DERR-2024-004045

Underground Storage Tank Inspection Verification Form
Facility ID:9000409
Owner Name:STAKER PARSON MATERIALS AND CONSTRUCTION Facility Name:ROOSEVELT FACILITY
Owner Address:89 WEST 13490 SOUTH, SUITE 100 Street Address:1368 S 3000 W
DRAPER, UT 84020 ROOSEVELT, UT 84066
Operator A:No Data / No Data / Operator B:No Data / No Data /
Owner Email:[e-mail] UTM Coordinates X/Y:580871 / 4459625
Disp ID/Alt
ID
Substance UDC Pipe Flex Loc Install Date UDC Install Date Fire
Valve
Sat
Present
UDC Test Disp Flex CP
Test
1 - 1/2 No No Yes
2 - 3/4 No No No
Tank ID/Alt ID:1 / 1 EGen/AST/Stat
e:
No / Yes /
Yes
Pipe Material-Mod: -
Siphon/Compart:No / No PVV/StageI:No Pipe Type/STP Cont:Safe Suction / No
Tank Status:Currently In Use STP Flex Connectors:
Installed/Cap/Loc:7/13/1910 / 20000 / LLD Model:
Substance Stored:Diesel / Diesel #2 (U.L.S.)Spill/Overfill/Sm deliv: / Automatic shutoff / No
Tank Material-Mod:Asphalt Coated or Bare Steel - Double-Walled PST Fund/Other Type:No / Insurance
ATG: / Tank/Pipe Rel Det:OTHER / OTHER / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG 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:Bare Steel -
Siphon/Compart:No / No PVV/StageI:Pipe Type/STP Cont:Safe Suction / No
Tank Status:Currently In Use STP Flex Connectors:
Installed/Cap/Loc:7/13/1910 / 1000 / LLD Model:
Substance Stored:Gasoline / Regular Spill/Overfill/Sm deliv: / Overfill alarm / No
Tank Material-Mod:Asphalt Coated or Bare Steel - Double-Walled PST Fund/Other Type:No / Insurance
ATG: / Tank/Pipe Rel Det:OTHER / OTHER / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:
ATG Test:Overfill Test:
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
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