HomeMy WebLinkAboutDERR-2025-003191Customer:Test Location:
Love's Travel Stops # 686
20 S 1550 W Street
Brigham City, UT 84302
Customer Phone:Test Date:
DDS Invoice #:Tester:
Facility ID:
SUMMARY OF UST TEST RESULTS
UST System Testing Results:Due Next:Notes:
Tanks
Lines
Leak Detectors
Shear Valves
ATG Certification
Sensor Functionality Test
X Overfill Pass 4/15/28
X Containment Pass 4/15/28
Stage I and II Testing Results:Due Next:Notes:
Stage I EVR Certification
Pressure Decay
Static Torque
Drop Tube/Drain Valve
P/V Vent Cap
Pressure Decay
P/V Vent Cap
Static Torque
Other Activities Results:Due Next:Notes:
Monthly Inspection
Annual Walk Through
Remote Fill
Emergency Stop
Helium Pinpoint Test
Other Activities
Comments:
Reviewed By: Douglas LaCount
Corporate Office: 127 E Arrow Hwy | San Dimas, CA 91773 | Phone (909) 394.1050 | Fax (909) 512.6610
Georgia Office: PO Box 944 | Loganville, GA 30052 | Phone (678) 620.3307 | Fax (678) 213.0972
(42) VST's
18 UDC Sumps, 9 STP Sumps & 6 Spill Buckets
6 Overfill
Installed:
DDS Environmental, Inc. thanks you for the opportunity to complete the above outlined work for you. Due next dates above are only considered
recommendations from DDS Environmental, Inc. The customer is responsible for maintaining compliance with federal, state, and local regulations.
314.772.4501
14519
Love's Travel Stops
Attn: Reva Fittro
10601 N Pennsylvania Ave
Oklahoma City, OK 73120
4/15/2025
Justin Zimmerman / Max LaRou
100698
pei.org 55
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities
APPENDIX C-5
Tester’s Name (print) ___________________________________ Tester’s Signature __________________________________
UST OVERFILL EQUIPMENT INSPECTION
AUTOMATIC SHUTOFF DEVICE AND BALL FLOAT VALVE
Facility Name:Owner:
Address:Address:
City, State, Zip Code:City, State, Zip Code:
Facility I.D. #:Phone #:
Testing Company:Phone #:Date:
This data sheet is for inspecting automatic shutoff devices and ball float valves. See PEI/RP1200 Section 7 for inspection procedures.
Product Grade
Tank Number
Tank Volume, gallons
Tank Diameter, inches
Overfill Prevention Device Brand
Type Automatic
Shutoff Device
Ball Float
Valve
Automatic
Shutoff Device
Ball Float
Valve
Automatic
Shutoff Device
Ball Float
Valve
Automatic
Shutoff Device
Ball Float
Valve
Automatic
Shutoff Device
Ball Float
Valve
Automatic
Shutoff Device
Ball Float
Valve
AUTOMATIC SHUTOFF DEVICE INSPECTION
1. Drop tube removed from tank? Yes No Yes No Yes No Yes No Yes No Yes No
2. Drop tube and float mecha-
nisms free of debris? Yes No Yes No Yes No Yes No Yes No Yes No
3. Float moves freely without
binding and poppet moves into
flow path?
Yes No Yes No Yes No Yes No Yes No Yes No
4. Bypass valve in the drop tube
open and free of blockage (if
present)?
Yes No
Not Present
Yes No
Not Present
Yes No
Not Present
Yes No
Not Present
Yes No
Not Present
Yes No
Not Present
5. Flapper adjusted to shut off
flow at 95% capacity?* Yes No Yes No Yes No Yes No Yes No Yes No
A “No” to any item in Lines 1-5 indicates a test failure.
BALL FLOAT VALVE INSPECTION**
1. Tank top fittings vapor- tight
and leak-free? Yes No Yes No Yes No Yes No Yes No Yes No
2. Ball float cage free of debris? Yes No Yes No Yes No Yes No Yes No
3. Ball free of holes and cracks
and moves freely in cage? Yes No Yes No Yes No Yes No Yes No Yes No
4. Vent hole in pipe open and
near top of tank? Yes No Yes No Yes No Yes No Yes No Yes No
5. Ball float pipe proper
length to restrict flow at 90%
capacity?***
Yes No Yes No Yes No Yes No Yes No Yes No
A “No” to any item in Lines 1-5 indicates a test failure.
Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Comments:
Use manufacturer’s suggested procedure for determining if automatic shutoff device will shut off flow at 95% capacity.
If a ball float is found to fail the inspection, another method of overfill must be used.
Use manufacturer’s suggested procedure for determining if flow restriction device will restrict flow at 90% capacity.
LOVES # 686
100698
20 S 1550 W ST
BRIGHAM CITY UT 84302
DDS ENVIORMENTAL
UNLEADED UNLEADED PREMIUM DIESEL DIESEL BIO DIESEL
1 2 3 4 5 6
19942 11624 7852 29780 29780 19942
65.66 66.58 77.19 65.73 65.37 47.77FRANKLINFRANKLINFRANKLINFRANKLINFRANKLINFRANKLIN
Loves Travel Stops
1601 N Pennsylvania Ave
Oklahoma City, OK. 73120
4-15-2025
Max LaRou
UTAH SPILL PREVENTION TEST
Spill Bucket Hydrostatic Test Form
Tester’s Signature______________________________
Facility Name Facility ID
Address Tester’s Name
Test Date Phone
Tank number
Product Stored
Capacity
Manufacturer
Construction Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Liquid and debris
removed
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Visual Inspection
No cracks, holes
or separations.
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Tank riser cap
included in test?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Is drain valve
included in test?
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Start Level
Start Time
Ending Level
End Time
Test Period
(Minimum of 1 hour)
Change in Level
Test Results Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Photos indicating water
levels are attached?
Pass/fail criteria: Must pass visual inspection, test duration at least one hour, must include photos with this form, water level
drop of less than 1/8 inch. Ref: PEI/RP 1200 6.2.5 Test Procedure
How was the liquid disposed?
Comments
I certify under penalty of law that the above information is true, accurate and complete. Aug 2016
LOVES
4/15/25
1 2 3 4 5 6
UNLEADED UNLEADED PREMIUM DIESEL BIO DIESELDIESEL
FRANKLIN FRANKLIN FRANKLIN FRANKLIN FRANKLIN FRANKLIN
5 5 5 5 55
686
20 S 1550 W ST
100698
BRINGHAM CITY, UT 84302
Max LaRou
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA N A NA NA NA NA
NA NA NA NA NA NA
Yes
Tested the site with Dri-Sump Equipment
UTAH CONTAINMENT SUMP TEST
Hydrostatic Test Form
Tester’s Signature______________________________
Facility Name Facility ID
Address Tester’s Name
Test Date Phone
Type of
containment
Sump
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Sump ID
(e.g. dispenser #, tank
location, product, etc.)
Sump Material
Construction Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Liquid and debris
removed
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Visual Inspection
No cracks, holes
or separations.
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Containment
Sump Depth
Height from bottom
to top of highest
penetration
Start Level
Start Time
Ending Level
End Time
Test Period
(Minimum of 1 hour)
Water Level
Change
Test Results Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Photos indicating
water levels attached?
Pass/fail criteria: Must pass visual inspection, test duration at least one hour, must include photos with this form, water level
drop of less than 1/8 inch. Ref: PEI/RP 1200 6.5 Test Method
How was the liquid disposed?
Comments
Aug 2016 I certify under penalty of law that the above information is true, accurate and complete.
LOVES
20 S 1550 W ST
5,1*+$0&,7< UT 84302 4/15/25
686
UNLEADED UNLEADED PREMIUM DIESEL DIESEL DIESEL
FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS
100698
Max LaRou
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NANANANANANA
Yes
Tested the site with Dri-Sump Equipment
UTAH CONTAINMENT SUMP TEST
Hydrostatic Test Form
Tester’s Signature______________________________
Facility Name Facility ID
Address Tester’s Name
Test Date Phone
Type of
containment
Sump
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Sump ID
(e.g. dispenser #, tank
location, product, etc.)
Sump Material
Construction Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Liquid and debris
removed
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Visual Inspection
No cracks, holes
or separations.
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Containment
Sump Depth
Height from bottom
to top of highest
penetration
Start Level
Start Time
Ending Level
End Time
Test Period
(Minimum of 1 hour)
Water Level
Change
Test Results Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Photos indicating
water levels attached?
Pass/fail criteria: Must pass visual inspection, test duration at least one hour, must include photos with this form, water level
drop of less than 1/8 inch. Ref: PEI/RP 1200 6.5 Test Method
How was the liquid disposed?
Comments
Aug 2016 I certify under penalty of law that the above information is true, accurate and complete.
%5,1*+$0&,7< UT 84302
LOVES
20 S 1550 W ST
4/15/25
BIO DIESEL
FIBERGLASS
DIESEL
FIBERGLASS
1
FIBERGLASS
1,2 3,4 5,6
686
FIBERGLASS FIBERGLASS FIBERGLASS
Max LaRou
100698
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
Yes
Tested the site with Dri-Sump Equipment
UTAH CONTAINMENT SUMP TEST
Hydrostatic Test Form
Tester’s Signature______________________________
Facility Name Facility ID
Address Tester’s Name
Test Date Phone
Type of
containment
Sump
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Sump ID
(e.g. dispenser #, tank
location, product, etc.)
Sump Material
Construction Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Liquid and debris
removed
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Visual Inspection
No cracks, holes
or separations.
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Containment
Sump Depth
Height from bottom
to top of highest
penetration
Start Level
Start Time
Ending Level
End Time
Test Period
(Minimum of 1 hour)
Water Level
Change
Test Results Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Photos indicating
water levels attached?
Pass/fail criteria: Must pass visual inspection, test duration at least one hour, must include photos with this form, water level
drop of less than 1/8 inch. Ref: PEI/RP 1200 6.5 Test Method
How was the liquid disposed?
Comments
Aug 2016 I certify under penalty of law that the above information is true, accurate and complete.
7,8 9,10 11,12 13,14 15,16 17,18
FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS
LOVES 686
20 S 1550 W ST
4/15/25
100698
BRINGHAM CITY, UT 84302
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
Yes
Tested the site with Dri-Sump Equipment
Max LaRou
UTAH CONTAINMENT SUMP TEST
Hydrostatic Test Form
Tester’s Signature______________________________
Facility Name Facility ID
Address Tester’s Name
Test Date Phone
Type of
containment
Sump
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Sump ID
(e.g. dispenser #, tank
location, product, etc.)
Sump Material
Construction Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Liquid and debris
removed
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Visual Inspection
No cracks, holes
or separations.
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Containment
Sump Depth
Height from bottom
to top of highest
penetration
Start Level
Start Time
Ending Level
End Time
Test Period
(Minimum of 1 hour)
Water Level
Change
Test Results Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Photos indicating
water levels attached?
Pass/fail criteria: Must pass visual inspection, test duration at least one hour, must include photos with this form, water level
drop of less than 1/8 inch. Ref: PEI/RP 1200 6.5 Test Method
How was the liquid disposed?
Comments
Aug 2016 I certify under penalty of law that the above information is true, accurate and complete.
%5,1*+$0&,7< UT 84302
19,20 21,22 23,24 25,26 27,28 29,30
LOVES
4/15/25
20 S 1550 W ST
686
FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS
100698
Max LaRou
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
NA NA NA NA NA NA
Yes
Tested the site with Dri-Sump Equipment
UTAH CONTAINMENT SUMP TEST
Hydrostatic Test Form
Tester’s Signature______________________________
Facility Name Facility ID
Address Tester’s Name
Test Date Phone
Type of
containment
Sump
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Dispenser
Transition
Tank Top
Sump ID
(e.g. dispenser #, tank
location, product, etc.)
Sump Material
Construction Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Single walled
Double walled
Liquid and debris
removed
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Visual Inspection
No cracks, holes
or separations.
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Containment
Sump Depth
Height from bottom
to top of highest
penetration
Start Level
Start Time
Ending Level
End Time
Test Period
(Minimum of 1 hour)
Water Level
Change
Test Results Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Photos indicating
water levels attached?
Pass/fail criteria: Must pass visual inspection, test duration at least one hour, must include photos with this form, water level
drop of less than 1/8 inch. Ref: PEI/RP 1200 6.5 Test Method
How was the liquid disposed?
Comments
Aug 2016 I certify under penalty of law that the above information is true, accurate and complete.
%5,1*+$0&,7< UT 84302
LOVES
20 S 1550 W ST
4/15/25
686
FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS
31,32 33,34 35,36
100698
Max LaRou
NA NA NA
NA NA NA
NA NA NA
NA NA NA
NA NA NA
NA NA NA
NANA
NA NA NA
NA
Yes
Tested the site with Dri-Sump Equipment
Containment Tightness
Test Report
Date 04/16/2025
Report # US218217
Site Loves 686
20 S 1550 W Street
Bringham
UTAH 84302
USA
Inspection Date 04/15/2025
E-mail: drisump@leightonobrien.com
Website: www.leightonobrien.com
Service Distributor: DDS Environmental, Inc.
www.ddsenv.com/
Tel. 480-277-6991
EXECUTIVE SUMMARY
All spill buckets and containment sumps passed the Dri-sump tests.
Page 2
AIM
To test all containment sumps on site for compliance purposes as part of the Leighton O'Brien service.
METHODOLOGY
Dri-sump Containment Tightness Test method uses the proprietary heavy vapor aerosol instead of water to completely fill
the sump, interstice or vessel. When installed per the manufacturer's placement requirements this method allows for
detecting heavy vapor egress from the containment at any point.
The method automatically tests for adequate flow of air and vapor through the backfill each time the system is activated.
Any stoppage of flow through the VST or backfill will cause increased vacuum on the View Chamber that is quickly
identified by a significant collapse of the View Chamber side walls. A leak is determined by observation of a change in
the specialized laser light beam from a dot to a line which is indicative of the presence of the proprietary heavy vapor.
COMMENTS/DISCUSSIONS
All spill buckets and containment sumps passed the Dri-sump tests. There are no recommendations.
SUMMARY OF DRI SUMP COMMUNICATION ASSESSMENT
Closed Hose Open Hose VST Connect
15.00 3.25 10.59
Page 3
SUMMARY OF DRI SUMP CONTAINMENT RESULTS AS TESTED
Tank Number
Product
Dispenser Number 1,2 3,4 5,6 7,8
Sump Type Dispenser Sump Dispenser Sump Dispenser Sump Dispenser Sump
Sump Capacity 100 100 100 100
Construction Single-Walled Single-Walled Single-Walled Single-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Tank Number
Product
Dispenser Number 9,10 11,12 13,14 15,16
Sump Type Dispenser Sump Dispenser Sump Dispenser Sump Dispenser Sump
Sump Capacity 100 100 100 100
Construction Single-Walled Single-Walled Single-Walled Single-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Page 4
Tank Number
Product
Dispenser Number 17,18 19,20 21,22 23,24
Sump Type Dispenser Sump Dispenser Sump Dispenser Sump Dispenser Sump
Sump Capacity 100 100 100 100
Construction Single-Walled Single-Walled Single-Walled Single-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Tank Number
Product
Dispenser Number 25,26 27,28 29,30 31,32
Sump Type Dispenser Sump Dispenser Sump Dispenser Sump Dispenser Sump
Sump Capacity 100 100 100 100
Construction Single-Walled Single-Walled Single-Walled Single-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Page 5
Tank Number 1 2
Product Unleaded Unleaded
Dispenser Number 33,34 35,36
Sump Type Dispenser Sump Dispenser Sump STP Sump STP Sump
Sump Capacity 100 100 300 300
Construction Single-Walled Single-Walled Double-Walled Double-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Tank Number 3 4 5 6
Product Premium Diesel Diesel Diesel
Dispenser Number
Sump Type STP Sump STP Sump STP Sump STP Sump
Sump Capacity 300 300 300 300
Construction Double-Walled Double-Walled Double-Walled Double-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Page 6
Tank Number 7 8 1 2
Product Diesel Bio Diesel Other... Other...
Dispenser Number
Sump Type STP Sump STP Sump Spill Bucket Spill Bucket
Sump Capacity 300 300 5 5
Construction Double-Walled Double-Walled Single-Walled Single-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Tank Number 3 4 5 6
Product Other... Other... Other... Other...
Dispenser Number
Sump Type Spill Bucket Spill Bucket Spill Bucket Spill Bucket
Sump Capacity 5 5 5 5
Construction Single-Walled Single-Walled Single-Walled Single-Walled
Liquid & Debris Removed Yes Yes Yes Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes Yes Yes Yes
Test in Seconds 60 60 60 60
Laser Verification Dot (PASS) Dot (PASS) Dot (PASS) Dot (PASS)
Final Test Results Pass Pass Pass Pass
Page 7
Tank Number 1
Product Other...
Dispenser Number
Sump Type Transition Sump
Sump Capacity 300
Construction Double-Walled
Liquid & Debris Removed Yes
Visual Inspection
(No cracks, loose parts or
sump/pipe separation
points.)
Yes
Test in Seconds 60
Laser Verification Dot (PASS)
Final Test Results Pass
LASER RESPONSE IMAGES AND SITE PHOTOS
Site Photo Equipment Set-up
VST Connected VST Closed
Page 8
VST Open Dispenser Sump 1,2
Dispenser Sump 3,4 Dispenser Sump 5,6
Dispenser Sump 7,8 Dispenser Sump 9,10
Dispenser Sump 11,12 Dispenser Sump 13,14
Page 9
Dispenser Sump 15,16 Dispenser Sump 17,18
Dispenser Sump 19,20 Dispenser Sump 21,22
Dispenser Sump 23,24 Dispenser Sump 25,26
Dispenser Sump 27,28 Dispenser Sump 29,30
Page 10
Dispenser Sump 31,32 Dispenser Sump 33,34
Dispenser Sump 35,36 STP Sump 1 VST 1
STP Sump 1 VST 2 STP Sump 2 VST 1
STP Sump 2 VST 2 STP Sump 3 VST 1
Page 11
STP Sump 3 VST 2 STP Sump 4 VST 1
STP Sump 4 VST 2 STP Sump 5 VST 1
STP Sump 5 VST 2 STP Sump 6 VST 1
STP Sump 6 VST 2 STP Sump 7 VST 1
Page 12
STP Sump 7 VST 2 STP Sump 8 VST 1
STP Sump 8 VST 2 Spill Bucket 1
Spill Bucket 2 Spill Bucket 3
Spill Bucket 4 Spill Bucket 5
Page 13
Spill Bucket 6 Transition Sump 1
Transition Sump 1
RECOMMENDATIONS
There are no recommendations.
Page 14
ADDENDUM
Technician Name Justin Zimmerman / Max LaRou
Report Prepared by Jason Weber
Leighton O’Brien Field Services are provided on the terms and conditions set out in the conditions of sale document.
The Leighton O’Brien service is warranted to the invoiced value of services performed as covered in section 68a of the
Trade Practices Act.
SITE LOCATION