DERR-2024-012503

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Facility Name c A 1 /I/},,,
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UST Operator Inspection -Utah
YEAR Ju.~'f
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F.acilit; ID
Address -1.'S_ott_ _ 5. _ ~ou W-_ )Primary Class 8 Opov:1tor ~c ,I'-U_R ✓J
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INAME(S) AN~ INITIALS OF PERSON(S) CONDUCTING MONTHLY INSPECTIONS: .
. 5es>"c'-~ f;,ty/ ~ Ccb,'h__ tbt,AL5,K£: M"( Serf-I' ) A:: _
.__ Please respond to ALL of the following questions with a y (Yes), N (No), or NA (Not Applrcable) ariswcr .
-Months of the Current Year
J A s 0 N
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1/F/MfA1M/J, --
Monthly Inspection -Release Detection j
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Release detection equipment is operating with no alarms or other unusual
1 operating conditions.
·y V V y '( 'i y
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2 Records of release detection (tanks and piping) are reviewed and current. V \I I V v '/ "-{ Ii 'YI I I
I , T r .
Monthly Inspection -Spill Prevention Equipment
3 Equipment is undamaged, intact and free from defects. v \( v y y V '( y '/ I
4 Equipment is free from debris, water, or product. \/ " \i ~ ,.; i/
y " ,I
5 Fill Pipe is unobstructed.
r r I , I y y1 I
V " \} V \/ V 'f
6 Fill cap is un-broken and is securely on the fill pipe. v \j ' I '-{ 7' y I
l/ " .J V , Y,~
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7 Double walled spill prevention equipment -Interstitial area is free from leaks. V I '-1_
\/ V V V V I
I I };" P>r Hv'
Initials of person performing Inspection. I/ \/ \I \J "
D
Annual Inspection -Containment Sumps Date of annual Inspection ---
I 8 / Secondary Containment Sumps Visual Inspection of sump indicates no damage and it is free from debris, water and fuel. -l
I (STP, Dispenser and Transition) The penetration fittings for conduits and piping entering the STP Sumps are intact • I 't
9 Double Walled Sumps Interstitial area is free from leaks.
I ,, I
Hand-held release detection Hand-held release detection equipment (bailer, gauge stick, etc.) is serviceable and
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equipment
operable.
I certify under penalty of law that I am the Class B Operator referenced above and that I am familiar with information on this form
and that it is true, accurate and was completed in accordance with R311-203-7.
Signatur~of t Primar :.,Class 8 Operator (Sign this document after the last inspection of the current Year) Date I ~1 :JO/;;,. '1
J ,,.,,
B Operator#
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Comments/Follow up:
T r, • record of JntcnfltfaJ Monjio'i -1--------;-;;;;-;;;,tiii:;::=-:i:'::-;::::----------
urn over o• • ng v sual jns1>cctions und Jm1ireiied Current rectifier checks.
'
UST Operator Inspection_ Utah_ Page 2 of 2
If you perform Interstitial Monitoring on your tanks and/ or piping and use a visual check rather than sump or
interstitial sensors for your monthly leak detection, complete the table to document the monthly visual checks.
Months of the Current Year J F M A M j J A I SI 0 N -D
Visual check of the interstitial space of the double-walled tank indicated no 1 y y y '( y r µp. ,~ 4 release or unusual operating conditions. y
Visual check of piping (STP, dispenser and transition} containment sumps
-
2 y y y y y y r tJ~N~
indicates normal function and no indication of water or leaked product. lL
Impressed Current 60 Day Rectifier Check J.) o /lCort ~ ,€£1-6tJ51 ri
Months of the Current Vear J F M A M J J A s 0 N D
Show the date the Impressed Current ,,,o i\ \ i }\'' q\,Q ~\i<> t/1q 1111 system was inspected to ensure the tJ~ tv I\
1)-A.
equipment is runnine properly
Amperage reading from impressed
l-{ ~ l\ '\ ~ '-/ (.,, rJt\ }//4 Al{ I
, current rectifier
I Voltage reading from impressed current l
I rectifier
INSTRUCTIONS
1. The monthly UST system inspections must be conducted by or under the direction of the Primary Class BUST Operator.
2. The Primary Class B UST Operator must alert the UST Owner or Operator of any condition discovered during the monthly visual
inspection that may require follow-up actions.
3. The UST Owner or Operator must maintain a copy of the monthly inspection reports for the most recent 12 months. The records
shall be maintained on-site or off-site at a readily available location.
Ver. 4/14/2016
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C.
5'
pei.org 57
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities
APPENDIX C-7
AUTOMATIC TANK GAUGE
OPERATION INSPECTION
Facility Name:Owner:
Address:Address:
City, State, Zip Code:City, State, Zip Code:
Facility I.D. #:Phone #:
Testing Company:Phone #:Date:
This procedure is to determine whether the automatic tank guage (ATG) is operating properly. See PEI/RP1200 Section 8.2 for the
inspection procedure. This procedure is applicable to tank level monitor stems that touch the bottom of the tank when in place.
Tank Number
Product Stored
ATG Brand and Model
1. Tank Volume, gallons
2. Tank Diameter, inches
3. After removing the ATG from the tank, it has
been inspected and any damaged or missing
parts replaced?
Yes No Yes No Yes No Yes No
4. Float moves freely on the stem without
binding? Yes No Yes No Yes No Yes No
5. Fuel float level agrees with the value pro-
grammed into the console? Yes No Yes No Yes No Yes No
6. Water float level agrees with the value pro-
grammed into the console? Yes No Yes No Yes No Yes No
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?
Yes No Yes No Yes No Yes No
9. Inch level from the bottom when the water
float first triggers an alarm.
10. Inch level at which the water float alarm acti-
vates corresponds with value programmed in
the gauge?
Yes No Yes No Yes No Yes No
If any answers in Lines 3, 4, 5, or 6 are “No,” the system has failed the test.
Test Results Pass Fail Pass Fail Pass Fail Pass Fail
Comments:
Tester’s Name (print) ___________________________________ Tester’s Signature _________________________________
Fast Stop 1120
1504 S 800 W,
Woods Cross, UT 84087
3000266
CGRS 10-1-24
T1 T 2 T 3
RUL PUL DSL
TS-550 Evo TS-550 Evo TS-550 Evo TS-550 Evo
11996 7194 5035
96.63 96.63 96.63
87 87 87
2 2 2
Larry Vasquez
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LIQUID SENSOR FUNCTIONALITY TESTING
Facility Name:Owner:
Address:Address:
City, State, Zip Code:City, State, Zip Code:
Facility I.D. #:Phone #:
Testing Company:Phone #:Date:
This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel. See PEI/RP1200
Section 8.3 for the test procedure.
Sensor Location
Product Stored
Type of Sensor
Discriminating
Non-discrimi-
nating
Discriminating
Non-discrimi-
nating
Discriminating
Non-discrimi-
nating
Discriminating
Non-discrimi-
nating
Discriminating
Non-discrimi-
nating
Discriminating
Non-discrimi-
nating
Discriminating
Non-discrimi-
nating
Test Liquid Water
Product
Water
Product
Water
Product
Water
Product
Water
Product
Water
Product
Water
Product
Is the ATG console clear of any active
or recurring warnings or alarms
regarding the leak sensor? If the
sensor is in alarm and functioning,
indicate why.
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
Is the sensor alarm circuit
operational? Yes No Yes No Yes No Yes No Yes No Yes No Yes No
Has sensor been inspected and in
good operating condition? Yes No Yes No Yes No Yes No Yes No Yes No Yes No
When placed in the test liquid, does
the sensor trigger an alarm? Yes No Yes No Yes No Yes No Yes No Yes No Yes No
When an alarm is triggered, is the
sensor properly identified on the ATG
console?
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
Any “No” answers indicates the sensor fails the test.
Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Comments:
Tester’s Name (print) ___________________________________ Tester’s Signature _______________________________________________
Fast Stop 1120
1504 S 800 W,
Woods Cross, UT 84087
3000266
CGRS 10-1-24
DISP 1/2 DISP 3/4 DISP 5/6 DISP 7/8 T1 RUL T2 PUL T3 DSL
PUL. RUL,DSL PUL. RUL,DSL PUL. RUL,DSL PUL. RUL,DS RUL PUL DSL
Larry Vasquez
UST Annual Compliance Inspection
Facility Information
Name:Fast Stop 1120 Certification/Inspection #:55131
Address:1504 S 800 W, Woods Cross, UT, 84087 State ID:3000266
Phone Number:Form Completed By:Larry Vasquez Date:10/01/2024
Tank Information
State Tank ID T3 DSL T2 PUL T1 RUL
Facility Tank # or ID (designation used by facility)T3 DSL T2 PUL T1 RUL
Tank Capacity 5035 gal 7194 gal 11996 gal
Product Name (describe in comments if not listed)Diesel Premium Unleaded
Compartment Only (mark only if NOT the entire tank)
Manifolded Tank (mark for true siphon manifold ONLY)
Tank Status*
if Tank Status = TC:IU IU IU
Date in TC (assessment & OPS extension required > 1yr)
Emptied to 1" or less? (release detection required if not)Y N NA Y N NA Y N NA
Date emptied to 1" or less
Tank Release Detection Method*ATG-Interstitial
Monitoring
ATG-Interstitial
Monitoring
ATG-Interstitial
Monitoring
Tank Corrosion protection*None None None
Tank Wall Type*FRP FRP FRP
Tank receives > 25 gallons at a time?Yes No Yes No Yes No
Spill Bucket? (required where UST receives >25 gallons at a time)Yes No Yes No Yes No
Spill Bucket Size
Spill Bucket Wall Type*
Overfill Protection? (required where UST receives >25 gallons at a time)Yes No Yes No Yes No
Overfill Protection Type*External Overfill
Alarm
External Overfill
Alarm
External Overfill
Alarm
Piping Corrosion protection*Flex-N/A Flex-N/A Flex-N/A
Flexible Connection - Tank*
Flexible Connection - Dispenser*
Piping Wall Type*DW DW DW
Piping Delivery System*Pressure Pressure Pressure
Line Leak Detector Type (required for PR system)*Electronic Electronic Electronic
Piping Release Detection Method*Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
STP (Turbine Pump) Containment Sump?No No No
STP Containment Sump Wall Type*NA NA NA
UDC (Under-dispenser) Containment Sump?No No No
UDC Containment Sump Wall Type*NA NA NA
Piping Transition Sumps?No No No
Transition Sump Wall Type*NA NA NA
11/11/24, 3:15 PM UST Annual Compliance
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Inspection Checklist
For each facility, complete the Annual Compliance Inspection Checklist below by answering the questions. If the facility contains more
than 5 tanks or 8 dispensers, additional copies of this form must be completed. Questions are designated as either a mandatory
compliance item(●) or a recommended practice item(®). If an item is identified as mandatory and recommended, further information is
provided in a note following the question. If "No" is the answer for any mandatory compliance item(●) question, an associated entry must
be made in the Return to Compliance Plan with documentation of the date when the issue was brought back into compliance. The State
must approve all compliance plan schedules. If "No" is the answer for a recommended practice item (®), it is strongly suggested that the
deficiency be corrected.
Tank Information
Inspection Item T3 DSL T2 PUL T1 RUL
Fill Equipment
●1 Is there a product tag on the fill riser pipe or are the lids painted in accordance with a
posted product code color chart?
Y Y Y
®2 Does the fill cap have adequate clearance between the cap and the manhole cover?Y Y Y
●3 Does the tank have a drop tube that extends to within 6 inches of the bottom (if no
diffuser is present)?
Y Y Y
Spill & Overfill Protection
●4 Is each UST that receives more that 25 gallons of product at any one time equipped
with spill and overfill prevention?
Y Y Y
●5 Is the spill bucket free of fuel, water or debris?Y Y Y
●6 Is the spill bucket in good condition and free of damage?Y Y Y
®7 Does the drain assembly work?Y Y Y
●8
Is the tank(s) equipped with an overfill device (e.g. overfill alarm, automatic shut-off
device or ball-float valve) and is the device installed according to manufacturer's
specifications to allow proper functionality?
Y Y Y
●9 Is the tank overfill alarm mounted near the fill port where it can be seen or heard by
the delivery person?
Y Y Y
Temporary Closure
●10
If the tank is in temporary closure and contains greater that 1 inch of product, is
approved release detection performed and maintained? NOTE: OPS recommends that
a tank in temporary closure be emptied (contains <= 1 inch of fluids).
NA NA NA
●11 If the tank is in temporary closure, is corrosion protection maintained?NA NA NA
●12
If the tank has been in temporary closure for greater than 3 months, is the vent line
open and has the piping, pumps, manways, and ancillary equipment been capped and
secured?
NA NA NA
Vapor Recovery (if Required)
●13 Are the vapor recovery adaptor and cap present and free of damage?Y Y Y
®14 Does the vapor cap have adequate clearance between the cap and the manhole cover
to enable hook-up?
Y Y Y
®15 Is the vapor cap in good condition with a gasket?Y Y Y
®16 Is the vapor recovery lid painted orange?Y Y Y
Submersible Turbine Pump (STP) Sump
®17 Are the external and/or internal lids easily removed for inspection?Y Y Y
®18 Are the sump lid, gasket and seals present and in good condition?Y Y Y
●19 Is the sump free of fuel, water or debris?Y Y Y
●20 Is the sump free of cracks, holes, bulges, or other defects?Y Y Y
●21 If the system contains secondarily contained piping with release detection consisting
of sump sensors installed in the sump, is the interstice open to the sump?
NA NA NA
●22 Is the sump sensor properly mounted at the bottom of the sump and operating
according to the manufacturer's specifications?
Y Y Y
●23
Are penetration fittings and entry boots intact, secure and free of damage? NOTE: If
the sump was installed prior to 8-1-08 and is not used for interstitial monitoring, this is
a recommended item.
Y Y Y
11/11/24, 3:15 PM UST Annual Compliance
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®24 Are junction boxes sealed and free of corrosion?Y Y Y
●25 Are the STP components, piping and flex connectors free of leaks or seeps?Y Y Y
●26 If no sump is present, are metal components that are in contact with the soil
cathodically protected?
NA NA NA
●27 Are piping and flexible connectors installed according to the manufacturer's
specifications (not kinked or twisted)?
Y Y Y
●28 Did the mechanical and/or electronic line-leak detector pass its annual functionality
test which includes a leak simulated in the line as part of the functionality test?
Y Y Y
®29 Is the mechanical leak detector properly vented? (vent tube not kinked or twisted)Y Y Y
ATG Port
®30 Is the manhole cover in good condition and is there adequate clearance between the
ATG probe cap and the manhole cover?
Y Y Y
®31 Is the cap in good condition and does it seal tightly?Y Y Y
®32 Are the probe wiring hole, electrical junction box and conduit sealed and in good
condition?
Y Y Y
●33 Are the probe, floats, and water/product warning alarms operating according to the
manufacturer's specifications?
Y Y Y
ATG Console
●34 Does the ATG console have power?Y Y Y
●35 Have all ATG leak alarms been properly addressed?Y Y Y
●36 Is the console programmed correctly for the tanks found at the site (e.g. product,
capacity, points, overfill alarm, in-tank test, line-leak detector test, etc.)?
Y Y Y
●37 Is the sump sensor properly mounted at the bottom of the sump?Y Y Y
●38 Are the sensors functioning according to the manufacturer's specifications?Y Y Y
Tank Interstice
●39 Are the interstitial sensors placed correctly in the tanks?Y Y Y
●40 Are the interstitial sensors functioning according to the manufacturer's specifications?Y Y Y
Cathodic Protection
●41 Are all system components that routinely contain product (tanks, lines, and other metal
components) and that are in contact with the soil properly cathodically protected?
NA NA NA
●42 Has your cathodic protection system (galvanic anodes or impressed current) been
tested within 6 months of installation/repair, and every 3 years thereafter?
NA NA NA
●43 Has the impressed current system (rectifier) been inspected for proper operation at
least every 60 days?
NA NA NA
●44
If you have an internally-lined tank without additional cathodic protection, has it passed
and internal inspection within 10 years after installation of the lining and every 5 years
thereafter?
NA NA NA
®45 If the system is equipped with impressed current, there are no damaged, frayed or
exposed wires?
NA NA NA
Vent Piping
®46 Is the vent cap present and is it the correct type?Y Y Y
●47 Is the vent piping of correct height and above obstructions?Y Y Y
●48 Are diesel and gasoline tanks vented with separate piping?Y Y Y
Unattended Fueling
●49 Is one or more clearly identified emergency shutoff devices located not less than 20 ft.
or more than 100 ft. from the dispensing devices, readily accessible to patrons?
Y Y Y
●50 Is a working telephone or other approved, clearly identified means to notify the fire
department provided on the site, and readily accessible to patrons?
Y Y Y
●51
Is a fire extinguisher with a minimum rating of 40-B, a maintenance inspection not
older than 1 year, and located no more than a 30 ft, travel distance from the
dispensing devices, readily accessible to patrons?
N N N
Monthly Inspection
●52 Have all Monthly inspections been performed and documented, and have all
deficiencies noted during the inspections been corrected?
Y Y Y
11/11/24, 3:15 PM UST Annual Compliance
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4Dispenser Information
Inspection item D1 D2 D3 D4
●53 Is hanging hardware free of visible signs of leakage or damage?Y Y Y Y
●54 Are all components of hanging hardware of the proper type and size?Y Y Y Y
●55 If applicable, is fuel product, safety, octane, diesel sulfur, ethanol, signage present and correct?Y Y Y Y
●56 Is the under-dispenser containment(UDC) sump free of fuel, water or debris?Y Y Y Y
●57 Is the UDC sump free of cracks, holes, bulges, or other defects?Y Y Y Y
®58 Are penetration fillings and entry boots intact, secure and free of damage? NOTE: If the sump was installed
prior to 8-1-2008 and is not used for interstitial monitoring, this is a recommended item.
Y Y Y Y
●59 If the system contains secondarily contained piping with release detection consisting of sump sensors installed
in the sump, is the interstice open to the sump?
NA NA NA NA
●60 Is the sump sensor properly mounted at the bottom of the sump?Y Y Y Y
●61 Are junction boxes sealed and free of corrosion?Y Y Y Y
●62 Are meters, piping and flexible connectors free of leaks or seeps?Y Y Y Y
●63 Are piping and flexible connectors installed according to the manufacturer's specification? (not kinked or
twisted)
Y Y Y Y
●64 If no UDC, are any metal piping components in contact with the soil properly cathodically protected?NA NA NA NA
●65 Are the shear valves operating according to the manufacturer's specifications?Y Y Y Y
●66 Is at least one fire extinguisher with a minimum rating of 40-B, and a maintenance inspection not older than 1
year, located within 100 feet of each dispenser and tank fill opening?
Y Y Y Y
●67 Is an emergency stop button present and operable?Y Y Y Y
Note:
Deficiency Information
Rec Item Item ID Equip ID Description Remedy Date Image
®51 T1 RUL no fire extinguisher within 30 feet
®51 T2 PUL no fire extinguisher within 30 feet
®51 T3 DSL no fire extinguisher within 30 feet
Operator Certification
By signing below, the operator certifies that the answers above are accurate and based upon performance of associated inspection
activities, and that the facility owner has received a copy of this inspection form.
Contractor Printed Name:Larry Vasquez Contractor Company Name:CGRS, Inc.
Certification Number:
Contractor Signature:
A or B Operator Printed Name:A or B Operator Cert. No.:
A or B Operator Signature:Date:10/01/2024
11/11/24, 3:15 PM UST Annual Compliance
about:blank 5/5
Automatic Tank Gauge Inspection
ATG 1
ATG 1659
Facility Information
Name:Fast Stop 1120 Certification/Inspection #:55249
Address:1504 S 800 W, Woods Cross, UT, 84087 State ID:3000266
Phone Number:Form Completed By:Larry Vasquez Date:10/01/2024
ATG Console Inspection
Tank Level Monitor Brand :Incon
1.Status upon Arrival:All Functions Normal
2.Status upon Departure:All Functions Normal
3.Is the display in good
condition and functioning?:
Yes
4.Is the keypad in good
condition?:
Yes
Tank Level Monitor Model :TS-550 Evo
5.Are all indicator lights
functional?:
Yes
6.Is printer functional?:Yes
7.Back-up battery tested? (if
applicable)?:
Yes
8.Back-up battery voltage (if
applicable):
Tank Information
Probe and Programing Inspection:
9.Tank # T1 RUL T2 PUL T3 DSL
10.Tank Facility ID T1 RUL T2 PUL T3 DSL
11.Tank # per ATG T1 RUL T2 PUL T3 DSL
12.Product:Unleaded Premium Diesel
13.Tank Volume, gallons 11996 7194 5035
14.Tank Dia/depth, inches 96.63 96.63 96.63
In-Tank Setup Parameters:
15.Thermal coefficient 0.000700 0.000450 0.000700
16.ATG Programmed Diameter 96.63 96.63 96.63
17.Number of points on profile 4 4 4
18.Full volume on profile 11996 7194 5035
19.After removing the probe from the tank, it has been inspected and any damaged or
missing parts replaced?
Yes Yes Yes
11/11/24, 3:15 PM ATG
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Pass/Fail Criteria: if any of questions 19, 20 ,21 & 22 are No, then the system has failed the test.
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
20.Do floats move freely along the stem without binding?Yes Yes Yes
21.Does product level match console value?Yes Yes Yes
22.Does water level match console value?Yes Yes Yes
23.Water warning (inches)(1")1 1 1
24.High water limit (inches)(1.5")2 2 2
25.Does console water alarm trigger at programmed level?Yes Yes Yes
26.Programmed Overfill Limit (90%)90 90 90
27.Does console overfill alarm trigger at programmed level?Yes Yes Yes
28.Programmed High Product Limit (95%)95 95 95
29.Does console high product alarm trigger at programmed level?Yes Yes Yes
30.Low Product (15% of tank volume or 15" whichever is greater)15 15 15
31.Tank test program enabled?Yes Yes Yes
32.Tank Test Method?Interstitial Interstitial Interstitial
33.Tank Test Rate
34.Test duration (hrs)Continuous Continuous Continuous
35.12 months of tank test history present?NA NA NA
Lines:
36.Electronic Line Leak Type PLLD PLLD PLLD
37.Line # and label in ATG (Q1, Unleaded)RUL PUL DSL
38.Line Test Rate 0.2 GPH 0.2 GPH 0.2 GPH
39.12 months of line test history present?Yes Yes Yes
40.Test Result Pass Pass Pass
11/11/24, 3:15 PM ATG
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Automatic Tank Gauge Sensor
ATG 1
Facility Information
Name:Fast Stop 1120 Certification/Inspection #:55251
Address:1504 S 800 W, Woods Cross, UT, 84087 State ID:3000266
Phone Number:Form Completed By:Larry Vasquez Date:10/01/2024
Sensor: #
Brand:FRANKLIN
FUELING
FRANKLIN
FUELING
FRANKLIN
FUELING fueling
FRANKLIN
FUELING fueling
FRANKLIN
FUELING fueling
Model:FMP-ULS FMP-ULS FMP-ULS FMP-ULS FMP-ULS
Type:Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Location:STP STP STP UDC UDC
Test Liquid, Fuel(F) and/or Water(W):Both Both Both Both Both
Is the ATG console clear of any active
or recurring warnings or alarms
regarding sensor?
If sensor is in alarm and functioning
indicate why below:
Y Y Y Y Y
Is the sensor alarm circuit operational?Y Y Y Y Y
Has the sensor been inspected and in
good operating condition?
Y Y Y Y Y
When placed in the test liquid does the
sensor trigger an alarm?
Y Y Y Y Y
Sensor removed for testing?Y Y Y Y Y
When an alarm is triggered, is the
sensor properly identified on the ATG
console?
Y Y Y Y Y
Sensor returned to proper placement
and verified to be functional after
testing?
Y Y Y Y Y
Any "No" answers above indicates the
sensor fails the test.
Test Result Pass Pass Pass Pass Pass
Sensor: #
11/11/24, 3:16 PM ATG Sensor
about:blank 1/2
Brand:FRANKLIN
FUELING fueling
FRANKLIN
FUELING fueling
FRANKLIN
FUELING
FRANKLIN
FUELING
Model:FMP-ULS FMP-ULS FMP-DIS FMP-DIS
Interstitial
Type:Non-
discriminating
Non-
discriminating
Discriminating Discriminating
Location:UDC UDC Intestinal space Intestinal space
Test Liquid, Fuel(F) and/or Water(W):Both Both Both Both
Is the ATG console clear of any active or recurring warnings
or alarms regarding sensor?
If sensor is in alarm and functioning indicate why below:
Y Y Y Y
Is the sensor alarm circuit operational?Y Y Y Y
Has the sensor been inspected and in good operating
condition?
Y Y Y Y
When placed in the test liquid does the sensor trigger an
alarm?
Y Y Y Y
Sensor removed for testing?Y Y Y Y
When an alarm is triggered, is the sensor properly
identified on the ATG console?
Y Y Y Y
Sensor returned to proper placement and verified to be
functional after testing?
Y Y Y Y
Any "No" answers above indicates the sensor fails the test.
Test Result Pass Pass Pass Pass
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
11/11/24, 3:16 PM ATG Sensor
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Leak Detector
Facility Information
Name:Fast Stop 1120 Certification/Inspection #:55250
Address:1504 S 800 W, Woods Cross, UT, 84087 State ID:3000266
Phone Number:Form Completed By:Larry Vasquez Date:10/01/2024
Tank Information
Tank #:T1 RUL T2 PUL T3 DSL
Capacity:11996 7194 5035
Product:Unleaded Premium Diesel
Line #:RUL PUL DSL
Line Type:Pressure Pressure Pressure
LD Brand:Incon Incon Incon
LD Model:TS-LLD TS-LLD TS-LLD
Serial #:0 0 0
Associated Tank:T1 RUL T2 PUL T3 DSL
Resiliency (ml):100 80 120
Check Valve Holding PSI:28 32 24
Opening Time:1 2 2
Result:Pass Pass Pass
Test Equip. Mfg.:Vaporless, LDT-890 Vaporless, LDT-890 Vaporless, LDT-890
Notes:
Tested per manufacturer specifications.
Contractor Signature:Printed Name:Larry Vasquez
Line Test
Facility Information
Name:Fast Stop 1120 Certification/Inspection #:55247
Address:1504 S 800 W State ID:3000266
Phone Number:Form Completed By:Larry Vasquez Date:10/01/2024
Tank Test Information
Tank #:T1 RUL T2 PUL T3 DSL
Capacity:11996 7194 5035
Product:Unleaded Premium Diesel
Line Test Information
Line #:RUL PUL DSL
LineType:Pressure Pressure Pressure
Line Material:DW Flex DW Flex DW Flex
Line ID Size (in):2 2 2
Line Length (ft):300 300 300
Pump Type:FE Petro FE Petro FE Petro
Associated Tank:T1 RUL T2 PUL T3 DSL
Test Equip. Mfg.:Triangle Triangle Triangle
Test Pressure (PSI):50 50 50
Initial Cyl. Level:350 130 290
Final Cyl. Level:350 100 290
Change in Time (mins):15 15 15
Change in Vol:0.0000 -30.0000 0.0000
Change in Temp (F):0 0 0
Coeff. Of Thermal Expansion (g/F):0.00070 0.00070 0.00045
Line Vol (gal):48.94 48.94 48.94
Leak Rate (GPH):0.0000 -0.0317 0.0000
Result:Pass Pass Pass
Notes
TIGHTNESS TESTING CERTIFICATION
CGRS certifies that the systems in the above table have been tested utilizing leak detection methods which meet the prescribed leak rate testing
standard of 0.10 gph with a minimum probability of detection of 95% and a 5% probability of a false alarm. CGRS further certifies that the protocol for
each test method was strictly adhered to, and that all precision tightness testing performed by CGRS was conducted in accordance with EPA 40 CFR
parts 280.43(c) and 280.44(b) and the National Fire Protection Association, Bulletin NFPA 329 criteria.
Contractor Printed Name:Larry Vasquez Contractor Signature:
Certification Number:TMI-301
11/11/24, 3:16 PM Line Test
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