DERR-2025-003274

Page 1 ot L
Ownership of Tanks
UTAH STATE FUEL NETWORK
4315 S 2700 W
SALT LAKE CITY UT :84115
Tanks lnstalled. Use additional pages as needed.
New lnstallation or Upgrade f,ULNumber \5
Material of construction (FRP, Steel, Composite, etc.)
Double walled - dry or brine filled
Substance to be stored
Capacity
Date installed
PreJnstallation pressure test date or vacuum date (dry interstice)
Reading of pressure or vacuum for pre-installation test (dry interstice)
Type of overfill prevention device (shutoff or alarm)
Overfill alarm has sign and is visible and audible to driver (RP100)
Type of spill prevention device (single or dw spill bucket, sump, etc)
Amount of tank deflection readings (initial)
Amount of tank deflection readings (hold down straps)
Amount of tank deflection readings (backfill top of tank)
Piping lnformation
Material of construction (Flex plastic, FRP, etc)
Type (Pressure, Suction, Safe Suction, Gravity)
Date pre-installation air test passed
Pressure for pre-installation air test
lnstallation Specifications
2 C
Utah Department of Environmental Quality
UST lnstallation lnspection
4001328
Location of Tanks
GRANITE SCHOOL SERVICE CENTER
380 W GREGSON AVE
SOUTH SALT LAKE UT 84'115
Tank No. ( Tank No.TankNo. )Tank No.
6^18 8816
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27aaa
EF
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Do you have a copy of the tank manufacturer's installat/cn manual and PEI RP100 with you
Certified tank installer A.-, Ch f i,t/ e 4, .4 Cerr. #: TL D Lt , b
Certified lnstallation Company C t 65 ry Cert. #: tC I b?7
Visual inspection of tank(s) reveals it is free from damage /
Gl"NA
Exp. Date: L^l ^ ? 6
Visual inspection reveals no brine on either the inside or outside of the tank(s) (from interstitial space of brine tank)
Damaged components have been repaired by the manufacturer
Tank and piping excavations are free of debris <@ No NA
Depth of backfill bedding for tank(s) (must be at least one foot) I , t
Type of backfill material (clean, free flowing, etc.) (Sieve report should match installation manual): /c^ G *n. I
Geotextile fabric used along sides of excavation (recommended) @ r.ro r.rn
Geotextile fabric separates any secondary backfill (required) @rlo f.fn
Estimated depth to groundwater 7 t
Tank(s) are placed at sufficient depth for traffic requirements, groundwater conditions (check installation manual) ,@ tlo run
Tanks are outside the shadow of the 45 degree factor of a structure's footing (PEl RP100 Fig 4-2)
- , r4!$ No NA
Distance from tank(s) to nearest property line: > t DOt Distance from tank(s) to nearest structure: < ZAI
Anchoring method is adequate for groundwater considerations. Note method here: 0 .. J ^,
q * B^ //r5/__Qt. Nn
Hold-down straps are in place according to manufacturer's specifications (check installation manual if clamps are used) .Gsltlo ttR
Tank spacing is at least 18" between tank(s) and excavation wall (stable wall) or 18" between tank(s) and 1t2 times tank
diameter exciavation wall (unstable wall) ]@t\o NA
Tank is level or sloped toward interstitial monitor probe @ uo run
Backfill has been adequately compacted for full suport along tank length at 5 and 7 o'clock <p No run
Date of pressure test after packfill to top of tank (before piping is installed)
l(name) O r"t) 6f i I fO certifythatlinspectedtheabove-namedfacilityon(date):{-8-|aZF
@@
Yes
No NA
No NA
No@
lnspector's Signature:
Ver.101512018 P Ell-k ^ La Z f-ao 32 33
cert.#: Tt ze d
Pase 2 of 3 Utah Department of Environmental Quality
UST Facility Site Plat
NORTH
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4001328
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of tank
plug (C), other
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Show locations of all buildings, streets, tanks, piping, and d
manways and identifo each: submersible pump (S), tank fill
(specify).
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51,"P
ispenser islands. lndicate the product in each tank. Show locations
(F), ATG probe (A), interstitial probe (l), vapor recovery U), capped
Comments: