DERR-2024-005239

Utah Department of Environmental Quality
UST lnstallation lnspection
Ownership of Tanks
SHERIK LLC
2674Visla Hill Drive
BLUFFDALE UT
Tanks lnstalled. Use additional pages as needed.
New lnstallation or Upgrade
UL Number
Material of construction (FRP, Steel, Composite, etc.)
Double walled - dry or brine filled
Substance to be stored
Capacity
Date installed
Pre-installation pressure test date or vacuum date (dry interstice)
Reading of pressure or vacuum for pre-installation test (dry interstice)
Type of overfill prevention device (shutoff or alarm)
Overfill alarm has sign and is visible and audible to driver (RP100)
Type of spill prevention device (single or dw spill bucket, sump, etc)
Amount of tank deflection readings (initial)
Amount of tank deflection readings (hold down straps)
Amount of tank deflection readings (backfill top of tank)
Piping lnformation
Material of construction (Flex plastic, FRP, etc)
Type (Pressure, Suction, Safe Suction, Gravity)
Date pre-installation air test passed
Pressure for pre-installation air test
lnstallation Specifications
Do you have a copy of the tank manufacturer's installation manual and PEI RP100 with you
Page 1 or -L
Location of Tanks
80001 1 I
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Delle City Station
1 W Main Street
GRANTSVILLE UT
Tank No. Tank No.
84029
Tank No. Tank No.
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Certified tank instailer D eu<-- blr4
Certified lnstallation Company Ct A-
Cert. #: TL t4 t//
Cert. #: lC
GNo
Exp. Date: 5/l/Z 7
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Visual inspection of tank(s) reveals it is free from damage
Visual inspection reveals no brine on either the inside or outside of the tank(s) (from interstitial space of brine tank)
Damaged components have been repaired by the manufacturer
Tank and piping excavations are free of debris
Depth of backfill bedding for tank(s) (must be at least one foot)
Type of backfill material (clean, free flowing, etc.) (Sieve report should match installation manual):
Geotextile fabric used along sides of excavation (recommended)
Geotextrle fabric separates any secondary backfill (required)
Estimated depth to groundwater
Tank(s) are placed at sufficient depth for traffic requirements, groundwater conditions (check installation manual)
Tanks are outside the shadow of the 45 degree factor of a structure's footing (PEl RP100 Fig 4-2)
Distance from tank(s) to nearest property line:Distance from tank(s) to nearest structure:
Anchoring method is adequate for groundwater considerations. Note method here:
Hold-down straps are in place according to manufacturer's specifications (check installation manual if clamps are used)
Tank spacing is at least 18" between tank(s) and excavation wall (stable wall) or 18" between tank(s) and 112 times tank
diameter excavation wall (unstable wall)
Tank is level or sloped toward interstitial monitor probe
Backfill has been adequately compacted for full suport along tank length at 5 and 7 o'clock
Date of pressure test after backfilf tontgp of tank (before piping is installed)
r(name) /(r.lf lrztl,/'l - ce,certify that I inspected the above-named facility on (date): 5d2; -q%{ffiy Jrtl,::.":i-X';:f"";;WV,
Ver. 101512O18
Cert.#: Tt /e/ 3/d21/ P'/,\> **t
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Pase 2 9f +-Utah Department of Environmental Quality
UST Facility Site Plat
NORTH
80001 1 I
7b"-
Show locations of all buildings, streets, tanks, piping, and dispenser islands. lndicate the product in each t nt.. S(u!u!A!r?tk* o^n
manways and identify each: submersible pump (S), tank fill (F), ATG probe (A), interstitial probe (l), vapor recovery (V), capped plug (C), other
(specify).
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