISION OF EIWIRONMENTAL RESPONSE AhID REMEDTATION
;lt0 Nofi t9f0 Wcrt 2ad Fha .. i
Sdr lrtc Gty. Urrh &il16
(80r) 53641m
(tOl) 359,tt53 Fu
(t0l) 536llrl r.o.o.
DnrE: 4'n'q3
RE: NON-COMPLIANCE oF ,uNDERcRouND sroRAGE TANKS ATrn;ir,iiiurv ro* Ioo rzo ---
To continue o maintain a valid cenificatc of compliance, the facility must pay all assessmena within60 days of the statuory dne.date for each yearll or quarrcrty uresr.oit o, tt. cinin .rc of compliarrceauomatically lapses. A rcview of our rccords has strown urat n" following p.l-*rc are lacking:
flt g'," TS Registration Fec AssessmentG) ind larc palment penalties remain unpaid and arcpas due' Please nrbmit a check for $ '-j€-- This will cover the fiscal yeu(s) l9gt.'gg. '90. ,91,,92, '93. ard (E
fl*i{,#ffiil[:',ii,rf"T iin#xTlH:"tTthis fiscal year. This would cover unpaid F.t ot",. st ..g. i-k Fund assessments for fiscal,;T.i3.ii ''. '93 and (9q rrre 'amount pas due up Io ne end of the currcnt quarter is
conmqrts:4 6z.ls 1-+-;l Auc--
Pleasc Gtum a copy of this spccd memo with thc above itcms to speed proccssing.
The above informuion must be nrbmined no rhis offrce uy (o' | . Q3 . If it is notreceived by the darc spccifild. If you have q.estionscorrceming t[s matrerornecd any assistanc""*ffiiffi'ffiry.qryryi*t witt ianr Mdor at(80r)si64r00.
OCI 0 { i:sJ
*,8'J6ff{Jil[$HIIIE$[1"-
D{
tl
tl
FmflssrBEeeffi
,
5C \61 ^'/"
r3
Leak Detection tnspection Checklist
l. Ownership of Tank(s)I tl. Location of Tank(s)
Owncr Namr rCorporrdon, lndlvldu-al. Publlc Agancyr or olrt.r .n0ty):
Rhr,r.otta.t &(
(lt 3.mc.t S.cdon l, ch.cr hc?o
-)
irclfi -.?i:ffnv Str toriEililiir .pelb.bb
Stra.t Addrct!--bzr, E S+A.tz 5t Su..r Addr.t. or S,t t. Ro.o. .r .Fnllc.bla19o N lbOC v)
Clty (nc.r.3rt' Slat z,p@,o
Frclfi t* IOOO tz-O
*'nt4* F^- L , uLr 8{oo 3
Clty ' Stat ZpCrd.o
tanx. ll thl! tacuty h8s mott t ran 4 tent€.llt. Tank lnformation t==ry!-1
fant oresernty in use
rl not. dat6 ta$ us€d
il emotr6€1. venfy 'l' or less d proOuct tn tank
Monrh ano Year Tank lnstall€d (E-€slimate or K-knownt I
r/'latenal ot Consruoion (E-estrmal6 or K-knownt ez(
Caoacrw ot Tank (in gallonsl (E-6r'mate or K-knownt I
Substance Slored (E-6timate or K-knownt
lV. A. Release Detection For Tanks checklhorcleerdsbc{onmerhod(slusodtoreetrtanr,6y'ttnrnm.
Manual Tank Gauging (only for tanks under 1.000 gal.)
Manual Tank Gauging anct Tank Tigmness l€stirE
(onry tor ranrc umer 2,000 gat.)
Tank Tightnes T6ting and lnvernory @nrd
Autornafic Tank Gauging
Olher aoprovecl mefiocl (rrrite in name ol methcll
lV. B. Release Detection For Piping chrckfi.rat.rdstocdogrndu!(slutedFprcr?rg.
Checr One lypr ol Plpang lbr oecn Tank
'iil;\tl,?'*vAuomaric Lrn6 l-eak oetectors. and
rcheck one ot th6 foltorving)
lV. C. Corrosion and Spill/Overfill Protection irNilE Fl*u *""'""
Corrosron orourcoon rnsuulect (indicate dat€)
S orll/overnil oroEcton rnstallEu ( indtcare oato I
V. Site lnformation
General sns oolBrvstiona and (uctnrty obs€rvalons. groun6 weter level. etc.)s t r-,.
M ?-/a'?s / no
tln.n---)fn-r-tC/,,
a.r. rar. tttr
PL
V<
Leak Detection for Piping
[o co lLo
PfgSSUfiZgd Piping A method must bo sslectod trom erch s€t WhorE eppllcabl€ indlcate dab ol last test ll this taciliiy ha3 more ttun 4
tanks, pleaso pirobcopry this pago and conpbE the inbrmalion for ail eddilional prping.
lf Vapor Monitoring, documenlation of monthly
rnoniloring is available
lf lrnerstilial Monitoring, clocumentation of rnonthly
monrtoring is availablo
It Grouncl-Water Monitoring. clocum€ntation of rnonthly
rnoniloring is available _
Qlhsr Approv€d Mefiod (specify in comments sactlon)
Suction PiOinq lndlcab dst6 ol nrocilr€cont b6rt ?-t
Une Tighrless Testlng (raquired every 3 yBls.)
Secondary Corftainment with lnterstilial Moniloring
Ou1€r Appro/€d M€thocl (specify in comm€nB s€clion)
No Leak Detestlon Requlted
(must 8nswer yet to ell o, thc lollowlng questlons)
Oporat6 at l6s than atrncptEric pr€$urB
Has mly one cfiek valve, which is located dir*tly
urder RJmp
Slope of piping allorrvs prodtJcl to drain back into tank
wh6n suction released
Al1 above information on suction piping is verifiable
On the back of this sh€st. please sketch the site. notlng all piping runs, tanks (lnctuding size & substarrces stor€cl)
and location of wells and their clislancs from tanks anc, piping.
Comments:
certily thst I hare inspected t,le above named lacility on
uxfillm, / /
tnsfisc'tor's sisnatrre: '-f '
"t/A/'/fZ-=Dab: 5lt2/q=
-
\./
54au'
fo
bk#
1
w"+*Ef
lD+ tooo t?-o
J-
r4\
XY
vies
ry\\
5o\
@,@intentoryControl and Tank Tigntness Testing
(oool')OFacrtrtv rC r
Merpo or Enx Eqnrre. tasung:
Name ano ao6rBi!! ol tanx tglwross *, 4/'
Please complete all inforrnation for each tank thts tacry hes mor€ fisn 4 tankt. please pnoEcogy thi! page end
thc tnbrmaton tor ell &ldiuond ttnk3
Date ot lasl tanx tightn€$ r€sr.
Dict tanl( oass rcsn lndiqrte yes or no. It no. soooty rn
commBnrs sedron b€low the $aus o, the unl( or wnat
adtons nave o€€n tal(en (e.9.. hari $ate b€€n notifi€d?l
Docr:merration d deliveriqi and sallgt balanoas wlth
catly m€asuremonts ot liquid yotume ln tank ara
matm:ltneo and avalabte.
vs x.2.
Overages or snorlag6 are l6sti t:Ein'lo/o + 't30 gas of
Enk's tlow rhror.€h volume.
ll no. wnrcn rnontls were not?
Please answeryes or no for each question
olvns/operator can €xpEin inv€mory @nrol m€tfl(cls arrl figur8 ussd arr, rordecl.
Recoros inctude rndfily water monrtonng.
BooKs app€ar us€d ancl evtdE'lcg ol recsm entn6 13 aopanEm.
Books ar6 rEnctl€d rnomhly.
Approonato €libratlon ch:n is us€d ror calqJlatir€ volutl'l€.
Disoenser oumE lray6 crrt?6m c3librauon suck€G.
Ths 6rop tube in t1e fill pipe enends to wrthan on€ fool ot lanl( bottom.*'ft'.tl
Owng can ogmon$rale conslslsnqy in diFtlckang tecfinlquC.
Momnry watg reaclin€s are usd in calculafing rnonfily lnvemory ba[rnc8s.
The oi6rlcl rs long enough lo reacll the bonom ot the tank.
The ends of th8 €6uge stlct( are tlat and nol wom oown.
The oipstlck i3 rnart€cl l€grbly and the producl lsvel can oe delermn*t to lhe n€arsil one€l€hirl
ol an tncn.
ThE anx has oe€n tBsrect wirhtn (he year and hius 9asss rhe tigmnoss teil (if n€cstrsaryf .
A thtrd-oan_v centffcation ot the tank ligmnossi t6t methocl is avallable.
Tank t6$er comoli€d wtth all cenrlicatron reQulremsnts.
Montrcnng ano te$tng arg matnt:ltneo anct avatlable tor tne oast 12 mornhs.yasl I no
li
Comments:
lnsprcto? t Signau.m:
st6$l
tutsH:
mplete items 1 andlot 2 for additional sorvicos.. -omplet6 items 3, snd 4a & b.
. Print your name and addross on the reverse of this form so that we can
return this card to you.
. Attach this torm to the tront of the mailpiece, or on the back if space
does not permit.
. Write "Return Receipt Requested" on the mailpiec6 b6low the article numbsr. The Return Receipt Fee will provide you the signatu16 of the person
to and the date of
3. Article Addressed to:
CARLOS HJORTH
712 N 16C0 r,[
MAPLETON UT 84654
I also wish to receive the
lollowing services (for an extra
fee):
1. ! Addressee's Address
2. E Restricted Delivery
Consult oostmaster for fee.
4a. Article Number
E lnsured
tr coo
n Return Receipt for
7. Date
Addressee's (Only if requested
and fee is paid)
4b. Service Typen Registered
ft Certified
E Express Mail
5. Signature
\Signature (Agent)
PS Form November 1 990 * U.S. GPo: 1991-2E7.066 DOMESTIC RETURN RECEIPT
UNITED STATES POSTAT SERVICE
Official Business ilil
Print your name, address and ZIP Code here
aa
DIVISION OII ENVIRONMENIAI, RI]SPONSI]
DEPARTMEN'I' OF ENVIRONME,NI'AL
QUALI]Y
S'tA'I'E OF U'IAII
sALl' LAKE ()'ry. U]' 841144840
PENALTY FOR PRIVATE
USE, S3OO
,-.-Certified Mail Recerpt :
)2, u: l[:'J3:i:,TffiXT" iiix;ii.'
P 6U5 3t? 0Ih
-
AH*perAIis" (See Reverse)
Sent to
CARLOS HJORTH
Slreet & No
712 N 1600 w
PO., State & zlP code
MAPLETON UT 84664
Postage
*1000120 $
Certified Fee
Special Oelivery Fee
Rastricted Oelivery Fee
Beturn Beceipt Showing
to Whom & Oate Delivsred
Return Receipt Shwing to Whom,
Oate, & Address of Delivery
TOrAL Postage
& Fees $
Postmark or Date
'o
O)
O)
ocf.:
ooo(l,
EIa(L
(e
s
e
r
c
d

O6
6
t

au
n
f

'0
0
9
9

'r
J
q
J

Sd
E€
E

E
EE
f
r

€
E
E
E=
E
E
E
:
E
a
E
E
E
e
i
EE
E
E
=
E
E
E
E
E
E
E
E
E
EE
E
g
g
E
E
E
E
E
r
E
l
g
E
E
r
:E
i

:€

SE
*
H

5c

EE

f
, DEPARTMENT OF EITVIRONMENTAL QUALIflT
DTVISION OF EM{RONMENTAI RESPONSE A}.ID REMEDIATION
Kenneth L. dkema '1950 West North Temple
Exeutive Director , Salt Lake Crty. l.Jtah
Kent P. Gray : (801) 536'4100
Di.ebr [phone] Fax
Reply to: State of Utah
Divrsion of Environmental Response and Remedtatton
Department of Env'ronmental Oualtty
satt Lake ciry. urah 84114-4840
Ndarch 31, L992
ERRU-I17-92
CER.TIHED IVIAIL
RETT'RN RECEIPT REOTIESTET)
Carlos Hjorth
712 North 1600 West
Mapleton, Utah 84664
RE: NOTICE OF INTEI\TT TO REVOI(E CER.TIFICATE OF COMPLIANCE NO. 4473-1.
Facility ID# 1000120
Dear Mr. Hjonh:
The Utah Underground Storage Tank Act (the 'Act"), Utah Code Ann., Section 19-6-401 d. seg., requires
that every owner or operator of a petroleum storage ank have a Certificate of Comptiance after July 1, 1991.
Section L9-6412(2) of the Act identifies the requirements which must be satisfied before a Certificate of
Compliance may be issued, including:
1. The owner or operator has a valid certificate of registration;2. The petroleum storage tank fee has been paid;
3. All state and federal statutes, rules and regulations have been
subsantially complied with; and4. Alt tank test rcquirements of Section 19-6-413 have been met.
The Division of Environmental Response and Remediation ("DERR") recently completed a compliance review
of its records rcgarding 1 fagility located at 790 North 1600 West, Mapleton, Utah, and designated facility
identifrcation number 1000120 (the "Facility.). Based upon a review of the records for this Facility, DERR
has deterrrined thafi
L. ' Carlos Hjorth owns or operates five undergrcund storage tanls ("USTs.) located at the above facility,
which are regulated under Subtitle I of the Resource Conservation and Recovery Act ("RCRA"), ii
USC Section 6991(c) er.Seq., and the Act.
2. A Certificate of Compliance (No. 4473-1) was issued to the Facility on or about October l, 1991.
3. The records establish that after the Certificate of Compliance was issued, the following conditions
necessary to continue the Certificate of Compliance have not been satisfied:
Printed on recycled paper
,^\ f.::,- ar, I : .,.- i"l !. !
'i li :l !.-r l, ::: I--: _,
@
Norman H. Bangerter
Govemor
Facility ID# 1000120
Page 2
Charles Hjorth, as the owner or operator of the facility identified above, has failed to:
1. Pay registration fees in the amount of $225.00, which arc now past due for the fiscal year 1992, as
required by Utah Code Ann., Section 19-6-408.
2. Pay PST fund fees in the amount of $93?.50, which ar€ now past due for the fiscal year 1992, as
required by Utah Code Ann., Section 19-6-411.
Section 19-6-414 of the Act provides that a Certificate of Compliance may be revoked if the Executive
Secretary (USD determines that any of the requirements listed above have not been satisfied. This letter will
serve as WRITTEN NOTICE to you, the owner or operator of the Facility described above, that:
1. Your Certificate of Compliance may be revoked.
2. You arc violating the eligibility requirements for the Petroleum Storage Tank Fund.
3. You have sixty (60) days following the receipt of this letter to demonstrate compliance with the
requirements of the Act or your Certificate of Compliance will be revoked and you will be
ineligible to receive payment for claims against the Petroleum Storage Tank Fund.
If the Executive Secretary (UST), determines that the compliance problems described above have not been
satisfactorily resolved after the sixty (60) day period, )ou will receive an Order stating that your Certificate
of Compliance is revoked for tanks # one(gasoline), two (gasoline) and thrree (gasoline), four (diesel) and five
(kerosene), and that you arc no longer eligible for payment of costs from the Petroleum Storage Tank Fund.
Please contact Ihemon Blatter at [phone] at your earliest convenience to discuss this
notice.
Sincerely,
5if, 3;,fJxl;.?#il",:?f#"ffi.3Board
KPc/rBrs*g,\f.d^1*, {' R'J
cc: Gary Kleemdn, EPA Region VItr
Fred Nelson, OfFrce of the Attorney General
Ioseph K. Miner, M.D., M.S.P.H., Director, City/County Health Department of Utah County
-1
:-:.::-::: ::. I fffl )t"
-
PST PROCESSTNG CHECKLIST
: €31'
L-nac:=c:abIe -:.cc:c:ab Le
tloc
Applicableilcn-l'larketer Discount
Previous
- r tlcryrlVJ I
- Fcr:
Pol}ution
Fi 1e
included ),
incid,
- ,.'erif-v tank/ Iines!/s registered
- Docunentation ok?
- Rate ok?
\r
I
'! /!i
'i /t!
-{
FunC paio
v/rr I
I Da'i A
----l
:'., ic?
?'l an?
tv a1)JL.
Y/N
/
1,.
\ ,,,
Co:.p I : ance
- Conpiiance Outstaniing?
- -eaj.: det,ec--:cn require:?
- ,ry.:i:cacicn up _-. da:= i
4.oo::caE,ion?
PROCTS$ED BY
cc:-pi ece ?
JUL 0 5 l99l
Da:e Quaiii:ed 0G 2q1l -
P.e'..:e:i c.:iDletei and cer__:::cace :ssuei b... n:
sIP?O?.T \ c: \. ctiECK: i s: . Ps:
PETROI.EUM STORAGE
FACILITY INFORMATION:
FT'ND . ,PI.ICATIONTANK
LOCATION OF TANKS:
Owner Name:Carl ac lf i rrrth
Street Address:
TYPE OF OWNER:
[ [ Marketer, or non-marketer with annual monthly throughput greater than 10,000 gallons.
I I Non-marketer with annual monthly throughput less than 10,000 gallons (Must verrity).
DESCRIPTION OF UNDERGROUND STORAGE TANKS:
Tank #
Age
Capacity
Substance
_1-
-2--gnJ+ --up+ -+pe-
-€a-- -4as-
q
-+aJ--+
--J(€resene
TANK TIGHTNESS TEST
Tank #
Pass/Fail
1
-?!rSft-
CERTIFICATE OF REGISTRATION
5
PASC
)
-PASS-
jA.s.S-
4las.1-
[ _] All Underground Storage Tanks (USI at this facility have been registered.
t I All registration TANK Fees have been paid.
COMPLIANCE WITH UST REGUIATIONS:
ts the applicant currently in compliance with all Federal, Slate, and Local UST regulations
[ * I Yes t 1 No - lf 'No" please describe item(s) of non'compliance:
PREVTOUS POLLUTTON TNCTDENT(S)
Have you ever had a pollution incident at your facility?[ ] Yes -- lf "Yesu please provide LUST (Leaking Underground Storage Tank) lnformation:
[ ] I neye.qbtained indepeq{gnttlrird-pqrty financial assurance by my comptiance date.
[ ] I will obtain independent third-party financial assurance by mi cofrrptiarice date-
I ceftify under penalty of lmt that the above repraeilaions made by me are tnk attd conect.
t *l No - lf 'No" please attach a letter stating that under customary business inventory
practice standards you are not aware of any release from any tank(s) at this facility.
I N DEPEN DENT FI NANCIAL ASSURANCE:
i I I hgve obtained financial responsibility requirements for the first $25.000/release:
l,(Sett lnsuranca I t Guarantee il Commerclal lnsurance il Surety Bond
[ ] Risk retentlon group I I Latter ol Credit [ | Other:
Orvner/Operator Signatu Date Signed:
,
FEUrY tD. I 100012n
i( $tr
PREVIOUS POLLI.JTION INCIDENTS
To:Mr. Deruris Downs
Executive Secretary
Utah Solid & Hazardous Wastes Committee
Dear Mr. Downs:
As required by paragraph 26-74e404 of the Undergrorurd Storage Tank Act, I have
performed a tank and line tightness test on each rurderground storage tank at my faciliry,
and based on this test, there has not been a release of petroleum. Additionally, based
on "customary business inventory practices standards", I am re! aware of any release of
perroleum from my tanls.
B
I have had the following releases of petroleum (detailed below; also mention any action
you took to clean up the release).
signarure of owner/operator
Failure to repon Brevious releases could void your coverage under the Petroleum Storage
Tank Fund.
h n ?rn r;le ,
Data Ghart lor Tank System Tightness Test
?tZ- N. l@ w.-'/G8u1. OWIIER --.rE
,r,a,a, E
2. OPEMTOR
REASOT{ FOR
TEST .
(Erplran fullyl
WHO REOUESTEO
ItsT At{o wHEt{
TATIK INVOLVED
lLddrblrd ll.-
lo. marliold- tanfa
IITISTALLATIOTI
OATA
UiIDERGROUIIO
WAIER
FILL.UP
ARRAI{GEMETITS
u AGl.ral|Llhra
loa.nrili
o. AllllalEl
3.
1.
l'aQho6.
?al?lEr
t*lh
lurandr
6.
hD.(odo7<
Ou0 u*+te
$a5.i,emora.Sallrnn
7.
8.
4o'bil.dorrllat t?
Er- K
tt,.oan,..(;ool* ?-ttlo n ^,,q..,,
€>t-, flaDuF 7S6-V-S/
oilttont.*lru
cmr g'oall't E'io ol? arlal tun irtl l-r,.--
?-ilarid oaodtrsllIl
tfr id I|b 6 r.€Yia? Co.r.a.L lO trd.
Lllhor
PLEASE PRINT
arg.
Y€-5
Aqb
nr&i ld.?
[dle-
-.-r u-\ lu
t!.ri hdo (,lEr.Y.
ir oa trabr. tC'
9.COI{TRACTOR.
MECHAiItCS.
r,t, dra? cdtltGo.
Ir€lraal
10. OTHER
IITIF()RMATION
OR REMARXS
11. TEST RESULTS
12. SENSoR
CERTIFICATION
briodoa-irllry
&Irldral abf,naba al rv alir ah.oorr a b -r-ar.ti dre a h 9.oer-d ca.tDIE rot-irl r.ria,tE 5. G.
TS rrl nd q| lb &r. tr* ry*n h sfip rlir r rtd,r erElbd h
r ilLdcr ddrd5 dELrtlrrfr - &l:
?Ilt Llrrdltclilr reid il.ld
13. ff f S crrff tlt tr fi rpfr Et 5d cr lr r-01 taEL ffE . frd r1f d tr cil$ dai t, !r
tlcrdft.ffitAr*iattrhl a'
?drilclrr
,. Steve Lvons
*,3_4Ll_3EL
e John M. Lyons
(-,',--t.32401.{052
Intermountain Manufacturing Inc. dba
P.o.Box 391 Collbran Co. 81624
l)^ feb nG ,^\
l. 0WNER ,..,', El',.*uv
2. OPEMTOR
3. REASOI FOR
TEST .
tclcraa arDl
1. WHo REoUESTO
TEST A}It) WHE}I
5. TAM( t[VotvEo
u.-.llboi r.-
E,lur{fokEf]lf.
6. INSTAIL Ttoil
t)ATA
UNOERGROUT{O
WATER
FILL.UP
ARRAIIGEilEIITS
lr.rar ro ar. tn, l.f tto'+
tdz
7.
8.
o m.rEr
laarararftafi?
Cln- El6
?drotar
tddEr
leiatoar
i-rnnd-
t\rf.
Qa".tO-<
OrJ uJftt
llsab.\ i.nol..lLlfrun
,*..-,,-&.-&. ?tt6o *, ^,r..ed!,
cn a e.!ad b !o c,r rra ilr t r t-r. tt xa dE ro rodo? ccr.&.' t\ao ta-.
?-r*rAcadrdilIl
Data Ghart lor Tank system rightness Test
l4raa
PLEASE PRINT
,J#oe.<
Lb+=Dlltf
ra.llrrill.l,tfi,.
e.., C r.rb.L tc
9.
EredIrtIry
CONTRACTOR.
HECHAfltCS.aruollranrao.
hraarn
10. OTHER
INF()RMATIOT{
OR REMARKS
r.lalb.ral hrbilab.t dt tU lr.r &ra.C etrr b b lta..t.m tO,f f n e.oe,:
11. TEST RESUTTS
?rt rrr.n& '' lh. h brr rfimr h r€ri.. rrtr r- recrdnr g.rart..r b.r Atl.dal ndrrd H6-r. rftrri r iofoo:
?ar* l{rm0ltcitdt E ?-rd
12. SENSoR
CERIIFICATIOII
t Ctfaa.t
'3' E Liffi Ni 6 rr d.(., drdr ll!.. E .t. ls.f r ir Glrm erand ! rh
Intermowrtain Manufacturing Inc. dba
.--ztl 7
Saaaa l!. C t}lrnd
tlac,
,. Steve Lvons
*.32491.L3.5.1 _
1 .TOhn M. ?.yohc 8L624
LEr
0 ^feTra Tf€
Data Ghart lor Tank System Tightness Test
?.aenaa.
t. 0WNER ;oxtrZ
,-rrrrV
2. OPERATOR
3. REASON FOR
IEST
lCrelrin Fullrl
4. WHO REOUESTEO
TEST ANO WHEN
5. TANX INVOLVED
l.ta aaldlrbad lla-
b il.naloldd tantt
6. INSTALLATIOI.I
t)ATA
UNt)ERGROUTIt)
WATER
FILL.UP
ARMNGEMENIS
7.
8.
t+o'+
Co.ncaa, o.
t-?o
g-/Abgllr
6^.\OfE
e@uW,
3rtha. h.trora.lbr. iltrErn
lf tra rt oYar 0t t&t?
Et- Ko.efi lo llia Wdr irda
tr,rla r,c b
Edra ,,€dsA !o 'loC ctf arxl ,uar tllt blr. l{tr an! rio t! ,crio? Coid(,.? NO taaC
?far{.ul o, ohr carlact
*. 1-//-0o o* ^,,r.,..,
PLEASE PRINT
,*v-.-
r=u', ltr
l{t Ui htda dri-tar.La, aa dI6. .tG.
S!a. fildall.n r.. OroCt,r. a.itol.all.
ba icica oa raeury
Cargmy
9.CONTRACTOR.
MECHAT{rCS.
aa, Clr ooatracto,hrolid
IO. OTHER
INFORMATIOT{
OR REMARKS
t blrc|.
11. TEST RESULIS
12. SENSoR
Aafil{lcral .lorrillita dr an, rta.ra abna J ArUt lO !a a(iftr€ rlxar Lat.,E a an ,oe,na oa coanellltad. violo.t o, ooaarx,t enaaarl (furmo ial, ac,
lit r.ra mrd. oo 0r. &r. lrlt ryilin h E drc. Illh L.l gr€drrr Dr..adbd fotr d.lrlh on il..rr.d L.l dr..b rllh ?alrllb I lo[ol.:
l.^l 6a.rnlEata.r ?i$t Oda lrrl
13. tf f b_6tU[y lh.l ln lrt .rrlrr rrr Brd qr llr drL(.t .IEUL rtE hdcdrd r 'ftff rut tr Grltd. ..t-ttr.d !t !
t{doad it ?106o Ar.det Praftrbf &!l,
,. Steve Lvons
c-tncdrn.3:49f852-
l Jahn M. LyOnS
cnnc.r.o., 324OL4O52
Intermountain Manufacturing Inc. dba/y{/ru
O{.2{7
P.O.Box 391 Collbran Co. 8L624
J)^PeF< Tlle
Data Ghart lor Tank System Tightness Test
dda {t{r1. 0WtlER *orrv8
fr.rfaf E
2, OPERATOR
3. REASON FOR
TEST
(Crelra iullyl
1. WHO REOUESIEO
TEST ANt) WHE}I
5. TAtrtK rllvoLvEo
lla-.$bn alLr-
h,IurilCrl- Lrtt
6. INSTALLATIOT.I
t)AIA
UNDERGROUN()
WATER
FILL.UP
ARRAI{GEMEI{TS
eaerr{rt.l|r.
Cc.iolrto. Alllkaai
talaghoaa
faaaehaara
$-a/tlt glaa
s
l|loio.ta
hmc.
S","Tioy'
gJaba. emola.llra il tnorr
7.
E.
Oacor to ira uual, taca
Lfd /
rr.r.b!.tm.a C.t& r.Od. lrt.ie.d !,
:xra r.oad b tc ora d tu r ia r rar.l{o? rrid rtro l.t e.orada? Con*ar ilO LaaA
PLEASE PRINT
ALll l)
t6.rn iarada Crarrr.ta- ol dal.o.r. alc.
9.CONIRACTOR.
MECHAI{ICS.
arry olir cgrlrrto.
h€lY.d
IO. OTHER
INFORMATIOII
OR REMARKS
11. IEST RESULTS
12. SENSoR
?a.{rr,rd oa ootaa ccrlE
ld no0ca , {r(|lr*,
Artdilloael hrloriloa o.| tl, rl.oa abra.oa c|r.,t to ba ta,rtrd rar.a rdiaie a h gaoeria oa co,neLtad lbao.t ot onariafl ,,!..rt rtua'{ til. alc'
T-b ra?. audr sr tho atoia lrlt ryttltt h Prdmcr dth tit Fa.drr- D..adH ht
r d.ld.d oo rt.dLd h.l dr.rb rllh randb r lolorr:
?a.l tdlrrtli.:{sr radldd
13.ft. f ba.0,lh.th-.tr*rydmrwr5ddllbdd.(.! iHrLn!..hdcdrdr1lglf lttilIrelld...Labhdb, I
ffddd lt ForcfbrAr.d.ica ?tn9hl.l &E.
licir.Ei..r
, Steve Lvons
c- ic.nn,3 24011352_
a Jr.hn M. LyOnS
c,r.ilGaba. 324014052
CERTlFlCATl0tiln#ra
Lq.
Sarrl la ol t'h..id
Sa{a.
Intermountain Manufacturing Inc. dba
P.O.Box 391 Collbran Co, 8t624
PATA CHART
For Urc Wlth
EIED
I Laltf3
I ffalr
t Oirtlaa!
a ruaff ril tllt
rr,,al.rr.,, "4trltns /lpn>t Oal& ?tt, lhll l</,
a t,aal rllllcilr|t
r co.,rra' o. Gor,.fi .ra ,.,, lnt'tloulE'rn ffiI.ou*lorrua---Iirramr.rrrlr ?eak Eetectlon P.O.BOX 391 COllbran CO. 81624
UNE Ttot*T
Lwe T/6frT
t r.OGenOt: 7 Llrfl
(?7 tf)I OtYr{tt:
I oriMror;kts,
xa
a rtaso'l ror ?cst
a tts? iaoutsrlo tY:
a trtct t tx3ttucnofit:
, comiAgroi oi conrAflY u^tltlo tel?utcnar.tc($ tart
r rE a ratt ?.3? ro .r EFr.rMAOi fi?X ?lrE url ?attt E ro
to *rr,rr1. fId ( r$.rciarurr ..t t^ris ZZ.a- r
a rr^il ano ttt o;runt or ot3let3tts
It loai?rrYclcx U||aAS ?ts?to
€ef
ta ltE? tasultt
coictuoollt ta?xi3 a,lo courtx?s
uipe f,rif
1
t!.EiR?6 eSS 6 Fo€D
790 fiefrEA 1600 tEst
uAPtEtotl u?fiB 84664
?AflK TGSTGE TBR 3.O1
-64 -.--rgE.t t'rrll:
c*P*e.I?r ?Ahfi( i xEnosEtE EonNEB- EQBTF.
!o33 eail€Hs
fEU?ER*mnE eeEFFI€.IEli?t 541 pno/dar. F
?ES? e*I?ERIfir {S.OOO C?E ?O -O..OOO 6pE
O6i2j"ifi ?ES?'filE FfiOU 1€t4li I€. l.lr52.
DAIA AltAtrSIS IiBIe*lFESt
A enOSS YOL0IG C6*IIGE OFr +0..&47-C*LIO[6
A VOfi.tUE CEA$CE DUE ?O ?$FBmTgnE OFr +0..0&3. C*U€NS
A LIWIB YOL&E R*18 OF CHJ|I{GE 0F: -0..039 GpE$ITA A 95 t eOilFfDEill€E I.ttlERy*L 0F: +/-O..OO3 CpB
F0..042. 1€. -0..036 GPH)
?a/As
costffEn.
BacaOar Up tors,
#h
crcrrrronmadc W.Z- ,t
?, L
/,/-u
SITE ARRIVAT TltaE/,/lrO am,pl
COIITACT PERSON
IIHE OF PRODUCT DELIYERY
AfiOU|T OF PROOUCT T() TOP
TII|E 0F EquIPHEI{T sET UP
CHANGES TO TANK SYSTE}I
---
_ESTII'IATED AI'IOUNT OF PR.,DUCT T., I.IAII{TAII{ TEST LE,,E
'J-TIHE TEST LEVEL t{As HAII{TAINED /O 4, ith,pm
TII'IE 0F .4 pSI DROI O- * O iCI,pm
TIHE 0F CALIBRATION , .
Em,pm
TIIIE 0F TEST COHPLETI0I{ _ rl tr n En,p,r
DEPTH oF ITATER TABLE iR a t,TCr(
REHARKS
#1
HORIIER EZY TEsf LoG
am, pm
- ar, p,
OFF 9; I
-
OPERAIOR
Gengg
l
wArE.t
OE.3TH
A. Tank Bot. to Grade 7 7 ,
!. ]ant< Top to Grads Ja ,,c. Tank Diameter
-
q. Tesi L;;'above grade %:,1 Depth of warer in 13nk fr,I Oepth for taking ,.;-pr. ff:,G. Gmp. probejjptn 1i'inector; ?:H. Gst le,rel to Tani< goi.-""- I I q ,
l !1yaw_ater abov€ tank bonom * n
'rroN. product pressure p., i; *;;'rffia,
Testfressurq Formula/# xLaAJ--( 4-^ .os6
1 = 4,3
N€? ?ESi
PF€SSUFE
Sec. 5/pg.2
\r
HORI{ER EZY CHEX II
OI.IIIER OR OEALER
ADDRESS (lro. s STREET)
CITY AND STATE
TAI{K II{FORI{ATIOI{
CAPACITY (NOHINAL) /' /'
CAPACTTY (Cxnnr; /' 3t/
t{rL
cALIBRATIon nunarn*]r7 3
TAflT LAYOUT
itueE
5/, /
PRODUCT TE}IPERATURE
coEFFicIENT oF ExpANsIoN (FR0H
TABLE
TABLE
n)
e)
rumBER oF cALLoNs AooED q
TorAL ceeecnt /03j
C0NTEI{TS (PR0DUCT ) f.*ra Olnn*
}rcflITOR }ODE RESULTS
TIHE RESULT CI
- -
__
-
_- _
COEFFICIE'{T CALCUI-,ATIOHS
I'IEASURED API GRAVITY
^t
I
HORII E R ItrE(PRODUCT LII.IE TESTI}IG
STATIOII
ADDRESS
clTY, S
[)ATE OF
NA HE
TATE
TEST
LIIIE START LIIIE END
PRoDUcT ID NUttBER H,z.raa*u-e_
TYPE OF SYSTEI.t SUBNERGED/SUCT tOn /,^ry'
APPLIED PRESSURE
eTllll
x.003
+/-RESULT TIHE
x.003
x.003
x.003
x.003
x.003
FrnAL REsuLT ,Oi? 4 i pAss oR FArL cRr
TEST I NG
REHARKS
OPERATOR IIAHE
l,crxsl'29
Ou.,NTR
Name
S t reet
City MA A
NON-NOTIF IER iNFORMAIION FORIl
o,th t"'o)
Coun\ A f ZiP //167
.ta,1 -/66?-
-Type
Phone (_)
FACILIIY
$lame
St ree t ovN
City
Phon e (
-_)
-706/Contac t . ^.1
Tan[ l'lo. 1 Tank No. Z Taqk No./ Tank No. /ct? k4 t. +
Tank JIo. f
TANKS
Status
Aqe
Capac i ty
Material
I nte rna I
Externa I
Piping
Substance
Last Used
Remaining
C I osed
t.r /r/. 4,t /tr i;ri14 /Zetotlt L ?
_/_/ _/_/_ / /- --/--/-
-/-/-
A.\ e4r La.e L-z^+Al.
,?lt o-
y'z ),:./
/tvr.-te/stlpr.n, J;+), c))- ?/- /rjt;
t,c fa
Comments:
Contac ted
r -"{ll6i*4tEilffffff"'llai:laFrd,r$.Erri ? -qr.
O^r"-W