DERR-2025-001879

Site 372 Compliance Report
February 1, 2024 to February 28, 2025
Site:Maverik 372 - Tremonton, UT Tank Owner:Maverik, Inc.
1035 West Main Street 185 S. State Street Suite 800
Tremonton, UT 84337 Salt Lake City, UT 84111
Report Created: February 13, 2025 7:46 AM
Tank Release Detection Results - Interstitial Monitoring
Tank Product Test Date Period Test Type Result
1 ETHANOL-FREE UNL 02/01/2024 02/2024 Interstitial Sensor Normal
2 DIESEL 02/01/2024 02/2024 Interstitial Sensor Normal
3 PREMIUM 02/01/2024 02/2024 Interstitial Sensor Normal
4 UNLEADED 02/01/2024 02/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 03/01/2024 03/2024 Interstitial Sensor Normal
2 DIESEL 03/01/2024 03/2024 Interstitial Sensor Normal
3 PREMIUM 03/01/2024 03/2024 Interstitial Sensor Normal
4 UNLEADED 03/01/2024 03/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 03/31/2024 03/2024 Interstitial Sensor Normal
2 DIESEL 03/31/2024 03/2024 Interstitial Sensor Normal
3 PREMIUM 03/31/2024 03/2024 Interstitial Sensor Normal
4 UNLEADED 03/31/2024 03/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 04/01/2024 04/2024 Interstitial Sensor Normal
2 DIESEL 04/01/2024 04/2024 Interstitial Sensor Normal
3 PREMIUM 04/01/2024 04/2024 Interstitial Sensor Normal
4 UNLEADED 04/01/2024 04/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 05/01/2024 05/2024 Interstitial Sensor Normal
2 DIESEL 05/01/2024 05/2024 Interstitial Sensor Normal
3 PREMIUM 05/01/2024 05/2024 Interstitial Sensor Normal
Tank Product Test Date Period Test Type Result
4 UNLEADED 05/01/2024 05/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 05/31/2024 05/2024 Interstitial Sensor Normal
2 DIESEL 05/31/2024 05/2024 Interstitial Sensor Normal
3 PREMIUM 05/31/2024 05/2024 Interstitial Sensor Normal
4 UNLEADED 05/31/2024 05/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 06/01/2024 06/2024 Interstitial Sensor Normal
2 DIESEL 06/01/2024 06/2024 Interstitial Sensor Normal
3 PREMIUM 06/01/2024 06/2024 Interstitial Sensor Normal
4 UNLEADED 06/01/2024 06/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 07/01/2024 07/2024 Interstitial Sensor Normal
2 DIESEL 07/01/2024 07/2024 Interstitial Sensor Normal
3 PREMIUM 07/01/2024 07/2024 Interstitial Sensor Normal
4 UNLEADED 07/01/2024 07/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 07/31/2024 07/2024 Interstitial Sensor Normal
2 DIESEL 07/31/2024 07/2024 Interstitial Sensor Normal
3 PREMIUM 07/31/2024 07/2024 Interstitial Sensor Normal
4 UNLEADED 07/31/2024 07/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 08/01/2024 08/2024 Interstitial Sensor Normal
2 DIESEL 08/01/2024 08/2024 Interstitial Sensor Normal
3 PREMIUM 08/01/2024 08/2024 Interstitial Sensor Normal
4 UNLEADED 08/01/2024 08/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 08/31/2024 08/2024 Interstitial Sensor Normal
2 DIESEL 08/31/2024 08/2024 Interstitial Sensor Normal
3 PREMIUM 08/31/2024 08/2024 Interstitial Sensor Normal
4 UNLEADED 08/31/2024 08/2024 Interstitial Sensor Normal
Tank Product Test Date Period Test Type Result
1 ETHANOL-FREE UNL 09/01/2024 09/2024 Interstitial Sensor Normal
2 DIESEL 09/01/2024 09/2024 Interstitial Sensor Normal
3 PREMIUM 09/01/2024 09/2024 Interstitial Sensor Normal
4 UNLEADED 09/01/2024 09/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 10/01/2024 10/2024 Interstitial Sensor Normal
2 DIESEL 10/01/2024 10/2024 Interstitial Sensor Normal
3 PREMIUM 10/01/2024 10/2024 Interstitial Sensor Normal
4 UNLEADED 10/01/2024 10/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 10/31/2024 10/2024 Interstitial Sensor Normal
2 DIESEL 10/31/2024 10/2024 Interstitial Sensor Normal
3 PREMIUM 10/31/2024 10/2024 Interstitial Sensor Normal
4 UNLEADED 10/31/2024 10/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 11/01/2024 11/2024 Interstitial Sensor Normal
2 DIESEL 11/01/2024 11/2024 Interstitial Sensor Normal
3 PREMIUM 11/01/2024 11/2024 Interstitial Sensor Normal
4 UNLEADED 11/01/2024 11/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 12/01/2024 12/2024 Interstitial Sensor Normal
2 DIESEL 12/01/2024 12/2024 Interstitial Sensor Normal
3 PREMIUM 12/01/2024 12/2024 Interstitial Sensor Normal
4 UNLEADED 12/01/2024 12/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 12/31/2024 12/2024 Interstitial Sensor Normal
2 DIESEL 12/31/2024 12/2024 Interstitial Sensor Normal
3 PREMIUM 12/31/2024 12/2024 Interstitial Sensor Normal
4 UNLEADED 12/31/2024 12/2024 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 01/01/2025 01/2025 Interstitial Sensor Normal
Tank Product Test Date Period Test Type Result
2 DIESEL 01/01/2025 01/2025 Interstitial Sensor Normal
3 PREMIUM 01/01/2025 01/2025 Interstitial Sensor Normal
4 UNLEADED 01/01/2025 01/2025 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 01/31/2025 01/2025 Interstitial Sensor Normal
2 DIESEL 01/31/2025 01/2025 Interstitial Sensor Normal
3 PREMIUM 01/31/2025 01/2025 Interstitial Sensor Normal
4 UNLEADED 01/31/2025 01/2025 Interstitial Sensor Normal
1 ETHANOL-FREE UNL 02/01/2025 02/2025 Interstitial Sensor Normal
2 DIESEL 02/01/2025 02/2025 Interstitial Sensor Normal
3 PREMIUM 02/01/2025 02/2025 Interstitial Sensor Normal
4 UNLEADED 02/01/2025 02/2025 Interstitial Sensor Normal
Site 372 Compliance Report
February 1, 2024 to February 28, 2025
Site:Maverik 372 - Tremonton, UT Tank Owner:Maverik, Inc.
1035 West Main Street 185 S. State Street Suite 800
Tremonton, UT 84337 Salt Lake City, UT 84111
Report Created: February 13, 2025 7:46 AM
Line Release Detection Results - PLLD
Label Test Date Period Test Type Result
DSL LINE 02/04/2024 02/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 02/02/2024 02/2024 PLLD 0.2 GPH PASS
PRM LINE 02/02/2024 02/2024 PLLD 0.2 GPH PASS
UNL LINE 02/02/2024 02/2024 PLLD 0.2 GPH PASS
DSL LINE 03/01/2024 03/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 03/03/2024 03/2024 PLLD 0.2 GPH PASS
PRM LINE 03/03/2024 03/2024 PLLD 0.2 GPH PASS
UNL LINE 03/03/2024 03/2024 PLLD 0.2 GPH PASS
DSL LINE 04/02/2024 04/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 04/01/2024 04/2024 PLLD 0.2 GPH PASS
PRM LINE 04/02/2024 04/2024 PLLD 0.2 GPH PASS
UNL LINE 04/04/2024 04/2024 PLLD 0.2 GPH PASS
DSL LINE 05/04/2024 05/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 05/04/2024 05/2024 PLLD 0.2 GPH PASS
PRM LINE 05/03/2024 05/2024 PLLD 0.2 GPH PASS
UNL LINE 05/01/2024 05/2024 PLLD 0.2 GPH PASS
DSL LINE 06/05/2024 06/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 06/01/2024 06/2024 PLLD 0.2 GPH PASS
PRM LINE 06/03/2024 06/2024 PLLD 0.2 GPH PASS
Label Test Date Period Test Type Result
UNL LINE 06/05/2024 06/2024 PLLD 0.2 GPH PASS
DSL LINE 07/01/2024 07/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 07/01/2024 07/2024 PLLD 0.2 GPH PASS
PRM LINE 07/01/2024 07/2024 PLLD 0.2 GPH PASS
UNL LINE 07/01/2024 07/2024 PLLD 0.2 GPH PASS
DSL LINE 08/01/2024 08/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 08/02/2024 08/2024 PLLD 0.2 GPH PASS
PRM LINE 08/02/2024 08/2024 PLLD 0.2 GPH PASS
UNL LINE 08/05/2024 08/2024 PLLD 0.2 GPH PASS
DSL LINE 09/01/2024 09/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 09/03/2024 09/2024 PLLD 0.2 GPH PASS
PRM LINE 09/01/2024 09/2024 PLLD 0.2 GPH PASS
UNL LINE 09/01/2024 09/2024 PLLD 0.2 GPH PASS
DSL LINE 10/01/2024 10/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 10/03/2024 10/2024 PLLD 0.2 GPH PASS
PRM LINE 10/01/2024 10/2024 PLLD 0.2 GPH PASS
UNL LINE 10/07/2024 10/2024 PLLD 0.2 GPH PASS
DSL LINE 11/03/2024 11/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 11/02/2024 11/2024 PLLD 0.2 GPH PASS
PRM LINE 11/04/2024 11/2024 PLLD 0.2 GPH PASS
UNL LINE 11/04/2024 11/2024 PLLD 0.2 GPH PASS
DSL LINE 12/02/2024 12/2024 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 12/04/2024 12/2024 PLLD 0.2 GPH PASS
PRM LINE 12/04/2024 12/2024 PLLD 0.2 GPH PASS
UNL LINE 12/06/2024 12/2024 PLLD 0.2 GPH PASS
Label Test Date Period Test Type Result
DSL LINE 01/01/2025 01/2025 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 01/03/2025 01/2025 PLLD 0.2 GPH PASS
PRM LINE 01/03/2025 01/2025 PLLD 0.2 GPH PASS
UNL LINE 01/11/2025 01/2025 PLLD 0.2 GPH PASS
DSL LINE 02/04/2025 02/2025 PLLD 0.2 GPH PASS
ETHANOL FREE LINE 02/02/2025 02/2025 PLLD 0.2 GPH PASS
PRM LINE 02/02/2025 02/2025 PLLD 0.2 GPH PASS
UNL LINE 02/02/2025 02/2025 PLLD 0.2 GPH PASS
Site 372 Compliance Report
February 1, 2024 to February 28, 2025
Site:Maverik 372 - Tremonton, UT Tank Owner:Maverik, Inc.
1035 West Main Street 185 S. State Street Suite 800
Tremonton, UT 84337 Salt Lake City, UT 84111
Report Created: February 13, 2025 7:46 AM
Sensor Status
Sensor Sensor Category Sensor Label Test Date Period Result
5 Annular ETHANOL FREE INT 02/01/2024 02/2024 Sensor Normal
6 Annular DSL INT 02/01/2024 02/2024 Sensor Normal
7 Annular PRM INT 02/01/2024 02/2024 Sensor Normal
8 Annular UNL INT 02/01/2024 02/2024 Sensor Normal
5 Annular ETHANOL FREE INT 03/01/2024 03/2024 Sensor Normal
6 Annular DSL INT 03/01/2024 03/2024 Sensor Normal
7 Annular PRM INT 03/01/2024 03/2024 Sensor Normal
8 Annular UNL INT 03/01/2024 03/2024 Sensor Normal
5 Annular ETHANOL FREE INT 03/31/2024 03/2024 Sensor Normal
6 Annular DSL INT 03/31/2024 03/2024 Sensor Normal
7 Annular PRM INT 03/31/2024 03/2024 Sensor Normal
8 Annular UNL INT 03/31/2024 03/2024 Sensor Normal
5 Annular ETHANOL FREE INT 04/01/2024 04/2024 Sensor Normal
6 Annular DSL INT 04/01/2024 04/2024 Sensor Normal
7 Annular PRM INT 04/01/2024 04/2024 Sensor Normal
8 Annular UNL INT 04/01/2024 04/2024 Sensor Normal
5 Annular ETHANOL FREE INT 05/01/2024 05/2024 Sensor Normal
6 Annular DSL INT 05/01/2024 05/2024 Sensor Normal
7 Annular PRM INT 05/01/2024 05/2024 Sensor Normal
Sensor Sensor Category Sensor Label Test Date Period Result
8 Annular UNL INT 05/01/2024 05/2024 Sensor Normal
5 Annular ETHANOL FREE INT 05/31/2024 05/2024 Sensor Normal
6 Annular DSL INT 05/31/2024 05/2024 Sensor Normal
7 Annular PRM INT 05/31/2024 05/2024 Sensor Normal
8 Annular UNL INT 05/31/2024 05/2024 Sensor Normal
5 Annular ETHANOL FREE INT 06/01/2024 06/2024 Sensor Normal
6 Annular DSL INT 06/01/2024 06/2024 Sensor Normal
7 Annular PRM INT 06/01/2024 06/2024 Sensor Normal
8 Annular UNL INT 06/01/2024 06/2024 Sensor Normal
5 Annular ETHANOL FREE INT 07/01/2024 07/2024 Sensor Normal
6 Annular DSL INT 07/01/2024 07/2024 Sensor Normal
7 Annular PRM INT 07/01/2024 07/2024 Sensor Normal
8 Annular UNL INT 07/01/2024 07/2024 Sensor Normal
5 Annular ETHANOL FREE INT 07/31/2024 07/2024 Sensor Normal
6 Annular DSL INT 07/31/2024 07/2024 Sensor Normal
7 Annular PRM INT 07/31/2024 07/2024 Sensor Normal
8 Annular UNL INT 07/31/2024 07/2024 Sensor Normal
5 Annular ETHANOL FREE INT 08/01/2024 08/2024 Sensor Normal
6 Annular DSL INT 08/01/2024 08/2024 Sensor Normal
7 Annular PRM INT 08/01/2024 08/2024 Sensor Normal
8 Annular UNL INT 08/01/2024 08/2024 Sensor Normal
5 Annular ETHANOL FREE INT 08/31/2024 08/2024 Sensor Normal
6 Annular DSL INT 08/31/2024 08/2024 Sensor Normal
7 Annular PRM INT 08/31/2024 08/2024 Sensor Normal
8 Annular UNL INT 08/31/2024 08/2024 Sensor Normal
Sensor Sensor Category Sensor Label Test Date Period Result
5 Annular ETHANOL FREE INT 09/01/2024 09/2024 Sensor Normal
6 Annular DSL INT 09/01/2024 09/2024 Sensor Normal
7 Annular PRM INT 09/01/2024 09/2024 Sensor Normal
8 Annular UNL INT 09/01/2024 09/2024 Sensor Normal
5 Annular ETHANOL FREE INT 10/01/2024 10/2024 Sensor Normal
6 Annular DSL INT 10/01/2024 10/2024 Sensor Normal
7 Annular PRM INT 10/01/2024 10/2024 Sensor Normal
8 Annular UNL INT 10/01/2024 10/2024 Sensor Normal
5 Annular ETHANOL FREE INT 10/31/2024 10/2024 Sensor Normal
6 Annular DSL INT 10/31/2024 10/2024 Sensor Normal
7 Annular PRM INT 10/31/2024 10/2024 Sensor Normal
8 Annular UNL INT 10/31/2024 10/2024 Sensor Normal
5 Annular ETHANOL FREE INT 11/01/2024 11/2024 Sensor Normal
6 Annular DSL INT 11/01/2024 11/2024 Sensor Normal
7 Annular PRM INT 11/01/2024 11/2024 Sensor Normal
8 Annular UNL INT 11/01/2024 11/2024 Sensor Normal
5 Annular ETHANOL FREE INT 12/01/2024 12/2024 Sensor Normal
6 Annular DSL INT 12/01/2024 12/2024 Sensor Normal
7 Annular PRM INT 12/01/2024 12/2024 Sensor Normal
8 Annular UNL INT 12/01/2024 12/2024 Sensor Normal
5 Annular ETHANOL FREE INT 12/31/2024 12/2024 Sensor Normal
6 Annular DSL INT 12/31/2024 12/2024 Sensor Normal
7 Annular PRM INT 12/31/2024 12/2024 Sensor Normal
8 Annular UNL INT 12/31/2024 12/2024 Sensor Normal
5 Annular ETHANOL FREE INT 01/01/2025 01/2025 Sensor Normal
Sensor Sensor Category Sensor Label Test Date Period Result
6 Annular DSL INT 01/01/2025 01/2025 Sensor Normal
7 Annular PRM INT 01/01/2025 01/2025 Sensor Normal
8 Annular UNL INT 01/01/2025 01/2025 Sensor Normal
5 Annular ETHANOL FREE INT 01/31/2025 01/2025 Sensor Normal
6 Annular DSL INT 01/31/2025 01/2025 Sensor Normal
7 Annular PRM INT 01/31/2025 01/2025 Sensor Normal
8 Annular UNL INT 01/31/2025 01/2025 Sensor Normal
5 Annular ETHANOL FREE INT 02/01/2025 02/2025 Sensor Normal
6 Annular DSL INT 02/01/2025 02/2025 Sensor Normal
7 Annular PRM INT 02/01/2025 02/2025 Sensor Normal
8 Annular UNL INT 02/01/2025 02/2025 Sensor Normal
pei.org 49
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities
APPENDIX C-9
MECHANICAL AND ELECTRONIC LINE LEAK DETECTORS
PERFORMANCE TEST
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Precision Testing Technologies Inc.801-886-9224
Maverik #372
1035 W. Main St.
Tremonton, UT 84337
0100654
Maverik Inc.
185 S. State St., Ste. 800
S.L.C., UT 84111
10/26/2024
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pei.org 47
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities
APPENDIX C-7
AUTOMATIC TANK GAUGE
OPERATION INSPECTION
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Maverik #372
0100654
10/26/2024
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Maverik #372
0100654
10/26/2024
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Max LaRou UT-412
pei.org 43
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities
APPENDIX C-3
SPILL BUCKET INTEGRITY TESTING HYDROSTATIC TEST METHOD
SINGLE AND DOUBLE-WALLED VACUUM TEST METHOD
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Maverik #372
0100654
10/26/2024
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APPENDIX C-6
OVERFILL ALARM
OPERATION INSPECTION
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Maverik #372
0100654
10/26/2024
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Max LaRou UT-412

FORM 1
SUMMARY OF SOURCE TEST DATA
SOURCE INFORMATION FACILITY PARAMETERS
GDF Name and addresss GDF Representative and Title
_________________________________
PHASE II SYSTEM TYPE
(Check One)
Balance ____
Hirt ____
Red Jacket ____
Hasstech ____ Healy ____Other
GDF Phone No. (___)________________
Permit Conditions Source: GDF Vapor Recovery System
GDF #
A/C # Manifolded? Y or N
Operating Parameters
Number of Nozzles Served by Tank #1 ______ Number of Nozzles Served by Tank #3 ______
Number of Nozzles Served by Tank #2 ______ Number of Nozzles Served by Tank #4 ______
Applicable Regulations: VN Recommended
Source Test Results and Comments
Tank #:
1.Product Grade
2.Actual Tank Capacity, gallons
3.Gasoline Volume
4.Ullage, gallons (#2-#3)
5.Initial Pressure, inches H 2 O
6.Pressure After 1 Minute, inches H 2 O
7.Pressure After 2 Minutes, inches H 2 O
8.Pressure After 3 Minutes, inches H 2 O
9.Pressure After 4 Minutes, inches H 2 O
10.Final Pressure After 5 Minutes, inches H 2 O
11.Allowable Final Pressure
Test Conducted by: Test Company: Date of Test:
California Air Resources Board July 26, 2012
TP-201.3, Page 14
40CFR63CCCCCC
Precision Testing Technologies
Maverik #372
V.R.S. Dual Point
4
1
CLR
11,527
6,979
4,548
2.00
1.86
1.80
1.76
1.74
1.73
1.69
3
PRM
11,527
3,506
8,021
2.00
1.94
1.90
1.88
1.87
1.86
1.82
4
REG
11,527
1,791
9,736
2.00
1.94
1.92
1.91
1.90
1.89
1.85
Max LaRou UT-412 10/26/2024
Maverik #372
Pressure/Vacuum (P/V) Vent Valve Data Sheet
Facility Name: Test Date:
Address: Test Company: Precision Testing Technologies
City: Tester Name:
Product:
P/V Valve Manufacturer: Model Number: Pass Fail
Manufacturers Specified
Positive Leak Rate (CFH):
Manufacturers Specified
Negative Leak Rate (CFH):
Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH):
Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O):
Product:
P/V Valve Manufacturer: Model Number: Pass Fail
Manufacturers Specified
Positive Leak Rate (CFH):
Manufacturers Specified
Negative Leak Rate (CFH):
Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH):
Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O):
Product:
P/V Valve Manufacturer: Model Number: Pass Fail
Manufacturers Specified
Positive Leak Rate (CFH):
Manufacturers Specified
Negative Leak Rate (CFH):
Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH):
Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O):
Product:
P/V Valve Manufacturer: Model Number: Pass Fail
Manufacturers Specified
Positive Leak Rate (CFH):
Manufacturers Specified
Negative Leak Rate (CFH):
Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH):
Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O):
2.5" to 6" wc
<=0.05 cfh @ 2" wc
2.5" to 6" wc
<=0.05 cfh @2" wc
2.5" to 6" wc
<=0.05 cfh 2" wc
2.5" to 6" wc
<=0.05 cfh 2" wc
6" to 10" wc
<=0.21 cfh @ 4" wc
6" to 10" wc
<=0.21 cfh @ 4" wc
6" to 10" wc
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6" to 10" wc
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Maverik #372 10-26-2024
Max LaRou UT-412
CLR
OPW 623V 4
0.04 cfh @ 2"wc
3.6"wc
0.20 cfh @ 4"wc
-9.0"wc
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0.04 cfh @ 2"wc
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-6.7"wc
Maverik #372
Max LaRou UT-412
10-26-2024
California Air Resources Board October 8, 2003
TP-201.1B, Page 5
Form 1
Static Torque of Rotatable Phase I Adaptors
Measurement Units: (Check Box): pound-inches pound-feet
Vapor Adaptor 1 Vapor Adaptor 2 Vapor Adaptor 3 Vapor Adaptor 4
Brand:Brand:Brand:Brand:
Model:Model:Model:Model:
Grade:Grade:Grade:Grade:
Torque 1:Torque 1:Torque 1:Torque 1:
Torque 2:Torque 2:Torque 2:Torque 2:
Torque 3:Torque 3:Torque 3:Torque 3:
Average:Average:Average:Average:
360 Rotation:360 Rotation: 360 Rotation:360 Rotation:
Product Adaptor 1 Product Adaptor 2 Product Adaptor 3 Product Adaptor 4
Brand:Brand:Brand:Brand:
Model:Model:Model:Model:
Grade:Grade:Grade:Grade:
Torque 1:Torque 1:Torque 1:Torque 1:
Torque 2:Torque 2:Torque 2:Torque 2:
Torque 3:Torque 3:Torque 3:Torque 3:
Average:Average:Average:Average:
360 Rotation: 360 Rotation: 360 Rotation:360 Rotation:
Comments: ___________________________________________________________________
Test Company:Conducted By:
Test Date:Facility Name:
Facility Address:City:
Precision Testing Technologies Max LaRou UT-412
10/26/2024 Maverik #372
Yes
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55
55
55
55
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40
35
30
35
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2025
UST Operator Inspection - Utah
YEAR
Facility Name Maverik 372 Facility ID 372
Address 1035 WEST MAIN STREET Primary Class B Operator PEC
NAME(S) AND INITIALS OF PERSON(S) CONDUCTING MONTHLY INSPECTIONS:
PEC
Please respond to ALL of the following questions with a Y (Yes), N (No), or NA (Not Applicable) answer.
Months of the Current Year J F M A M J J A S O N D
Monthly Inspection— Release Detection
1 Release detection equipment is operating with no alarms or other unusual
operating conditions.
Y Y Y Y Y Y Y Y Y Y Y Y
2 Records of release detection (tanks and piping) are reviewed and current. Y Y Y Y Y Y Y Y Y Y Y Y
Monthly Inspection — Spill Prevention Equipment
3 Equipment is undamaged, intact and free from defects. Y Y Y Y Y Y Y Y Y Y Y Y
4 Equipment is free from debris, water, or product. Y Y Y y Y Y Y Y Y Y Y Y
5 Fill Pipe is unobstructed. Y Y Y Y Y Y Y Y Y Y Y Y
5 Fill cap is un-broken and is securely on the fill pipe. Y Y Y Y Y Y Y Y Y Y Y Y
7 Double walled spill prevention equipment - Interstitial area is free from leaks. Y Y Y Y Y Y Y Y Y Y Y Y
Initials of person performing Inspection. PEC PEC PEC PEC PEC PE PEC PEi PEI PEC PEC PEC
Annual Inspection — Containment Sumps Date of annual inspection
8
Secondary Containment Sumps
STP, Dispenser and Transition)
Visual Inspection of sump indicates no damage and it is free from debris, water and fuel.
The penetration fittings for conduits and piping entering the STP Sumps are intact.
9 Double Wailed Sumps Interstitial area is free from leaks.
10
Hand-held release detection
equipment
Hand-held release detection equipment (bailer, gauge stick, etc.) is serviceable and
operable.
I certify under penalty of law that I am the Class B Operator referenced above and that I am familiar with information on this form
and that it is true, accurate and was completed in accordance with R311-203-7.
Signature of the Primary Class B Operator (Sign this document after the last inspection of the Current Year)
B Operator #
Date
Comments/Follow up:
Turn over for record of Interstitial Monitoring visual inspections and Impressed Current rectifier checks.
2024
UST Operator Inspection - Utah — Page 2 of 2
If you perform Interstitial Monitoring on your tanks and/or piping and use a visual check rather than sump or
interstitial sensors for your monthly leak detection, complete the table to document the monthly visual checks.
Months of the Current Year 1 F M A M J 1 A S O N D
1
Visual check of the interstitial space of the double -walled tank indicated no
Y Y Y Y Y Y Y Y Y Y Y Y
release or unusual operating conditions.
z Visual check of piping (STP, dispenser and transition) containment sumps
Y Y Y Y Y Y Y Y Y Y Y Y
indicates normal function and no indication of water or leaked product.
Impressed Current 60 Day Rectifier Check
Months of the Current Year J F M A M J f A S O N D
Show the date the Impressed Current
system was inspected to ensure the NA NA NA NA NA NA NA NA NA NA NA NA
equipment is running properly
Amperage reading from impressed NA NA NA NA NA NA NA NA NA NA NA NA
current rectifier
Voltage reading from impressed current NA NA NA NA NA NA NA NA NA NA NA NA
rectifier
INSTRUCTIONS
1. The monthly UST system inspections must be conducted by or under the direction of the Primary Class B UST Operator.
2. The Primary Class B UST Operator must alert the UST Owner or Operator of any condition discovered during the monthly visual
inspection that may require follow-up actions.
3. The UST Owner or Operator must maintain a copy of the monthly inspection reports for the most recent 12 months. The records
shall be maintained on -site or off -site at a readily available location.
Ver. 4/14/2016
Cole Hudson 3/4/2025 3/4/2025 Mamun Rashid, Maverik's Program
Ashton Bilyeu 2/4/2025 2/4/2025 Mamun Rashid, Maverik's Program
Betty Bosch 1/24/2025 1/24/2025 Mamun Rashid, Maverik's Program
Daxton Gibbs 11/30/2024 11/30/2024 Mamun Rashid, Maverik's Program
Justin Vandeusen 11/25/2024 11/25/2024 Mamun Rashid, Maverik's Program
MELISSA WORTHINGTON 11/25/2024 11/25/2024 Mamun Rashid, Maverik's Program
Trayton Miller 11/7/2024 11/7/2024 Mamun Rashid, Maverik's Program
Tessa Chavez 11/4/2024 11/4/2024 Mamun Rashid, Maverik's Program
Jan Hill 10/29/2024 10/29/2024 Mamun Rashid, Maverik's Program
Kaylie Rawlings 10/25/2024 10/25/2024 Mamun Rashid, Maverik's Program
Jana Burdick 10/19/2024 10/19/2024 Mamun Rashid, Maverik's Program
Shiann Dunn 10/17/2024 10/17/2024 Mamun Rashid, Maverik's Program
Aiden Beverley 10/13/2024 10/13/2024 Mamun Rashid, Maverik's Program
Kristen Limon 10/12/2024 10/12/2024 Mamun Rashid, Maverik's Program
Theron Melton 10/7/2024 10/7/2024 Mamun Rashid, Maverik's Program
Dominik Fellenz 9/24/2024 9/24/2024 Mamun Rashid, Maverik's Program
Lilly Topham 9/20/2024 9/20/2024 Mamun Rashid, Maverik's Program
Logan Gamble 8/31/2024 8/31/2024 Mamun Rashid, Maverik's Program
Leah Scarlet 5/30/2024 5/30/2024 Mamun Rashid, Maverik's Program
Joseph Shumway 4/3/2024 4/3/2024 Mamun Rashid, Maverik's Program
Kristen Holmgren 3/16/2024 3/16/2024 Mamun Rashid, Maverik's Program
Aubrey Catalini 2/17/2024 2/17/2024 Mamun Rashid, Maverik's Program
Chelsea Winn 2/16/2024 2/16/2024 Mamun Rashid, Maverik's Program
Maverik Store #372 100001035 West Main Street, Tremonton, UT