DERR-2024-010728

Annual Sump Inspection
LEAK DETECTOR
Line Tightness Test
MONITOR CERTIFICATION
SPILL BUCKET TEST
11000 N. MoPac Expressway, Suite 500
Austin, Texas 78759
Phone: [phone]
Fax: [phone] Date Printed and Mailed: 9/16/2024
UTAH DEPARTMENT OF ENV. QUALITY
UST
PO Box 144840
SALT LAKE CITY, UT 84114
Test Date: 8/26/2024
Order Number: 2364377
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
Jackson Foods #142
365 W. 7200 S.
Midvale, UT 84047
Testing performed:
Sincerely,
Dawn Kohlmeyer
Manager, Field Reporting
Product Line Tightness Test Page 1 of 1
Work Order: 2364377 Date: 8/26/2024
Site Name/ID: Jackson Foods #142 / 142
Address: 365 W. 7200 S.
City: Midvale State: UT Zip: 84047
Tank Information
Test Method
Customer Tank ID
Product Name
Delivery Type
Test Pressure (psi)
Test Start Time
Test End Time
Final Leak Rate (gph)
Test Result(P/F/I)
Test was performed per
3rd party certifications as
specified in 40 CFR parts
280 and 281
Tank # 1
Line # 1
TLD-1
T1
UNLEADED
Pressure
50
11:31
12:31
0.00
Pass
Yes
Tank # 2
Line # 1
TLD-1
T2
PREMIUM
Pressure
50
11:31
12:31
0.00
Pass
Yes
Tank # 3
Line # 1
TLD-1
T3
Low Sulfur
Diesel
Pressure
50
11:31
12:31
0.00
Pass
Yes
Tank #
Line #

Tank #
Line #

Tank #
Line #

Technician Comments: UT151
Technician Name:David Mathie Certification #:41442 exp:
10/20/2025
Technician Signature:

Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com
Jackson Foods #142
365 W. 7200 S.
Midvale UT 84047
142
Tanknology, Inc.
JACKSONS FOOD STORES
3450 COMMERCIAL COURT
MERIDIAN ID 83642
208-888-6061
08/26/2024
UNLEADED PREMIUM
Red Jacket
FX1V
Red Jacket
FX1V
Red Jacket
FX1DV
30
20
300
4
10
6
30
20
300
4
10
6
30
20
100
3
10
4
UT151
David Mathie
NW1-2364377
Low Sulfur Diesel
TUNLEADED:1 TPREMIUM:1 TDSL:1
Jackson Foods #142 JACKSONS FOOD STORES
365 W. 7200 S.
Midvale UT 84047
142
Tanknology, Inc.
3450 COMMERCIAL COURT
MERIDIAN ID 83642
208-888-6061
800-964-1250 08/26/2024
1 2 3
RUL PREM DSL
EVO550 EV0550 EVO550
19703 14976 6847
117.75 117.75 92
UT151
David Mathie
365 W. 7200 S.
Jackson Foods #142
365 W. 7200 S., Midvale, UT 84047
142
Tanknology, Inc.
JACKSONS FOOD STORES
3450 COMMERCIAL COURT
MERIDIAN, ID 83642
208-888-6061
08/26/2024
ANNULAR ANNULAR ANNULAR STP STP STP UDC
RUL PREM DSL WET RUL PREM DSL 1/2
UT151
David Mathie
365 W. 7200 S.
Jackson Foods #142
365 W. 7200 S., Midvale, UT 84047
142
Tanknology, Inc.
JACKSONS FOOD STORES
3450 COMMERCIAL COURT
MERIDIAN, ID 83642
208-888-6061
08/26/2024
UDC UDC UDC UDC
3/4 5/6 7/8 9/10
UT151
David Mathie
Jackson Foods #142
365 W. 7200 S.
Midvale, UT 84047
142
Tanknology, Inc.
JACKSONS FOOD STORES
208-888-6061
08/26/2024
3450 COMMERCIAL COURT
MERIDIAN, ID 83642
1
RUL
5
EBW
2
PREM
5
OPW
3
DSL
5
EBW
30 WC
1137
30WC
1142
5 MIN
0
30 WC
1143
30 WC
1144
1 MIN
0
30 WC
1147
30 WC
1152
5 MIN
0
UT151
David Mathie
ANNUAL CONTAINMENT SUMP INSPECTION
This form may be utilized to document the inspection of containment sumps.
Date of Inspection
8/26/2024
UST Facility Person Conducting Test
Facility Name
Jackson Foods #142
Facility ID #
142
Tester's Name
DMATHIE
Physical Address
365 W. 7200 S.
Company
Tanknology Inc.
City
Midvale
County
SALT LAKE
State
UT
Certification #
41442
Expiration Date
10/20/2025
UST Owner
JACKSONS FOOD STORES
Tester's Signature Date
8/26/2024
Containment Sump Inspection
Sump Material
of Construction Fiberglass Reinforced Plastic Thermoplastic Steel Composite
Containment Sump Inspection Procedure
1. Clean-out and properly dispose of all debris, soil and/or fluids from the containment sump.
2. Visually examine the containment sump to ensure there are no cracks, holes, deteriorated seals, deformation or other
indications that the sump is not liquid tight.
3. If the sump appears to be liquid tight and no water was in the sump, the inspection result is "pass" and no further
action is required.
4. If the sump appears to be liquid tight but water was present within the sump, the inspection result is "fail".
5. If there is visual evidence that the sump is not liquid tight, then repair or replacement (see note below) of the sump is
required.
Inspection Results for the Year 2024
Sump ID
(product stored for STP or
dispenser number)
Sump lid/gasket in good
condition (yes/no)
Sump is dry (yes/no)
All penetration fittings in
good condition (yes/no)
Sump walls/bottom in
good condition (yes/no)
Are there any leaks from
pipe components (yes/no)
Inspection Result
(Pass/Fail)
STP:T1 UNLEADED - 1
NA
N
Y
Y
N
Pass
STP:T2 PREMIUM - 1
NA
N
Y
Y
N
Pass
STP:T3 Low Sulfur Diesel
- 1
Y
Y
Y
Y
N
Pass

Comments:

WO: 2364377
Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2364377
Site ID / Name:142 / Jackson Foods #142
Address:365 W. 7200 S.
City:Midvale State:UT Zip:84047