DERR-2025-002481

Underground Storage Tank Inspection Verification Form
Facility ID:0100520
Owner Name:RAMDAS JI HYRUM LLC Facility Name:CORINNE SHORT STOP
Owner Address:325 W MAIN ST Street Address:3878 W HWY 13
HYRUM, UT 84319 CORINNE, UT 84307
Operator A:No Data / No Data / Operator B:No Data / No Data /
Owner Email:[e-mail] UTM Coordinates X/Y:407615 / 4600463
Tank ID/Alt ID:1 / 1 EGen/AST/Stat
e:
No / Yes /
Yes
Pipe Material-Mod:Flexible Plastic - Secondary Containment
Siphon/Compart:Yes / No PVV/StageI:Pipe Type/STP Cont:Pressurized / No
Tank Status:Currently In Use STP Flex Connectors:Booted Steel Flex
Installed/Cap/Loc:1/1/1910 / 6000 / LLD Model:
Substance Stored:Gasoline / Regular Spill/Overfill/Sm deliv:5 gal. Spill Bucket / / No
Tank Material-Mod:Galvanic Cathodic Protection (STIP3) -
Secondary Containment
PST Fund/Other Type:Yes /
ATG: / Tank/Pipe Rel Det:TTT/IC / LTT / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:PVV Test:Overfill Test:
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
Tank ID/Alt ID:2 / 2 EGen/AST/Stat
e:
No / Yes /
Yes
Pipe Material-Mod:Flexible Plastic - Secondary Containment
Siphon/Compart:No / No PVV/StageI:Pipe Type/STP Cont:Pressurized / No
Tank Status:Currently In Use STP Flex Connectors:Booted Steel Flex
Installed/Cap/Loc:1/1/1910 / 6000 / LLD Model:
Substance Stored:Gasoline / Regular Spill/Overfill/Sm deliv:5 gal. Spill Bucket / / No
Tank Material-Mod:Galvanic Cathodic Protection (STIP3) -
Secondary Containment
PST Fund/Other Type:Yes /
ATG: / Tank/Pipe Rel Det:TTT/IC / LTT / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:PVV Test:Overfill Test:
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
Tank ID/Alt ID:3 / 3 EGen/AST/Stat
e:
No / Yes /
Yes
Pipe Material-Mod:Flexible Plastic - Secondary Containment
Siphon/Compart:No / No PVV/StageI:Pipe Type/STP Cont:Pressurized / No
Tank Status:Currently In Use STP Flex Connectors:Booted Steel Flex
Installed/Cap/Loc:1/1/1910 / 5000 / LLD Model:
Substance Stored:Gasoline / Premium Spill/Overfill/Sm deliv:5 gal. Double Walled Spill Bucket / / No
Tank Material-Mod:Galvanic Cathodic Protection (STIP3) -
Secondary Containment
PST Fund/Other Type:Yes /
ATG: / Tank/Pipe Rel Det:TTT/IC / LTT / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:PVV Test:Overfill Test:
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
4/4/2025 Page 1 of 1