DERR-2024-011301

Page 1ol 2 Utah Department of Environmental Quality
UST Release Detection Inspection
0100694
Ownership of Tanks Location of Tanks
MAVERIK, INC,MAVERIK #526
185 SOUTH STATE STREET, STE 8OO 304 S MAIN STREET
SALT LAKE ctrY lur 184111 LOGAN UT 44321
oP A: MAMUN RASHTD l(801) 910-7062 OP B: MAMUN RASHID l(801)910-7062
Verify tests on tank data theot
are curent and on filo.
AnnualTests 3 Y€ar Tosts
ATG system:<t@ No NA Single walled Spill buckets:Yes No 6@
Line leak detector:@ t',to run Overfllldevice:@ruo run
Line tightness(suction 3yr):Yes No d@ Containment sump:@ tlo run
Comments:UDC sump:(EJ tto rue
Cathodic Protection:Yes No ($
Comolete for each tank,trL E3 #q #5
Capacity of tank (gallons):t@ t3oe Sooo * 7on / ta-o
Substance stored:R.t R""Dics,J
Date last used/deoth of oroduct:
Type of spill prevention device:Dd 58 Ord 58 O\D SB Dd SB DyJ sR
Double Walled spill bucket gaug€ is
checked monthly and valid:@norun f!) Ho r.n @*oto @ruo run @"o *o Yes No NA
Spill bucket is clean, intact, etc.:F9 No e9 r.lo k!,1 ruo es, No Ye! ruo Yes No
Type of overfill Prevention device:Aln a AIa.rn AL,'"T
Overfill alarm (audible or visible) is properly located so delivery driver can hear or see it, and is clearly idenlified:(g) t'ro u
STP Flex protection method (Sump,
Cathodic Protection, lsolated, Booted):5, *?5*,e S ^'-p s,^*e S*-p
Containment sumps dry:(g/ r.ro tu 7eJ to ttl tesl No NA r9 No NA /e9 No NA Yes No NA
Sump comments:
Stage 1 Vapor Recovery:I coax None Coax None ) Coax None Coax None 2pt Coax t(on)2pt Coax None
Pressuae Vent Valve is on vents:gj/ No NA ?rs) tto run Yeq, No NA /€sl No NA YeY No NA Yes No NA
Complgtq for each dispenser r r/?-r 3/q E 5l b P 1/8 # q/to * rlln_
Flex protection method (UDC,
Cathodic Protection, lsolated, Booted):UDC vDc IJAC UI rc vDc IJDC
UDC sump dryi Cd No NA 1et No NA No NA No NA 9ey' ruo ra t9 No NA
DW piping have jumpers in place:gr,J t'to run 'eJ t'to run No NA ;")No NA JgJ t'lo run ;",s/ ruo run
Fire valve anchored, located below
grade, and without ball valve:f,e5,'r ruo run 1$,'r t'to u re>) No NA {9 No NA @) tto rue GsJ trto run
Comments:
Additional dispenser questions t B/tq # tt//b * tl /tg #t1 7e
Flex Drotection method (UDC.
Cathodic Protection, lsolated, Booted):UDC \roc UDC url
UDC sump dry:(9 No NA @ t'to run 6@ ruo run {9t No NA Yes No NA Yes No NA
DW piping havejumpers in place:(@ r'ro rue 1@ro u @ro ua lygJ r.ro run Yes No NA Yes No NA
Fire valve anchored, located below
grade, and no ball valve:
@9rou @) No NA @ r'ro run {9s) No ttr Yes No NA Yes No NA
lmpressed Currenl Cathodic Prot€ctlon Last three dates rectifier checked:
Operator Training Financial Responsiblllty (State Use Only)
"A" Operator cunent?<E No FR Method:Method OK? | Yes No by:-
'8" Operator cunent?q@ ruo Slgnatu.es
'C'Operators trained or unmanned site sign is visible?@Ho Nn
L lgg!-Sl"ka- Inspected th,s tacirity o ^
ql ul lflfthe site is unmanned and dispenses fuel, does it have
an emergency shutoff device?@ ruo r'rn "*"rww " ozb,lMonthly checklist available and complete?@ r.ro
Comments:oto si:natyet; ,,
P-oge 2 ol u
b4 Monthly monltorlng
I .2 gph monthly test
I SrR
IX Interstial monitoring
[ ] GW monitoring
Type of lL4? ATG or Manual
[ ] Vapor monitoring
Tank and Piping Release Detection
Automatic Tank ing/lnterstitial Monitoring
Tanks installed after October 1, 2008 must do Interstitial Monitoring.
0100694
[ ] ATG Shutdown test
.TL S.
Yes or No for each question. In the last column, explain and identify by tank any exceptions to the answors given in the Urst column.
Typ€ of socondary containment used:
System is capable ofdetecting a releas€ of regulated substances from any
portion of the primary tanUpiping within one month of releasei
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational:
Ths tiank was fill€d to at least the minimum level required to ensure a valid leak
test, and the tank size is within the allowod uoDsr and lower size limits:
Show resulls ot monitoring tor oach tank for thg lagt'12 months. Indlcale Pass, Fail, Invalid, or No Results tor gach month. For ATG Shutdown tgsts,
show the highost product levol testod for each month.
lndlcats the method used:
Leak Delector and one other
Suction piping must be tested every 3 years or have monthly monitoring. lf sale suction, leak detection is defened.
[t Llne Leak Ootector Testlng Plplng Installod after October 1, 2008 must do Interstltial Monltoring.
I I Llne Tlghtness Testlng
pl."-s. (ep la,<,
Vet. 1015/2018