DERR-2025-002330

STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UT 84141-1152
[phone]
AST INSPECTION REPORT
Facility Name and Site Address: Date:
Facility ID #
Purpose:Regular Reinspection Complaints Annual Inspection
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Pumps Tested for Calibration
ACTION TAKEN
Tank
Piping
Dispenser
Valves
Fill
Vent
Drive Pad
Sumps
Storage Tanks Properly Labeled
Dispenser Continuity Test
Inspection Remarks:
Received By: Inspected By: Steven B. Martin UT121
Applied Environmental Services L.C.
UTAH DOT 423A
SR-46
LASAL, UTAH
2-26-2025
5000218
X
1-2 X X
INSTALLED NEW PV VALVE ON UNLEADED VENT

BILLING ADDRESS FACILITY ADDRESS
WORK ORDER # DATE:
CONTACT: DEQ ID#
APPLIED ENVIRONMENTAL SERVICES, L.C.
SEND PAYMENT TO : APPLIED ENVIRONMENTAL SERVICES
ALL TESTS WERE PERFORMED IN A PROFESSIONAL MANNER, AND WITHIN COMMON PRACTICES OF THE INDUSTRY.
DUE TO VARIABLES OF TIGHTNESS TESTING, THESE RESULTS CANNOT BE GUARANTEED. THERE ARE NO WARRANTIES.
EXPRESSED, WRITTEN, OR IMPLIED.
PO BOX 1073 BOUNTIFUL, UTAH 84011
.
PO#
801-540-9258
STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UTAH 84141-1152
UTAH DOT #423A
SR-46
LASAL, UTAH
BRETT GURNEY 246107 5000218 / 1301
25009 2-26-2025
DISPENSER CALIBRATION
1 @ 50.00 50.00
INSTALLED NEW STATE SUPPLIED PV VALVE ON UNLEADED VENT
1 HR @ 70.00 70.00
TRIPS SHARE OF TRAVEL
108 MI @ 2.00 216.00
336.00TOTAL DUE: