DERR-2025-001122

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UST Installation Inspection
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Ownership of Tanks Location of Tanks
ESTES EXPRESS LINES __ J G.I. TRU_9 KING _9 0MPANY OBA ESTES W~ST
1
1234 S 3200 W
84104 ----SALTLAKECITY ,uT
Tanks Installed. U~add ~onal pages a~~~-_____ Tank No. J-Tank N~ tf, Tank No.
New Installation or Upgrade
~~~t;~:;~~-n~~ru _ct_io_n_(F=R=P~_.~S_!_e_e_l-,_Co-_-m~-po-~-it-e-, e-t-c-.)----:_-_-_-:_-:.. 1-~ --_1 ____ __.l....,..J __
Double walled -dry or brine filled ±
Substance to be stored t!'5.
Capacity ---'~t<~ ----t
Date installed ~
4601 SPEAKER ROAD -~
KANSAS CITY KS 184104
,-.
Tank No.
~
---,
Pre-installation pressure test date or vacuum date (dry interstice) -..
Type of overfill prevention device (shutoff or alar~ ---1' ------"'\.~ --
0vert111 .;Jann !"'-;; si gn and is vi~ble and a;;iible ID driwr iRf'.: 00) l _ _ -t--~ ~, \ _ ~ -: -
Type of spill prevention_d~vice J:ingle or dw spill bucket, sump , etc) _ _ _ ' _ 0 --+-----
..........
Amount of tank deflection readings (hold down straps)
Amount of tank_ deflection readings (initial) _
1
--+---1-· -\ -;
--------1------1------Amount of tank deflection readings (backfill top of tank)
-----------.....L Piping Information
, 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 --------Installation Specifications --Do you have a copy of the tank manufacturer's installation manual and PEI RP100 with you
_9 ertified tank in ~taller X.,4~ _/.l_(J.cclm e,_t:) ___ __J C:rt. #: TL _ (2_( _,'2 ,b_
Certified Installation Company p d to_W~ b _J:.ri ~ !Ce~: IC _ _
r Yes No NA
E~P.:. Date: [2.. -_5 -.2Q.2..5
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)
---------------------t
_____ Yes ~o@
~s_No~
Yes No~-
~ No-NA -_c~--
Type of backfill material (clean , free flowing, etc.) (Sieve report should match installation manual):
Geotextile fabric used along sides of excavation (recommended)
Geotextile 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) ------------
1 Tanks are outside the shadow of the 45 degree factor of a structure's footing (PEI RP100 Fig 4-2)
--_-f+-·-~_:_:_ -~:-~:
Yes No NA ----
Yes No NA _____ __.__ ---
Distance from tank(s) to nearest property line: I Distance from tank(s) to nearest structure: ------------
Anchoring method is adequate for groundwater considerations. Note method here: _____ Yes No
• Hold-down straps are in place acc~~d ~g !O manufacturer's specifications (check installation manual if c~mps are used) ➔ Y;s No
Tank spacing is at least 18" between tank(s) and excavation wall (stable wall) or 18" between tank(s) and 1/2 times tank
diameter excavation wall (unstable wall) Yes No
--r -
NA
NA
NA
Tank is level or sloped toward interstitial monitor probe Yes No NA -----------------------,
Backfill has been adequately compacted for full suport along tank length at 5 and 7 o'clock ' Yes No NA
Date of pressure test after backfill to top of tank (before piping is installed)
1 (name) 5 ea n vta r 11 ~ _ _ certify that I ins~~ed ~he abov;-n__:1 medfacility o n-(dataj: 2.l-z/.2!J-25
lnspector'~Signature:_~ 41'~ ____________ Cert.#: Tl ~ { f
Ver. 10/5/2018
Page2or _ Utah Department of Environmental Quality 4001470
UST Facility Site Plat --------......... ---.--,--.----
NORTH
Show -•ions of all 00;1d;ngs, streets, tanks, p1p;~nse;:1.!~~lcate the product In each ten~ Show locatOns of tank
manways and identify each : submersible pump (S), tank fill (F), ATG probe (A), Interstitial probe (I), vapor recovery (V), capped plug (C), other
(specify).
Comments :
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