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Home My WebLink AboutDERR-2024-004378EZY CHEK SYSTEMS TEST DATE PRODUCT LINE TESTER Testing Company Information DATA SHEET Name Address City Test Location Information Precision Testing Technologies, Inc. 2026 W. Elk Creek Crt. Bluffdale, UT Test Location Information Phone Name Address Technican Information City Name Phone Cert # 801-886-9224 Contact Applied Pressure #1 Product Type:#2 Product Type: TIME DATA -/+GPL RES GPH TIME DATA -/+GPL RES GPH 00.0037 0.0000 0.0000 00.0037 0.0000 0.0000 0.0037 0.00370.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 FINAL RESULT:FINAL RESULT: #3 Product Type:#4 Product Type: TIME DATA -/+GPL RES GPH TIME DATA -/+GPL RES GPH 00.0037 0.0000 0.0000 00.0037 0.0000 0.0000 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.00370.0037 0.0037 0.0037 0.0037 FINAL RESULT:FINAL RESULT: #5 Product Type:#6 Product Type: TIME DATA -/+GPL RES GPH TIME DATA -/+GPL RES GPH 0 0.0037 0.0000 0.0000 0 0.0037 0.0000 0.000000.0037 0.0000 0.0000 0 0.0037 0.0000 0.0000 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 0.0037 FINAL RESULT:FINAL RESULT: Facility ID# : 02/07/2024 1000906 Harts #80 10022 N 4800W Cedar Hills, UT 84062 (801)592-5958 55 PSI Regular E 0 39 15 39 0 0 0 30 39 0 0 0 Pass Regular W 0 45 15 45 0 0 0 30 45 0 0 0 Pass Premium 0 23 15 23 0 0 0 30 23 0 0 0 Pass Diesel 0 67 15 67 0 0 0 30 67 0 0 0 Pass Red Diesel 0 72 15 72 0 0 0 30 72 0 0 0 Pass 02/07/2024 Sammy Labrum UT-0325 pei.org 49 Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities APPENDIX C-9 MECHANICAL AND ELECTRONIC LINE LEAK DETECTORS PERFORMANCE TEST )DFLOLW\1DPH2ZQHU $GGUHVV$GGUHVV &LW\6WDWH=LS&RGH&LW\6WDWH=LS&RGH )DFLOLW\,'3KRQH 7HVWLQJ&RPSDQ\3KRQH'DWH 7KLVGDWDVKHHWFDQEHXVHGWRWHVWPHFKDQLFDOOLQHOHDNGHWHFWRUV0//'DQGHOHFWURQLFOLQHOHDNGHWHFWRUV(//'ZLWKVXEPHUVLEOH WXUELQHSXPS673V\VWHPV6HH3(,536HFWLRQVDQGIRUWHVWSURFHGXUHV /LQH1XPEHU 3URGXFW6WRUHG /HDN'HWHFWRU0DQXIDFWXUHU /HDN'HWHFWRU0RGHO 7\SHRI/HDN'HWHFWRU 0//' (//' 0//' (//' 0//' (//' 0//' (//' 0//' (//' 0//' (//' MLLD (ALL PRESSURE MEASUREMENTS ARE MADE IN PSIG) 673)XOO2SHUDWLQJ3UHVVXUH &KHFN9DOYH+ROGLQJ3UHVVXUH /LQH5HVLOLHQF\POOLQHEOHHGEDFNYRO XPHDVPHDVXUHGIURPFKHFNYDOYHKROG LQJSUHVVXUHWR]HURSVLJ 6WHS7KURXJK7LPHLQ6HFRQGVWLPHWKH 0//'KHVLWDWHVDWPHWHULQJSUHVVXUH EHIRUHJRLQJWRIXOORSHUDWLQJSUHVVXUH DVPHDVXUHGIURPSVLJZLWKQROHDN LQGXFHGRQWKHOLQH 0HWHULQJ3UHVVXUH673SUHVVXUHZKHQ VLPXODWHGOHDNUDWHJSKDWSVLJ 2SHQLQJ7LPHLQ6HFRQGVWKHWLPHWKH 0//'RSHQVWRDOORZIXOOSUHVVXUHDIWHU VLPXODWHGOHDNLVVWRSSHG 'RHVWKH673SUHVVXUHUHPDLQDWRU EHORZWKHPHWHULQJSUHVVXUHIRUDWOHDVW VHFRQGVZKHQWKHVLPXODWHGOHDNLV LQGXFHG" <HV1R<HV1R <HV1R <HV1R <HV1R <HV1R 'RHVWKHOHDNGHWHFWRUUHVHWWULSZKHQ WKHOLQHSUHVVXUHLVEOHGRIIWR]HURSVLJ"<HV1R <HV1R <HV1R <HV1R <HV1R <HV1R 'RHVWKH673SURSHUO\F\FOHRQRIIXQGHU QRUPDOIXHOV\VWHPRSHUDWLRQFRQGLWLRQV"<HV1R <HV1R <HV1R <HV1R <HV1R <HV1R $´1RµDQVZHUWRHLWKHURIWKHDERYHTXHVWLRQVLQGLFDWHVWKH0//'IDLOVWKHWHVW ELLD (ALL PRESSURE MEASUREMENTS ARE MADE IN PSIG) 673)XOO2SHUDWLQJ3UHVVXUH +RZPDQ\WHVWF\FOHVDUHREVHUYHG EHIRUHDODUPVKXWGRZQRFFXUV" 'RHVWKHVLPXODWHGOHDNFDXVHDQDODUP"<HV1R <HV1R <HV1R <HV1R <HV1R <HV1R $´1RµDQVZHUWRWKHDERYHTXHVWLRQLQGL FDWHVWKH(//'IDLOVWKHWHVW 'RHVWKHVLPXODWHGOHDNFDXVHDQ673 VKXWGRZQ" <HV1R 1$ <HV1R 1$ <HV1R 1$ <HV1R 1$ <HV1R 1$ <HV1R 1$ Test Results 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO Comments: 7HVWHU·V1DPH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HVWHU·V6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc.801-886-9224 Harts #80 10022 N. 4800 W. Ceder Hills, UT 84062 1000906 Harts Gas + Food LLC P.O. Box 418 American Fork, UT 84083 801-592-5948 02/07/2024 1 Reg W. VR FXIV 4 41 22 80 1 19 3 4 4 4 4 2 Reg E. VR FXIV 4 40 19 110 1 16 3 4 4 4 4 3 Premium VR FXIV 4 40 18 90 1 21 4 4 4 4 4 4 Diesel VR FXIDV 4 40 20 70 1 19 3 4 4 4 4 5 Red DSL VR FXIDV 4 39 16 90 1 18 3 4 4 4 4 Sammy Labrum UT-0325 PEI/RP1200-12 pei.org46 APPENDIX C-6 OVERFILL ALARM OPERATION INSPECTION )DFLOLW\1DPH2ZQHU $GGUHVV$GGUHVV &LW\6WDWH=LS&RGH&LW\6WDWH=LS&RGH )DFLOLW\,'3KRQH 7HVWLQJ&RPSDQ\3KRQH'DWH 7KLVSURFHGXUHLVWRGHWHUPLQHZKHWKHUWKHKLJKOHYHODODUPLVRSHUDWLRQDODQGZLOOWULJJHUZKHQWKHWDQNLVQRPRUHWKDQIXOO 6HH3(,536HFWLRQIRUWKHLQVSHFWLRQSURFHGXUH7KLVSURFHGXUHLVDSSOLFDEOHWRWDQNOHYHOPRQLWRUVWHPVWKDWWRXFKWKH ERWWRPRIWKHWDQNZKHQLQSODFH 7DQN1XPEHU 3URGXFW6WRUHG 7DQN/HYHO0RQLWRU%UDQGDQG0RGHO 7DQN9ROXPHJDOORQV 7DQN'LDPHWHULQFKHV 'RHVWKHRYHUILOODODUPDFWLYDWHLQWKHWHVWPRGH DWWKHFRQVROH"<HV1R <HV1R <HV1R <HV1R :KHQDFWLYDWHGFDQWKHRYHUILOODODUPEHKHDUG RUVHHQZKLOHGHOLYHULQJWRWKHWDQN"<HV1R <HV1R <HV1R <HV1R $IWHUUHPRYLQJWKHSUREHIURPWKHWDQNKDVLW EHHQLQVSHFWHGDQGDQ\GDPDJHGRUPLVVLQJSDUWV UHSODFHG" <HV1R <HV1R <HV1R <HV1R )ORDWPRYHVIUHHO\RQWKHVWHPZLWKRXWELQGLQJ"<HV1R <HV1R <HV1R <HV1R 'RHVPRYLQJSURGXFWOHYHOIORDWXSWKHVWHP WULJJHUDODUP"<HV1R <HV1R <HV1R <HV1R ,QFKOHYHOIURPERWWRPRIVWHPZKHQDODUP LVWULJJHUHG 7DQNYROXPHDWLQFKOHYHOLQ/LQH &DOFXODWH/LQH/LQH[ ,V/LQHOHVVWKDQ"<HV1R <HV1R <HV1R <HV1R 'RHVWKHIXHOIORDWOHYHORQWKHFRQVROHDJUHH ZLWKWKHJDXJHVWLFNUHDGLQJ"<HV1R <HV1R <HV1R <HV1R 'RHVWKHRYHUILOODODUPDFWLYDWHDWDQ\SURGXFW OHYHODERYHWDQNFDSDFLW\"<HV1R <HV1R <HV1R <HV1R ,IDQ\DQVZHUVLQ/LQHVRUDUH´1RµRU/LQHLV´<HVµWKHV\VWHPKDVIDLOHGWKHWHVW Test Results 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO Comments: 7HVWHU·V1DPHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HVWHU·V6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc.801-886-9224 Harts #80 1000906 02/07/2024 1 Regular VRTLS 450 19782 118 3/8" 4 4 4 4 4 99 1/8" 17803 89 4 4 4 4 2 Premium VRTLS 450 7899 90 1/2" 4 4 4 4 4 75 5/8" 7109 89 4 4 4 3 Diesel VRTLS 450 11904 118 3/8" 4 4 4 4 4 98 5/8" 10713 89 4 4 4 4 Red Diesel VRTLS 450 3765 90 1/2" 4 4 4 4 4 76 3/8" 3388 89 4 4 Sammy Labrum UT-0325 pei.org 47 Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities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´1RµWKHV\VWHPKDVIDLOHGWKHWHVW Test Results 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO Comments: 7HVWHU·V1DPHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HVWHU·V6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc.801-886-9224 Harts #80 1000906 1 Regular VRTLS 450 19,782 118 3/8" 4 4 4 4 99 1/8" 4 4.5" 4 4 2 Premium VRTLS 450 7,899 90 1/2" 4 4 4 4 75 5/8" 4 4.5" 4 4 3 Clear DSL VRTLS 450 11,904 118 3/8" 4 4 4 4 98 5/8" 4 4.5" 4 4 4 Red Diesel VRTLS 450 3,765 90 1/2" 4 4 4 4 76 3/8" 4 4.5" 4 4 02/07/2024 Sammy Labrum UT-0325 PE I / R P 1 2 0 0 - 1 2 pe i . o r g 48 AP P E N D I X C - 8 LIQUID SENSOR FUNCTIONALITY TESTING )Dcilit\ 1DPe2Zner $GGress$GGress &it\ 6tDte =iS &oGe&it\ 6tDte =iS &oGe )Dcilit\ ,' Phone Testing &oPSDn\Phone 'Dte This SroceGXre is to GeterPine Zhether liTXiG sensors locDteG in the interstitiDl sSDce oI 86T s\stePs Dre DEle to Getect the Sresence oI ZDter DnG IXel 6ee P(,5P 6ection Ior the test SroceGXre 6ensor /ocDtion ProGXct 6toreG T\Se oI 6ensor 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting Test /iTXiG :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct ,s the $T* console cleDr oI Dn\ DctiYe or recXrring ZDrnings or DlDrPs regDrGing the leDN sensor" ,I the sensor is in DlDrP DnG IXnctioning inGicDte Zh\ <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o ,s the sensor DlDrP circXit oSerDtionDl" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o +Ds sensor Eeen insSecteG DnG in gooG oSerDting conGition" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o :hen SlDceG in the test liTXiG Goes the sensor trigger Dn DlDrP" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o :hen Dn DlDrP is triggereG is the sensor SroSerl\ iGentiIieG on the $T* console" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o $n\ ´1oµ DnsZers inGicDtes the sensor IDils the test Test Results PDss )Dil PDss )Dil PDss )Dil PDss )Dil PDss )Dil PDss )Dil PDss )Dil Comments: Tester·s 1DPe BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Tester·s 6ignDtXre BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc. Harts #80 10009060 02/07/2024 Reg 1 STP Regular Reg 2 STP Regular Prem STP Premium DSL STP Diesel Red D STP Red Diesel Reg INT Regular DSL INT Diesel Sammy Labrum UT-0325 PE I / R P 1 2 0 0 - 1 2 pe i . o r g 48 AP P E N D I X C - 8 LIQUID SENSOR FUNCTIONALITY TESTING )Dcilit\ 1DPe2Zner $GGress$GGress &it\ 6tDte =iS &oGe&it\ 6tDte =iS &oGe )Dcilit\ ,' Phone Testing &oPSDn\Phone 'Dte This SroceGXre is to GeterPine Zhether liTXiG sensors locDteG in the interstitiDl sSDce oI 86T s\stePs Dre DEle to Getect the Sresence oI ZDter DnG IXel 6ee P(,5P 6ection Ior the test SroceGXre 6ensor /ocDtion ProGXct 6toreG T\Se oI 6ensor 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting 'iscriPinDting 1onGiscriPi nDting Test /iTXiG :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct :Dter ProGXct ,s the $T* console cleDr oI Dn\ DctiYe or recXrring ZDrnings or DlDrPs regDrGing the leDN sensor" ,I the sensor is in DlDrP DnG IXnctioning inGicDte Zh\ <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o ,s the sensor DlDrP circXit oSerDtionDl" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o +Ds sensor Eeen insSecteG DnG in gooG oSerDting conGition" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o :hen SlDceG in the test liTXiG Goes the sensor trigger Dn DlDrP" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o :hen Dn DlDrP is triggereG is the sensor SroSerl\ iGentiIieG on the $T* console" <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o <es 1o $n\ ´1oµ DnsZers inGicDtes the sensor IDils the test Test Results PDss )Dil PDss )Dil PDss )Dil PDss )Dil PDss )Dil PDss )Dil PDss )Dil Comments: Tester·s 1DPe BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Tester·s 6ignDtXre BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc. Harts #80 10009060 02/07/2024 Pr/R DSL INT Prem/DSL Sammy Labrum UT-0325 Pressure/Vacuum (P/V) Vent Valve Data Sheet Facility Name: Test Date: Address: Test Company: Precision Testing Technologies City: Tester Name: Product: P/V Valve Manufacturer: Model Number: Pass Fail Manufacturers Specified Positive Leak Rate (CFH): Manufacturers Specified Negative Leak Rate (CFH): Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH): Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O): Product: P/V Valve Manufacturer: Model Number: Pass Fail Manufacturers Specified Positive Leak Rate (CFH): Manufacturers Specified Negative Leak Rate (CFH): Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH): Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O): Product: P/V Valve Manufacturer: Model Number: Pass Fail Manufacturers Specified Positive Leak Rate (CFH): Manufacturers Specified Negative Leak Rate (CFH): Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH): Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O): Product: P/V Valve Manufacturer: Model Number: Pass Fail Manufacturers Specified Positive Leak Rate (CFH): Manufacturers Specified Negative Leak Rate (CFH): Measured Positive Leak Rate (CFH): Measured Negative Leak Rate (CFH): Positive Cracking Pressure (in H2O): Negative Cracking Pressure (in H2O): 2.5" to 6" wc <=0.05 cfh @ 2" wc 6" to 10" wc <=0.21 cfh @ 4" wc 2.5" to 6" wc <=0.05 cfh @ 2" wc 2.5" to 6" wc <=0.05 cfh @ 2" wc 6" to 10" wc <=0.21 cfh @ 4" wc 6" to 10" wc <=0.21 cfh @ 4" wc 6" to 10" wc <=0.21 cfh @ 4" wc 2.5" to 6" wc <=0.05 cfh @ 2" wc Harts #80 10022 N 4800 W Cedar Hills, UT 84062 02/07/2024 Sammy Labrum UT 0325 Regular OPW 523v 4 0.04 4.7 0.18 6.8 Premium OPW 523v 4 0.04 4.8 0.18 7.8 1 of 3 parkland fueling equipment worksheet 022023 Fueling Equipment Worksheet Store # / Name: _________________________ Address:__________________________________ ***** FUEL TANKS Product: If Other, list Product: AST / UST Tank Type (ACT 100, FRP, Steel, STI-3) Tank Material? Double Wall? ( Y / N ) Capacity Gallons (per chart if available): Tank Chart available? Diameter Inches (measured): Length Inches (per chart): Drop tube present? # Of inches Drop Tube of bottom. Stage I VR Type (Coaxial, 2-pt) Swivel Type Stage I Adaptor ( Y / N) Vapor Bucket type (SW / DW / Manway? Tank #: Tank #: Tank #: Tank #: Tank #: Tank #: U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N SW / DW / M SW / DW / M SW / DW / M SW / DW / M SW / DW / M SW / DW / M Overfill Protection Present / Not Present ( P / NP ) Ball Float (BF), Drop Tube Valve (DTV) BF & Ex Alarm (BFE) ; Ex. Alarm (EA) P / NP P / NP P / NP P / NP P / NP P / NP Overspill Containment Catchment Basin, Multi-Port w/ bucket Spill Bucket Single or Double wall? Model / Manufacturer: Overspill Condition ( G / B )? Drain Valve Functional? Spill Bucket Size? CB / MP CB / MP CB / MP CB / MP CB / MP CB / MP S / D S / D S / D S / D S / D S / D G / B G / B G / B G / B G / B G / B Y / N Y / N Y / N Y / N Y / N Y / N Fill Riser Adaptor? (Locking, Stationary, Swivel) L / ST / SW L / ST / SW L / ST / SW L / ST / SW L / ST / SW L / ST / SW ESO Button(s) Operational? Y / N Y / N Y / N Y / N Y / N Y / N Location of ESO (s) ***** FUEL SUB-PUMPS Sub-Pump (STP) No: Tank #: Product: U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other Hart's #80 10022 N 4800 W Cedar Hills, UT 84082 1 2 3 4 UST UST UST UST FRP FRP FRP FRP FRP FRP FRP 19,782 7,899 11,904 3,765 118 3/8"118 3/8"90 1/2"90 1/2" E 7" W 8"8"6"6" 2-PT 2-PT DTV DTV DTV DTV OPW OPW OPW OPW 5GAL 5GAL 5GAL 5GAL 1 1 3 42 5 4321 2 of 3 parkland fueling equipment worksheet 022023 FUEL SUB-PUMPS (Cont.) If Other, list Product: Leak Detector Type: E / M E / M E / M E / M E / M E / M Manufacturer? Serial Number: Type: FX, PLD, FE, Etc. Sub Pump Sump/Liner Type: (Sump/Liner/None) Sump Condition (Good / Bad) Turbine Pump (STP) Horsepower? Beaudreau Sensors present? ( Y / N ) Positioned on bottom? ( Y / N ) ATG Sensors present? ( Y / N ) Positioned on bottom? ( Y / N ) S / L / None S / L / None S / L / None S / L / None S / L / None S / L / None G / B G / B G / B G / B G / B G / B Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N ***** FUEL DISPENSERS Number of Hoses: Condition of Hoses (G / B)? Dispenser Model: Type Code: (Single, Dual, Multi.) Manufacturer? Blender Installed? Blender = Mechanical / Electronic? Blend Ratio? Are Shear Valves anchored? Shear Valve Operational? Disp. #: Disp. #: Disp. #: Disp. #: Disp. #: Disp. #: G / B G / B G / B G / B G / B G / B S / D / M S / D / M S / D / M S / D / M S / D / M S / D / M Y / N Y / N Y / N Y / N Y / N Y / N M / E M / E M / E M / E M / E M / E Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Disp. Flex Hose (Present? Y/N) Disp. Flex Hose Booted/CP/Cont.? Y / N Y / N Y / N Y / N Y / N Y / N B / CP / Cont. B / CP / Cont. B / CP / Cont. B / CP / Cont. B / CP / Cont. B / CP / Cont. Flex Hose or Swing Joint? F / S F / S F / S F / S F / S F / S DWFRP Boots Connected or Open? C / O C / O C / O C / O C / O C / O Dispenser Sump/Liner Type:(Sump/Liner/None) Sump Condition (G / B) Beaudreau Sensors present ? ( Y / N ) Positioned on bottom? ( Y / N ) ATG Sensors Present? ( Y / N ) Positioned on bottom? ( Y / N ) S / L / None S / L / None S / L / None S / L / None S / L / None S / L / None G / B G / B G / B G / B G / B G / B Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N DYE DSL VR VR VR VR VR ----- FX1V FX1V FX1V FXIDV FXIDV ----- 1/2 3/4 5/6 7/8 9/10 11/12 3 of 3 parkland fueling equipment worksheet 022023 Additional Comments: Company:_______________________________________ Representative:___________________________________ Date:___________________________________________ ***** FUEL LINES Product: If Other, list Product: Type: DWFRP, FRP, Steel, Unknown) Type (Enviroflex, Flexworks, Etc.)? Manufacturer ? STP Flex Hose present? STP Flex Hose Booted /CP/ Cont.? Tank #: Tank #: Tank #: Tank #: Tank #: Tank #: U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other Y / N Y / N Y / N Y / N Y / N Y / N B / CP / Cont. B / CP / Cont. B / CP / Cont. B / CP / Cont. B / CP / Cont. B / CP / Cont. Sub Pump Connection: (Flex Hose, Swing Joint, Unknown) DWFRP Boots Connected or Open? F / S / U F / S / U F / S / U F / S / U F / S / U F / S / U C / O C / O C / O C / O C / O C / O ***** VENTS Product: Product: Location: C=Canopy; L=Lot; B=Building Manifolded Aboveground? ( Y / N ) Pressure/Vacuum Cap Type? U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other U UL+ S D Other C / L / B C / L / B C / L / B C / L / B C / L / B C / L / B Y / N Y / N Y / N Y / N Y / N Y / N ***** CATHODIC PROTECTION Impressed Current System: (Y / N) Rectifier Location ? Rectifier Log on Site ? Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N ***** AUTOMATIC TANK GAUGE Model? Comments: Software Version No? Is Software up to date? Y / N ***** RELEASE DETECTION METHOD Tank Primary Release Detection: Comments: Tank Secondary Release Detection: Piping Primary Release Detection: Piping Secondary Release Detection: **** OPERATIONAL CHECKS Gasoline/Compliance Binder Present? Y / N Last Test Dates? 30-Day Inspections completed by: UST Permit / Delivery Certificate Present (onsite) and Current? Y / N Emergency Response Plan Posted? Y / N SPCC Available (if required) Y / N 1 1 2 3 4 DYE DSL VR TLS 450 Precision Testing Technologies, Inc. Sammy Labrum 2/7/2024