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Home My WebLink AboutDERR-2024-012933Location of Tanks 6oenR use l(- tr r.rlh Number of tanks at the Tank lnstallation Date lndicate if tank is siphoned or comoartmented. Show related tanks. lf not in use, qive date last used and depth of product in tank. Current vear tank taos are in Material of construction of tanks containment bucket is intact, clean. and free of Overfill alarm (audible or visible) is orooerlv located so hear or see it. and is clearlv i are sealed, free from water Cathodic Protection Testinq. Date of last te6t: ^/-lmpressed Current System is checked for proper operation at Dates of last three checks: 7 Utan UST Program Release Detection I Checklist all UST system components. ldentify each dispenser by pump number(s)i show ref,dings Drawing North RECEiVilE tPr"^-l N.Arart DIC ,r r0nmSl.ta' Bestir,sr E Comments lndicate below the corrosion protection for the most recent cathodic Utal,JST Program Automatic Tank Gau lnterstitial Monitorin TANK LEAK Tank method used: t I ATG Shutdown Tes Manufacturer, name and model of Yes or No for each tank anv ereeotl-ons to the answers oiven in the first column. 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 for at least one year after work is ATG console or other equipment used to take readings and perform tests is Documentation of valid testing or monitoring is available for the last 12 months. Show results in table below. The probe is located at the lf not in center, show tilt Tilt: #1 #2 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. System is capable of detecting a release of regulated substances from any of the orimarv tankioioino within one month of release Show results of monitoring for each tank for the last 12 months. lndicate Pass, Fail, lnvalid, or No Results for each month. For ATG t6ts, show the level tested tor each month. s60 PIPING LEAK DETECTION tr Piping qualifies as Safe Suction. Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, has only one check valve (under pump), and has proper slope of piping. lf all these criteria are met, no leak detection is required on the piping. Piping method(s) used. Pressurized piping must have an Automatic Line Leak Detector and one other form of leak detection. El Automatic Line Leak Detector Tank 1 Tank 2 Tank 3 Tank 4 @e o EE o 9 E o @e o ^N ornrn Evtt,,l^f\1nin P{x\, e a p + s{).2 .t sfA.z .t sgp.z.t s1.@.2 .t Tester name:Cert. Number UT ^> /-d Test Method:........: Type (Mechanical, Electronic, Other): Manufacturer and model ofeach leak detector:g Date of last leak detector performance test lndicate type of test:Simulated L tq Hsrr" as above Tester name:- Cert. N,,mber UT Test Method: lh '^ tr Monthly monitoring. lndicate the method used: tr .2 GPH Monthly Testing ! lnterstitial Monitoring. Type of lM Documentation: tr SIR n GW Monitoring n Vapor Monitoring for the last 12 months. lndicate COMMENTS Distribution: Whit R, Yellow-lnsp6tor, Pink- Facility/Owner Ldatgim12os.doc {.) U i UST Program Release Detection lnspection Ghecklist Facility lD l1-o Uit y PaEe I ot ?- Ownershlo of Tanks Locatlon of Tanks 5}fteaaUreontv ownerr.ra,ie f\h^J ltt rrl"Ylq,&,r n(^.LocationName M;^; M^tt E* Address llr> t-b }L*t Address ,tr,c l;- ,-B \Nnr? citv o ^r!*- state ()T: zio * LlYav City O*'Lfo state UT- zio y\netY contact L]\.*- /^ociL pno\Eo',/>a t -v,2*contact Lilt-n ,, UEsi{- ,n.k?ll tLt .- a./ \e Complete for each tCrk. ll the laclllty has more than four tanks, complde the lnlormatlon fdr addltlonCtanks on a s€oarde fdm. Number of tanks at the facilitv:Tank 1 Tank 2 Tank 3 Tank 4 Tank lnstallation Date \ltr/*t c lrr/*q l,</r'z 1/,-r-[*> Capacitv of Tank (in qallons)t?-k rr,k /k 6i< lndicate if tank is siohoned or comoartmented. Show related tanks. U Lts Substance Stored tr^0 b F."-c l),'z Tank is in use-z/AJ No G,l No Grt No db) No lf not in use- oive date last used and deoth of oroduct in tank. N A Current vear tank taqs are in place..6r ) ruo zrG) ruo R.) No (GN No Material of construction of tanks \l-t€l sl<-./gk&5kt,9 Material of construction of oioino €R P f:R P i=/Q f t=4 P Pioino tvoe pl't9lLa<-pttt9vf I Ft ru<D^QS5u./a Tvpe of Spill Prevention device f sa-l fq*t ?oa,)fe"L Spill containment bucket is intact, clean, and free of product, water, debris As9 No G) No Geht '' tto Ce5; No Tvoe of Overfill Prevention device nst 49,,/+9 O ft9t, Overfill alarm (audible or visible) is orooerlv located so deliverv driver can hear or see it. and is clearlv identified.Yes No d7A-) Containment sumps are sealed, free from water, product, etc.G) ruo N/A The results of the last two cathodic protection tests are available (within six months of rnstallatio,n anfu>very three vears,theraafter).Yes No N/A CathodicProtectionTestino. Dateoflasttest: *:i.k - n,g r""t", ",:lz(';UE:{7 ' <e'\ cx"v UT OILlY lmpressed Current System is checked for proper operation at least every 60 days and the results ofthe last three checks are available.Yes No N/A Dates of last three checks: \J-,i j , io-l - o: lndicate below the corrosion protection methods in place for all UST system each dispenser by pump numbe(s). Show readings 4 ,{l" for the most recent cathodic Commenls Rf€\ Ht *.P*h'-'r'$t' ffi, @t ry,} UST Program Automatic Tank lnterstitial Monitori tD lV oU 1\ LEAK DETECTION (9Lt> Tank method used: t I ATG Shutdown T Testinq I llnterstitial Monitori Manufacturer, name and model of Yes or No for each column. exolain and identifu bv tank anv exceotions to the answers oiven in the first column. of lM Documentation used: 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 for at least one year after work is ATG console or other equipment used to take readings and perform tests is Documentation of valid testing or monitoring is available for the last 12 The probe is located at the center of the tank. lf not in center, show tilt Tilt: #1 #2 #3 #4 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 Third Partv Minimum Level: System is capable of detecting a release of regulated substances from any ioino within one month of release ffieachtankforthelast12months.lndicatePass,Fail,lnvalid,orNoResultsforeachmonth.ForATGtests,showthe PIPING LEAK DETECTION n piping qualifies as Safe Suction. Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, has only one check valve (uncler pump), and has proper slope of piping. lf all these criteria are met, no leak detection is required on the piping. N lA piping method(s) used. Pressurized piping must have an Automatic Line Leak Detector 7lF fr Automatic Line Leak Detector Type (Mechanical, Electronic, Other): Manufacturer and model ofeach leak detector: Date of last leak detector performance test:Results: lndicate type of test: simulated Leak, 3 gph, .2 gph, .1 gph (3, .2, .1- electronic LLD only) Tester name:Cert. Number UT and one other ,etecilon. Tank 1 fank2 Tank 3 Tank 4 trDe o 6le o Ci-ze o Ga-lE o (J Fxr ''z /\J F)</U XJ FXlV .\{ FRl v sI 3.2.1 sL3.2.t s1 3.2.1 s1 3.2.1 Test Method: Date of last line tightness test:,t Results: Cert. Number UTI Same as above Tester name:Test Method: tr Monthly monitoring. lndicate the method used: tr .2 GPH Monthly Testing tr SIR E lnterstitial Monitoring. n GW Monitoring Type of lM Documentation: fl Vapor Monitoring DiStribUtion:White.DERR,YellowLdatgim,1205.doc JON M. HUNTSMAN, JR. Governor GARY HERBERT Lieutenant Governor .\, State of Utah Department of Environmental Quality Dianne R Nielson, Ph.D. Execative Director DTVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION Brad T Johnson Director Apil20,2005 L. Jerry Cassity Mini Mart Inc Of Ogden ll77 t2thst Ogden, UT 84404 Re:Non-compliance of underground storage tank(s). Mini Mart #7 located at7l0 S Washington Ave, Ogden, Utah; Mini Mart #8 located at 1015 E. l2th St, Ogden, Utah Facility Identification No. 12001 12 and 1200334. The Utah Underground Storage Tank (UST) Act provides that the Executive Secretary (UST) may revoke a Certificate of Compliance if it is determined that a facility is not in substantial compliance with all state and federal UST statutes, rules and regulations. At the request of the Executive Secretary (UST), the Division of Environmental Response and Remediation (DERR) performed a compliance review for the underground storage tanks at the above facility. The compliance review, performed on April 19,2005, indicates you have not satisfied the requirements of the Act and are out of compliance. To achieve compliance you must do the following: l. Facility # 1200112 (USTs # 1,3,4,5) Submit documentation to show that you have had a qualified cathodic protection tester test your cathodic protection system within the last three years. Due to 2004 UST rule changes all cathodic testing must be performed by a State of Utah certified tester utilizing DERR approved testing criteria. 168 North 1950 West. PO Box 144840. Salt l^ake City, UT 841 14-4840. phone (801) 536-4100 . fax (801) 359-8853 T.D.D. (801 ) 536441 4 . www.deq.utah.gov ^ -it*" 2. Facility # 1200334 (USTs # 1,2,3,4) Submit cathodic test results for this facility which have recently been completed but were not available on-site during the inspection. The above information must be submitted to this office by May 31,2005. Please fan or mail the required information along with a copy of this letter. If it is not received by the date specified, we will comme,nce the revocation process of your Certificate of Compliance. If you have questions concerning this matter or need any assistance, please contact Victor Scherer at (801) 536-4240. fifl H#,;i.J.;; . : ' _- Ownership of Tanks ".fficetiG ffiii:.l.::..,i;: ffi owner Name MlNl MART INC OF OGDEN Location Ns,1s MlNl MART #8 Address 1177 12fH Sf Address 1015 E 12TH ST 6i1y OGDEN StateUT 7i6 84404 g;W OGDEN State UT 7is84054 Contact L.JERRY cASStrY Phone Contact scott cook Phone Tank Number:2 3 4 Tank lnstallation Date 9t1511987 9t15t1987 9t15t',t987 9t',t5t1987 Caoacitv of Tank (in oallons)1 2000 't 2000 6000 6000 lndicate if tank is siphoned or compartmented. Show related tanks.IJ L)t\) 0 Al c)t\) 1) Substance Stored lrNvGasoline t) Gasotine g(({1}asoline Diesel Tank is in use.Currently in Use _Currently in Use _Currently in Use _Currently in UseNf< inritt INK ltJklf not in use. qive date last used and depth of product in tank. ,AI Current vear tank taos are in olace.7- n .-Au>L- f -f>\4.t,0 Material of construction of tanks lmprdtsed Current Ca lmpressed Current Ca lmpreBsed Current C€lmpressed Curent Ca Material of construction of oioinq Fiberglass Reinforced Fiberglass Reinforced Fiberglass Reinforced Fiberglass Reinforced Pipinq type Pressurized Pressurized Pressurized Pressurized Type of Spill Prevention device. Note on form if tank is filled by transfers of less than 25 oallons. lf so. no soill orevention is required.4r:r*90 n 7r^1,!,r-.,Itr-^Llt-€,,, ^il-tt) Spill containment bucket is clean, dry, and free of product, !{A!e! q9!!s'(vd{ No ,ei ) No YeC./" No ivlY No Type of Overfill Prevention device. Note on form if tank is filled by transfers of less than 25 gallons. lf so, no overfill prevention is required'k<*)'{+b t*o KQo lf an overfill alarm is the primary overfill device: Alarm is located where it can be seen and heard. and alarm is clearly marked.Yes No Yes No Yes No Yes No rhin,kri iliin; Arls €f,rllle:follotrr.iir!*;tdrall::1f,iijlts,, Corrosion Protection method used on tanks I (-fc TC Corrosion Protection method used on pipinq ,\ )tA./,A liAl,,t, I \A./,lJVlu Corrosion Protection method used on flex connectors, swing joints, etc..^(H"#t Jriffi)!" ,S"?'H -rc ?iAt di=o.n."r., [ft1,r t Loilt+'l - f e,P Enclosed containment sumps at tanks and dispensers At tanks: Yes ( f.fo)At drsoensers: t - tt V;; "Zh"a Containment sumos are sealed. free from water, product, etc.yes No AJ N=.--- Indicate dates of uoorades- lininq, tank or piping cathodic protection l*titilri, Shon,,ttrld1tiii6uh*o&tli$:ltiestrdillirittE*$fi$tirBaefl.tar The results of the last two cathodic protection tests are available (within six months of installation and every three yea.rs thereafter).€"\ No Tank Tester t$.:-; .:n 5' ie r P.rrgwr Date volts volts volts volts Pioino rester t\)M I FR-D lN{ Date volts volts volts volts Flex Gonnectorsl swing .loints (!o\i(vtc tn e\trr Ar t"nk)- Tester p61s NPV Ewr,t\rot\ep Ardispenser volis volts volts volts volts volts volts volts ;for lmpressed Current Systems: The results of the last three equipment'ooeration checks are available (required every 60 days).ves\ ruo rtr tr tr ) Emergency generator tanks only, leak detection USTs temporarily closed and empty; leak detection not required Site Drawing (North tft , X (2ar St *[ il-*.In" l:/ oq {r STo 125 usrs temSllll closed, locked and secured. CDi teA \ l.wo)"> * i ?ftfn''J va,ar^ Cr<,.rk'b1t - 1 q t - 3 G ).9 -Itah UST Program Tank and Piping Leak Detection Facili$r lD 1200334 tr/etrod *"0 f, t'an'rs:ATG NIetfDd used for pipirp: ALD LTT lrrhrufadurer,nanBandnDdel nunberof system veederRoor rls-3so u:) CSUD System3dpartycert.rraaor/ZJr,n CirdeYesorlSforeachquestion. lnthelatcolumn,expldnandidentifytrytankanyexceptionstotheanswerinthef,rs Mumn. -Ari Rcords onsite docunent that the systemis propery installed, calibrated, and naintained (systern and tank setu p reoorts, nBintenance recorG ).Q\* ttd rur Dv ice docurrBntstion b available on-s ite (ow ner's nant.a l, etc. )VXM hnr ftuipnent rced to acqdre data, tale redings, perform test is adequate, accessible and f Lnctioral. lrcl. ATG corsole, dipstick, etc.Q' I{o V/-r:\ Dcunentation of valid testing or nonitoring is available for the bst 12 nnnhs. Show bstino or nmitorhq results in qrid below.GNo Adt\"lhe probe is located atthe center cf the hnk. lf not, the tilt corredion factorfor each hnk is shown on the tark setuo remrt. $"J r.ro t9 Ihe tank w as f illed to at leastthe nhinumlevd reqdred by the nanufacturer's 3quipnent potocol to ensure a vald leaktest and the tanksLe is w ithin the allowed roerand loru er size lirits.GNo cstA 6% IM Sec{fuqy barrier is proper} placed ard corstructed, designed forgw mnsiftr\s, lns an acceptable perneation rate, is conpatide w itr the substance stored, is ncrNQonodiUe, and is nd in the 25-yr f loodplain (per site assessnent). Yes f{o C MTG SIR hvenbry readin$*[or prodrct inprts ard w ithdrawals are properly obtained ard recorded. Fbadirgs\e properly reconciled.Yes M CSR Rcords include tre prlqr nrnber of water readirps, ard w ater readings are used to diust inventorv balances )s necessarv.Yes M C MTG SIR An appropriate tank calbratia{t rfla used and is avaihbb fs revierv.Yes M CSR Dsoersers have current calbration st)bkers or orooer calibratbn docunBntation.Yes M CSR Dop trbes are present and e"rtend to vntl rlr ore f oA of the tank bottom Yes Nlo Shorv results of monitorinqforeachtankforthe last12months. lndicate pass.fail.noresults.orinconclusive. tttloffr 5/04 6/04 7t04 8/04 9/04 10t04 't1to4 12t04 1/05 2t05 3/05 4/05 #l tns<)hs<\ns:ljrss DftS1 ifi ss )ts:tJnss DAS5 0As<Pnss DftS< *\Dhss Qns5 QNS aA:r,Q[\-::0Ass Qhs )hss )A5 p\=s Dnss D \-.-.,..,*i PH€t QNS:QN6'\r>{}\s<QNSS Ons<ti\s5 phss QASS ONSS OASS Q nss*tL Dl\r(Qtr6:Qh$klhtr )Nt6 ]\SS l),\3i 0flsa \),51 oA<<a'ff(D A.r< Tank lnd Line Tightness Testing, Line Led< tbtector Testing:Tank I Tank 2 Tard< 3 Tank 4 Date of lat tishtness test f or tanks: trilA I t:rff,--Test results Mne and certf icatim nunber d tester:Test ltnethod: Dateof lattiqhtnesstestforoiohq: '1 -A9- O9 qt IOOOG Testresutts Pnss D ns\,0rus.s 0nsc Mne and certlication nunber cf tester: Ro." SO{f x\,6 o;n Of OOO (> Test trrbthod: HCa rut R -? yX-lr nf, --) Aubnptic Line Leak Detector tvre and nndd ttYt € C lr,att rcrJ K'\ --'4z*n F\I -a4oe KY 4rG 01 l\J / -fn t oo0 Dateof lat leakdetector pefornancetest: 1- D1- OL+ i'tf ooo (o Test results Dhs<oAss QASs Qh(< Safe Suction piring: Docunentation is available and verif iabb to show tlnt piping operates at less than u,*rrrffi pressure, has only me check valve (under punp), and has propa slope of piping. t 'V+/Yes tb Y.Am,l O f )J',',\lilJbA CSIA Jo V .,.)-T7-( - 35cOonnBnb *Lb I,uJe & U11,6-t +o Lu-ltq- Chc.*1-", \-\ run} ",'l- Utah UST Program Release Detection lnspection Checklist Complete lf the facllity has more than 4 tanks, complete the lnformaiion for addlildnal tanks on a separate torm. Number of tanks at facility: Capacity of tank (in gallons) lndicate if tank is siphoned or compartmented. Show related tanks. Tank is in use (Yes / No). lf not in use, give date last used lf not in use, depth of product in tank (in inches) Answorthe following for all tanks. Note any exceptions ln the last column. Current year tank tags are in place Material of construction of tanks Material of construction of piping less than 25 oallons. lf so, no overfill prevention is it can be seen and heard, and alarm is clearlv marked Corrosion Protectlon. Answer the lollowlng for all tanks. Note any exceptlons In the last column. Corrosion Protection method used on tanks Corrosion Protection method used on piping Corrosion Protection method used on flex connectors Enclosed containment sumps at tanks (subpump) and dispensers lndicate dates of upgrades- lining, tank or piping cathodic protection. Cathodic Protection Testing. Show the results of the most rccent test lor each tank, llne, or llex connector. results of the last two cathodic 6 months of installation and every 3 a SubPumP -16l- niqnanscr Pase I ot U -D3 3 Distribution Ldcheck.wpd r€v0902 Utah UST Program Tank and, Piping Leak Detection Facility lD Method used for tanks: Manufacturer. name and model number of 7ZS =o 3'o oartv cert. available Yes No Circle Yes or No lor each question. ln the last column. exDlain and identifu bv tank to the answer in the first eolumn. Records on site document that the syslem is properly installed, calibrated, and and tank setuo reooris. maintenance Device documentation is available on-site (owner's manual. etc. Equipment used to acquire data, take readings, perform test is adequate, accessible and Iunctional. lnclude ATG console. diDstick. etc. Documentation of valid testing or monitoring is available for the last 12 months. Show The probe is located ai the center of the tank, or, if not in the center, show the tilt factor for each lank from the tank Tilt Factors: #1 #2 #3 The tank was filled to at least the minimum level required by the manufacturer's equipment protocol to ensure a valid leak test, and the tank size is within the allowed Secondary barrier is properly placed and constructed, designed for groundwater considerations, has an acceptable permeation rate, is compatible with the substance stored, is non-corrodible, and is not in the 25-vr flood lnventory readings for product inputs and withdrawals are properly obtained and Records include the proper number of water readings, and water readings are used to An appropriate tank calibration charl is used and is available for review have current calibration stickers or oroper calibration documentation. and extend to within one foot of the tank bottom. No lnvalid (ATG) or lnconclusive and Line Tightness Testing, Line Leak Detector Tesiing: Date of last tiohtness test for tanks: Name and certification number of tester: Name and certification number of tester: ' '/ - 5O - A L Automatic Llne Leak Detectors. lndicate type and model number for each leak detector.h. il.{ Date of last leak detector oerformance test: '/ -5 a - Safe Suction piping: Documentation is available anU verifiable to show that piping operates at less than atmospheric pressure, has onlv one check valve (under oumo). and has orooer slope of oioino. J,-- lZsf Distribution: White-Ldall.wpd rev0302 PRECISION TEBT]NG John Labrum Ptrr:ision Trl/ikg Teefintrl ogi w, lno I I119 Sanily Gulc'lt Rotd Sandy, Ul'8409,t Nll-"t9s-2M6 Ntl-576-9925 lux aor.57Bss25 OS r'18/BS OB r 6Eem P . IAAB Certification Dafce: 07130107 Facility ID: Mini lvlart Inc. 1015 Eaqt 12 Street Ogden, UT l'est Date: 91123!lL Test Nurnher: 072302-l R Operator: Robert Labrum Iltah Ccrtificate No.: UT0269 Prtssurized Product Lines The abo'e location has been testerj using the Horncr|il Pipline't'ester. This pipelinc lEak detection systcm meets all requirements set forth by NFPA 329-87 and I-ISEPA 40 CtR Part 2E0 and lras receivod third party certification' Plc,asc see the encloscd Third Party cerlificatirn for details. Linc [,eek Dst$torc l,he mechanicsl lirrc lcak clelectors at thc ahlvu krcatron werc testcd in accordonce with IISEPA 40 CFR 280.a4(a). ffihffi -Functbnal unhurtql sqr"r Red JackctFXlV I t6-056 Functhnal tjnhuded Prefir, Red Jackcffxlv 116"056 FunctiOnal Dicscl Voporl ccrtificdrostcr,ffi John Labrum Precisian Testing Specialist - I l"l9 fi**$v {ixtuh {toud ,l'*urrJi'. f )7' llJflsj ,t#i-J95-3fi{J4 It$ l--i "rr- 99f 5 l*s Dale; A7i30102 FacilitylD: Mini Mart Inc- l0l5 East 12 Street Ogden, UT RECEIVED !,'l 1?S02 DEO :nrirnni"l't qes0onse & R0l[06itltil Certification kunzt / RECEIVED sEP I | 2092 DEO Envlmnmonhl Response & f,emadhflon Test Date: 07D3102 Test Number: 072302-lR Operator: Robe* Labmm Utatr Certificate No.: UT0269 Pnessurized Product Li nes The above location has been tested using the f{rrmrcrr'" Pipelfoie Tester. This pipelirn leak detection system meets all rquirements set forth by NFPA 32y87 aod USEPA 40 CFR Part 280 and has received third party certification Please see the enclosed Third Party Certificatbn for details. Unleaded Reg. Unleaded Plus Unleaded Prem. Diesel Tokheim Tokhim Toktreim Toliteim 50 50 50 50 psi psi psi .000 .000 .000 .000 Pass Pass Pass Pass Line Leak Detectors The mechanical line leak detectors at ttre above locationwere tested in accordarrce withUSEPA 40 CFR 280.r$4(a). Unleaded Reg. LTnleaded Super rr--l--J-J n..--^tjilrcaucu rrclll Diesel Red Jacket FXIV Red Jacket FX1V Red Jacket FXIY llG,056 11G0s6 I lo.UJo LD 2000 Functiooei Functional Furctioaal Functionalv Certified Tester: i tzoa\/ CATHODIC PROTECTION RECTIFIER MAINTENAI{CE Customer Location: lllini Mart 1015 East 12u Street OgderU Utah Location of Rectitier Unit: Outside building SW corner Type of Rectilier Unifi TaP Adjust Number of Anodes: TYPe of Anode: Type of Ground Bed: Distributd Surfrce Location: Tank Perimeter Recffier Manufectured by: Benchmrk Modek bps-ssr Serial #: 9805217 Rectifier AC Inpuft 120 V 6.86 A Phse I 60 Hz Rectifier DC Outpufi 48 V 12 A Shunt: 50mv-15a :.8mv Installation l)ate: Comments: Hours = 29153.0 RECEIVED s[p I 1 2002 DEO Envlronmentat nlsoonse & netttediali6ll I A-2 4.88 .24 081302 labrum 3 Yr. CP Survey 2 3 4 5 6 7 8 9 t0 ll t2 l3 l4 l5 ^ {N\t\ I ._ . : {u -G l t:65 oGI .o a 6f r r tr 6 = Hr tr Et s Es r =. E :* g& E g: ll ) E t- . b 9 !c EE ! .A = N+ EE c) 9E o E- 2^ H? 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Silndt' (i*{th Roild .lirrirJr'" tj l" #Jf/{.J ,$iJl-J95-ffi/lar ,fsJi -5 7tr,,9{ai i fir-s Mini-lvlart 1015 East 126 Street Ogden, Utatr Irryressed Curent Cathodic ProtectbnTest, sitemp and test locations. This map is not to scale. &.Cettr 0aP. I 1n, i'le 'a Ne . tcrc? DttP- € :i :i: ,;ligi, r \?00#q ilF,r,l"E * E* ?Erf iw a?. 200t 4loo fl rtt-^nLLEl $fr:fl.%ffi'sl-392-261I l.h$ 3r: 2oot atoo ,r I.EAA t'EgT TEPOI|, , I l:Ett! PROP SEnldL r{rt (E9lt9 IE T BIAPTTX} iIErmY 2?. 200t i am s ffiHffi31.s.8:?& LEAI( IEB? NEEI.IE ,0.2o cal/rc tlst PE 'r. 2(!! arOO s t!g? tEom I nLaDED I-Elt{. ilrt omero r JlL 30. 2@L asGarf LEAI 1t'? EOIG..: hlisi&,*,.r, *io, trET sr*tllal lt]!] ' - JrL 0. aItD. l3rffi'. ',.-.. 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VOLGE ' 2571.8 eL ?[.H,FH?* ' rrrrtElOtritr i ffi ffiI:gcd:gE LElq( EBl nE8.Crs.o.a (nu}n 1lll DeE ftq#Hn+:,l:"i_f JE 30. aol .!oo dih Hilffi,MEOI-394-2al I JU. ar. 200t a3alt nr LEIX ?E XTDOD. ?.:DIEE. tBo8e sEtta. illt ocIIIt TEgt E Atrtfo ?UG!Jr.[- 30. 20ot I :o f,t TEBI LEXrlx -. 3-o EsTIl? vOLu! - 20Et:a oA. LEAX T8E? IESU.TBo.20 ce!/rc rEEi E rrrrtElOtrrrt tc70 +srr.*fltibr{i ' oz,ifrt asGn-"' lraf ilrt loill-* . " i.t ? I:DtE .. nol gtn|. il.rr Eltr: fl ffi;"-r cst l,ElGttl - 0.0 lf,A Stf,lI t,OLlrG - 4?iO.8 GA.. LEAa IEBT nEBI.T&" " -o-20 ryR tEgt PAA ffi l.o.t:g EE ffiffiIrn.o8:3ffi if.[#h;** EI.E ffiS ps J , I*otg,H,* il,, oeJ26 a 3sPf,tsrii.i,i-nl.c t. 200L 41oO *l :.;.q'^5rr I ffi',il^lIlf IIEE'*, ;,*^*JC1d " i#,Eu;ffi,PnI ocT t4, 2oot 4:oo A}l LEfl( TE T REPORT T t :pltig PPOSE SEnIAL NtSt o8ol99 Ift.Jil;^r ! ftL5 "':^ I,ffihHp\&'I t€\, I. 2@t .:o fr. i I.r X tttf rDqr I tr J,iF&r". iln oG* I IF*lsti" ilEL I ffiffiffit.or8:8ffi Lff5o@fiFffir.o .IIITIEtllDTIII. LEAX TEBT RE'{'rrI It C:unLeADEo I PROBE SENIAL Nt}I O832ICI TEET STARTI]G TII.1E:ocT la. 200t t!00 dl TEST l.EtGtH . 3.0 HRA sTRf, VoLU.rE . 648tt.6 GAtr ITAI( TEST REB1JL1E - 0.20 GAL./HR TESir Pn88 /....rENDrrrrr /* rrrr REponr \ T 3:PREtttlt \ PROBE'SERIAL XLH OESEO6I TETIT STARTING TIHE:&t t4. zoot r !o0 01 gffiT 15ffi t..,1:8 8E LEAX TEST RESI.,LTS0.20 cAL,/Hn TESf pAeS GilG""^il:;'.;I I#,iB'SE"%. ,* or.rlu H,::gUr IISEL SFI t5ffiE .. ,,,i:f ,ffi :TTPS1*:PA'*..- ffiffi:!!ol:gg[ tft tl rtIF;. .- . 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H.gTlE;li" I!ffiL ffirtffi..rori:g& ?5oH_FsF,,- ..rr.ElErrrrr ffiilgu;-*sEE:F '-D--- -' F' ir Iocto \ - STOP IN.TANK LEhI( TEBTT 3lPRElfltlt JAN 31, 2OO2 4:00 *l Sc"n TRI -VALLE/IOI5 IzTH STREET oGDEN. UT. 84404 801 -392-281 r JAN 31, 2002 4:00 A.l LEAK TEST REPORT T 33PRE}TIU}T PROBE SERIAL NI,J}I 083206 iHlilffir* JAN 3t, 2oo2 4:OO Ar.r LEAX TEST REPORT i-S,ig'Effit* Nulr o'o2os 1ffi.?l^E66!" IIBE'* $FFI i5ffifr! t.,,f:g ffi til5o'Efl,.g*ttfE3F ,*I,. I(ITENDITIII B il16ltf IIELIt ,,-!m;Tffir,r@ i8 22. ASel*$OO At, LEAX TEST REPORT I*6iE &,"r Nrr.r oB3ree TH"il^ET[!" IIEE'* ffi.?T E[[Lo TIBE'* 3ffi UEitrE ].,r8:8 gH LEAT TEET NESULIB rEsT LETETH - 9.0 HRS 0.20 cAt./HR TEBT PABS STRT vOLt'18 ' 2844.1 GAL T 2:UNLEADED PROBE SERIAL NtIt O832IO , HHffile.,!:iHE FPffi:- ;ffi',rlHBH ter1! ?. . * ,. aOOa trOn \tlt-T/ilIEY H#ff;ffi, I r{a l. 2@ ar8,'r. ,( t o3letG ir8?oisEi*,LEAX TErr JAN 3t. 2002 4:00 API IEET ETARTIIS TII.TE: I FEB 22, 2002 l:00 A.ri I TESf LEEIH - 3.0 HRSgTnr voltrlE - 9208.8 GAL LEAK TEEf, NESULIE0.20 GAL./Hi TEBT PASS T 3:PRE!,ilu.| PNOBE BERIAL Nt.}t 083206 LEAX TEST RESULTB _9_€0, g3l/.8 rEEIr PAss I#iE'#* N$r o's2os IH'rEllEAI' IIBE'*' I gFff $titrE I .u.8:8 EIi HIoHr-[FfSf ,^* IIIXIENDTxIxx fflInf;ltrIlE#l tEEt Emfl{ - t,O HntBtR? rroLua . 80-.e d- l,BI tElr tanti0,4 OrLl. tlrt ,.!. relt lrcrrriirrg -.1'...r l.:ua. tlo.'*- Imffi3:rr,*!& BbEffiS,,* IB".?'I^EEAf II[E'* \ TEST LETSTH - 3.0 HRSSTRt vOLtUE - 3945.8 GAL ffi+ffi:im., ren r. zooz fitd rsnx tEr nEorr 1 I"3i3t#t* r,r o.&Isr { m"mu"llm'* Ji imwmr.,o3:BE, ' iSii.qE-ff*+- 3^n \flo f??rlEo* LEAK rEr JAN 31. 2oo2 4:OO A.r TRI -VALLET IOI5 I2TH STREETOGDEN, UT. A44O'801 -392-281 I JAN 31, 2002 4:00 Alt LEAX TEgf REPORT T I:PLI.B PRoBE SERIAL [t]l 083199 TEST TArrrThE TII{E: JAN 31. 2002 I :OO Alt gffi tEffiE I orr?:t EE 'Bl[,H.,[Fiffi,^* LEAX TEBT RESTJLTS-6.20 cAL/HE TEEtr PAEa rxrrrEilDxrrllt I 3lfl?sii{f,iHl 'fl,T Hriltil;i,* JAN 3t, 2oo2 4!00 A|' ' EAK TEBT REPORT I'6d!-5H?El Nu.r osszro ]Efi"?I^E66IO IIBE'.,, 3FFI i6i8ilE I .,.1:g EIi T5o'HL[Ff!3i,^o it I ?rgirl5ltr r-slx rEsr JAN 3t, 2002 4,OO s, TRI-VALLEY T eEiEuil!!,iHlffi ,^n a,. ,oo, 43oO A,t LEAX TEST REPORT ffi rta t. 20qt ar@ At"r&r flrr rDollt- -. I*iF&r*, rri o.r!, TRI -VALLEY IOIS IzTH STREET OGDEN, UT. 84404801-392-281t APR 26. 200! 4:00 A|1 LEAK TESTT REPORT T I tPlr.ts PROBE SERIAL NI..}l 083199 TEST STARTII$ TIME: APR ?6, 200? l:00 r\ll rRr-vALLF/ tWD IOI5 IzTH, STREET OGDEN. UT. 9440.1 80t -392-2Sl I APR ?6. 2002 4:00 At"l LEAX TEEIT REP9RT T 2IUNLEADED PROBE SERIAL NI.FI O832IO TEST STARTTts TIME:APR 25, 2002 i:00 r+.r SFiT iEiSIE I ,,.8:g 8ffi LEAX TEST *'S,,,"A0.20 GAL./HR rSSi nnssr) X I I I I END x ,\T- ii LEAI( TEstr 4!00 Am lnt-v{,Le,IOIS IZrl{ BTREEI':, oGDEI. r.tT. e440c ; mv i zooz oroo s+ i ., LFnI( TEET NEPORT ::] T 4IDIEEI:. PttoEE sEnIA[, Nlrt o8g20c 'r,i TEr SrAnTnG ltlrE:-mY 9. 2oatil l:oo nfi-..,t . 1. a.-a APR 26. ?oo2 4:OO ,+t LEr|X TEST REPOBT I-8dE-Si!X,. Nrlr o.sao6 Itr EI^E[6!'IIEE'* LEAI( 4:00 Alf k?n,( I.,flhll;llrx LEAK rEsr hDr36. 2002 4too Ar{ TEST LEI.(iTH . S.O ,dn STRT VOLI..F1E . 509?.II GAL i ..A' LEAK TEST nrsulrs/ 5. O.2O GAL.TIR TESI PASS \ ,x.x?eulrrV to"loTRI-VALLEY . 1 IOI5 IzTH STREET OGDEN. UT. 84404 801 -392-281 I APR 26, 200? 4:00 Ar.t LEAK TEST REPORT T 4:DIESEL PROBE SERIAL NW 083205 TEST STARTING TIME,APR 26, 2002 I !00 A"l IFFT ioi8il! I goug:8 EIE EAK TEsr RssuLrs-4.0.20 GALzHR fesf[ p,rss \ ii.xxENDrx;/ I ,I I I iEis;ffip#D lr t'N4 ffoH,FlS,* *trllElorrarr lffi iSISE t,o,18:8 EIi t . zguz. {:00 Ar?; IETIBOE|E. .' Sti5ffi,ff',oo.*,t LEAI( TEAT REEIJLTg O.2O GAI../HN TEET PAEA, r r r r i El{t r r r *r .,ffi[Fk{,h r r r END ,i .\*/ -ffii&-;:H*.. rht 9. 2OO? ...@ *,I umr ragr nEDonr . ' , t 3:PnBtrt.r.r JiPROE sEnt{- Nlrl o€3zue Michael O. Leavitt Governor Dianne R. Nielson, Ph.D. Executive Director Kent P. Gray Director -..i - !t 4r . a 1-. ;-f,,:t;:::tusffiI&sug4'r-; .&E. ! &a M ;; ltESnn l 4 :- L u.ii{, -"/ t.tau"%. q-' . r DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION 168 North 1950 West P.O. Box 1214840 Salt Lake Ciry, Utah 84114-4840 (801) s36-4100 (801) 359-8853 Fax (801) 536-4414 T.D.D. www.deq.state.ut.us Ju,ly 16,2002 TO: L. JERRY CASSITY IVIINI MART INC II77 I}TH ST OGDEN, UTAH 84404 Underground Storage Tank Section Gary A. Harris Etrvircmntal ScieDtist RE: Non-compliance of underground storage tanks at MINI MART, OGDEN Facility I.D. # 1200334 The inspection performed on 6-24-02 , indicates that you have not satisfied the State Rules and Regulations for underground storage tanks. To achieve compliance you must do the following: 1. Submit a copy of a line tightness test for all product lines. (Lines need to be tested every year) 2. Submit a copy of a function test on all automatic line leak detectors. (Leak detectors need to be tested every year) 3. Submit documentation that the Automatic Tank Gauging (ATG) system performed a monthly leak test for TIIE PAST YEAR (ATG should go into test mode once a month) 4. Submit a copy of you Corrosion Tests for your USTs. (Last test was conducted in 1998) Test should be conducted every 3 years. Submit the above required information to this office by 15 SEP 2002 . If it is not received by this date we will start the process to revoke your Certificate of Compliance. If you have questions concerning this matter or need assistance, please contact Gary Harris at (801) s36-4160 Utah UST Program Release Detection lnspection Checklist Location of Tanks . State UT Zifrfvc i Phone 31.;z Complete for each taftk lf tacitityhas more than 4 tanks, complete informatlon for addltlonA tanks o/separate form. Number of tanks at facility: Capacity of tank (in gallons) Tank is in use (Y) or, if not in use, give date last used lf not in use, depth of product in tank (in inches) Answer the lollowing tor all tanks. Noto any excepllom ln tho fd.dirlumn Current year tank tags are in place Material of construction of tanks (steel, FRP, composite, etc.) Material of construction ol piping (steel, FRP, flex plastic, etc.) Piping type (pressure, safe/US suction, gravity, etc.) ype ol spill Prevention Devace(sEjel'A5.gal, cont. sump, etc. alarm: Alarm is located where it can be seen Corrosion Protection. Answer the lollowlng lor all tanks. Note any exceptlons ln the last column. Method used on tanks (NM, CS, lL, lC, SA, NP) Method used on piping (NM, CS, lC, SA, NP) Method used on llex connectors (8, CS, NC, CP, NM, NP, N/A) Enclosed containment sumps at tanks (subpump) and dispensers lndicate dates of upgrades- linlng, tank or piping cathodic protection. Cathodic Protectlon Testing Complete for each tank. 6 months of installation and Tank Tester Date Flex Connectors subpump Tester Date d 2Y- /-Lthat I inspected the above-named lacilitv on z/-o u Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner Ldcheck.wpd rev070 l , ' Utah,U$T Pragram , Tank and Piping Leak Detection Fecillty lD Method used for tanks: Manufacturer. name and model number of 3'd oartv cert. available Yes No Circle Yee or No loreaoh questiqn, In the last and,identifir by tankanyexceptionato:lhe answer irt tfte first column; Records on site document that the system is properly installed, calibrated, and and tank setuD reoorts. maintenance records Device documentation is available on-site Equipment used to acquire data, take readings, perform test is adequate, accessible and functional. lncl. ATG console, dipstick. etc. Documentation of valid testing or monitoring is available for the last 12 months. Show probe is located at the center ol the tank. lf not, the tilt correction factor for each shown on the tank tank was filled to at least the minimum level required by the manufacturer's protocol to ensure a valid leak test and the tank size is within the allowed Secondary barrier is properly placed and constructed, designed for gw considerations, an acceptable permeation rate, is compatible with the substance stored, is non- and is not in the tory readings lor product inputs and withdrawals are properly obtained and include the proper number of water readings, and water readings are used to An appropriate tank calibration chart is used and is available for review. have current calibration stickers or proper calibration documentation. and extend to within one foot ol the tank bottom. Show results of monitoring lor each tank for the last 12 months. lndicate pass. fail. no results. or inconclusive. Tanlr and Line Tightners Teating, Line Leak Oetector Tesfing: Date of last tiohtness test for Name and certification number of tester: Date of last tiqhtness test for Name and certification number of tester: Date of last leak detector pedormance test: Safe Suction piping: Documentation is show that piping operates at less than atmospheric pressure, has onlv one check valve (under i,,(k LL, flol-rtilr*n L stribution Yellow-l nspector, Pink-Facility/Owner Ldall rev0201 .wpd Ftfi O7t94 'a- wHm - tnonce CANARY - Seller/Aoency PlNr - 6uyer/AOerEy Voucher Dcte Budget FY Vendor Code Vendor Nome Address STATE OF UTAH DIVISION OF FINANCE VENDOR PAYMENT VOUCHER V€nd(, Poyrpnl WdI$p|l M(x. Eomf(rdl I l/94 24-Se't-Al i.:cc.,.r:riir' g i e;tcc t:'; lL FM/IYI\4M/DD/YY 02 TRI.VAttEY DISIRIBUTING @r $902.00 PO BOX 70 M032-007CHEBER CITY Stote Descriotion (25 Chorocters) TRI.MART #90/DBLE PAY Vendot lnvoice Une tund Aoency org \pprop I lnit Aclivity Expend Revenue Projecl ?eporting Colecorv Bolonc€ Sheel Amounl 12m334 73t 480 4731 731 4395 4XXX s6M.00 t2m$4 tm /|80 4371 NAC 23t0 4)Ofi s298.00 IOTAL s902.00 h\ occornlonl Environmentol Quolitv DERR A8r[! ]Ld or AUO(nad Af.il Approvd Ori8iarin8 A8.n(!/D\ iskn UNDERCROUND STORACE TANK PROCRAM Adjustment Tracking Form FAc# lZ0Ct374 TRI* t(l arFACILITY NAME: OWNER NAME: REASON FOR: (circle one) Adjustment Delete/Waive Ta,z t'c € . 61-/ss z- - D: z^: t44tl7 €ry1 dr'rti-atn/un RE-BILL? Yes No APPROVED BY: DArE: q-/f^A t l. Ownership of Tank(s)ll. Location otTanl({$}: , , y' "t" 4€, .9^'" u* f?3#7 Area Code Phone Number Facility Name Certilicate of Compliance ortti%{ lrlo Certificate Year: Street City lll. Tank lnfOrmatiOn Complete for each tank. lf facility has more than 4 tanks, complete information for additional tanks on separate form. Number of tanks at facility: Current year tag is displayed lf not in use, date last used lf not in use, depth of product in tank (in inches) Month and year tank installed Capacity of tank (in gallons) Material of construction of tank (steel, FRP, etc.) Material of construction of piping (steel, FRP, etc.) Piping type (pressure, suction, gravity, etc.) lV. ReleaSe DeteCtiOn FOf TankS lndicate the method(s) used for each tank. Complete the appropriate checklbt for each rnethod used. Method used (enter method used and complete appropriate form) Emergency Generator tank (leak detection deferred) V. Release Detection For Piping lndicate method(s) used and compl€te appropriate tank checklists,where applicahler Method used (complete separate lorm where applicable) Automatic Line Leak Detector type and model Date of last Leak Detector performance test Date of last Line Tightness Test Test result (pass/fail) Name and company of certified tester //.1"*o( Cert. No. UT d No leak detection required (must answer "yes" to all questions below) Operates at less than atmospheric pressure Slope of piping allows ALL product to drain into tank when suction is released Has only ONE check valve, located directly under pump Above information is verifiable; use comments section below to document how it is verifiable certify that I have inspected the above-named facility on 3 - 4 - O t Signature of Owner or Owner's Representative Present During lnspecti on, /' UTAH UST PROGRAM Release Detection I Faeility lD,*g Ghecklist ( IN N CA Distribution: White-DERR lnspector, Pink-Facility/Owner LDchecklist.wpd 2/99 UTAH UST PROGRAM Facllity lD and Corrosion Protection lnspection Checklist Please complete all information for each tanlc Use additional lorms as neceesary if ttre lacility has more than 4 tanks. SPILUOVERFILL PREVENTION -*.,- Tanh-{4ank2 >,/fank3/,/lank 4 ,/ ls the UST system is filled by transfers of 25 gallons or less? lf yes, spill and overfill prevenlion is nol required.ves @ ves /i(5--r Yes @ ves dG ) ls there a spill containment device that will prevent release of product into the environment? lndicate type: Spill bucket <5 gal., Spill bucket >5 gal., Containment sump at tank fill. *--- '.W No ,4ei> ruo CeP No Q&->No ls there an overfill prevention device installed on the tank? lndicate type : Ball float (in vent tine), orro@larm, or other (specitv) G-)ruo CP No @No @*o For overfill alarm only: ls the alarm located where it can be easily seen and heard by the delivery driver?Yes No Yes No Yes No Yes No For overfill alarm only: ls the alarm clearly marked to indicale what is meant when the alarm sounds?Yes No Yes No Yes No Yes No CORROSION PHOTECTION ,/fan}-*Tan*?I{nk3-/ank 4, lndicate the type of corrosion prolection: Non-metallic (NM), Composite steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacrificial Anode -fank/c s+an--Tank/C Tanl/- (SA), or Not protected (NP). ({77 Piplng Piping /C Piping /C Piping/L lndicate the type ol corrosion protection on Flex connectors and/or Sffribg ioints: Booted (B), Total containment (TC), Nol in contact with soil or water (NC), Cathodically protected (CP), Non-metallic (NM) and Not Protected (NP) Sub-Pump/<Sub-PumpiC /a Sub-Pump/C- Disp€nsor Olsp€nser/C Olsp€nsr IC Olspensr/c- Tank lining lJ tank or piping has been upgraded, indicate date Tank cathodic protection upgrades were performed: Piping cathodic protection The results of the last two cathodic protection tests are available. (within 6 months of installation and every 3 years thereafter).Yes V", q@ ,"" a@ Yes @ Tank. Tester Date volts volts volts volts Piping. Tester Date volts volts volts volls Flex. Tester Date Sub-Pump volts Sub-Pump volis Sub-Pump volts Sub-Pump volts Dispenser volts Oisp€nser volts Oisp6n*r volts Dispe@r volts For impressed current system: The results of the last three equipment operation checks are available. (Equip. check required every 60 days.)Yes No Yes No Yes No Yes No co ^"nrc, * Y4nf --rtnf zzzt4)-(tr/,4_/ r^ >zz,z-a( zb-r.f lnspector's Signature: Signature of Owner or Owner's Representative Present During lnspection: .3- i{-a / Distribution: White-DEFlR, Yellow-lnspector, Pink-Facility/Owner Ldspillover.wpd 2/99 66\8\Z Pe3t^.Urauro/Alttcel-Iutd'UUIO-aUqi :uolmqFrslo 6uUnO luasardaallelueserdeu s,Jauag /-_ ro rauag 1o ern1eu61g r a- y'./- {;slEq t s,,tolcitosul =u I:lsal pellBl Iue lo (s)qpout alBclput lI-:1se1 Eulssgur ro p!lB^u! lo (s)quou elpctpul oN@oNsoN@oN ,e96<--Y) '(uollBclluec AuBo pre, urrBlB eslEl lo AllllqBqors ssal ro 7og puB uollcolop 1o lllgeqord ralBar6 ro yoS6 qyn qd6 Z'O lo qEq papp ot Alllqe aql sr orls puB alqBllB^B s! ernlBal lsal IBel cllBuromB eql .rol surlBlo ecueuuoyad Jo uollBluauncog @*^@""1@""^8*^'ualq ueeq e Bq suollcB on-aollo, lBqr^ puE'lBeA'qluout aql aolaq aceds aql u; l{11ceds 'sal ll aleel pollBl B pa1eqpu! spodar lsel IBel eql lo lup eaeH ONGon,6DoN@lsel {8e! pllB B ernsua ol losolo.rd lueudlnbe s,reJnlcBlnuBur aq1 Iq per;nba sllull ozls ranol pue rcddn aql ulqpn s; fi;cedec IuBl aql oN(:@oN (€Eoqd6oN@lsol rlEel P!!BA B arnsua ol locolorq luaurolnDa s/ernlcBlnuEur aq Iq perlnber lolet urnurtulur eql lsBel lB ol pallll sBA IuBl eql (ruBSSACOU Jl ilOlAq aCBOS osn 'rBeI puB srlluor,u fitceds);,pauuoyad lou lsal pllBl E sBA Bqluour qclqfi rol'ou ll oN@"N 4frondilFsquoru zl lsBl oql rcl qluolu B acuo lsBol lB lsel IBol p!lE^ B paruroyed eSneg 1ue1 clleruouv or{l lBql Eullerlsuourep elqBllB B s! uollBluaurncoo oN@'@o*€ (uollBluouncop sunseJ rol redBd lo llor rlllm paddlnbo s! ac!^ap aqt "o'!) 5u11rom s! ec!^ap oql lBql acuap!^a st aroql pua gueserd s! xoq 6u!.ro1uour V oNeON €PONffoN@lqDlaq lBuJeUt s,Iuq aql lo a6uer 11n1 aql ra^o qaaq p;nb;; Iuel-u! eql srolluou ec!^e6 ON (-?PoN a_134_oN ( sp^, -t7 ON'FEA-qcul uB lo 8[[ lserBeu eq] ol lcnporo eql lo ]qDlaq oql aJnsBau uBc ocl^ao :lM oN .TgI> :llll ON<=E :llI oN cg,oN@ruorl rolcBl uoDceJJoc Ill alBclpu! 'ou ll 'uooor onlas luel oql 'IuBl eql lo reluar aql lB pa1eool s! aqord eql or,rQoN@"N@oN@ '(alls uo olqBllB B ,ara sprocer) suollcnrlsul s.JarnlcBnuBur q1r ocuBprocce u! paulelulBru sg uelsIg oN.@oNgPON CDONU'(uooar onles {uBl puE urals^s) pqeJqllEc puB palelsu! Ilredord sem urilslts aql lBql luauncop ells uo spJocou oNa se^\_s/oN (llga_oNSlr.<oN q-e3A-'(lBnuEur s.leumo "E'e) ells-uo alqBllB^B sl uollEluaurncop acl^ao <yry&vGyv) 'urol elErBdes ro slua |Buolttppe lol uonputJolu! alelduoo ,stuBl ? usql erour s3q {uuaE $ IuBl q.Ea rol uot$onb qcBe ro, oN Jo seA olcJlc osE?ld a>€ 5'7Jw:ualsls lo roquJnu lapour puB eurBu 'Jernlcelnueyl trulDnEEixuBI cllEruom l,llvusoud rso HVtn ot r$llc"J Qpw -t'-* UTAH UST PROGRAM Release Detection lnsoectior Facility lD No. Checklist l. Ownership of Tank(s)ll. Location of Tank(s) vlf' owner Name '-/ / / /-L L/"t'/(t Facirity Name Y*Add'e* /rfuL'70'Street Address /itr5 iz'{{Sf City Qkar;i'^'" rl r zUf,9f: --'City State/rr 2?2'.e., r//, ti Area Code Phone Number countv LEirn ContactEer€on At.lJST Locatif Phone # - o.//" ,hrt- - A')r- /t-tr: '/4/5q5<certif icate of compliance on@e-year:-/€rV il. Td6k lnformation Complete for each tank. ll facility has more than 4 tanks, complete information for additional tanks on separate form. Number of tanks at facility:(rqnJr)Cranri-'@t @r' Current year tag is displayed @t'to @)tto d6., No @-) No Tank presently in use .#' No .ft'' No A;J No 7YEi2 tto ll not in use, date last used lf not in use, depth of product in tank (in inches) Month and year tank installed /'r87 /€B 7 /f37 1t;t 7 Capacity of tank (in gallons) Substance stored Material ol construction of tank (steel, FRP, etc.)1rC ?.-3 j'r-T F:i <n ?+.*)- P3 Material ol construction of piping (steel, FRP, etc.)ffift'f <r 1**-R* Piping type (pressure, suction, gravity, etc.)f7g4'3:,+f7..+.,*-FJ..1-.*?.*rr; lV. Release Detection For Tanks lndicate the method(s) used for each tank. Complete the appropriate checklist lor each method used. Emergency Generator tank (leak detection deferred) Method used (enter method used and complete appropriate form)t4*r t+rl H7a,*77 V. Release Detectlon For Piping lndicate method(s) used and complete appropriate tank checklists where applicable. Method used (complete separate form where applicable) Automatic Line Leak Detectortype and model A Fy t V a--'L-1- Date of last Leak Detector performance test ?..o* g'c fr -Q',.f',q- ec 9-6q Test resull (pasVfail)f.sS ?B)?*sS 7n< t Date of last Line Tightness Test €- </?z-u,+- €<t e.-c4 Test result (pass/fail)/).+*fzbs fl+ss lwJ Nameandcompanyof certifiedtester JQS 7 t t, 1r(iid P Cert.No. UT 1274 No leak detection required (must answer'yes'to all questions below) Operates at less than atmospheric pressure Yes No Slope ol piping allows ALL product to drain into tank when suction is released Yes No Has only ONE check valve, located directly under pump Yes No Above information is verifiable; use comments section below to document how it is verifiable Yes No t(€that I have inspected the above-named facility on /a- t3--?f lnspector's 'Ly',*--(lMth, day. ,€ar, lim) ,^r., /zt- /3 - i'f. Signature ol Owner or Owne/s Representative Present During lnspection:4 Distribution: WhitgroERR, Yellow-lnspector, Pink-Facility/Owner Revised 2/4/99 il UTAH UST PROGRAM Overfill, and Corrosion Protection lns Faci tiry to t td. 2A2-3 il_ n Checklist Please complete all inrormation lor each tank. Use additional lorms as necessary il the facility has more than 4 tanks. SPILL/OVERFILL PREVENTION ffiW /rank2/(ranE3-'-(Ienk4_> The UST system is filled by transfers of 25 gallons or less. lf yes, spill and overfill prevention is not required.vei <-@r Yes 6i?;Yes (@>ves@-.r ls there a spill containment device that will prevent release of product into the environment? lndicate type: Spill bucket <5 gal., Spill bucket >5 gal., Containment sump at tank lill. @No qlret> No ( Yas*"-to C$ No ls there an over Ball lloat (in venr (specify) enlion device installed on the tank? lndicate type : e), Au!fioli-ffiIfmelD Alarm, or other CP *"dE) ruo de,s.)t'lo (E) No For overfill alarm only: ls the alarm located where it can be easily seen and heard by the delivery driver?Yes No Yes No Yes No Yes No For overlill alarm only: ls the alarm clearly marked to indicate what is meant when the alarm sounds?Yes No Yes No Yes No Yes No CORROSION PROTECTION Tanll-l Tank2 Tank 3 Tank 4 lndicate the type of corrosion protection: Non-metallic (NM), Composite steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacrilicial Anode (SA), or Not protected (NP). Tank /(- Tank/o-Tanl Tank f#fr i%aci:Z?*/Gle- lndicate the type ol corrosion protection on Flex connectors and/or Swing joints: Booted (B), Total containment (TC), Not in contact with soil or water (NC), Cathodically protected (CP), Non-metallic (NM) and Not Protected (NP) Sub Pump / (-Sub-Pump IC Sub-Pump /C Sub-Pump t C-- 0rspenser4#Disrenser JJ? Oisp€nser -al{ DisFnser*-f Tank lining ll tank or piping has been upgraded, indicate date upgrades Tank cathodic protection were performed: Piping cathodic protection /c-/L /<-a (.-) CATHODIC PBOTECTION TESfS Bgcord results of the most rec€nt cathodic Brptectionleflt. Record the lowest reading for each langpipinMlex se1 The results of the last two cathodic protection lests are available. (ry:fhln., 6 months of installation and every 3 years thereafter). \N/(,/,,\'-v v 7! . Yes No Yes No Yes No Yes No / Tank. Tester - Date - volts volts volts volts Piping. Tester Date volls volts volts volts Flex. Tester Sub'Pump volts Sub Pump ^. ?, volts Sub Pump volts Sub Pump volts :ffh*\r lffin'"'ro,,.Dispsnser volts Dispenser volts For impressed current system: The results of the last three equipment* operation checks are available. (Equip. check required every 60 days.)N\;" @ Yes @;Yes @ Yes ((6_J fu-r*z- ,)-Comments: lnspector'sSignature: /(42 Sionature of Owner or Owner's .<. //1: Present Oul]!g Inspectio Distribution: White DERR. Yellow 6L nk'Facility/Owner Bevised Z4l99 UTAH UST PROGRAM FacnnyrD xo /2? n 9iy_ Automatic Tank GauEinq Manutacturer, nameand modelnumberort .r. , ll€t' .rtrlz - fura:f 'ft .9 j {?r- Pleass clrcle Yes or I{o for each question for each tank ll faclllty has more than 4 tanka, complete lnfrormatlon Sor addltlonal tanks on r@aratc tom. rfffi-trtu -ffiP &ffikA-, Device documentation is available on-slte (e.q.. owner,s manual).rr"o Na ,@' uo ,)resr' No .,63, No Records on site document that the system was properly lnstalled and calibratod (system and tank setup reoort). (E't'lo 1@x,,n6i-r No Gi'ro System ls maintalned in accordance wlth manufacturer's ln3tructions (r€cords are avallqble on slte).&- *o cG) *"<fsg) uo &'*" The probe Is located at tho center of the tank ll no, lndlcate tllt conectlon factor from the tank s€tup roport. 4T,no ffiiCno)1tr/@x, Titt: 6gru no TIIT: Devlce can meagure the holEht ol the product to ths nearest 1Ig ol an inch ffit No -'t€) no 4; Na -tes) xo Device monitors the an-tank llquld levels over the lull range ol the tank,s lnternal height 4r No & No(Tg No (g *" A monitorlng box ls present and there ls evldence that the devlco ls worklng (1.e., the devlce is equlpped wlth roli ol paper lor results documentafionl (fu.@uo @.-t No @, ro Documentatlon Ia avallable demonstraung that ths Automailc Tank Gauge perlormed (a valld leak test at loast once a month for tho last 12 months {.Dno @ ro6 3) No 1G-,H" !f no, lor which months was a valld test not performed? (speclfy months and y€ar, uso space below if necessary) The tank was filled to at least tho mlnlmum level requlrsd by the manufacturor,a equipment protogol to ensure a yalld loak tert dC6 @ro @"4s,-' uo The iank capaclty ls wlthln the upper and lower stze limlts requlrcd by the manufacturcr'9 equipment protocol to enaure a valld leak test S, no Yqp No 11$ no <E: n" Have any of the leak test roports lndicated a lalled test? lf yes, speclfy ln the space below the month, year, and what follow-uD actlons have been iaken_ -ves @ ves @.':Yes 6o-Yes €L Documentatlon ot performance ctaims tor the automatlc leak test teaturo ls avallable and shows the ability to detect leaks ot 0.2 gph wlth 9s% or gr€ater probabllity ol detectlon qnd 5olo or less probablllty of false alarm (3rd oartv cerilflcerionl- @, ro deDro --\ QLee- ) No @.-'t'lo lndicate month(s) of lnvalld or missang test: lndicate month(s) of any falled test: /---> lnspoctor's Signature of Owner or Owner's Representative present During Date: Dlstrlbutlon: Whlte-DERR,R.vbcd A8L99Plnk-Faclllty/Owner tzcc:3q -w qiz* TROY R. STILLEY, P.E. CERTIFIED CORROSION SPECIALIST NATIONAL ASSOC. OF CORROSION ENGINEERS REGISTRATION NO. 1297 '\t 07/09t98 DATE 'tll HAZTEC OF AI\{ERICA rNC. CATI{ODIC PROTECTION COMPLETION CERTIFICATE TRI.VALLEY DISTRIBUTING 1690 South Hiway 40 Rt. I Box 421 Heber City, Utah 84032 Ogden Tri-Mart l2th& Monroe OgderL Utatr JOB DESCRIPTION - CERTIFICATION OF IMPRESS CI.JRRENT CATHODIC PROTECTION SYSTEM FOR (2) I2,OOO, (2) 6,000 GALLON STEEL UNDERGROUND STORAGE TA}IKS. CERTIFICATION - I IIEREBY CERTIFY THAT I HA\iE REVIEWED TIIE SYSTEM REFERENCED ABOVE WITH THE RESULTS ENCLOSED TMREIN. THIS WAS DONE TO COMPLY WITH THE FEDERAL E.P.A. A}.ID TIIE STATE OF UTAII DIRECTTVES THE SYSTEM PROVED TO IIAVE SUFFICIENT READINGS TO PROVIDE PROTECTION FOR THE UNDERGROUND SYSTEM IN ACCORDA}ICE WITH THE MINIMUM STANDARDS OF THE NATIONAL ASSOCIATION OF CORROSION ENGINEERS. 1. 2. 3. 4. 5. PERFORMANCE VERIFICATION HNLTEC OF AMERICA,INC. SYSTEM OPERATION A}.ID ALL TEST POINTS WERE MEASURED (YEs) A CONTINUITY CT{ECK WAS PEPJORMED A}ID ALL STRUCTURES POTENTTALS ARE CONSTSTENT. (YES) ALL TA}..IK POTENTIALS ARE ..85 OR MORE NEGATIVE AS INDICATED ON TEST RESULTS WHEN REFERENCED TO A COPPER\COPPER SULFATE HALF CELL. (YES) VoLTAGES WERE ADruSTED rF NECESSARY. (yES) ALL UNDERGROUND STRUCTURES, NOT INCLUDED IN THE CATHODIC PROTECTION SYSTEM HAVE BEEN CI{ECKED FOR INTEPJ'ERENCE. CIIANGES TO ANY NON-SYSTEM STRUCTURES ARE NOT GREATER TIIAN 50 MV (0.s0 volTs) rN A pOSrTr\iE DTRECTTON. (\CS) HAZTEC OF AMERICA" INC., GUARA}ITEES COMPLIAI{CE WITH THE ABOVE CATHODIC PROTECTION ITEMS A}.ID AGREES TO HOLD HARMLESS TROY R. STILLEY A}{D GUARDIA}I CORROSION CONTROL CORP. FOR ANY CLAIMS FILED AS A RESULT OF TTIE WORK PERFORMED BY HAZTECOF AMERICA INC. PERFORMED FOR: TRI.VALLEY Ogden Tri-Mart l2th& Monroe Ogdeq Utah SITE NAME & LOCATION RECTIFIER SIZE RECTIFIER OUTPUT DATE & TIME 1 HAZTEC OF AERICA INC. CATHODIC PROTECTION SITE TEST Ogden Tri-Mart 12th Street & Monroe Ogden, Utah 48Yl12amP 3V/2amPs July 9 1998 2:05 PM *t*******t*ta*******ffiffi*ffi****ffifi**************ffi**#******ffit******t**t*t*****t****** Test point t.D.# 1- 2- 3- 10- 11- 12- 13- 14- 15- 16- 17- 18- Gas line Water line Conduit Other NOTES: Native pipe to soil 6LP, -0.565 -0.492 -0.783 Conduit listed is to PaY Phone. Rectifier energized pipe to soil -0.804 lLb oilL -1.11 6- -0.823 , -1.28 , - rt- -1'31 8_ _0.817 GL > -1.2s 9-- l.JU -1.37 -0.716 -0.701 -0.735 -0.699 -0.702 -0.7'11 -'1.28 -1.22 -1.21 -1.34 -1.32 -0.567 -0.495 -0.784 r**ttrt*******rt***tii*!*rr*********i*stttri**tfir*it*****i*tl**t*ttl#*****asl#**t****t*t**t**t***'*i******** R.G. Wood Itfr***i**tt l,LL gt-s Tested by: ^ 1 /, EI - (o O e 3. ! (. rs f ! ,o ) i= rr -l - r- r to = a - a- 5 CI 0i ? ?. + S -b =[ B I $. + _JJO t/ t = c+ -t P P" f r ) =' + 1- . ' r0 : r u t/ t T _o _ r0 O= - rD + ut ! \o H rur c-)rur U s UI ch Ho H ru (r ) r u '- ,. ; L S- \ S xN x !' . t -& s $F L EI a ll r r i ilq 8r *r I T :l : \rF o)F NF lig il I.l ll l lr FACIUTY ID# /oroo 339 PETROLET]M STORAGE TANh FINANCIAL RESPONSIBILITY DECLARATION Complete one form for each facility Return completed fom by IVIay l,Lgg7 FAcrLrrYNAruE -?i - A/ ** + qo FAcrrJryADDREss )O lS Oq Ao . r r.0-a+ Evqir= -r Check Onlv One D4*oose to continue to participate in the psr rrust Fund. o Submit this Financial Responsibility Declaration form by May t,lgg7. O Submit the Fiscal Year 1998 Facility Throughput Declaration (blue form) by May l,lgg7. ' All tanks including aboveground storage tanks (ASTs) locued at this facility may be rcquiredto panicipate in the pSTTrust Fund. O Indicate number of ASTs, if any, located at this faciliry F I choose another Financial Assurance Responsibility Mechanism(s)o Submit this Financiar Responsibitiry Declararion form by May l, Lggl. O By June 15, 1997,-submit acceptable financial assurzrnce documents and $10fi) processing feeper mechanism (Use the exact format required by federal regulation, 40 CFR part 2g0,Subpan H.). O Indicate your Company's .. Fiscal year,' end,ing date ,l 11 65.{-o7, IETitle phone S *2-e) DateSignarure . SEND NO PAYMENTATTHIS TIME ' Contact Pereon At UST Location Phone f Street Addrcso , D r,f - l) t' -{-*.., * I A/c ot- C:r certify that I have inspected tho above-nsmod facility on ./, s Reprssentative Present During lnspection: \\- I I Distribution: Whita-DERR, u a $ ft.+*#;iiiil;iiiiiii *u*iii*illffi iiiiiiiuffi ;[us*g,tFlm .i,itiii!li::,.:':.: rffi..tt illi!i,:i,i,li ngiii This method of leak detection requires both monthly inventory control reconciliation and tank tightness testing. lf the UST has not been upgraded (upgraded means that the tank and piping are protscted from corrosion and that spill and overfill prevention devices have been installed) the tank needs to be tightness tested annually. ll the UST is upgraded the iank nseds to be tested every live years. lnventory records must be kept for each opera1ng day. Xil;,ilf;sr{r#i:.fi:irii:' Record of last Tank Tightness Test available on-site @No a"fYeg No @ruo f€3, No Date of last Tank Tightness Test ,p - t - ,) V /../A )t Fv ( a///-^/",1 Result of last Tank Tightness Test. It fail, specify in comments section whal actions have been taken to correct the problem. Has DERR been notified? @ r",,@ Fail (@ rart @ Fait Tank Tightness Testing method:f , A tl,t,,tlro'/ Name and company of tank tightness tester: u lf ,rlrp Utah Tester Certification Number: UT Documentation of performance claims for the Tank Tightness Test method is available and shows the ability to detect leaks of 0.1 gph with 95% or greater probability of detection and 5olo or less probability of false alarm (3rd party certification)@No i:::i:.::l::iill,iiii.iiiirii..:ii:i:lifiifriiiiifri,l+ifiil fifdHVl$fiffib[l,::i.:.i:ii:.rr:;ri'li::ii:i:il:r:ll;;;;;lSlii:iiiiii iiiiiiiitiir:ii:rii:,i..,i,,;iiiiiiirft*,iiiilililii:ri niiiiili+i"{,#$,1$","-$;iilliH lnventory volume measurements for regulated substance inputs, withdrawals, and the amount still remaining in the tank are recorded each operaling day @No (D No @, No @No lnventory is reconciled monthly (sum of daily overages and shortages for each month is less than 1% ol tank's flow through volumo + 130 gallons)@No @No @No @, No lf no, which months were not? (specify month and year) lnvontory Control records are maintained and available for the past 12 months for each tank dF No @. No @$ No @t No Records include monthly water monitoring to the nearest 1/8'rngD No ;169 No /65 No d6-n No Monthly water readings are used to adiust monthly inventory balances /), tL Yes No Yes No Yes No Yes No Appropriate calibration chart is used lor converting product level measurement to gallons and is available for review @No @No @No @No Dispenser pump has a current calibration sticker or appropriate documentiation /^\(YeS) No dU No €B No @No The drop tube in the fill pipe eritends to within one foot ol tank bottom (6-n No dB No ddn No d6\ No l:i Owner/operator can explain inventory control methods and figures recordsd &No Books appear used and evidence ol recent entries is apparent Gs No Owner can demonstrate accoptable gauging techniques tlTh Yes No The gauge stick is long enough to reach the bottom of the tank iTrG Yes No The ends of the gauge stick are flat and not worn down fi ft;Yes No The gauge stick is marked legibly and the product level can be determinsd to the nearest 1/8 ol an inch over the full range of the tank's intemal height /, D Yes No comments: FZ.f/: fxtur*L A, tlur'rrf-o/ ,L*L /turrJ Distribution: White-DERR,Pink-Facility/Owner Automatic Flow Restrictor lif ves, indicate model in comments eectionl Automatic Shut-off Device (if yes, indicate model in commonts section) I Continuous Alarm Sy8tem (if yes, indicate model in comments sectionl Records of last Line Loak Dstector performance test aro available on-gite Date of last Line Leak Detector performanco test Result of last Line Leak Detector performanco test Records of last Line Tightness Tost are available on-site Date of last Line Tiohtness Teet Rerult of last Line Tishtness Tost Name and comDany of cortifiod t€stor:Utah Tester Certification Number: UT Groundwater Monitorins (if ves, use Groundwater Monitoring checklist) lntorstitial Monitoring (if yes, use lnterstitial Monitoring checklistl Statistical lnventory Reconciliation lslRl (if yos, use SIR checklietl Othsr apDroved method (if yes, use othsr method checklistl Records of last Line Tightness T€st ar€ available on-site Date of last Lins Tiohtnoss Tost Result of last Line Tightness Test Groundwater Monitorino (if yes, use Groundwatsr Monitoring checklistl lnterstitial Monitoring (if yes, use lnterstitial Monitol Statistical lnventorv Reconciliation ISIRI (if yes, us6 Other aooroved method (if yes, use bther product to drain into tank when suction is on suction piping is VERIFIABLE, us6 comments to document how it i6 verifiable. lnspector's Signature: Signature of Owner or Distribution: White-DERR, Y Pink-Facility/Owner l L lit$ilffi i,## #[-r.irLr :, I iiiiui:iiirir :i :i:Itiiiiiiii;:i i;lilliiiiil iiijlr:'.{l1i:::1:::::ijji:l:::::::1}1:::]ri\\i$ t*.r!fr*iiirl t: Tank I Tank 2 Tenk 3 Tank A The UST system is filled by transfers of 25 gallons or less. lf yes, spill and overfill prevention is not required. Yes @ Yes @ Yes (fij Yes @ ls there a spill containment bucket or another device that will prevent release of product into the environment? (@ No @No 6ENo @No ls there an overfill prevention device installed on the tank? lf yes, indicate tho type of deMce: Ball float (in ventline), &!ggg$Iglq[ (in fill pipe), Alarm, or Other (specify) @No @No dF No @No For overlill alarm only: ls the alarm located where it can be easily seen and heard by the delivery driver? Yes No Yes No Yes No Yes No For overfill alarm only: ls the alarm clearly marked to indicate what is meant when the alarm sounds? Yes No Yes No Yes No Yes No fili! Tank I fank 2 Tank 3 Tank 4 lndicate the type of corrosion protection: Noncorrodible material (FRP), Composite steel (CS), lntemal lining (lL), lmpressed Cunent (lC), Sacrificial Anode (SA), or Not protected (NP). l, FRP or CS do not complete the remainder of this section. Tahk )*l d tl Tenk i' ;? Tank <E Tmk -f t, lJm i:Ao Um i:A P Llm Fn 0 llm i: .(? o lf the UST is not protected, was the tanMine installed before May 7, 1985? lf yes, corrosion p.otection is not required until Dec. 22' 1998; do not complete the remainder of this section. Yes No Yes No Yes No Yes No The results of the last two cathodic protection tests are available. (within 6 monlhs of installation and every 3 years thereafter). Yes No Yes No Yes No Yes No Results ol the most recent cathodic protection test. Name of tester: Test Date:L{ - )f-- ?, Tar* . volts* /,0V Tank . volts-- I ni, Tahk . volts Tank - volts,- l.n 2 Um - . . voltsr-hl tr/ 7 votts ir|f 'ot",n j ,ort. For impressed current system: The results of the last three equipment operation checks are available. (Equip. check required every 60 days.) Yes No Yes No Yes No Yes No lf the trank has been retrofit (lined or cathodically protected), indicate the date the retrofit was completed. Comments: lnspector's signature: /1. J SZt'; oate: if ')) -?t $:iG,HfiEEr*o*.fffi ffiN understand that the following marked items must be completed by December 22, 1998 in order to meet the 1998 upgrade requirements: ! Spill prevention for tank(s)# Pvertitt prevention for tank(s)#E Conosion protection for tank(s) # ! Conosion protection for piping assoc. with tanxls) * ,f / / .n A ,*yOs 1998 upgrade requirements. Signature of owner or Owner's Representative Present During lnspection !/rry'lrfl f'ilQL,M Distribution: White-DERR,, Pink-Facility/Owner Distribution: Whit€-DERR, Yollow-lnspector, This method ol leak detection requires both monthly inventory control reconciliation and tank tightness testing. lf the UST has not been upgraded (upgraded means that the tank and piping are protected from corrosion and that spill and overfill prevention devices have been installed) the tank needs to be tightness tested annually. lf the UST is upgraded the tank needs to be tested every five years. lnventory records must be kept for each operating day. t+$iiit ni liX:ix:**iiiirl*Jiiii*:itiltiiitliii:l:iiiiiitiii*in*liiliijiiii**+i,,.i.Ir,,l''i!.Itff*Lil(iii$ii Record ol last Tank Tightness Test available on-site a(Yes-, No 6No f") ruo @, No Dateof tastTankTightnessTest ,_r4/t/ty h l$hJ/ 9y fi-t -9v L /t , t -q q /r /l Q ,/eut .) Result of last Tank Tightness Test. lf fail, specify in commenls section what actions have been taken to correct the problem. Has DERR been notified? @ r"ir (@ rait @ r"ir @' Fair TankTightnessTesting m€thod: U JTHilt "fiA /u)rh,J Name and company of tank tightness tester:Utah Tester Certification Number: UT Documentation ol performance claims for the Tank Tightn€ss Test melhod ts arrailable and sfrows thg ability to detect leaks of 0.1 gph with 95o/o or greater probability of detection and 5% or less probability of false alarm (3rd party certification) No rr:i::!::::!rr!r,i i'iiiiiiii:hllilrlr:liiii :lillr jiil,:tf nt'rsirll:ii. lnventory volume measurements for regulated substance inputs, withdrawals, and the amount still remaining in the tank are recorded each operating day @No @D No @No @No lnventory is reconciled monthly (sum of daily overages and shortages for each month is less than 1% of tank's flow through volume + 130 gallons)@No @No @No @No lf no, which months were not? (specify month and year) lnventory Control records are maintained and available for the past 12 months for each tank @No @ No (@ No @No Records include monthly water monitoring to the nearest 1/8'@No CfD No 17"pNo d@ No Monthly water readings are used to adjust monthly inventory balances de9 No @No @No &g No Appropriate calibration chart is used for converting product l€vel measurement to gallons and is available for review @No @No @No @No Dispenser pump has a current calibration sticker or appropriate documentation -.<tYes (No)Yes 6A Yes 6A Yes @ The drop tube in the fill pipe extends to within one foot of tank bottom @No l6i- No @No f"9 No ffi i*iiiiiiil#iii,tffi [iiifri$lil,l,.E.i,fllE#l**fffi iiiiliiirffi iii*t,i+rr im Owner/operator can explain inventory control methods and ligures recorded @ No Books appear used and evidence of recent entries is apparenl d@ No Owner can demonstrate acceptable gauging techniques nra Yes No The gauge stick is long enough to reach the bottom of the tank tv rG Yes No The ends of the gauge stick are flat and not worn down tl Tn Yes No The gauge stick is marked legibly and the product level can be determined to the nearest 'l18 of an inch over the lull range of the tank's internal height t. tJ Yes No iij [$fi l,iffi iii$Iiiiii:,i}iin$Ei+i#xffi ilxtffi lnspector's Date: , -21-9J- Signature of Owner or Distribution: White-DERR, Yellow-lnspector, Pink-F I .,ili,'lXi!:1:iiiiliiiiiillilr;iili:iri ..,.,,,..,,.arr,;;tUTfi H. :rjlij,ifr:iliii;;i:1,if'tjffilf1::fi'xijiliii ::::::!i:Ilf ,iiHgIeASEi r\nili!.iii!riii'':"' ififfiIilfl+irir+-il jjjirjjiririr+rjiiiii.,lr.i"ri;iixlii....rrliiili f.iiHffi rlb,iN6:lirlii{r*l ii'i..:iiril l,l.,t,it+1ffi i*.*{i$## iiffiHffi*Al ffiur;xir*s'g*U ffiiffi$iiifi fillii{ Set 1 Tank 1 Tank 2 Tank 3 Tank 4 Automatic Flow Restrictor (if yes, indicate model in comments section below)tlt -t)0 // { vlo tl/ -n3o ltn *6 ) a Automatic shut-off Device (if yes, indicate model in comments section below) conlinuous Alarm system (if yes, indicate model in comments section below) Records of last Line Leak Detector performance test available on-site (CA No &9 No C6 No aTe?|, No Date of last Line Leak Detector performancs test 2-P - 2o-2'f -?.t^) 4 ^4s*2 'f ^l.t Result of last Line Leak Detoctor p€rformanco tesl ,6 Fait ffass) rair 6.) r"ir (@ ratr Set 2 Records of last Line Tightness Test available on-site @Noan-"? No f6t No GNo Date of last Line Tightness Test // JT/, tryl J t tZ ut , ,/t ^ ,/a.,4)-+1+12 '-?t?*/f .-t-sv k /r {t't7.....,..._-> Result of last Line Tightness Test a€dS Fair @ Fair /A$ Fair d6G\ rair Vapor Monitoring (if yes, use Vapor Monitoring checklisl) Groundwater Monitoring (if yes, use Groundwater Monitoring checkrist) lnterstitial Monitoring (if yes, use lnterstitial Monitorino checklist) Statistical lnventory Reconciliation ISIRI (if yes, use SIR checklist) Other approved method (if yes, use othor method checklist) isjildiis"',ijiiildi ixiiilxixiixtiii iiiiiliii{1i:iiiii j,i RecordsoflastLineTightnessTestavailableon-..."T iil:rili:i:L:i.1lniiiiiiiiiti: iiiiiil:i. iirii.i.iiii:iiii Yes No Yes No Yes No Yes No 9q9of last Line Tightness Test Result of last Line Tightness Test Pass Fail Pass F rf Pass Fail Pass Fail Vapor Monitoring (if yes, use Vapor Monitoring checklist) Groundwater Monitoring (if yes, use Groundwater Monitoring chsckrist) lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklist) Statistical lnventory Reconciliation ISIR] (if yes, use SIR checklist) -/ Other approved method (if yes, use other method checklist) Dsrtttlg iltit .iiir:iiiiiil;iiiii:ii:iiii Operates at less than atmospheric pressure -/Yes No Yes No Yes No Yes No slope of piping will allow ALL producydrain inlo tank when suction released Yes No Yes No Yes No Yes No Has only ONE check vatve, lopa(d directly under pump ing is VERIFIABLE, use comments section Yes No Yes No Yes No Yes No All above information on Juction pip Yes No Yes No Yes No Yes No lnspector's Signature: Signature ol Owner or -,t ,*/fi17-I wntre-uEHH, ye[ow-lnspector, pink. Distribulion: White-DERR, Yellow-lnspector, Pink-Facility/Owner., VU LINETEC INC.a^466 72L 9e55 A P.1E n'ij::-Yl:i?':':?.t'-ijl','Jliil!H',ll'l::.iffii'# ".d{::i:.iij!l{ifii?,r:gfi#,"1;l?r:a;:TIregulated UST system'- Thls r"'^itt'i.", pr.p.ruo to assrst you in providr,rg iii, Information. -eefo; instailing or upgrading an UST systorn' please ti,-plr, irui roi.'"Ji.,h Ir ro'rhe Di;i$; of Environmenrar Response and:il",1'jff;1,*;lm*::i;JtTiffixJ:ffi#i.s..,;:;;fr:f:ik;,,::*. p,an ro^hose rankso,rinei Facility tOfi (if not a new facility) r 200334 _Date work willcornmence 5 Harch ApriI-I Tankowne Phone #@ ::::::,' stare__ur. zip_lgeol__ UST lnstallation/Upgrade Notification I J New lnstaltation I x ] Upgrada Facility NamE Address rnls r-,rh qt. -citylQglencontact person John Barlow -- v^Jr-v" state-uT. - zip@- Phone # Certifled Tank lnstaller Name .e u r Lepnens Cert. # TLO1 33 Exp. date_Jan 1 qo7.orp.nr -lphone # r-rrsseut? .Stal6l,{T. .Zlplg&0g_ lnsta I lat Io ry'Lt pgrado tnf orma Uon Tank # lnstalUupgrade Capacity (gailons) Type (FRp, Sreet, etc.) Substance to be stored Piping fype (press., Suction, Gravtty) Tank Leak'Dstection method Line leak derectlon method Form of Corroslon protecilon Spill device to be lnstalted (y/N) overfilt device to be installed (yiN) -- Unusual or ext6nuatlng clrcumstances expecled: I-+L2 , o00 SteeI - Gas press.. AT6 - ALLD - sri.p 3 Yes - Yes 2 --. uo 12 , oo0 - Steel - Gas P ress-. AT5 - ALLD - stip 3 - Yes - Yes none 3 uo 6,000 Steel - Gas - Press. AT6 - ALLD stip 3 Yes - Yes 4 - uq 6, 0oo - Steel Di ese 1 Press . A?6 - ALLD srip 3 Yes Yes -- - - - - - - - - Barlow Utah Department of Environmental eualitv llv-ls.lon of E nviron menta t n espo;.-;;' h " m ed I ar io n168 North 19SO West. tst Floor Mail completed form to: Sart Lake Clty, Utah 84116 .-!-- NRY g1 ',94 13:31 1 P. L/7 - rtrr I //" ''/t ;'JM//*ru fis/t H-/tL/'n7s7ool FAy olvo'r* 4alfrDl- l ful'5 ---lhY At '94 13:33 t a P.7/t Petlo leclt, lnc. 11170 Sandy Gulch Road SandY, Utah 8a091 Pnone (801) 572'9303 Far (801) 5i1-8975 nffiwl/{#a,lt'ffsjl/NG Under 40 CFR 280.31, the EPA reguires all corrosion -Protectionii"i.*r nruit n" "p#ated and maiitainea to continuously pro-vi-de c3rrosion protectiln to the metal components of that portion of the i;;i-;;d pfping that routinely contain regulated substances and are ln contact with the ground- AII cathodic protection systens must be tested within 5 nonths of lnstallation ind at least every 3 years thereafter. The following steel tank systems weT: tested with a stiP3 tan]< rnonitor to s-how the structlure-to-soil potential indicating th? Ievel of cath"ai. fiotection. Due to vaiying soil conditions and other factors befond our contro], W€ cannot guarantee these results. This i; only a prelirrinary survey; a more extensive survey can be perforned at your request' The stiPg meter should read more negative than -O'85 volts' According to the Steel Tank Institu€e, this voltage reading indicatet tne tanks/lines are properly protected. TANI( I-D. }IATERIAL REEULII:S Test Date: Site Iocation: Regular Unleaded Regrular Diesel Premiuu UnLeaded Regular Unleaded Regular Diesel Premiurn Unleaded @BROSION PBoIIECIIOI april 26, ]-994 Kar Kwik /2oo?7,,/ 1015 12th Street Ogden, Utah Steel (stip3) Stee1 (stiPs) Steel (StiP3) Steel (stip3) rRP rRP FRP rRP Test Ito: 940426I -1.04 volts -1.04 volts -1.03 volts -1. 08 vol.ts pltorrlrcI, LrrIE I.D- l[a:rt7RIAI. nEslrLtrs N/A N/A N/A N/A /1 "6 q-c-w l\ Leak Detection nspection Checklist l. Ownership of Tank(s)ll. Locatlon of Tank(s) Ownor llme (Corporedon, lndMdu.l, Publb Agoocr. o? du odty): ,z*^ /i'.+./: /oc. (ltrrmrerSodooI,oltd(lxr._) v6yA-Fdlty llur c Comprny 8f foffi.r rpplc.bb J- t./-.. tt..,,'/^ 4 -StrrtAddtx."''---L/ t\-- 2, t !h'"*SuorAddruro? Str0. Rord. ll.pp{clbb /o /!- * /z ^ .ff.-rr7LCounty , tLC?at4 ulr/trGlty/,t)rJt- Strb ZpCodr A ki. .f qvo I Clty (norror$ Strb le @ Oc ah,,t- tt Aln ,/ v? c )ffihonoNumbr(eo/ iA)- ov% Frcfllty ltJ,., / /, LY' 3 J qCoficPrrronAtUST l-orrrtor ,.r!^-. Phonol 6 2 )-o L/?t Ill. Tank lnformation Pleesa cdnd€te aI hlbrmdon lqeecft br{c llftb lhdlity,tra mo(olhan 4 tanlcl ptease phdoopy lhb page and compleb tho ffiormatlon 6r dl dcritonal bnke. Tank prsently ln use ;,--fank1 v Tank3 -Tank 4 It not. dat€ last usad tf emplied, verify 1' or l6ss of ptoclwt ln tank Month and YearTank lnstalled (E-estlmate or K-knorn)tOr?)- h /qf ) -r I 0,ro\ - )<t9P)-k Materlal of Conslndion (E-6tirnate or K-known)J--rt / <JYt n J .t7/ / ?r:f/ r' ? Capacrty of Tank (ln gallons) (E-€stimato d K-known))2.c:cnru,/.t2 AtO n/*2 I tte ,J,l'- ctt r d,/- Sub$ancs Stored (E-stlmaftt c K-known)/(or ry'o-r/^/) , i o,f,Pu., , //,/,tt).,,V tV. I Release Detection For Tanks crreo, tre rorasiddirdon nr.trod(t1 ura # eur mr< q N/A il rsre ?s$.*€o- Manr.ral Tank crauglrp (mly br taril<s u1d6r 1,000 gal.) Manjal Tank Ciauglrp and Tank Tghrnss Testlng (mly lbr tarilG url* 2.000 gal.) Tar* Trghtrl6 T6tlng anc, In\rfitory Contsol ArlomatbTar* Gat,glrP Vapor Moibdrp Grouncnrarer Monllorlno lnto.stlthl Mqtitorino Ottre approved rn€rhod (wrlle ln name of ntettod)t/ tbl nota,-l It 4 ///t,Lra / . lV. B. Release Detection FOr Piping,,,, , chedr trc rsbara dcbcdon mGhod(r) urcd ta ffirlng: Clrd< Ono'Dfcol PlPlng for rcfiTad(Prrartad Flphe Sr,rdo.r mane Alornallc Une loak Delectola, aoC (cfr€ck one of th€ bllowino) Vapor Monitorlng Grouncnrater Monltorlno Secor6arv Cortainment with Monitoring Line Tlohhes T6tlng IV,,,,G. Corrosion and Spill/Overfill Protection::,: ) Conodon pr@cdon installed (lndbedab) ,, -.f- At/ lr' J^b- SfrlUOirerff probcton hslalled (rdklab d8b) O u, *fi ,n,#rJir. ,^M/ S -. it /rt7-t ,-.-- - * // L,,L V. Site lnformation 11. Generd sib observations End commenb (vdr{ty ob6en atione, grcund wder la,el, eb.) , ,4$ ,- ilffi',-,. csrlify ttal I have inspected rhe abo\re named ladllty m - tnspecbr'c signatu.: ,7rl r J1i" Date:i -/ ? * ?ll srGlr y0 (t /1 lnventory Control and Tank Tightness Testing FdtylD*/ La'()33ri Mrtpd d Nerrp ftd addrs c, tank tghh€st bsbc Please complete all ,.,.,,.:' ',', ",,,,:':,',: " ' ' . ::.:::. :i':: :..::' :: " information for each tEnk:,'::,:I llts8l&itty hermo.Etlgi aErl.l. plBq yu$ paecatrd, ':::oomPbbt1cffirn&rlbfdffird'til{{3,"', .:,,,,.,, Tank I Tank 2 Tlnf 3 Tank tl Date d last tank tlghtns test.u.f Yrl /l StA t ,hJ Did tank oass tesf,l lndicate yes or no. lf no' sp€cify in comnrenb s€ction b€low th€- slalus of the lank or what aaiors have been taken (e.9., has state beon ndinedt)/ t4'/ t'^/'^ Docurrentatlon d deliveriG arld sales balances wlth ctally nreasr.remonts of liquid volume ln tank ate maiirtaineO arrd avallable.7 ?t'./o t'/^ Overagps or shortag6 are ls flan 1% + 130 gBls d tank's flow throuoh volume. lf no, YYhlcfi rnonths were notrl rneiho6 and llgurs tsed and ffi:ye8 nol Records lrclude monhly wat{ monltdlng.ys nol -Books appear usod and evidenc8 ol r€cent enrie ls apparent y6 no Books ars reconcll€d nnnhlY.yE nol Approprtate callbratlon chart ls t/sod for calorlatlrp volume.y6 rpI Olsperser pumps have cur€nt calibratlm slcker8.7-6 -?l !16 nol The dr.op tube ln tho ltll plpe extencb b withln me bd of tank bottom.y6 nol O,yner can dentorEtrate corsistency ln c,lpstld(lng tecfnlquc'y€8 no Montttly wat€r reaclirpB are r,sed ln calcuhtlng nnnthly hvenlory balanc6.!16 rpI TIl3 dlp6[ld' b long €nough to roach th€ bottom of tl€ tartc !16 ml The ends cf the gar.rge stlck are fiat and not wqn cbtYn.ye8 t_:nol tevel carr b€ deGrmlned b trp near*t me-€bhth o, an inch.'\ yesl -rpl me anr. rras oeen rcsr@ pass€d rre fighrt€sg tqf(it rr(x:c*yf.y6 rEl I triropartv cstificatim of the tank tlgffiEss t6t rngd1od ts available.y6 mI Tank t€st€r complied with all certification requirernenE'y6 l'/r1o I Monitorirq and testing are rnaintiained anO aralhOfe fotUre pasl 12 nronths. I yo L -"1 . - l-. -,' ,,. Cornmetrts: lnspec,ur's SQn&rrc: t 'r D*: r'/f '-?lG't sr&9-3 ction for Piping /)-cro33t/ Pressurized Piping:A nrdrocl mudbe$l€cbdtom e&h lot Wh€lt appffcaOn hdbela deb ollstbot tttrtl tx*tttytrr nrontran * unfc, pbase ptrOoopy !{s pegs and cqnpleE tha lnttinraton for aI ffind pflip: ) , ti-f l lf Vapor MonitorirU, doonrentalion of rnonhly rnonitoring is available f Inteistitial Monltorlng, ctocum€ntath of monthly rnonitoring ls avallable f GrcLmcFWaEr Monibring, chqJrn€ntaiion of rnonhly rnonitorlng is avallable Otrt€rAppror€dMdlod(@ I Suction Piping' ' tnotam oauamo*'tuclttt!*," ,,,, Urre Tlglrtne T€stlng (requlred ev9ry I ygrs.l Oul€r Approv€d Metrtocl (specify ln commerts sacllon) No Leak Detecllon Requlred (must ansrver yea to lli o!th! to!!9-!n9 Operal6 at ls than atrnosph{lc b draln back into tank Itl 'aoove tffialon on $.tctiqr piping is verifiable ffi skerch-rh€ qtre, notlrg-q!!.qlplng IrnB, tanks flrrludirng slze & suls9rrc.es stor€q] anOtocationof wellsancltheirdislian-cafiOmtad€andpipatlg; ,: " .':' "", '':,,' , , ' certilyt|rarlha\,olnsp€codthoaboronamedtrrlity * / -lr=L-=!'L= nro.itr, drt,YaJrltL Sloo5e-5 ugrldMt 8rR grgrEr{ 9Jr Annual ttghtnaaa Report t2a3Jt( 6 Sta0e: UT SEatjon lla.me; Addtese t 7A1.5 PAET A: Thte report ta onthe perJod of Company rrarr€ ;KAI &aR rp/rr ffe 72 TT{ 9TREET Ciby: OODAil rn r.tr Tank tDt DLS4 PRA3 RECT UNL2 Syetem Status; 7TCHT TTGHT TZCHT TTGHT Product: DTESEL, PREMXUM RgCULIAR UNIJEADSD DaEa Qup, Tityt ,., oooD aooD ooaD GOOD Sales; 71.62 34728 24857 73093s Dele: 854e 35776 23678 733625 U$?ttAll INDU9TRIES filC. te e qdrtified gtatJe tlcal InvanEoty ReconcJl latlon(9rR) teleasa detecElon vendot, Tank statua teeult,e tor rigtrtneei- t."E!ngars baEed on parenetera apeelftad by the .EPA ptotoaol for SIR meulrodg. PARf 8r Cornmentg ead Eaco&m€ndatJone O/8 Ttgtad bclow teprele;at temoval.a, addttloae ot d,ctiwety dlacrcpaaeleawhtoh w€ta aceounted for ae patt of Ehe grR enaJyele (s/ez/u93:DEL -6?3] {a/s/tss3:DEL zso} ts/ts/tge3:DErt 4as} DLg4 PRE3 RBGI tg/Ze/tge3IDEL -702] uMrrz {e_t!4.se3tDEL -e5} .(A/e/tsstt -122J _ {a/u/tss3: -7j7} {9/73/Xee3rDEL -422} {S/tt/tssS, -97} 80'd 100'oN I0:II 16,!-I 130 /za8-986-t0t: 0I NUl^t1Srt Jr.hq.g)rlilsrillt*Iistsilhlii+tlli{rr{sf.rqiiiii{dtii;hiUq;ix"-::t!.li{i:ri .,..i, TORE S RODUCT,PRESSURE LEAK RATE7OZ=3GPH PRESSURE RISE;SLI6HT DIP, THEN II,{MEDIATE JUf,IP . TO FULL PRESSURE PASS/FA I L .UNLEADED i/?c{55 PREH I UN 3o ('a l<.?"* REGULAR )o 0k ?"<s D I ESEL Js--{o<.a ;leas THE AEOVE LINES TESTED EY UTAH TESTED o*--rchl::- STATE trERTIFIED U.StT. INSTALLER *TLO 1 30 I.INE NITROGEN PRESSURE TEST RESULTS PRODUC']'POUNDS OF PRESEURE APPLIED Ttr LINE MINUTES PRESSURE LEFT IN LINE PASS/FAI L UNLEADED Li s-7-,r*s3 PREH I UI,I LIS LO y'r,s IIEGUI-AR t4 7d ?,,, D I ESEL ( a;-2'y'., s2 rHE AEovE LrNEs TESTED uN--J z- lstLe*------ .i i, _// ,r/ rEsrED By urAH srArE cERrrFrED u.s.r. INsTALLER i-A:l:i{-?-----*rLolso ,/ ,!r.' q ,t* . Complete items 1 and, for additional servicsso Complete items 3, and 4a & b. . Print your name and addrBss on the revsrse of this form so that we can rsturn this card to you. . Attach this lorm to the front of the mailpiscs, or on th6 back if spaco does not permit. . Write "Return Beceipt Requested" on the mailpiece below the articlo number . Tho Return Receipt Fee will you thg signature ot the person to and the date of 3. Article Addressed to: DAVE FLETCHER, DIRECTOR UTAH STATE DIVISION OF FUELS DISPENSING 3120 STATE OFFICE BUILDING SALT LAKj] CITY UT 84114 I also :l to receive the following services (for an extra fee): 1. n Addressee's Address 2. E Restricted Delivery Consult for fee. 4a. Article Number P805 363 866 4b. Service TypeE Registered (Certitiea E Express Mail ' E lnsured E coo ! Return Beceipt for 5. Signature (Addressee) 6. Signature (Agent) Addressee's Address (Only if requestod and fee is paid) PS Form November 1 *u.s.GPo:1e01-287o66 DOMESTIC RETURN RECEIPT UI{ITED STATES POSTAL SERVICEv Offlcial Buslners ilil PENALTY FOR PRIVATE USE, 93OO Print your name, address and ZIP Code here UTAH DEPT OF E}W QUALMY DERR 1950 WEST NORTH TEMPLE SALT LAKE CITY UT 841144840 -r I 1 :ic::::'/ :f . PST PROCESSING CHECKLIST /\l'iear cl r Unacceptable lion-Marketer Discount ?revious PoIlucion Incicienc - LUST File r/N - Forn Included 1/l.I - Yerify tank/ Linesvs registered - Documentation ok? aL Y - Rat,e ok? fund Paid - FY 9T? : :es Fa ici - nY 3g? - ?'{ 39? - rY 90? - FY 91_? SonpIiance \ @in v Y Y Y - Conpliance Outstanding? - Leak detection required - llotif ication uD to date v Y& & (ot1- oqlb f.e'riew completed '//N Y .//N Y //N Y //N Y/N in use? Y/N complece? 'I /ll Dace Quaiified and certifi.cate issued by Fv Ql a:, ttol (o,{s yta , Not .l,cceptable Applicab INITIAL iDNo. ILoo]3V INSPECTION & COMPLIAI{CE Compiiance # ( r-l SU}I}IARY FORII SusDense oate 6-Ta-za inspector 4L- Tank 0rmer Ind. _dba _ Corp. NATIE Closed Out pther Date(acguiretl/Inc.)_ STREET CITY COUTITY/STATE ZIP coilTAcr IITLE PHO]IE Tank Ooerator -[nd. ,dba _ Corp.pther Date(acguired/Inc.)_ BusrlrEss ro* T"- C,i T-. t FACILITY NO. STREET CITY COUI{TY ZIP C(lTITACI TITLE PHOI{E vI0LATIotl t 8l Q)' i' R1LE COTIPLIATICE Actlon 0ate Actlon rsT coilTACr zTID COIITAGT 3R0 Cot{TAcT 4IH COI{TACT il0u ONOER FITE.A6 EPA REFERRAT cLosE our t,ATE Suspense 0ate )o v Pcnalty t- \- Lo -cLa 7 ot,.(( t-.rl FItAt ASSESSIEilr t nool01 tloollL n@.ro tzot tt, tzooLlll t"colt9 tuollz lZ003r,( 4to4 7to t?t q 340r /04 { q?0 ll4o ha),. { ? .rl 3 Riuethk l?l uhel^hiL atJ tt( (( v 94 bqqo( frl/, h' dl'l t?t t tZt{Sf -392'2.8 A 5o . O1)a,- I - 6zz-o44b ,t truyil y . tss,h.^) L r"')) *it. \ ar-1, ,6iJ^ 1,,^ l>l-1, s* Lto$ ft 76l.lr, St(. Ll{l{.,|{Z ht i* trrn url', Ptr(,^J4/ *, l-1, tk rzmtt4 n cc*t* uuL; tlbfyw( ilfur h lzt9t lo(s-dr/o$ # pwtqt h /irb u4,tAirL. ,,/ wul* lJoo lqt / P*o*, Ptr WN.f* fi( 0wtr tAts0{ S-fw Zo? 84tlo3 uU;/ Wa//'t4 /u ,,rr'r* ' ,,Zte q A4ilr^lil-'-7L i;;3u4 s+-? F^.rrr,, ,o. * - t@Q-311- pEfnOUEUM ,,SIO-RAGe,' fAUX FUND APPuCATION FACILIW INFORMATION:LOCATION OF TANKS: Facillty Name: _ Street Address: CitY:Crty: A99pt Street State: Phone: Contast @- state:tz)2. Pnone: Contact TYPE OF OWNER: hroughpgt^qP{9; !!an 1 0'000 gallons' [ ] Ndffiri<eter ;igi ;;I;i montNv ttiiougnput iess thin '10,0b0 gallons (Must verifv). DESCRIPTION OF UNDERGROUND STORAGE TANKqRa+T 3 3Tank # Age Capacity Substance ff-ffi- TANK TIGHTNESS TEST Tank # Pass/Fail CERTI FICATE OF REGISTRATION ilitY have been registered' fij All registrltion TANK Fees have been paid' COMPLIANCE WlrH usT nEqlJ-lrfloNs: b?'S? 33*h?"'fl Y t' res u ratio ns PREVtous PoLLUTION INCIDENT(S [r"1fiBfl.[?',{,13", jffi"rnroundstoraserank)tnrormation: ).(1 ' jJ, r. rli' ryr No - n'I,,?"tf?:i"f,ff5&',s$T,:'ixlgJJ}?:'JlxTr",:?::9fl#:ffi:'l[is)"l?fris faci,itv PST FUND FEES ilitv is included w.rth.thls flPplication'[ ] Quarterty payrienilidii ererv tantiitthis facilitv ffi I certify under p€nalty of larr that the abore representatlons made by m€ are true and conect' Applicant's signature:Date sisne a: /tr,v /4 / o ?O FTOUTT UI # PREVIOUS POLLUTION INCIDENTS Mr. Deruris Downs Executive Secretary Utah Solid & Hazardous Wastes Committee Dear Mr. Downs: As required by paragraph 26-l4e-404 of the Underground Storage Tank Act, I have performed a tank "od lir,e tightness test on each underground storage tank at my facility, and based on this test, tlrere has not been a release of petroleum. Additionally, based on "customary business inventory practices standards", I am not aware of any release of petroleum from mY tanls. oR, I have had the following releases of petroleum (detailed below; also mention any action you took to clean up the release). signature of owner/olremtor Tank Fund. #i {" rl,ry.L _ .' a November 15, 1990 Kent Wangsgard Kar Kwik 1 140 36th Street, Suite 209 Ogden, Utah 84403 Re: Precision Tank Tests - Kar Kwik 12th Street & Monroe. Ogden. Utah Dear Kent, precision tests were performed on four (4) underground storage.tanks at the above location from September 26, 1990 through October 25, 1990 using the Tracer Tight " method for tank tightness testing. We have reviewed the data produced in co-njunction with this test for purposes oiverifying the results and certifying the tank ,y.i"r. The testing was performed in accord-ance with Tracer Tight* protocol, which meets the criteria set forth in NFPA 329 for a precision tank test. The results of tank testing indicate that the tanks are in compliance with the EPA criteria of less than .05 gallons per hour. gJ Enclosuires Johnson, P.O. Box 8490. Meso, Arizono 85214 ' (602) 926-3000 ' 1800) 229'2930 iNGtttrrntNG & TESTING PREPARED FOR: Kent Wangsgard Kar Kwik 1140 36th Street, Suite 209 Ogden, Utah 84403 Tracer Tight* Test of Underground Storage Tanks at the Kar Kwik Site Ogden, Utah November 6, 1990 Tracer Job No. 90-1179-01 Horizon Job No. 312-90 P.O. Box 8490 o Meso, Arizono 85214 o (602t 9263000 ' (8001 229'2930 8jr' fj l'| - '\ F $ : )E.,aTroN AND IMPLEMENTATIoN----'- CONCEPT OF OPERFiTION AND IIV CR|TEBIA FOR CI.ASSI FICATION APPENDIX A: ANALYTICAL RESULTS APPENDX B: FIGURES-----. 1 1 2 3 4 5 t*f q r - i* *,y,$*.i:i I '., : INTRODUCTION Horizon Engineering & Testing un: Tracer Research Gorporation performed ''i*r, rishtn '+ ';'* :]::?"rsround :i:l:n" tanks at the Kar Kwikr site rocated at 1Ah street & Monroe.in ogoen, utah' The tanks were inoculated w.rth tracer septemb er z611990 ,o u .on.entration of approximately 10 ppm. Samples were .o,"o"o on octobe,r 25,1990. The following table shows the tank size, product it contained, and tracer that was used for testing in each tank' Tank No. Product Size '(9al) Tracer Tank A Unfea-OeO 12'OO0 1148.2 Tank B Regular 12'OOO DDM Tank C Premium 6'000 DDM Tank D Diesel 6'000 1148;2 i I I i t Thetracerleakdetectionmethodreliesupontheadditionofahighly vorat*e riquid chemical to the fuer. rf a leak occurs in the underground fuel system, fuel is released into the 'u"ouitnn '::^t[Jtff:l"tt:ffi-:l'l: n*-i*i;:*. #= : ::"fi :'",[:'"'ffi i: *" o" n" lmed bv d rivins probes into the grounO in the ",.,.* .r1n" i"nX' andpipes' Each probe has an effectivedetectionradiusot"pp,o*i,atelyl0to12feet.Thismeansthata siven probe should detect a leak ;;;;;"; within the area described bv the 10 root radius arou n d the prob e "" ;"J ;':",t-'1Ti :l:|[;:iXl]?1'X: i; i ; H:[i::::1[']T:"*rffi ;1;i=',,i",noo to be effective rhis process of leak detection by placing " ,,0.",,0 .,u.", in a liquid product followed by detection of the tracer underground in the vapor pn"r" is protected under TRc patents. ' 1 Thef.ollowingcriteriaarelJsedforthedassificationofleakswhentracer is detected. Tank and Une Status Pass:Ratelessthan.0sgallonsperhour.Maximumconcentrationsofless than 1 mg/L in the soil vaPor' Fail: Rate greater than '05 gallons per hour' Maximum concentrations of tracergreaterthanlmg/LneartheSource,increasingorsustaining concentrationbelowthree(3)feetortothetopofthegroundwater table. 2 .d,+#ffi- ,1. Horizon Job No' 312-90 November 6, 1990gERTlFlcATloN Location:Kar Kwik 1fih Street & Monroe Ogden, Utah' Tank Line Tank No. Prqduct $ize (Gal) Tlager Status Status Tank A ilnr""o"o ftnbo- tt---* Pass Pass' rank B Regurar i;:ilo PPl4 tT:. Pass- rank c Premium ;:doo- ?Pl't Pass' Pass Tank D Diesel ;:ooo 114P;2 Pass' Pass Horizon Engineering & Testing ?p Tracer Research corporation certifies that the tanks ano pipJ';G#;ri;ieJ in th"lbove table have been tested bv means ot Tracer rignt*, i.i#';;d,n" .ri[ri" sel tortn in urpn 329 for a precision leak test. Submitted bY Kenneth J. Tolman irinCin nEsEARcH coRPoRArloN President i{oFilzoN ENGINEERING & TEsrlNG The forowing criteria are used for the classification of reaks when tracer is detected. ffin.05gallonsperhour.Maximumconcentrationsofless than 1 mg/L in the soil vaPor' Fail:Rategreaterthan.05gallonsRelhoul.lvlaximumconcentrationsof tracergreaterthanlmg/t-neartheSource,increasingorsustaining concentration betow three ifi;;i;.to the top of the groundwater table. 3 APPENDIX A: ANALYTTCAL RESULTS 4 Kar Kwik 12th Sfreet & Monroe Ogden, Utah Horizon Job No. 312-90 November 5, 1990 Condensed Data Location 01 01 01 01 07 07 07 07 /1 pompound 114B,2 BCF DDM TPHC '114B,2 BCF DDM TPHC 114B.2 BCF DDM TPHC 1'.|4B.2 BCF DDM TPHC 114B,2 BCF DDM TPHC 114B.2 BCF DDM TPHC 114B,2 BCF DDM TPHC 114B.2 BCF DDM TPHC Page 1 Goncentration 0.0000 0.0000 0.0000 5.8740 0.0000 0.0000 0.0000 0.0000 -9999999999.0000 -9999999999.0000 -9999999999.0000 -9999999999.0000 02 02 02 02 03 03 03 03 04 04 o4 04 06 06 06 06 08 08 08 08 09 09 09 09 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 'm$i{i'i' Horizon Job No. 312-90 November 5, 1990 Condensed Data 10 10 10 10 BLANKOl BLANKOl BLANKOl BLANKOl BLANKO2 BLANKO2 BLANKO2 BLANKO2 TPHC in mg/L Tracers in ug/L 0.0000 - Not detected Detection Limits: Tracer (0.0005) -9999999999 = No sample AIB AIR AIH AIB 114B,2 BCF DDM TPHC 114B,2 BCF DDM TPHC 114B.2 BCF DDM TPHC 114B.2 BCF DDM TPHC Page 2 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.7880 - -9999999999.0000 -9999999999.0000 -9999999999.0000 -9999999999.0000 0.0000 0.0000 0.0000 0.0000 ll : l l l,ao,. . 14 r x; ', n? t3 XF . o a. lo tr EE F2 x -r Aoa -( ,TS afooa: a doos NA okoAa :I Ee; Ei . .A zoI.2-tAxf' l qss\sb.tE\ t- /. ei (,zaJpm du r n d sp u B l E l re r s o l i i : ' , . . : l,riF.Ji DEC AB '94 LSI?? rr rr;rf rttrrttltt FAI{ TRA}Ii|{I!3I0N 1 IilFON}IATIA[ P.1,/3 ltftltlltttlllllt RECEIVED DEc i I Beo s,'#,-[iffitEflffh$,er l--]]--;.,-{-n=--*-t---eL**-{---l-,.*/.-----+r---a-; . rF ?HEBE T'E8E ANY PRqBLEIIB UITH THE ?RAIIEIIISEIOTI PLE^3E CEHTACT Ug ITIIIEDIATELY. FAXr (g0l) e87-g{ge PHortE ieor r B?z-o{{B tsETIDEBI l(AR l(Tlf fil(,, --M.----+r OTHEF SEIIDEB-----!r--x------ COltTAGT- r-*-- a--rF-r-----'5- COIITACT-- - - {-r--sr-r --" rrr-r TIENERAL S DATET 19----- TIIIE I o----*--- Alt. Pl{' ,ut{BER op pABEs EE}tr rtlcLuDr}tg rt{r' BHEET ---.3---- FAX }'ACHIIIEI i::*$Ii:;il;..tt: t(AR t(t u( tllc. rt{o gSth ltr.rtl ogdrnr uT. e{{og. DEC ZB 'W L32??P,Z/3 Decernber 28, L990 GERY ESHTON sIIABE IIEALTH DEPT REIERENCE: KAR K!{IK 1015 leTH gtrREEl[, OGDEN, UTAH 84401. ATTACHED: THE BACK SHEEf FOR PETROIJETJU STORAGE TAT{K FTIND APPLfCATION. AS PER OUR COM/ERSATION THERE ARE NO KAR KWIK STATTONS AII EITIIHER ],215 L?TII StrREET OR AT 1045 12TH STBEET. KAR KIOIN I![C 1140 36TH STREET OGDEN, UTAII 84403 A.\ I ,a DEC EB '9@ L5I?3 1. CERTIFICATE OF REGISTRATION: ^€+__t. tergr.wr** it 2. COMPLIANCE WITH UST REGUIATIONS: @-ietease detec{ion requirelnents. I I Tank$ tn$alled belore 1965 or unknown: release derecfiilrn by Dec, 1989. JfTantts lndeil€d t96$1988: release detection to be complsted by my compliance datc. [ | Release dete{ilion completed upon lndallstion. S1,n;n in compliance wifi all other Federal, State, and Local UST regulations. FUND FEES - ANNUAL FACILIW MONTHLY TtsBQllGlEUr; arketer with annual facility monthly throughput greater 10,000 gallons. t I S250 paymentltank Fiscal year (July t, 1990'June 30' lgel). t I Ourrtuy p.ym€nts @ t6es0/tank (Due thc rst day ol Jul, Ocil, Jan, and Apr). f I I am a non-marketer with annualfacilitv monthly throughput leqq t!a-n ]0rOOO gallons, I j t rrave compteted the APPL|CATIoN FoR NON-MARKETEHE DISCOUNT form. I I t125 paymert/unlr: Flscal ymr (Juty I' lgg0'June 30' 1991). I t Orniledy p6yment* @ $31.25/tlnt (Dua tha lst day ol.lul, Ost, Jan, and Apf, 4. TANK & LINE TIGHTNESS TEST - ACTIONS BEOUIHED AEIEB-!',EST: tlfl Underground Storage Tanks (USTs) have been registtsred - Forrn 7530 (Revised 9€9). ffiegistration Tank Fees have beeh paid - 1988/1989 - $zstankffr, 1990/1901 = $aS/tankfir ,lsvstems oass the tank and line tightness teStS.ffi submifi;ng the resutts c'f tlre tahk tightness test and a copy of the field report. t I Alltanks do not rneetthe rqqg_qerlFnts seJ b.y rul.e regarding tank tightno.ss testing. Ii t frave contacted the State USt office and willsubmit evidence of a plan for review. 5, PREUTOUS POLLUTION INCIDENTS: Us poLLtmON NCTDENTS fomr whictr states wtsther unOer arstomiary business irnrentory prac'tice standards, I am ari/are of any release frorn the tank, If. Guarantee ]l lincf ctEredir ll Commerclal lnsunnco Il Suety Bond 6. TNDEPENDEUf HNANCIAL ASSURANCE (Keep.r,ecords at your facility): @al responsibility requirements for the first $25,0ffilrelease: lffil'on,o ., I I hldr.rrileril&ongroup f t I have obtained indeoendentthir&partyfinancial assuranca by my cornpliane date.ji{wtn obtain independent third-party financia! assuran@ by my compliance date. *SeeaefardOnstllldor,llowdOlgHdAilEd-? ; ,i.,. ., it..j!.:...,;,.r..., DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH Bureau of Solid & Hazardous Waste 288 North 1 460 Wesl. P O Box 1 6690 salt Lake crly, utah 841 1 6.0690 (801 ) 538-61 70 Norman H. Bangerter (;()vernor Suzanne Dandoy. M.D.. M.P.H. Executive I)ire.tor Kenneth L. Alkema I )rrecror RE: 4,PR 2 0 tgga R. K. Wangsgard Kar Kwik, Inc. 2784 Jefferson Avenue Ogden, Utah 84403 CERTIFIED MAIL RETURN RECEIPrT REOUESTED NOTICE OF VIOLATION, #90041247;26-14e-3O2, Utah Code Annotated, 1953, as amended; Non-payment of UST Fees. Dear Mr. Wangsgard: Based on evidence in record you have violated Section 26-74e-3O2, Utah Code Annotated, 1953, as amended, for non-payment of Underground Storage Tank (UST) fees. The violation is based on the findings below: 1. Kar Kwik, [nc. owns or operates the facility located at 1215 12th Street, Ogden, Utah which has been assigned the Facility ldentification Number of 1200334. 2. Kar Kwik, [nc. owns or operates four (4) Underground Storage Tanks (USTs) at the facility which are regulated under Subtitle t of the Resource Conservation and Recovery Act, 42 U.S.C. 56991c, et seq. The tanks are not closed. 3. Kar Kwik, [nc. has failed to pay fees for the fiscal year 1988, July 7, 1987 to June 30, 1988, of $25.00 per tank as required by 26-l4e-3O2 of the Utah Code furnotated, 1953, as amended. Accordingly, Kar Kwik is required to come into compliance with 26-14e-302, Utah Code Annotated, 1953, as amended; by payrng the fee assessment for fiscal year 1988 which totals one hundred dollars ($100.00). Payment is to be received within 14 days of receipt of this NOTICE OF VIOLATION. ^ a Should you have any questions, please direct them to Janet Keller at 538-6170. Sincerely, Utah Solid and Hazardous Wastes Committee c: EPA Region V[[[, Jim Rakers Weber/Morgan District Health Department DRD/JIVds BSHWNGFY2y65 Norman H. Bangeiter Gortrnor Suzanne DairCoy, I'1.D., M.P.H. E\.cu[i!c I)ir(\ ror Xerineth L. Alle;la l)irecl.tr I ,:''; , .. I ;'i i .1. l x DEPARTI'/IEI.]T OF HEALTH nn n^r^ir ft[nn rYr' Ur r,'lDl\J]\ Ur I!l\ V rr{,UI\ lvlDl\ r.rrL frDAL I rl , . Bureau ol Solrd & l-laza:dous Wa"le . 288 North '! 460 U,,esr. P.O. Eox 16690 Sait Lake Cily, Utah gz I 1 6-0690 1801) 538-6170 EEBTTEIED_MAIL RETURN RECETPT REOUESTED 1.,,, 1 - " t\. . APR 2 C B9A R. K. Wangsgard Kar Kwik, Inc. 2784 Jefferson Avenue Ogden, Utah 84403 (1 ,t, : ' j, YL t):-i trzv /' RE: NOTICE OF VIO[/.TION, #90 047247; 26-14e-3O2, Utah Code Annotated, 1953, as amended; Non-payment of UST Fees. Dear Mr. Wangsgard: Based on evidence in record you have violated Section 26-74e-302, Utah Code Annotated, 1953, as amended, for non-payment of Underground Storage Tank (UST) fees. The violation is based on the findings below: 1. Kar Kwik, Inc. owns or operates the facility located at 1215 12th Street, Ogden, Utah which has been assigned the Facility Identification Number of 1200334. 2. Kar Kwik, [nc. owns or operates four (4) Underground Storage Tanks (USTs) at the faciiity which are reguiate<i under Subtitie i of the Resource Conservation and Recovery Acl, 42 U.S.C. $6991c. et seq. The tanks are not closed. 3. Kar Kwik, Inc. has failed to pay fees for the fiscal year 1988, July 7, 7987 to June 30, 1988, of $25.00 per tank as required by 26-14e-302 of the Utah Code Annotated, 1953, as amended. Accordingly, Kar Kwik is required to come into compliance with 26-14e-302, Urah Code Annotated, 1953, as amended; by paying the fee assessment for fisca1 year 19BB which totais one hundred dollars ($100.00). Paymenr is to be received within 14 days of receipt of this NOTICE OF VIOI"{TION.