DERR-2024-004815

APPLIED ENVIRONMENTAL SERVICES, L.C.
PO BOX 1073 BOUNTIFUL, UTAH 84011 801-540-9258
TEI 5000 NON VOLUMETRIC, TEI 4000 VOLUMETRIC, TEI ULLAGE, TEI LT3
PRECISION TANK & LINE TEST RESULTS SUMMARY
INVOICE ADDRESS:TANK LOCATION: WORK ORDER #
TECH # 94027
TECHNICIAN: SM
STATE TECH #
STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UTAH 84141-1152
UTAH DOT # 4467
SR-24
HANKSVILLE, UTAH
24008
UT 0121
DATE:
2-21-2024
TIME START:TIME END:GROUNDWATER DEPTH:
TANK TANK
CAPACITY
PRODUCT
DSL
R/UL
TANK
AST
AST
VENT
AST
AST
PRODUCT
LINE
PASS
PASS
LINE LEAK
DETECTOR
PASS
PASS
WATER IN
TANK
PUMP
TYPE
PRESS
PRESS
TANK
MATERIAL
AST
AST
1.
2.
3.
4.
5.
6.
PRODUCT LINES TESTED AT 50 PSI FOR 15 MIN
LINE RATES (GPH)
1.
2.
3.
5.
6.
DSL -.010
R/UL -.009
ADDITIONAL INFORMATION:ABOVEGROUND TANK WITH UNDERGROUND PRODUCT LINES
CERTIFIED TECHNICIAN SIGNATURE:DATE:2-21-2024
These systems meet all requirements set forth by USEPA 40 CFR and has received third party certification.
4.
TEST METHODS USED FOR THIS LOCATION
TEI 5000 NON VOLUMETRIC TANK TEST TEI 4000 VOLUMETRIC TANK TEST TEI TANK ULLAGE TEST TEI LT3 LINE TEST X
LINE LEAK DETECTOR TYPE & SIMULATED LEAK RATE
1.
2.
3.
M = MECHANICAL E = ELECTRONIC # = (GPH) RATE
4.
5.
6.
M 3
M 3
All tests were performed according to manufacturer protocol, and within the common practices of the industry. However due to the variables of
tightness testing, these results cannot be guaranteed. There are no warranties expressed, written or implied.
DEQ ID#2000208
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.02.26 12:22:45 -07'00'
Reason: I am the author of this document
UTAH DOT # 4467
SR-24
HANKSVILLE, UTAH
2000208
APPLIED ENVIRONMENTAL SERVICES
STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UTAH 84141-1152
BRETT GURNEY 435-602-4872
801-540-9258 2-21-2024
TK INTER
BOTH
X
X
X
X
X
X
X
X
TRANS SU
BOTH
X
X
X
X
X
X
X
X
W DISP
BOTH
X
X
X
X
X
X
X
X
E DISP
BOTH
X
X
X
X
X
X
X
X
STEVEN B MARTIN
APPLIED ENVIRONMENTAL SERVICES, L.C. PO BOX 1073 BOUNTIFUL, UTAH 84011
801-540-9258 [e-mail]
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.02.26 12:54:52 -07'00'
Reason: I am the author of this document
SPILL PREVENTION TEST
Spill Bucket Hydrostatic Test Form
Facility Name Facility ID
Address Tester's Name
Test Date Phone
Tank Number
Product Stored
Capacity
Manufacturer
Construction
Liquid and Debris
Removed
Visual Inspection
No cracks, holes,
or separations
Tank Riser Cap
Included in Test
Is Drain Valve
Included in Test
Start Level
Start Time
Ending Level
End Time
Test Period
(minimum of 1 hour)
Change in Level
Test Results
Photos indicating water
Levels are Attached?
Pass / Fail Criteria: Must pass visual inspection, test duration at least one hour, must include photos with this
form, water level drop of less than 1/8 inch. Ref: PEI / RP 1200 6.2.5 Test Procedure
How was Liquid Disposed?
Comments
I certify under penalty of law that the above information is true, accurate and complete
Tester's Signature
UTAH DOT # 4467 2000208
SR-24
HANKSVILLE, UTAH
STEVEN MARTIN AES TESTING UT 0121
2-21-2024 801-540-9258
1 & 2
R/UL / DSL
11 G
MORRISON
SWS
YES
PASS
NO
YES
4 1/2
11:57
4 1/2
13:12
1 HR 15 MIN
0
PASS
NO
REUSED
DUAL COMPARTMENT AST WITH UNDERGROUND PRODUCT LINES
SPILL CONTAINMENT IS ABOVEGROUND AND 100% VISABLE
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.02.26 12:44:44 -07'00'
Reason: I am the author of this document
UTAH STATE FUEL NETWORK AST ANNUAL INSPECTION
Facility Name and Site Address: Date:
Facility ID #
Purpose:Regular Reinspection Complaints Annual Inspection
Nu
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r
Te
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t
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d
Sa
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Re
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Pumps Tested for Calibration
Is tank grounding strap in good condition ?
Is tank coating free of corrosion / damage ?
Is tank free of noticable distortion, denting, buckeling ?
Flanged connection bolts appear tight ?
Normal and emergency vents appear in good condition ?
Inspection Remarks:
Technician signature
Inspected By: Steven B. Martin UT121
Applied Environmental Services L.C.
UTAH DOT # 4467
SR-24
HANKSVILLE, UTAH
2-21-2024
2000208
X
1-4 X X
X
X
X
X
X
X
X
X
X
X
State Fuel Contact : Brett Gurney 385-602-4872
801-540 9258 [e-mail]
Email: [e-mail]
X
X
X
X
X
X
X
X
Fill and vapor connections in good condition ?
DUAL COMPARTMENT AST WITH UNDERGROUND PRODUCT LINES
XTank containment structure in satisfactory condition ?
Free of tank settlement and foundation washout ?
Tank supports in satisfactory condition ?
Is water able to drain off tank pad and tank top ?
Gasoline vent has P/V valve installed where required ?
Valves / syphons / solenoids appear in good condition ?
Spill containment visable and appears in good condition
Electrical junction boxes and conduits in good condition
Tank monitor free of active alarms ?
Emergency shutoff installed ?
Dispenser static test ?
Tank overfill equipment installed ?
Piping sumps appear in good condition ?
COMMENTS / ACTION
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.02.26 12:26:38 -07'00'
Reason: I am the author of this document