DERR-2024-011065

1
UNDERGROUND STORAGE TANK CLOSURE PLAN (rev. 1/05) FACILITY ID# 3000026 …
LHD USE ONLY
Date Received
Reviewer
Date LHD Approved
Date mailed to State
Closure Plan prepared at the request of the owner/operator (identified below) by Mark Stewart
of (company name) Maverik, Inc. Phone # [phone]
Address 185 S State Street, Suite #800 City Salt Lake City StateUT Zip 84111
A Contractor may prepare this Closure Plan as the owner/operator's agent. In preparing the Closure Plan, the Contractor must act with
the owner/operator's knowledge and approval. The owner/operator must sign the Closure Plan.
This Closure Plan is submitted in compliance with the requirements contained in 40 CFR 280 Subpart G and R311-204 (U.A.C.)
Tank # 1 2
Type (Steel,FRP,etc.) Steel Steel
Date Installed 1980 1980
Capacity 12K 8K
Substance stored* Unleaded Premium
Date last operated 9/9/2024 9/9/2024
Removed/In Place/ Change in
Service (CIS)? Removed Removed
*Indicate the specific substance stored in each tank to be closed (regular, unleaded, diesel, waste oil, etc.)
For waste oil tanks: Have degreasing or other types of solvents been stored or mixed with the waste oil?
Yes (identify if known) N/A . 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.)
STATE USE ONLY
Date Received
Date Mailed to LHD
Date Received From LHD
Reviewer/Date Approved
Mgr. Review/Date
FACILITY INFORMATION
Tank Owner Maverik, Inc. Phone # [phone]
sole proprietorship partnership corporation
Address 185 S State Street, Suite #800 City Salt Lake City State UT Zip 84111
Facility Name Maverik Store #145
Address 95 N Main St. City Centerville
State
UT Zip 84014
Contact person Mark Stewart Phone # [phone]
Total number of regulated underground tanks at this site 2
Total number of regulated underground tanks at this site to be closed 2
9/4/2024
9/4/2024 GAH
2
Before the closure plan is submitted for approval, the local health and fire departments where the facility is located must be
contacted. If the facility is in Beaver, Carbon, Davis, Emery, Garfield, Grand, Iron, Kane, Salt Lake, San Juan, Wasatch, or Washington county contact
DERR (UST) at [phone] instead of the local health district. You still must contact the local fire department in these counties.
CONTACT LOCAL HEALTH DISTRICT: Name of Dist. Date
Contact Title Phone#
CONTACT LOCAL FIRE DEPT. Name of Dept. South Davis Metro Fire Date
Contact Title Phone#
DISPOSAL INFORMATION
Tank(s) will be disposed at: Facility Western Metals Recycling
Address City Salt Lake City State UT Zip 84104
Contact person Scale House Phone#
Product lines will either be: removed or cleaned, secured in place, and capped.
Vent lines will either be: removed or cleaned and secured open.
Piping will be disposed at: Facility
Address City State UT Zip 84104
Contact person Scale House Phone#
Tank(s) will be emptied by: company Maverik, Inc. Phone# [phone]
Tank(s) will be cleaned by: company Sump & Trap Cleaning Phone# [phone]
Contaminated water in the tank/rinsate will be disposed at: Facility Sump & Trap Cleaning
Contact person Shane Adolph Phone# [phone]
Tank(s) will be: purged or rendered inert by the following method: Dry Ice
Residual sludges will be disposed at the following facility: Sump & Trap Cleaning
Address 618 S 4050 West City Salt Lake City State UT Zip 84104
Contact person Shane Adolph Phone# [phone]
FOR CLOSURE IN PLACE ONLY
Approval for in-place closure has been granted by the Local Fire Department.
Fire Dept. Phone# Contact person Date
Approval for in-place closure has been granted by the Local Health Department.
Health Dept. Phone# Contact person Date
Substance to be used to fill tanks:
TANK REMOVER Name Aaron Spackman Cert. # TR0436 Exp. Date
Company Spackman Enterprises Phone #
Address P.O. Box 1276 City Centerville State UT Zip 84014
SOIL/GROUNDWATER SAMPLER Name Mark Stewart Cert. # GS1842 Exp. Date 10/8/2025
Company Maverik, Inc. Phone # [phone]
Address 185 S State Street, Suite #800 City Salt Lake City State UT Zip 84111
801.598.7928
UDEQ/DERR
4/1/2025
Salt Lake Valley Solid Waste
6030 California Ave Salt Lake City
385.468.6370
4201 W 700 S
801.975.9669
801.677.2400
Gary Harris Environmental Specialist 385.251.1756
Cole Fessler Fire Marshall
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SITE ASSESSMENT
A site assessment must be performed for all UST closures and change-in-service. Site assessments must be performed as outlined in 40 CFR
280.72 and R311-205 (U.A.C.). If contamination is suspected, additional samples must be collected at the location where contamination is
most likely to be present. If groundwater 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 or
Product Type
Contaminant Compounds to be Analyzed for Each
Substance or Product Type
ANALYTICAL METHODS1
Soil, Groundwater
or Surface Water
Gasoline
Total Petroleum Hydrocarbons (purgeable TPH as gasoline
range organics C6 - C10)
EPA 8015B or EPA 8260B
Benzene, Toluene, Ethyl benzene, Xylenes, Naphthalene,
(BTEXN) and MTBE
EPA 8021B or EPA 8260B
Diesel
Total Petroleum Hydrocarbons (extractable TPH as diesel
range organics C10 – C28)
EPA 8015B
Benzene, Toluene, Ethyl benzene, Xylenes, and Naphthalene
(BTEXN)
EPA 8021B or EPA 8260B
Used Oil
Oil and Grease (O&G) or
Total Recoverable Petroleum Hydrocarbons (TRPH)
EPA 1664A or
EPA 1664A (SGT*)
Benzene, Toluene, Ethyl benzene, Xylenes, Naphthalene
(BTEXN) & MTBE; and Halogenated Volatile Organic
Compounds (VOX)
EPA 8021B or EPA 8260B
New Oil Oil and Grease (O&G) or
Total Recoverable Petroleum Hydrocarbons (TRPH)
EPA 1664A or
EPA 1664A (SGT*)
Other Type of analyses will be based upon the substance or product
stored, and as approved by the Executive Secretary (UST)
Method will be based upon the
substance or product type
Unknown
Total Petroleum Hydrocarbons (purgeable TPH as gasoline
range organics C6 - C10)
EPA 8015B or EPA 8260B
Total Petroleum Hydrocarbons (extractable TPH as diesel
range organics C10 – C28)
EPA 8015B
Oil and Grease (O&G) or
Total Recoverable Petroleum Hydrocarbons (TRPH)
EPA 1664A or
EPA 1664A (SGT*)
Benzene, Toluene, Ethyl benzene, Xylenes, and Naphthalene
(BTEXN) and MTBE; and Halogenated Volatile Organic
Compounds (VOX)
EPA 8021B or EPA 8260B
1 The following modifications to these certified methods are considered acceptable by the Executive Secretary (UST):
•Dual column confirmation may not be required for TPH and BTEXN/MTBE analysis.
•A micro-extraction or scale-down technique may be used for aqueous samples, but only for the determination of extractable TPH as diesel range
organics (C10 – C28).
•Hexane may be used as an extraction solvent.
•*Silica Gel Treatment (SGT) may be used in the determination of Total Recoverable Petroleum Hydrocarbons.
NOTE: The sample preparation method and any modification(s) to a certified method must be reported by the laboratory.
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CONTAMINATED MATERIALS MUST BE DISPOSED AT AN ACCEPTABLE FACILITY:
All materials generated from UST closures must be managed and disposed in a manner that does not place those materials in 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 yd3), must be a Certified UST Consultant.
Contaminated soils generated as part of tank removal are to be disposed at the following facility: E.T. Technologies
Address 6030 West California Ave. City Salt Lake City State UT Zip 84104
Contact person Phone [phone]
Complete the Facility Site Plat and Sample Information Table on pages 4 and 5 to provide site assessment information.
CONTAMINATION INFORMATION
If contamination at the facility is suspected or confirmed, the information must be reported to the Executive Secretary (UST) at (801) 536-
4100 within 24 hours. The Division of Water Quality must be notified at [phone] if Free Product is encountered or if surface water
has been impacted. If contamination is confirmed, any person assisting in the remediation process for a fee must be a Certified UST
Consultant.
SAMPLE INFORMATION TABLE
Complete table for all samples to be taken for closure.
1 Soil (SS), Groundwater (GW), or Unified Soil Classification (USC). 2 Approx. depth in feet below grade. The required minimum site assessment samples must be taken at 0-2 feet below the backfill/native soil interface. 3 Contaminant compounds to be analyzed for each sample (from table on p. 3). 4 Appropriate analysis methods for contaminant compound(s) in each sample (from table on p. 3).
Sample
#
Substance
stored in tank
Sample
type1 Depth2 Compounds3 Analysis method(s)4
SS-1 Gasoline SS 10' MBTEXN/GRO 8260
USC-1 Gasoline USC 10' Soil Type ASTM D2488
GW-1 Gasoline GW 10' MBTEXN/GRO 8260
SS-2 Gasoline SS 10' MBTEXN/GRO 8260
GW-2 Gasoline GW 10' MBTEXN/GRO 8260
SS-3 Gasoline SS 10' MBTEXN/GRO 8260
SS-4 Gasoline SS 10' MBTEXN/GRO
SS-5 Gasoline SS 3' MBTEXN/GRO 8260
SS-7
Gasoline SS 3' MBTEXN/GRO 8260
USC-2 Gasoline USC 3' Soil Type ASTM D2488
Dawn Rinaldi
8260
SS-6
MBTEXN/GROGasolineSS3'8260
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Facility Site Plat (Closure Notice)
The site plat must be drawn to an appropriate identified scale. It must show planned sampling locations, substances stored in tanks, and
other relevant information. Tank and sample identification numbers must be consistent with the information given on p. 1 and 4 of the
Closure Notice.
Facility ID: Drawn By: Date:
X = Sample locations (SS-#, WS-#, USC-#) Site Plat Must Indicate Actual Locations Of:
0 = Monitoring Wells (MW-#) √Current & former tanks, piping & dispensers
= Soil boring (SB-#), or Geoprobe Boring (GP-#) √ Location of all samples to be taken
●= Water Wells (domestic, livestock, etc.)√ Buildings, fences, & property boundaries
Slope of Surface Topography: (N,NW,W,SW,S,SE,E,NE)√ Utility conduits (sewers, gas, water, storm drains, electrical, etc.)
Land Use At Site: Residential Commercial Industrial √ Depth to groundwater (if encountered)
Surrounding Land: Residential Commercial Industrial √Excavations, GW monitoring wells & soil stockpiles
Scale: 1”= 40 Feet
Mark Stewart 09/04/20243000026
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Approximate depth to groundwater in the vicinity of the tanks: >10 feet.
Regional groundwater flow direction: Wes t /Southwest
State Certified Laboratory to be used: Chemtech-Ford
Address 9632 South 500 West City Sandy State UT Zip 84070
Contact Person Pat Noteboom/Mark Broadhead Phone [phone]
I certify under penalty of law that I am the owner/operator of the tank(s) referenced above and that I am familiar with the
information on this form and that it is true, accurate and complete, and further, that the procedures described herein will be followed
during tank closure.
Signature of tank owner
Full Name of tank owner Mark Stewart for Maverik, Inc. Date 9/04/2024
Please explain any unusual or extenuating circumstances expected regarding the site assessment or closure:
The UST system at the site will be permanently closed via removal.