DERR-2024-004862

Underground Storage Tank Inspection Verification Form
Facility ID:0100725
Owner Name:WALMART INC.Facility Name:Walmart Supercenter Fueling Station #1888
Owner Address:2101 SE SIMPLE SAVINGS DR Street Address:1550 N Main St
BENTONVILLE, AR 72716 LOGAN, UT 84321
Operator A:JOHANNA TORRES / [phone] / 12/5/2026 Operator B:JOHANNA TORRES / [phone] / 12/5/2026
Owner Email:[e-mail] UTM Coordinates X/Y:414108 / 4593227
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 11/01/2023 11/01/2023 Yes No 1/8/2024
2 - 3/4 Gas/Diesel Yes 11/01/2023 11/01/2023 Yes No 1/8/2024
3 - 5/6 Gas/Diesel Yes 11/02/2023 11/01/2023 Yes No 1/8/2024
4 - 7/8 Gas/Diesel Yes 11/01/2023 11/01/2023 Yes No 1/8/2024
5 - 9/10 Gas/Diesel Yes 11/01/2023 11/01/2023 Yes No 1/8/2024
6 - 11/12 Gas/Diesel Yes 11/01/2023 11/01/2023 Yes No 1/8/2024
7 - 13/14 Gas/Diesel Yes 11/01/2023 11/01/2023 Yes No 1/8/2024
8 - 15/16 Gas/Diesel Yes 11/01/2023 11/01/2023 Yes No 1/8/2024
Tank ID/Alt ID:1 / 1 EGen/AST/Stat
e:
No / No / No Pipe Material-Mod: -
Siphon/Compart:No / No PVV/StageI:Pipe Type/STP Cont: / No
Tank Status:Currently In Use STP Flex Connectors:
Installed/Cap/Loc:8/3/2023 / 20000 / LLD Model:
Substance Stored:Gasoline / Regular Spill/Overfill/Sm deliv: / / No
Tank Material-Mod:Fiberglass Reinforced Plastic - Double-Walled PST Fund/Other Type:Yes /
ATG: / Tank/Pipe Rel Det:OTHER / OTHER / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:2/9/2024 Overfill Test:2/9/2024
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
Tank ID/Alt ID:2 / 2 EGen/AST/Stat
e:
No / No / No Pipe Material-Mod: -
Siphon/Compart:No / No PVV/StageI:Pipe Type/STP Cont: / No
Tank Status:Currently In Use STP Flex Connectors:
Installed/Cap/Loc:8/3/2023 / 20000 / LLD Model:
Substance Stored:Gasoline / Regular Spill/Overfill/Sm deliv: / / No
Tank Material-Mod:Fiberglass Reinforced Plastic - Double-Walled PST Fund/Other Type:No /
ATG: / Tank/Pipe Rel Det:OTHER / OTHER / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:2/9/2024 Overfill Test:2/9/2024
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
Tank ID/Alt ID:3 / 3a EGen/AST/Stat
e:
No / No / No Pipe Material-Mod: -
Siphon/Compart:No / Yes PVV/StageI:Pipe Type/STP Cont: / No
Tank Status:Currently In Use STP Flex Connectors:
Installed/Cap/Loc:8/3/2023 / 8000 / LLD Model:
Substance Stored:Gasoline / Premium Spill/Overfill/Sm deliv: / / No
Tank Material-Mod:Fiberglass Reinforced Plastic - Double-Walled PST Fund/Other Type:Yes /
ATG: / Tank/Pipe Rel Det:OTHER / OTHER / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:2/9/2024 Overfill Test:2/9/2024
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
Tank ID/Alt ID:4 / 3b EGen/AST/Stat
e:
No / No / No Pipe Material-Mod: -
Siphon/Compart:No / Yes PVV/StageI:Pipe Type/STP Cont: / No
Tank Status:Currently In Use STP Flex Connectors:
2/16/2024 Page 1 of 2
Installed/Cap/Loc:8/3/2023 / 12000 / LLD Model:
Substance Stored:Diesel / Spill/Overfill/Sm deliv: / / No
Tank Material-Mod:Fiberglass Reinforced Plastic - Double-Walled PST Fund/Other Type:Yes /
ATG: / Tank/Pipe Rel Det:OTHER / OTHER / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:2/9/2024 Overfill Test:2/9/2024
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
2/16/2024 Page 2 of 2