Temp - DERR-2024-011145

Utah Department of Environmental Quality
UST lnstallation lnspection
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Date instailed 1- a7.- 1a2a
Pre-installation pressure test date or vacuum date (dry interstice) dl^ Ze - 20 24
Readingofpressureo4@ro,pre-installationtest(dryinterstice)#q*-,2l
Type of overfill prevention device (shutoff or alarm)
Location of Tanks
TAYLORSVILLE-BENNION IMP. DIST.
47oO S 18oO W
SALT LAKE CITY UT
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6 -2y242, SzzFA.p 5
drt
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ie k_ loK
84118j
Tank No.
l
i
1
No NA
Exp. Date: I -026
NA
NA
@
NA
NA
Page I of_400'1824
Ownership of Tanks
TAYLORSVILLE BENNION IMP DIST
PO BOX 18579
SALT LAKE CITY UT 841 18
Tanks lnstalled. Use.add!t!ona! Fages as needed.
New lnstallation ot. ypgl?g.9.-
UL Number
Material of construction (FRP, Steel, Composite, etc.)
Double walled - dry or brine filled
Substance to be stored
Capacity
Overfill alarm has sign and is visible and audible to driver (RP100)
Type of spill prevention device (single or dw spill bucket, sump, etc)
Amount of tank deflection readings (initial)
Amount of tank deflection readings (hold down straps)
Amount of tank deflection readings (backfill top of tank)
Piping !nformation
Material of construction (Flex plastic, FRP, etc)
Type (Pressure, Suction, Safe Suction, Glavity)
Date pre-installation air test passed
Pressure for pre-installation air test
lnstallation Specifi cations
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l2,o'/1
l2o t/'t
tt
t,
Do you have a copy of the tank manufacturer's installation manual and PEI RP100 with you
Certified tank installer -i/O-l 3 Qatkl41 n Cert. #: TL O tZ 4
certified rnstarlation company S f,aCLirTa " €nLffp {,\f;tt.*:tc i be b
Visual inspection of tank(s) rereals li is trle frdm'damage
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Visual inspection reveals no brine on either the inside or outside of the tank(s) (from interstitial space of brine tank)
Damaged components have been repaired by the manufacturer
Tank and piping excavations are free of debris
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ns'[a a'i'n manua ): p u, e' d at
Geotextile fabric separates any secondary backfill (required)
Estimated de-pth to groundwater
Tank(s) are placed at sufficient depth for traffic requirements, groundwater conditions (cttgck installation manual)
Tanks are outside the shadow of the 45 degree factor of a structure's footing (PEl RP100 Fig a-2)
Distance from tank(s) to nearest propefi tine: I O C t
M Distance from tank(s) to nearest structure: ZO'
Anchoring method is adequate for groundwater considerations. Note method here: dCAf Wen "/ -
Hold-down straps are in place according to manufacturer's specifications (check installation manual if clamps are used)
Tank spacing is at least 18" between tank(s) and excavation wall (stable wall) or 18" between tank(s) and 112 times tank
diameter excavation wall (unstable wall)
Tank is level or sloped toward interstitial monitor probe
Backfill has been adequately compacted for full suport along tank length at 5 and 7 o'clock
Date of pressure test after backfill to top of tank (before piping is installed)
NA
@q
NA
No
No
No
No
No NA
No NA
3irNoNA
No NA
5
t!6$ no
ffi*"
Yes No
ies rvo
deJ\ uok-/
r(name) lan W ar ne( ,
rnspector's Sisnat[rei' ",flp)w< /4 Cn/,U/.
Ver. 10/5/2018
certify that I inspected the above-named facility on (date): q - 27JOA+
@2:2
@
Yes
Yes
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Cert.#: Tl .'lA hr
120" 120 1/4"
Flexible plastic
Pressure
10/8/2024
50 psi
Page 2 of_Utah Department of Environmental Quality
UST Facility Site Plat
NORTH
4001824
wal\
5l40p
Show locations of all buildings, streets, tanks, piping, and dispenser islands. lndicate the product in each tank. Show tocationts of tank
manways and identify each: submersible pump (S), tank fill (F), ATG probe (A), interstitial probe (l), vapor recovery (V), capped plug (C), other(
specify).
Comments: