DERR-2024-005209

UTAH STATE FUEL NETWORK AST ANNUAL INSPECTION
Facility Name and Site Address: Date:
Facility ID #
Purpose:Regular Reinspection Complaints Annual Inspection
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Pumps Tested for Calibration
Is tank grounding strap in good condition ?
Is tank coating free of corrosion / damage ?
Is tank free of noticable distortion, denting, buckeling ?
Flanged connection bolts appear tight ?
Normal and emergency vents appear in good condition ?
Inspection Remarks:
Technician signature
Inspected By: Steven B. Martin UT121
Applied Environmental Services L.C.
PROVO CITY SHOPS
424 EAST 1325 SOUTH
PROVO, UTAH
3-20-2024
1000228
X
1-4 X X
X
X
X
X NO DEDICATED GROUND
X SOME PAINT FLAKING
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X
X
X
State Fuel Contact : Brett Gurney 385-602-4872
801-540 9258 [e-mail]
Email: [e-mail]
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X
NO
Fill and vapor connections in good condition ?
TRENCH
TWO ASTS WITH PIPING IN UNDERGROUND TRENCH
XTank containment structure in satisfactory condition ?
Free of tank settlement and foundation washout ?
Tank supports in satisfactory condition ?
Is water able to drain off tank pad and tank top ?
Gasoline vent has P/V valve installed where required ?
Valves / syphons / solenoids appear in good condition ?
Spill containment visable and appears in good condition
Electrical junction boxes and conduits in good condition
Tank monitor free of active alarms ?
Emergency shutoff installed ?
Dispenser static test ?
Tank overfill equipment installed ?
Piping sumps appear in good condition ?
COMMENTS / ACTION
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2024.03.20 13:59:18 -07'00'
Reason: I am the author of this document