DERR-2024-012208

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 #
SPACKMAN ENTERPRISES
PO BOX 1276
CENTERVILLE, UTAH 84014
TAYLORSVILLE - BENNION IMP
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
24127
UT 0121
DATE:
10-25-2024
TIME START:
10:00
TIME END:
16:00
GROUNDWATER DEPTH:
N/A DW TK
TANK TANK
CAPACITY
10065
10065
PRODUCT
DSL
R/UL
TANK
PASS
PASS
VENT
PASS
PASS
PRODUCT
LINE
PASS
PASS
LINE LEAK
DETECTOR
PASS
PASS
WATER IN
TANK
0.0"
0.0"
PUMP
TYPE
PRESS
PRESS
TANK
MATERIAL
DWF
DWF
1.
2.
3.
4.
5.
6.
PRODUCT LINES TESTED AT 50 PSI FOR 15 MIN
LINE RATES (GPH)
1.
2.
3.
5.
6.
DSL -.002
R/UL -.001
ADDITIONAL INFORMATION:DOUBLEWALL FIBERGLASS COMPARTMENT TANK ( DRY SPACE )
CERTIFIED TECHNICIAN SIGNATURE:DATE:10-25-2024
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 TESTXX 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.
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.10.26 12:36:53 -07'00'
Reason: I am the author of this document
TAYLORSVILLE - BENNION IMP DIST
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
4001824
TAYLORSVILLE - BENNION IMP DIST
APPLIED ENVIRONMENTAL SERVICES
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
DAN MCDOUGAL 801-968-9081
801-540-9258 10-25-2024
1
DSL
FE PETRO
X
29
28
350
5
14
5
X
X
X
X
2
R/UL
FE PETRO
X
26
25
250
2
14
2
X
X
X
X
STEVEN B MARTIN
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.10.26 12:41:08 -07'00'
Reason: I am the author of this document
UST OVERFILL EQUIPMENT INSPECTION
AUTOMATIC SHUTOFF DEVICE AND BALL FLOAT VALVE
Facility Name:
Address:
City, State, Zip Code:
Facility I.D. #
Testing Company:
This data sheet is for inspecting automatic shutoff devices and ball float valves. See PEI/RP 1200, Section 7 for inspection procedures.
Owner:
Address:
City, State, Zip Code:
Phone#
Tester Phone#
Product Grade:
Tank Number:
Tank Volume, gallons:
Tank Diameter, inches:
Overfill Prevention Device Brand:
Overfill Type
AUTOMATIC SHUTOFF DEVICE INSPECTION
1. Drop tube removed from tank?
2. Drop tube and float mechanisms
are free of debris?
3. Float moves freely without
binding and poppet moves into
flow path?
4. Bypass valve in the drop
tube is open and free of
blockage (if present)?
5. Flapper is adjusted to shut off
flow at 95% ?*
A "NO" to any item in Lines 1-5 indicates a test failure.
BALL FLOAT VALVE INSPECTION * *
1. Tank top fittings are
vapor-tight and leak free?
2. Ball float cage free of debris?
3. Ball free of holes and cracks
and moves freely in cage?
4. Vent hole in pipe open and
near top of tank?
5. Ball float pipe is proper length
to restrict flow at 90% capacity?***
A "NO" to any item in Lines 1-5 indicates a test failure.
Test Results:
* Use manufacturer's suggested proceedure for determining if automatic shutoff device will shut off flow at 95% capacity.
Tester's Name:
TAYLORSVILLE - BENNION INPROVMENT DIST
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
4001824
AES UTAH LICENCE # UT 0121
TAYLORSVILLE - BENNION INP
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
DAN MCDOUGAL 801-968-9081
801-540-9258
Date: 11-1-2024
DSL
1
10065
119 3/8
OPW 71SO
AUTOMATIC
YES
YES
YES
YES
R/UL
2
10065
119 3/8
OPW 71SO
AUTOMATIC
YES
YES
YES
YES
Steven B. Martin Testers Signature:
* * If a ball float is found to fail the inspection , another method of overfill must be used.
* * * Use manufacturer's suggested procedure for determining if flow restriction device will restrict flow at 90% capacity.
Comments
PASS PASS
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.11.02 15:33:48 -07'00'
Reason: I am the author of this document
TAYLORSVILLE - BENNION INP
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
4001824
APPLIED ENVIRONMENTAL SERVICES
TAYLORSVILLE - BENNION INP
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
DAN MCDOUGAL 801-968-9081
801-540-9258 11-1-2024
TK INT
DSL / R/UL
X
X
X
X
X
X
X
X
DISP SUMP
DSL / R/UL
X
X
X
X
X
X
X
X
DSL STP
DSL
X
X
X
X
X
X
X
X
R/UL STP
R/UL
X
X
X
X
X
X
X
X
XEREX DOUBLE WALL TWO COMPARTMENT UST WITH DRY SPACE INTERSTICIAL
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: 2024.11.02 15:48:20 -07'00'
Reason: I am the author of this document
AUTOMATIC TANK GAUGE OPERATION INSPECTION
Facility Name:
Address:
City, State, Zip Code:
Facility I.D. #
Testing Company:
Owner:
Address:
City, State, Zip Code:
Phone #
Testers Phone #
Date:
This procedure is to determine whether the ( ATG) is operating properly. See PEI/RP1200 Section 8.2 for the proper inspection procedure.
Tank Number
Product Stored:
ATG Brand and Model
1. Tank Volume, gallons
2. Tank Diameter, inches
3. After removing the ATG from the tank, has it
been inspected and any damaged or missing
parts replaced?
4. Float moves freely on the stem without
5. Fuel float level agrees with the
value programmed into the console?
6. Water float level agrees with the value
programmed into the console?
7. Inch level from bottom of stem when 90%
alarm is triggered.
8. Inch level at which the overfill alarm
activates corresponds with value programmed
in the gauge?
9. Inch level from the bottom when the water
float first triggers an alarm.
10. Inch level at which the float alarm activates
corresponds with value programmed in the
gauge?
If any answers in Lines 3,4,5, or 6 are "NO" the system has failed the test.
TEST RESULTS
Comments:
Testers Name: Steven B. Martin Testers Signature:
TAYLORSVILLE -BENNION INP
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
4001824
AES UTAH TESTER # UT 0121
TAYLORSVILLE - BENNION INP
1800 WEST 4700 SOUTH
TAYLORSVILLE, UTAH 84118
DAN MCDOUGAL 801-968-9081
801-540-9258
11-1-2024
1
DSL
VEED TLS4
10065
119.3
YES
YES
YES
YES
99 3/4
YES
2.0
YES
2
R/UL
VEED TLS4
10065
119.3
YES
YES
YES
YES
99 3/4
YES
2.0
YES
PASS PASS
XEREX DOUBLE WALL COMPARTMENT TANK
ALL SENSORS FUNCTION NORMALLY
SETUP REPORT PRINTED
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.11.02 18:49:11 -07'00'
Reason: I am the author of this document