DERR-2024-005498

Product Line Tightness Test Page 1 of 1
Work Order: 2365034 Date: 3/13/2024
Site Name/ID: 7-ELEVEN #34623 / 34623
Address: 2680 WEST 10400 SOUTH State ID 4002241
City: SOUTH JORDAN State: UT Zip: 84095
Tank Information
Test Method
Customer Tank ID
Product Name
Delivery Type
Test Pressure (psi)
Test Start Time
Test End Time
Final Leak Rate (gph)
Test Result(P/F/I)
Test was performed per
3rd party certifications as
specified in 40 CFR parts
280 and 281
Tank # 1
Line # 1
TLD-1
TNK1 Regular
RUL
Pressure
50
13:41
14:41
0.00
Pass
Yes
Tank # 2
Line # 1
TLD-1
TNK2 Premium

PUL
Pressure
50
13:41
14:41
0.00
Pass
Yes
Tank # 3
Line # 1
TLD-1
TNK3 Diesel
Low Sulfur
Diesel
Pressure
50
13:41
14:41
0.00
Pass
Yes
Tank #
Line #

Tank #
Line #

Tank #
Line #

Technician Comments: ut151
Technician Name:David Mathie Certification #:41442 exp:
10/20/2025
Technician Signature:

Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com
7-ELEVEN #34623
2680 WEST 10400 SOUTH State ID 4002241
SOUTH JORDAN UT 84095
34623
Tanknology, Inc.
7-ELEVEN, INC.
P.O. BOX 711
DALLAS TX 75221
972-828-7575
03/13/2024
RUL PUL
Vaporless LD-
2000
Vaporless LD-
2000
Vaporless LD-
2000LD200LD2000LD2000
30
30
200
3
20
4
28
28
200
3
20
4
30
30
175
2
20
3
UT151
David Mathie
NW1-2365034
Low Sulfur Diesel
TTNK1 Regular:1 TTNK2 Premium:1 TTNK3 Diesel:1
Impact Valve
Inspection
Impact Valve Operational
Inspection
Work Order:2365034 Date:3/13/2024
Site Name/ID:7-ELEVEN #34623
Address:2680 WEST 10400 SOUTH State ID 4002241
City:SOUTH JORDAN State:UT Zip:84095
How Inspected: Line Test NFPA 30A PEI RP1200 Other
Dispenser
Number Grade
Secure
Mount?
Valve
Lock?Pass/ Fail Comments
1/2 40 Pass Fail Not Tested
1/2 85 Pass Fail Not Tested
1/2 91 Pass Fail Not Tested
3/4 85 Pass Fail Not Tested
3/4 91 Pass Fail Not Tested
5/6 85 Pass Fail Not Tested
5/6 91 Pass Fail Not Tested
7/8 85 Pass Fail Not Tested
7/8 91 Pass Fail Not Tested
9/10 40 Pass Fail Not Tested
9/10 85 Pass Fail Not Tested
9/10 91 Pass Fail Not Tested

Technician Comments:
Technician Name:David Mathie
Signature:
Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com
7-ELEVEN #34623 7-ELEVEN, INC.
2680 WEST 10400 SOUTH State ID 4002241
SOUTH JORDAN UT 84095
4002241
Tanknology, Inc.
P.O. BOX 711
DALLAS TX 75221
972-828-7575
800-964-1250 03/13/2024
1 2 3
RUL PUL DSL
VR350 VR350 VR350
11849 11849 10369
119 119 119
UT151
David Mathie
2680 WEST 10400 SOUTH State ID 4002241
7-ELEVEN #34623
2680 WEST 10400 SOUTH State ID 4002241, SOUTH JORDAN, UT
8409534623
Tanknology, Inc.
7-ELEVEN, INC.
P.O. BOX 711
DALLAS, TX 75221
972-828-7575
03/13/2024
ANNULAR ANNULAR ANNULAR STP STP STP
RUL WET PUL WET DSL WET RUL PUL DSL
UT151
David Mathie
7-ELEVEN #34623
2680 WEST 10400 SOUTH State ID
4002241SOUTH JORDAN , UT 84095
4002241
Tanknology, Inc.
7-ELEVEN, INC.
972-828-7575
03/13/2024
P.O. BOX 711
DALLAS, TX 75221
1
RUL
5
OPW
2
PUL
5
OPW
3
DSL
5
OPW
14.5
1329
14.5
1429
1 HR
0
14.5
1326
14.5
1326
1 HR
0
30 WC
1322
30 WC
1323
1 MIN
0
UT151
David Mathie
PVVC tested ==>RUL Manifolded
Final Test Result (Pass / Fail) ==>Fail
PVVC Manuf. ==>OPW Model Number ==>623V-2203
Is this Original or
Replacement?
Original
If this cap is being
replaced, check here:
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 25 0.0530 Fail
Low High Measured
Pos Cracking (in H2O)2.50 6.00 0.06 Fail
Neg Leak Rate (CFH)0.21 100 0.2120 Fail
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -0.08 Fail
PVVC tested ==>RUL Manifolded
Final Test Result (Pass / Fail) ==>Pass
PVVC Manuf. ==>OPW Model Number ==>723V
Is this Original or
Replacement?
Replacement Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 6 0.0127 Pass
Low High Measured
Pos Cracking (in H2O)2.50 6.00 3.66 Pass
Neg Leak Rate (CFH)0.21 17 0.0360 Pass
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -6.83 Pass
PVVC tested ==>PUL Manifolded
Final Test Result (Pass / Fail) ==>Fail
PVVC Manuf. ==>OPW Model Number ==>623V-2203
Is this Original or
Replacement?
Original
If this cap is being
replaced, check here:
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 25 0.0530 Fail
Low High Measured
Pos Cracking (in H2O)2.50 6.00 0.00 Fail
Neg Leak Rate (CFH)0.21 100 0.2120 Fail
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 0.00 Fail
PVVC tested ==>PUL Manifolded
Final Test Result (Pass / Fail) ==>Pass
PVVC Manuf. ==>OPW Model Number ==>723V
Is this Original or
Replacement?
Replacement Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 8 0.0170 Pass
Low High Measured
Pos Cracking (in H2O)2.50 6.00 3.54 Pass
Neg Leak Rate (CFH)0.21 18 0.0382 Pass
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -6.76 Pass
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
11000 N. MOPAC EXPRESSWAY, SUITE 500, AUSTIN, TX 78759
[phone]
QP-08-03-FF-02 Pressure Vacuum Vent Cap TP-201.1E Field Form
Rev C 1/27/2011
Site Overall Test Results: Pass
Total +ve LR: 0.0297
Total -ve LR: 0.0742

Test Date 3/13/2024
Technician Name David Mathie
WO #2365034
Facility Name / Loc #7-ELEVEN #34623 34623
Street 2680 WEST 10400 SOUTH State ID 4002241
City, St, Zip SOUTH JORDAN, UT 84095

Pressure Vacuum Vent Cap Test Form TP-201.1E

Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2365034
Site ID / Name:34623 / 7-ELEVEN #34623
Address:2680 WEST 10400 SOUTH State ID 4002241
City:SOUTH JORDAN State:UT Zip:84095