DERR-2025-003947

UNIVERSITY HOSPITAL LOADING DOCK
50 NORTH MEDICAL DRIVE
SALT LAKE CITY, UTAH
4000303
STATE FUEL NETWORK
APPLIED ENVIRONMENTAL SERVICES
PO BOX 141152
SALT LAKE CITY, UT
BRETT GURNEY 385-602-4872
801-540-9258 5-17-2025
1
DSL
VEED
PLLD
X
33
2
X
X
X
2
DSL
TANKS 1-3 PRODUCT LINES MANIFOLDED WITH 1 PLLD SUPPLYING BOILERS. TANK 4 SUPPLIES GENERATOR
STEVEN B MARTIN
3
DSL
4
DSL
VEED
PLLD
X
31
2
X
X
X
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2025.05.19 13:42:27 -07'00'
Reason: I am approving this document
UNIVERSITY HOSPITAL / LOADING DOCK
50 NORTH MEDICAL DRIVE
SALT LAKE CITY, UTAH
4000303
APPLIED ENVIRONMENTAL SERVICES
STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UTAH 84141-1152
BRETT GURNEY 385-602-4872
801-540-9258 5-17-2025
TK1 RET
DSL
X
X
X
X
X
X
X
X
TK1 STP
DSL
X
X
X
X
X
X
X
X
TK2 RET
DSL
X
X
X
X
X
X
X
X
TK2 STP
DSL
X
X
X
X
X
X
X
X
TK3 STP
DSL
X
X
X
X
X
X
X
X
TK4 STP
DSL
X
X
X
X
X
X
X
X
TK1 ANNUL
BRINE
X
X
X
X
X
X
X
ANNULAR SENSORS WERE REMOVED FROM BRINE TO TEST, DID NOT USE ANY LIQUID TO TEST.
STEVEN B MARTIN
APPLIED ENVIRONMENTAL SERVICES, L.C. PO BOX 1073 BOUNTIFUL, UTAH 84011
801-540-9258 [e-mail]
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2025.05.19 13:44:09 -07'00'
Reason: I am approving this document
UNIVERSITY HOSPITAL LOADING DOCK
50 NORTH MEDICAL DRIVE
SALT LAKE CITY, UTAH
4000303
APPLIED ENVIRONMENTAL SERVICES
STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UTAH 84141-1152
BRETT GURNEY 385-602-4872
801-540-9258 5-17-2025
TK2 ANNUL
BRINE
X
X
X
X
X
X
X
TK3 ANNUL
BRINE
X
X
X
X
X
X
X
TK4 ANNUL
BRINE
X
X
X
X
X
X
X
GEN TRANS
DSL
X
X
X
X
X
X
X
X
SUP TRANS
DSL
X
X
X
X
X
X
X
X
RET TRANS
DSL
X
X
X
X
X
X
X
X
ANNULAR SENSORS WERE REMOVED FROM BRINE TO TEST, DID NOT USE ANY LIQUID TO TEST.
STEVEN B MARTIN
APPLIED ENVIRONMENTAL SERVICES, L.C. PO BOX 1073 BOUNTIFUL, UTAH 84011
801-540-9258 [e-mail]
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2025.05.19 13:45:49 -07'00'
Reason: I am approving this document
APPLIED ENVIRONMENTAL SERVICES, L.C.
PO BOX 1073 BOUNTIFUL, UTAH 84011 801-540-9258
TEI 5000 NON VOLUMETRIC, TEI 4000 VOLUMETRIC, TEI ULLAGE, TEI LT3
PRECISION TANK & LINE TEST RESULTS SUMMARY
INVOICE ADDRESS:TANK LOCATION: WORK ORDER #
TECH # 94027
TECHNICIAN: SM
STATE TECH #
STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UTAH 84141-1152
U OF U, HOSPITAL LOADING
50 NORTH MEDICAL DRIVE
SALT LAKE CITY, UTAH
25045
UT 0121
DATE:
5-17-2025
TIME START:TIME END:GROUNDWATER DEPTH:
N/A DW TKS
TANK TANK
CAPACITY
24970
24970
24970
24970
PRODUCT
DSL
DSL
DSL
DSL
TANK
N/T
N/T
N/T
N/T
VENT
N/T
N/T
N/T
N/T
PRODUCT
LINE
PASS
PASS
PASS
PASS
LINE LEAK
DETECTOR
PASS
N/A
N/A
PASS
WATER IN
TANK
PUMP
TYPE
PRESS
PRESS
PRESS
PRESS
TANK
MATERIAL
DWF
DWF
DWF
DWF
1.
2.
3.
4.
5.
6.
PRODUCT LINES TESTED AT 50 PSI FOR 15 MIN
LINE RATES (GPH)
1.
2.
3.
5.
6.
BOILER -.033 GEN -.028
ADDITIONAL INFORMATION:TANKS 1-3 SUPPLY BOILER, TANK 4 SUPPLIES GENERATOR
TANKS 1-3 BOILER SUPPLY LINES ARE MANIFOLDED WITH 1 PLLD.
CERTIFIED TECHNICIAN SIGNATURE:DATE:5-17-2025
These systems meet all requirements set forth by USEPA 40 CFR and has received third party certification.
4.
TEST METHODS USED FOR THIS LOCATION
TEI 5000 NON VOLUMETRIC TANK TEST TEI 4000 VOLUMETRIC TANK TEST TEI TANK ULLAGE TEST TEI LT3 LINE TEST X
LINE LEAK DETECTOR TYPE & SIMULATED LEAK RATE
1.
2.
3.
M = MECHANICAL E = ELECTRONIC # = (GPH) RATE
4.
5.
6.
E 3 E 3
All tests were performed according to manufacturer protocol, and within the common practices of the industry. However due to the variables of
tightness testing, these results cannot be guaranteed. There are no warranties expressed, written or implied.
DEQ ID#4000303
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2025.05.19 13:38:35 -07'00'
Reason: I am approving this document
AUTOMATIC TANK GAUGE OPERATION INSPECTION
Facility Name:
Address:
City, State, Zip Code:
Facility I.D. #
Testing Company:
Owner:
Address:
City, State, Zip Code:
Phone #
Testers Phone #
Date:
This procedure is to determine whether the ( ATG) is operating properly. See PEI/RP1200 Section 8.2 for the proper inspection procedure.
Tank Number
Product Stored:
ATG Brand and Model
1. Tank Volume, gallons
2. Tank Diameter, inches
3. After removing the ATG from the tank, has it
been inspected and any damaged or missing
parts replaced?
4. Float moves freely on the stem without
5. Fuel float level agrees with the
value programmed into the console?
6. Water float level agrees with the value
programmed into the console?
7. Inch level from bottom of stem when 90%
alarm is triggered.
8. Inch level at which the overfill alarm
activates corresponds with value programmed
in the gauge?
9. Inch level from the bottom when the water
float first triggers an alarm.
10. Inch level at which the float alarm activates
corresponds with value programmed in the
gauge?
If any answers in Lines 3,4,5, or 6 are "NO" the system has failed the test.
TEST RESULTS
Comments:
Testers Name: Steven B. Martin Testers Signature:
U OF U SCHOOL OF MEDICINE LOADING
150 NORTH MEDICAL DRIVE
SALT LAKE CITY, UTAH
4000303
AES UTAH TESTER # UT 0121
STATE FUEL NETWORK
PO BOX 141152
SALT LAKE CITY, UTAH 84141-1152
BRETT GURNEY 385-602-4872
801-540-9258
5-17-2025
1
DSL
TLS450 PLUS
24970
119
YES
YES
YES
YES
101
YES
2
YES
2
DSL
TLS450 PLUS
24970
119
YES
YES
YES
YES
101
YES
2
YES
PASS PASS PASS PASS
3
DSL
TLS450 PLUS
24970
119
YES
YES
YES
YES
101
YES
2
YES
4
DSL
TLS450 PLUS
24970
119
YES
YES
YES
YES
101
YES
2
YES
BATTERY BACKUP FUNCTIONS PROPERLY, SETUP REPORT PRINTED
ALL TANK INTERSTICIAL SENSORS FUNCTION PROPERLY, ALL SUMP SENSORS FUNCTION PROPERLY
Digitally signed by STEVEN B MARTIN
cn=STEVEN B MARTIN, o=AES, c=US
Date: 2025.05.19 13:40:24 -07'00'
Reason: I am approving this document