DERR-2024-012504

UST Annual Compliance Inspection
Facility Information
Name:Fast Stop 1128 Certification/Inspection #:55098
Address:33 W 1100 N, Salt Lake, UT, 84054 State ID:3000504
Phone Number:Form Completed By:Larry Vasquez Date:10/07/2024
Tank Information
State Tank ID T1 DSL T2 PUL T3 RUL
Facility Tank # or ID (designation used by facility)T1 DSL T2 PUL T3 RUL
Tank Capacity 4714 gal 9816 gal 14975 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-CSLD ATG-CSLD ATG-CSLD
Tank Corrosion protection*FRP-N/A FRP-N/A FRP-N/A
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)*Mechanical Electronic Mechanical
Piping Release Detection Method*NA NA NA
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
Comments
11/11/24, 3:23 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 T1 DSL T2 PUL T3 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?NA Y Y
®14 Does the vapor cap have adequate clearance between the cap and the manhole cover
to enable hook-up?
NA Y Y
®15 Is the vapor cap in good condition with a gasket?NA NA NA
®16 Is the vapor recovery lid painted orange?NA NA NA
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?
Y Y Y
●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
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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 NA Y
®29 Is the mechanical leak detector properly vented? (vent tube not kinked or twisted)Y NA 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?NA NA NA
●40 Are the interstitial sensors functioning according to the manufacturer's specifications?NA NA NA
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
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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?
Y Y Y Y
●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 DSL No Fire Extinguisher Present Within 30 feet From
Dispensing Device.
®51 T2 PUL No Fire Extinguisher Present Within 30 feet From
Dispensing Device.
®51 T3 RUL No Fire Extinguisher Present Within 30 feet From
Dispensing Device.
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:10/07/2024
11/11/24, 3:23 PM UST Annual Compliance
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Automatic Tank Gauge Inspection
ATG 1
ATG 1662
Facility Information
Name:Fast Stop 1128 Certification/Inspection #:55101
Address:33 W 1100 N, Salt Lake, UT, 84054 State ID:3000504
Phone Number:Form Completed By:Larry Vasquez Date:10/07/2024
ATG Console Inspection
Tank Level Monitor Brand :Veeder Root
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 :TLS-350
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):
3.6
Tank Information
Probe and Programing Inspection:
9.Tank # T3 RUL T2 PUL T1
DSL
10.Tank Facility ID T3 RUL T2 PUL T1
DSL
11.Tank # per ATG T3 RUL T2 PUL T1 DSL
12.Product:Unleaded Premium Diesel
13.Tank Volume, gallons 14975 9816 4714
14.Tank Dia/depth, inches 91 91 91
In-Tank Setup Parameters:
15.Thermal coefficient .000700 .000700 .000450
16.ATG Programmed Diameter 91.10 91.10 91
17.Number of points on profile 4 4 4
18.Full volume on profile 14975 9816 4714
11/11/24, 3:24 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
19.After removing the probe from the tank, it has been inspected and any damaged or missing parts
replaced?
Yes Yes Yes
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")1.5 1.5 1.5
24.High water limit (inches)(1.5")2.5 2.5 2.5
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?CSLD CSLD CSLD
33.Tank Test Rate 0.2
34.Test duration (hrs)12 12 12
35.12 months of tank test history present?Yes Yes Yes
Lines:
36.Electronic Line Leak Type NA PLLD NA
37.Line # and label in ATG (Q1, Unleaded)N/A T2 PUL N/A
38.Line Test Rate N/A 3 GPH N/A
39.12 months of line test history present?NA Yes NA
40.Test Result Pass Pass Pass
11/11/24, 3:24 PM ATG
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Automatic Tank Gauge Sensor
ATG 1
Facility Information
Name:Fast Stop 1128 Certification/Inspection #:55099
Address:33 W 1100 N, Salt Lake, UT, 84054 State ID:3000504
Phone Number:Form Completed By:Larry Vasquez Date:10/07/2024
Sensor: #
Brand:Veeder Root Veeder Root Veeder Root Veeder Root Veeder Root
Model:794380-208 794380-208 794380-208 794380-208 794380-208
Type:Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Location:RUL STP PUL STP DSL STP DISP 1-2 DISP 3-4
Test Liquid, Fuel(F) and/or Water(W):W W W W W
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: #
Brand:Veeder Root Veeder Root
11/11/24, 3:24 PM ATG Sensor
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Model:794380-208 794380-208
Type:Non-
discriminating
Non-
discriminating
Location:DISP 5-6 DISP 7-8
Test Liquid, Fuel(F) and/or Water(W):W W
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
Is the sensor alarm circuit operational?Y Y
Has the sensor been inspected and in good operating condition?Y Y
When placed in the test liquid does the sensor trigger an alarm?Y Y
Sensor removed for testing?Y Y
When an alarm is triggered, is the sensor properly identified on the ATG console?Y Y
Sensor returned to proper placement and verified to be functional after testing?Y Y
Any "No" answers above indicates the sensor fails the test.
Test Result Pass Pass
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
11/11/24, 3:24 PM ATG Sensor
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Leak Detector
Facility Information
Name:Fast Stop 1128 Certification/Inspection #:55096
Address:33 W 1100 N, Salt Lake, UT, 84054 State ID:3000504
Phone Number:Form Completed By:Larry Vasquez Date:10/07/2024
Tank Information
Tank #:T1 DSL T2 PUL T3 RUL
Capacity:4714 9816 14975
Product:Diesel Premium Unleaded
Line #:DSL PUL RUL
Line Type:Pressure Pressure Pressure
LD Brand:Red Jacket Veeder Root Red Jacket
LD Model:FX1DV PLLD FX1V
Serial #:0 0 0
Associated Tank:T1 DSL T2 PUL T3 RUL
Resiliency (ml):150 130 200
Check Valve Holding PSI:20 32 29
Opening Time:2 1 3
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 1128 Certification/Inspection #:55100
Address:33 W 1100 N State ID:3000504
Phone Number:Form Completed By:Larry Vasquez Date:10/07/2024
Tank Test Information
Tank #:T1 DSL T2 PUL T3 RUL
Capacity:4714 9816 14975
Product:Diesel Premium Unleaded
Line Test Information
Line #:DSL PUL RUL
LineType:Pressure Pressure Pressure
Line Material:DW Flex DW Flex DW Flex
Line ID Size (in):2 2 2
Line Length (ft):200 200 200
Pump Type:Red Jacket Red Jacket Red Jacket
Associated Tank:T1 DSL T2 PUL T3 RUL
Test Equip. Mfg.:Triangle Triangle Triangle
Test Pressure (PSI):50 50 50
Initial Cyl. Level:200 120 120
Final Cyl. Level:190 90 90
Change in Time (mins):15 15 15
Change in Vol:-10.0000 -30.0000 -30.0000
Change in Temp (F):0 0 0
Coeff. Of Thermal Expansion (g/F):0.00045 0.00070 0.00070
Line Vol (gal):32.62 32.62 32.62
Leak Rate (GPH):-0.0106 -0.0317 -0.0317
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, 3:24 PM Line Test
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