DERR-2025-003117

Ownership of Tanks Location of Tanks
UTAH STATE FUEL NETWORK SAN JUAN SCHOOL DISTRICT NAVAJO MOUNTAIN HIGH SCHOOL
4315 S 2700 W RESERVATION ROAD #16
SALT LAKE CITY UT 84129 BLANDING UT 8451 1
Contact Name:
Plan?: Yes No Last Fire Marshal lnsp:ATG lnfo:
for each tank.
Capacity of tank (gailons):80 ao
Orientation of tank:)
Bottom of tank in contact with (soil,
gravel, concrete, not touching):.w/ fa tt4,
Substance stored:
Date last used/depth of product:
Type of spill prevention device:
Type of Piping (Pressure or Suction):r'
Does pressure piping have LLD:Yes .@ run Yes NA Yes No NA Yes No NA Yes No NA Yes No NA
Spill bucket is clean, intact, etc.@No Y@ tto Yes No Yes No Yes No Yes No
Type of overfill Prevention device:
Overfill alarm (audible or visible) is properly so driver can orhear seedelivery it,nda IS identilied:clearly Yes No NA
Pipe trans flex protection method
(Sump, CP, lsolated, Booted):
Containment sumps dry:No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Sump comments:
Stage 1 Vapor Recovery:None ?pt Coax @ 2pt Coax None 2pt Coax None 2pt Coax None 2pt Coax None
Pressure Vent Valve is on vents (@ ruo NA Yes No Yes No NA Yes No NA Yes No NA Yes No NA
Secondary containment area
comments:
Complete for each dispenser I
, Flex protection method (UDC,
Cathodic Protection, lsolated, Booted)
UDC sump dry:No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Fire valve anchored, located below
grade, and without ball valve:@_ ruo NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Comments:
dispenser questions
Flex protection method (UDC,
Cathodic Protection, lsolated, Booted):
UDC sump dry:Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Fire valve anchored, located below
grade, and no ball valve:
Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Comments:
Page 1 of_
Additional Comments:
Utah Department of Environmental euality
APST Equipment Verification lnspection
5000744
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Financial Responsibility (State Use Only)
FRMethod: (fI Method OK?r(gQ/ Nlo by: {JU l/.
Signatures
O a, ,J Lt,"(r'n
Inspected this facility on_
Signature TI
O/O Signature:
Tank lnfo Sheet to lnspection with any edits.Attach
by )tcr,*hr./,'n e1 ?-rzg/zaq