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Home My WebLink AboutDERR-2024-012412Utah Department of Environmental Quality - UST Release Detection TANK OWNERSHIP Name MAVERIK, INC. Address 185 SOUTH STATE STREET, STE 800 SALT LAKE CITY, UT 84111 Contact MAVERIK, INC. Phone Email mamun.rashid@maverik.com TANK LOCATION Name MAVERIK #561 Address 13551 S 200 W DRAPER, UT 84020 A Operator MAMUN RASHID Phone (801) 910-7062 B Operator SAME Phone SAME Facility ID: 4002340 Inspection Date: 11/19/2024 DISPENSER DETAILS DISP ID/ALT ID SUBSTANCE UDC PIPE FLEX LOC INSTALL DATE UDC INSTALL DATE FIRE VALVE SAT PRESENT UDC TEST DISP FLEX CP TEST 1 - 1/2 Gas/Diesel Yes Steel Flex in Sump None None Yes No None None 2 - 3/4 Gasoline Yes Steel Flex in Sump None None Yes No None None 3 - 5/6 Gasoline Yes Steel Flex in Sump None None Yes No None None 4 - 7/8 Gas/Diesel Yes Steel Flex in Sump None None Yes No None None 5 - 9/10 Gas/Diesel Yes Steel Flex in Sump None None Yes No None None 6 - 11/12 Gasoline Yes Steel Flex in Sump None None Yes No None None TANK DETAILS Tank ID/Alt ID 1 / 1 E-Gen/AST No / No Siphon/Compart No / No Tank Status Currently In Use Installed/Cap/Loc May 21, 2003 / 15000 / East Substance Stored Gasoline / Regular Tank Material- Mod Fiberglass Reinforced Plastic- None ATG Veeder Root / TLS-350 CSLD No Manifold LTT Test None LLD Test Nov. 1, 2024 Pipe Material- Mod Flexible Plastic / Double-Walled Pipe type/STP Cont Pressurized / Yes STP Flex Connectors Steel Flex in Sump LLD Model Veeder Root PLLD Spill/Overfill/Sm Delivery 5 gal. Double Walled Spill Bucket / Overfill alarm / No PST Fund/Other Type No / Insurance Tank/Pipe Rel Det TankATG PipeAutoLineLeakDetection / PipeMonthlyLineTest CP Tank Test None CP Pipe Test None 2024-11-19 Page 1 of 8 Tank ID/Alt ID 2 / 2 E-Gen/AST No / No Siphon/Compart No / No Tank Status Currently In Use Installed/Cap/Loc May 21, 2003 / 12000 / Center Substance Stored Gasoline / Premium Tank Material- Mod Fiberglass Reinforced Plastic- None ATG Veeder Root / TLS-350 CSLD No Manifold LTT Test None LLD Test Nov. 1, 2024 Pipe Material- Mod Flexible Plastic / Double-Walled Pipe type/STP Cont Pressurized / Yes STP Flex Connectors Steel Flex in Sump LLD Model Veeder Root PLLD Spill/Overfill/Sm Delivery 5 gal. Double Walled Spill Bucket / Overfill alarm / No PST Fund/Other Type No / Insurance Tank/Pipe Rel Det TankATG PipeAutoLineLeakDetection / PipeMonthlyLineTest CP Tank Test None CP Pipe Test None Tank ID/Alt ID 3 / 3 E-Gen/AST No / No Siphon/Compart No / No Tank Status Currently In Use Installed/Cap/Loc May 21, 2003 / 10000 / West Substance Stored Diesel / Tank Material- Mod Fiberglass Reinforced Plastic- None ATG Veeder Root / TLS-350 CSLD No Manifold LTT Test None LLD Test Nov. 1, 2024 Pipe Material- Mod Flexible Plastic / Double-Walled Pipe type/STP Cont Pressurized / Yes STP Flex Connectors Steel Flex in Sump LLD Model Veeder Root PLLD Spill/Overfill/Sm Delivery 5 gal. Double Walled Spill Bucket / Overfill alarm / No PST Fund/Other Type No / Insurance Tank/Pipe Rel Det TankATG PipeAutoLineLeakDetection / PipeMonthlyLineTest CP Tank Test None CP Pipe Test None INSPECTION COMMENTS None 2024-11-19 Page 2 of 8 FACILITY RESPONSES Financial Responsibility Financial responsibility method is ok?Yes The above accurately represents the facility's release detection records Yes Operator Training A Operator current?Yes B Operator current?Yes Monthly checklist available and complete?Yes Is the site unmanned?No C Operators trained?Yes TANK RESPONSES Tank 1 Spill/Overfill Tank has a spill prevention device?Yes Are you able to visually inspect the spill containment bucket(s) for functionality? (i.e. are the buckets clean enough to see cracks, etc?) Yes Is the spill containment bucket intact?Yes Is the spill containment bucket(s) able to contain a spill? (i.e. is there water, product, debris, etc in the spill bucket to prevent it from containing a spill?) Yes Tank has an overfill device?Yes If an overfill alarm is being used is it properly located so the delivery driver can hear or see it, and is clearly identified? No Tank 1 ATG/IM ATG/IM - Records on site document that the system is properly installed, calibrated, operated, and maintained (system and tank setup reports, maintenance records)? Written documentation of calibration, maintenance, and repair is kept for at least one year after work is completed? Yes ATG/IM - ATG console or other equipment used to take readings and perform tests is adequate, accessible, and operational? Yes ATG/IM - Documentation of valid testing or monitoring is available (must have records for the two most recent months and 10 of last 12 months)? Show results in the RD tab. Yes ATG - The tank was filled to at least the minimum level required to ensure a valid leak test, and the tank size is within the allowed upper and lower size limits? Yes Tank 1 Cathodic Protection Tanks are protected from corrosion?Yes Piping is protected from corrosion?Yes Flex connectors at the tank sub-pumps are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Tank 1 Pressure Piping Leak Detection Does the pressurized piping system have a line leak detector?Yes Does the pressurized piping system have a valid line leak detector test?Yes Does the pressurized piping system have a valid annual line tightness test or valid monthly monitoring? Yes Tank 1 Spill/Overfill Does the spill bucket have a valid 3- year test, valid monthly monitoring for DW buckets, or the tank is exempt? Yes Does the overfill device have a valid 3- year test or the tank is exempt?Yes Tank 2 Cathodic Protection Tanks are protected from corrosion?Yes Piping is protected from corrosion?Yes Flex connectors at the tank sub-pumps are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes 2024-11-19 Page 3 of 8 Tank 1 ATG/IM Does the ATG system have a valid annual test?Yes Tank 2 Spill/Overfill Tank has a spill prevention device?Yes Are you able to visually inspect the spill containment bucket(s) for functionality? (i.e. are the buckets clean enough to see cracks, etc?) Yes Is the spill containment bucket intact?Yes Is the spill containment bucket(s) able to contain a spill? (i.e. is there water, product, debris, etc in the spill bucket to prevent it from containing a spill?) Yes Tank has an overfill device?Yes If an overfill alarm is being used is it properly located so the delivery driver can hear or see it, and is clearly identified? No Tank 2 ATG/IM ATG/IM - Records on site document that the system is properly installed, calibrated, operated, and maintained (system and tank setup reports, maintenance records)? Written documentation of calibration, maintenance, and repair is kept for at least one year after work is completed? Yes ATG/IM - ATG console or other equipment used to take readings and perform tests is adequate, accessible, and operational? Yes ATG/IM - Documentation of valid testing or monitoring is available (must have records for the two most recent months and 10 of last 12 months)? Show results in the RD tab. Yes ATG - The tank was filled to at least the minimum level required to ensure a valid leak test, and the tank size is within the allowed upper and lower size limits? Yes Tank 2 ATG/IM Does the ATG system have a valid annual test?Yes Tank 2 Pressure Piping Leak Detection Does the pressurized piping system have a line leak detector?Yes Does the pressurized piping system have a valid line leak detector test?Yes Does the pressurized piping system have a valid annual line tightness test or valid monthly monitoring? Yes Tank 2 Spill/Overfill Does the spill bucket have a valid 3- year test, valid monthly monitoring for DW buckets, or the tank is exempt? Yes Does the overfill device have a valid 3- year test or the tank is exempt?Yes Tank 3 Cathodic Protection Tanks are protected from corrosion?Yes Piping is protected from corrosion?Yes Flex connectors at the tank sub-pumps are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Tank 3 Pressure Piping Leak Detection Does the pressurized piping system have a line leak detector?Yes Does the pressurized piping system have a valid line leak detector test?Yes Does the pressurized piping system have a valid annual line tightness test or valid monthly monitoring? Yes Tank 3 Spill/Overfill Does the spill bucket have a valid 3- year test, valid monthly monitoring for DW buckets, or the tank is exempt? Yes Does the overfill device have a valid 3- year test or the tank is exempt?Yes 2024-11-19 Page 4 of 8 Tank 3 Spill/Overfill Tank has a spill prevention device?Yes Are you able to visually inspect the spill containment bucket(s) for functionality? (i.e. are the buckets clean enough to see cracks, etc?) Yes Is the spill containment bucket intact?Yes Is the spill containment bucket(s) able to contain a spill? (i.e. is there water, product, debris, etc in the spill bucket to prevent it from containing a spill?) Yes Tank has an overfill device?Yes If an overfill alarm is being used is it properly located so the delivery driver can hear or see it, and is clearly identified? No Tank 3 ATG/IM ATG/IM - Records on site document that the system is properly installed, calibrated, operated, and maintained (system and tank setup reports, maintenance records)? Written documentation of calibration, maintenance, and repair is kept for at least one year after work is completed? Yes ATG/IM - ATG console or other equipment used to take readings and perform tests is adequate, accessible, and operational? Yes ATG/IM - Documentation of valid testing or monitoring is available (must have records for the two most recent months and 10 of last 12 months)? Show results in the RD tab. Yes ATG - The tank was filled to at least the minimum level required to ensure a valid leak test, and the tank size is within the allowed upper and lower size limits? Yes Tank 3 ATG/IM Does the ATG system have a valid annual test?Yes DISPENSER RESPONSES Dispenser 3/4 Flex connectors at the dispensers are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Fire valve is anchored properly?Yes Does the line tightness test port on the fire valve have the manufacturers plug installed in it? (no ball valves) Yes Is the fire valve located properly below grade?Yes Is the fire valve's fuseable link intact?Yes Dispenser 1/2 Flex connectors at the dispensers are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Fire valve is anchored properly?Yes Does the line tightness test port on the fire valve have the manufacturers plug installed in it? (no ball valves) Yes Is the fire valve located properly below grade?Yes Is the fire valve's fuseable link intact?Yes 2024-11-19 Page 5 of 8 Dispenser 7/8 Flex connectors at the dispensers are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Fire valve is anchored properly?Yes Does the line tightness test port on the fire valve have the manufacturers plug installed in it? (no ball valves) Yes Is the fire valve located properly below grade?Yes Is the fire valve's fuseable link intact?Yes Dispenser 11/12 Flex connectors at the dispensers are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Fire valve is anchored properly?Yes Does the line tightness test port on the fire valve have the manufacturers plug installed in it? (no ball valves) Yes Is the fire valve located properly below grade?Yes Is the fire valve's fuseable link intact?Yes Dispenser 5/6 Flex connectors at the dispensers are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Fire valve is anchored properly?Yes Does the line tightness test port on the fire valve have the manufacturers plug installed in it? (no ball valves) Yes Is the fire valve located properly below grade?Yes Is the fire valve's fuseable link intact?Yes Dispenser 9/10 Flex connectors at the dispensers are protected from corrosion?Yes Containment sumps are sealed, free from water, product, etc?Yes Fire valve is anchored properly?Yes Does the line tightness test port on the fire valve have the manufacturers plug installed in it? (no ball valves) Yes Is the fire valve located properly below grade?Yes Is the fire valve's fuseable link intact?Yes MONTHLY LEAK DETECTION MONITORING Nov '23 Dec '23 Jan '24 Feb '24 Mar '24 Apr '24 May '24 Jun '24 Jul '24 Aug '24 Sep '24 Oct '24 Tank 1 Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Line Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Tank 2 Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Line Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Tank 3 Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Line Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass NON-COMPLIANCE ITEMS TANK 1 Question:If an overfill alarm is being used is it properly located so the delivery driver can hear or see it, and is clearly identified? Comments: Sign is missing TANK 2 2024-11-19 Page 6 of 8 Question:If an overfill alarm is being used is it properly located so the delivery driver can hear or see it, and is clearly identified? Comments: sign is missing TANK 3 Question:If an overfill alarm is being used is it properly located so the delivery driver can hear or see it, and is clearly identified? Comments: sign missing 2024-11-19 Page 7 of 8 Prepared by fueloperator.com Inspection Information Inspector:Wilson, David Record Created:Nov. 19, 2024, 10 a.m. Inspection Date:Nov. 19, 2024 2024-11-19 Page 8 of 8 Site 561 Compliance Report October 1, 2023 to October 31, 2024 Site: Maverik 561 - Draper, UT Tank Owner: Maverik, Inc. 13551 South 200 West 185 S. State Street Suite 800 Draper, UT 84020 Salt Lake City, UT 84111 Report Created: October 24, 2024 9:48 AM Tank Release Detection Results - 0.2 GPH ATG Tank Product Test Date Period Test Type Volume % Full Result 1 UNL 10/01/2023 10/2023 0.20 gal/hr test 9,808 65% PASS 2 PRM 10/01/2023 10/2023 0.20 gal/hr test 4,293 37% PASS 3 DSL 10/01/2023 10/2023 0.20 gal/hr test 5,138 53% PASS 1 UNL 11/01/2023 11/2023 0.20 gal/hr test 9,405 62% PASS 2 PRM 11/01/2023 11/2023 0.20 gal/hr test 4,894 42% PASS 3 DSL 11/01/2023 11/2023 0.20 gal/hr test 6,463 67% PASS 1 UNL 12/01/2023 12/2023 0.20 gal/hr test 9,626 64% PASS 2 PRM 12/01/2023 12/2023 0.20 gal/hr test 5,886 51% PASS 3 DSL 12/01/2023 12/2023 0.20 gal/hr test 5,773 60% PASS 1 UNL 01/01/2024 01/2024 0.20 gal/hr test 9,546 63% PASS 2 PRM 01/01/2024 01/2024 0.20 gal/hr test 6,775 58% PASS 3 DSL 01/01/2024 01/2024 0.20 gal/hr test 6,872 71% PASS 1 UNL 02/01/2024 02/2024 0.20 gal/hr test 11,644 77% PASS 2 PRM 02/01/2024 02/2024 0.20 gal/hr test 6,183 53% PASS 3 DSL 02/01/2024 02/2024 0.20 gal/hr test 7,338 76% PASS 1 UNL 03/01/2024 03/2024 0.20 gal/hr test 10,562 70% PASS 2 PRM 03/01/2024 03/2024 0.20 gal/hr test 5,936 51% PASS 3 DSL 03/01/2024 03/2024 0.20 gal/hr test 6,183 64% PASS 1 UNL 04/01/2024 04/2024 0.20 gal/hr test 9,752 65% PASS Tank Product Test Date Period Test Type Volume % Full Result 2 PRM 04/01/2024 04/2024 0.20 gal/hr test 5,223 45% PASS 3 DSL 04/01/2024 04/2024 0.20 gal/hr test 4,909 51% PASS 1 UNL 05/01/2024 05/2024 0.20 gal/hr test 10,272 68% PASS 2 PRM 05/01/2024 05/2024 0.20 gal/hr test 6,426 55% PASS 3 DSL 05/01/2024 05/2024 0.20 gal/hr test 5,705 59% PASS 1 UNL 06/01/2024 06/2024 0.20 gal/hr test 9,274 61% PASS 2 PRM 06/01/2024 06/2024 0.20 gal/hr test 5,609 48% PASS 3 DSL 06/01/2024 06/2024 0.20 gal/hr test 4,192 43% PASS 1 UNL 07/01/2024 07/2024 0.20 gal/hr test 8,987 60% PASS 2 PRM 07/01/2024 07/2024 0.20 gal/hr test 4,977 43% PASS 3 DSL 07/01/2024 07/2024 0.20 gal/hr test 5,708 59% PASS 1 UNL 08/01/2024 08/2024 0.20 gal/hr test 8,670 57% PASS 2 PRM 08/01/2024 08/2024 0.20 gal/hr test 5,476 47% PASS 3 DSL 08/01/2024 08/2024 0.20 gal/hr test 5,123 53% PASS 1 UNL 09/01/2024 09/2024 CSLD 9,932 65% PASS 2 PRM 09/01/2024 09/2024 CSLD 4,516 38% PASS 3 DSL 09/01/2024 09/2024 CSLD 6,513 67% PASS 1 UNL 10/01/2024 10/2024 CSLD 9,200 60% PASS 2 PRM 10/01/2024 10/2024 CSLD 4,786 41% PASS 3 DSL 10/01/2024 10/2024 CSLD 5,806 59% PASS Site 561 Compliance Report October 1, 2023 to October 31, 2024 Site: Maverik 561 - Draper, UT Tank Owner: Maverik, Inc. 13551 South 200 West 185 S. State Street Suite 800 Draper, UT 84020 Salt Lake City, UT 84111 Report Created: October 24, 2024 9:48 AM Line Release Detection Results - PLLD Label Test Date Period Test Type Result DSL LINE 10/01/2023 10/2023 PLLD 0.2 GPH PASS PRM LINE 10/01/2023 10/2023 PLLD 0.2 GPH PASS UNL LINE 10/03/2023 10/2023 PLLD 0.2 GPH PASS DSL LINE 11/04/2023 11/2023 PLLD 0.2 GPH PASS PRM LINE 11/02/2023 11/2023 PLLD 0.2 GPH PASS UNL LINE 11/04/2023 11/2023 PLLD 0.2 GPH PASS DSL LINE 12/02/2023 12/2023 PLLD 0.2 GPH PASS PRM LINE 12/04/2023 12/2023 PLLD 0.2 GPH PASS UNL LINE 12/04/2023 12/2023 PLLD 0.2 GPH PASS DSL LINE 01/03/2024 01/2024 PLLD 0.2 GPH PASS PRM LINE 01/03/2024 01/2024 PLLD 0.2 GPH PASS UNL LINE 01/01/2024 01/2024 PLLD 0.2 GPH PASS DSL LINE 02/02/2024 02/2024 PLLD 0.2 GPH PASS PRM LINE 02/02/2024 02/2024 PLLD 0.2 GPH PASS UNL LINE 02/04/2024 02/2024 PLLD 0.2 GPH PASS DSL LINE 03/01/2024 03/2024 PLLD 0.2 GPH PASS PRM LINE 03/01/2024 03/2024 PLLD 0.2 GPH PASS UNL LINE 03/01/2024 03/2024 PLLD 0.2 GPH PASS DSL LINE 04/02/2024 04/2024 PLLD 0.2 GPH PASS Label Test Date Period Test Type Result PRM LINE 04/02/2024 04/2024 PLLD 0.2 GPH PASS UNL LINE 04/02/2024 04/2024 PLLD 0.2 GPH PASS DSL LINE 05/02/2024 05/2024 PLLD 0.2 GPH PASS PRM LINE 05/04/2024 05/2024 PLLD 0.2 GPH PASS UNL LINE 05/02/2024 05/2024 PLLD 0.2 GPH PASS DSL LINE 06/03/2024 06/2024 PLLD 0.2 GPH PASS PRM LINE 06/01/2024 06/2024 PLLD 0.2 GPH PASS UNL LINE 06/03/2024 06/2024 PLLD 0.2 GPH PASS DSL LINE 07/03/2024 07/2024 PLLD 0.2 GPH PASS PRM LINE 07/02/2024 07/2024 PLLD 0.2 GPH PASS UNL LINE 07/01/2024 07/2024 PLLD 0.2 GPH PASS DSL LINE 08/04/2024 08/2024 PLLD 0.2 GPH PASS PRM LINE 08/02/2024 08/2024 PLLD 0.2 GPH PASS UNL LINE 08/02/2024 08/2024 PLLD 0.2 GPH PASS DSL LINE 09/03/2024 09/2024 PLLD 0.2 GPH PASS PRM LINE 09/03/2024 09/2024 PLLD 0.2 GPH PASS UNL LINE 09/01/2024 09/2024 PLLD 0.2 GPH PASS DSL LINE 10/01/2024 10/2024 PLLD 0.2 GPH PASS PRM LINE 10/03/2024 10/2024 PLLD 0.2 GPH PASS UNL LINE 10/03/2024 10/2024 PLLD 0.2 GPH PASS pei.org 49 Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities APPENDIX C-9 MECHANICAL AND ELECTRONIC LINE LEAK DETECTORS PERFORMANCE TEST )DFLOLW\1DPH2ZQHU $GGUHVV$GGUHVV &LW\6WDWH=LS&RGH&LW\6WDWH=LS&RGH )DFLOLW\,'3KRQH 7HVWLQJ&RPSDQ\3KRQH'DWH 7KLVGDWDVKHHWFDQEHXVHGWRWHVWPHFKDQLFDOOLQHOHDNGHWHFWRUV0//'DQGHOHFWURQLFOLQHOHDNGHWHFWRUV(//'ZLWKVXEPHUVLEOH WXUELQHSXPS673V\VWHPV6HH3(,536HFWLRQVDQGIRUWHVWSURFHGXUHV /LQH1XPEHU 3URGXFW6WRUHG /HDN'HWHFWRU0DQXIDFWXUHU /HDN'HWHFWRU0RGHO 7\SHRI/HDN'HWHFWRU 0//' (//' 0//' (//' 0//' (//' 0//' (//' 0//' (//' 0//' (//' MLLD (ALL PRESSURE MEASUREMENTS ARE MADE IN PSIG) 673)XOO2SHUDWLQJ3UHVVXUH &KHFN9DOYH+ROGLQJ3UHVVXUH /LQH5HVLOLHQF\POOLQHEOHHGEDFNYRO XPHDVPHDVXUHGIURPFKHFNYDOYHKROG LQJSUHVVXUHWR]HURSVLJ 6WHS7KURXJK7LPHLQ6HFRQGVWLPHWKH 0//'KHVLWDWHVDWPHWHULQJSUHVVXUH EHIRUHJRLQJWRIXOORSHUDWLQJSUHVVXUH DVPHDVXUHGIURPSVLJZLWKQROHDN 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Premium 4 4 4 4 4 4 4 4 DSL STP Diesel 4 4 4 4 4 4 4 4 Dominic Salas UT-378 I`- Fr—t, f T t"'? --USTST 4?4`c Q eI`tS s€.''C i ii --Utah 1; - Y EAR, FadlitV Nam-- d r+ . Facility [D lWdre_S5 i,70 t'r PrirrEary Class 13 Operator NAME(S) AND INITIALS OF PERSON(s) CONDUCTING MONTHLY INSPECnONS; G Please respond to ALL of the following questions with a Y (Yes), N (No), or IAA (Not Applicable) answer, Months of the Curr ent Year F M A M!! A S 0 N D A Release detection equipment is operating with no alarms or other Unusual J conditions. 12411--y— Records of release detection (:auks and piping) are reviewed and current._....._..- Poperating 3 EgLRpment is undamaged, intact and free from defects. I i l i 4 Equipment is free from debris, water, or product. l Y 7 5 { Fill ripe is unobstructed. I 1 1 V y ly i( Y b I Fill cap is un-broken and is securely on the fill pipe. II1 Illy 7 7 Double walled spill prevention equipment- Interstitial area is free from leaks. I Y Y 7 f ty Initials of person performing Inspection, rsnJ c:t._ - 1. ]3-_._ -gri a rimer ..0 sa- - _ - t i ciri:=.-_.::- Secondary Containment Sumps Visual Inspection of sump indicates no damage and it is free from debris, water and fuel. 8 The penetration fittings for conduits and piping entering the STP Sumps are intactSTP, Dispenser and Transition) S Double {Mailed Sumps Interstitial area is free from leaks. I 10 Hand-held release detection, Hand-held release detection equipment (bailer, gauge stick-, etc.) is serviceable and equipment operable - certify under penalty of laL! that I am the Class S Operator referenced above and that I am familiar with information on this form and that it is true, accurate and was completed in accordance trsith P,311-203-7.- SignatureofthePrimaryClassBOperator(Signthisdocumentaftertheisst..inspectionoftheCurrentYear) Date B Operatorn Turn over for record of Interstitial Morznarieg visual hasp ections and Impressed Current -rectifier checks. Scanned with CamScanner t 1 t Ett't`tlhlt' ittskta;'IiAtt • iltntk —1'a n i Olt w tf Vou perfonn Interstitial Monituring on your tanks mid/or plpinil anti tmo a vlsttal check rMhor tlk ti sump nr Intal'stltlt1l sonsom for our montht loi%k dolecthrn, com ile+to the tnhla to docuoient the neonthl visual checks. Months of the Current -ToYeajJIFMAMJJASO YlSunl clitICk Of fljo InteratItIal $pace Of 111e duuhia waited lank huticated no it olso or unu u t1 O aLrratin condltions. Y. 1 l Y \L Y y L— _ l_ Y_ y Visual chock of p1ping (SIP, dispenser and transitlon) containment sumps Y ytndleatesnormalfunctionandnoindicationofwatrrorleakedproduct. Y 1 _ Y _ itu iressett Current till Day Rectlilrr Check Months ofihu airivnt Yrar i It M A M J J A A O N n Shove Cho dnte tho LitprMcd C:nrrrnl system vos 111cluuted to cusure like ry o uI iiutnnt is rum%NUk ro twl Amperage remllug Wom Impressed rorrout r'ertiflkw Voltaire n ading tivtu Impressed current VA - vectiflcr INSTRUCTIONS 1. Tho inouthly UST ttystam inspoetlons must be conducted by or wrier Ilia direction of the Primary Class D UST Operator. 2. Tho Primary Class D UST Oprrntor nr+tst alert tho UST Ownor or Opoi-tttor of any condition discoycrcd during tha wonthly visual inspection that may rctiuira fbllow-up actions. Tho UST Owktor or Opeulor mist nuksntnik it cagy orthe monthly inspection reports fur the most tact ut 12 wonths. Tho records shall be mnintaincd on -site or off-sitt at a rcndity nvnilnbla lnrnllotz. Var. 411 V2016 Scanned with CamScanner Neilson Shannon 10/8/2024 10/8/2024 Mamun Rashid, Maverik's Program Migliaccio Amanda 8/10/2024 8/10/2024 Mamun Rashid, Maverik's Program Bernal Abraham 6/2/2024 6/2/2024 Mamun Rashid, Maverik's Program Nava Gustavo 3/7/2024 3/7/2024 Mamun Rashid, Maverik's Program Simancas Rivas Isabel 3/7/2024 3/7/2024 Mamun Rashid, Maverik's Program Lancaster Kevin 3/7/2024 3/7/2024 Mamun Rashid, Maverik's Program Pehrson Kaden 2/29/2024 2/29/2024 Mamun Rashid, Maverik's Program Valencia Alejandra 2/16/2024 2/16/2024 Mamun Rashid, Maverik's Program hermosillo Lizeth 2/13/2024 2/13/2024 Mamun Rashid, Maverik's Program Rivera Andrew 11/30/2023 11/30/2023 Mamun Rashid, Maverik's Program Julian Jorden 8/8/2023 8/8/2023 Mamun Rashid, Maverik's Program Crane Melinda 6/8/2023 6/8/2023 Mamun Rashid, Maverik's Program Maverik Store #561 1000013551 South 200 West, Draper, UT