DERR-2025-004067

WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

MECHANICAL AND ELECTRONIC LINE LEAK DETECTOR PERFORMANCE TESTS
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This data sheet can be used to test the mechanical line leak detector (MLLD) and electronic line leak detector (ELLD) with submersible turbine
pump (STP) systems. See PEI/RP 1200 Sections 9.1 and 9.2 for test procedures.
Line Number 1 2 3
Product Stored RUL PUL DSL
Leak Detector Manufacturer Veeder Root Veeder Root Veeder Root
Leak Detector Model PLLD PLLD PLLD
Type Of leak Detector
☐MLLD
☒ELLD
☐MLLD
☒ELLD
☐MLLD
☒ELLD
☐MLLD
☐ELLD
MLLD (ALL PRESSURE MEASURMENTS ARE MADE IN PSIG)
STP full operating pressure
Check valve holding pressure
Line resiliency (ml) (line bleedback volume as measured
from check valve holding pressure to 0 psig)
Step through time in seconds (time the MLLD hesitates at
metering pressure before going to full operating pressure as
measured from 0 sig with no leak induced on the line)

Metering pressure (STP pressure when simulated leak rate 3
gph at 10 psig)
Opening time in seconds (the time the MLLD opens to allow
full pressure after simulated leak is stopped)
Does the STP pressure remain at or below the metering
pressure for at least 60 seconds when the simulated leak is
induced? ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No
Does the leak detector reset (trip) when the line pressure is
bled off to zero psig? ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No
Does STP properly clycle on/off under normal fuel system
operating conditions? ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No
A "No" answer to any of the above questions indicates that the MLLD fails the test.
ELLD (ALL PRESSURE MEASURMENTS ARE MADE IN PSIG)
STP full operating pressure 35 35 35
How many test cycles are observed before alarm/shutdown
occurs? 1 1 2
Does the simulated leak cause on alarm? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
A "No" answer to the above question indicates that the ELLD fails the test.
Does the simulated leak cause an STP shutdown? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
Test Results ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail ☐Pass ☐Fail
Comments:
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature
WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

AUTOMATIC TANK GAUGE OPERATION INSPECTION
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to determine whether the automatic tank gauge (ATG) is operating properly. See PEI/RP1200 Section 8.2 for the inspection
procedure. This procedure is applicable to tank monitor stems that touch the bottom of the tank when in place.
Tank Number 1 2 3
Product Stored RUL PUL DSL
ATG Brand and Model TLS 450 TLS 450 TLS 450
1. Tank Volume, gallons 19,782 7,901 10,420
2. Tank Diameter, inches 118.4 118.4 118.4
3. After removing the ATG from the tank, it has been
inspected and any damaged or missing parts replaced? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
4. Float moves freely on the stem without binding? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
5. Fuel float level agree with the value programmed into
the console? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
6. Water float level agree with the value programmed into
the console? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
7. Inch level from the bottom of the stem when 90% alarm
is triggered? 99.125 99.875 98.5
8. Inch level at which the overfill alarm activates
corresponds with the value programmed in the gauge? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
9. Inch level from the bottom when the water float first
triggers an alarm? 1 1 1
10. Inch level at which the water float alarm activates
corresponds with the value programmed in the gauge? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
If any answers in Lines 3, 4, 5, or 6 are "No" the system has failed the test.
Test Results ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail ☐Pass ☐Fail
Comments:
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature
WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

LIQUID SENSER FUNCTIONALITY TESTING
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to determine whether liquid sensors, located in the interstitial spaces of the UST systems, are able to detect the presence of water and fuel. See
PEI/RP1200, Section 8.3 for the test procedure.
Sensor Location L1 STP L2 STP L3 INT L4 INT L5 FILL L6 FILL L7 FILL
Product Stored DSL RUL RUL PUL/DSL DSL RUL PUL
Type of Sensor
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
Test Liquid ☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
Is the ATG Console clear of any active or
recurring warnings or alarms regarding
the leak sensor? If the sensor is in alarm
and functioning, indicate why.
☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No
Is sensor alarm circuit
operational? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No
Has sensor been inspected and in good
operating condition? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No
When placed in test liquid, does the
sensor trigger an alarm? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No
When alarm is trigger, is the sensor
identified on the ATG console? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No
Any “No” answers indicate the sensor fails the test.
Test Results: ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail
Comments:
Tester’s Name: Taber DeHart, UT-0394 Tester’s Signature
WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

LIQUID SENSER FUNCTIONALITY TESTING
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to determine whether liquid sensors, located in the interstitial spaces of the UST systems, are able to detect the presence of water and fuel. See
PEI/RP1200, Section 8.3 for the test procedure.
Sensor Location L8 STP L9 UDC 1/2 L10 UDC 3/4 L11 UDC 5/6 L12 UDC 7/8 L13 UDC 9/10
Product Stored PUL ALL ALL RUL/PUL RUL/PUL ALL
Type of Sensor
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☒ Non-Discrimi-
nating
☐ Discriminating
☐ Non-Discrimi-
nating
Test Liquid ☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☒ Water
☐ Product
☐ Water
☐ Product
Is the ATG Console clear of any active or
recurring warnings or alarms regarding
the leak sensor? If the sensor is in alarm
and functioning, indicate why.
☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☐ Yes ☐ No
Is sensor alarm circuit
operational? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☐ Yes ☐ No
Has sensor been inspected and in good
operating condition? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☐ Yes ☐ No
When placed in test liquid, does the
sensor trigger an alarm? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☐ Yes ☐ No
When alarm is trigger, is the sensor
identified on the ATG console? ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☒ Yes ☐ No ☐ Yes ☐ No
Any “No” answers indicate the sensor fails the test.
Test Results: ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☒ Pass ☐ Fail ☐ Pass ☐ Fail
Comments:
Tester’s Name: Taber DeHart, UT-0394 Tester’s Signature
WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

OVERFILL ALARM OPERATION INSPECTION
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to determine whether the automatic tank gauge (ATG) is operating properly. See PEI/RP1200 Section 8.2 for the inspection
procedure. This procedure is applicable to tank monitor stems the touch the bottom of the tank when in place.
Tank Number 1 2 3
Product Stored RUL PUL DSL
ATG Brand and Model TLS 450 TLS 450 TLS 450
1. Tank Volume, gallons 19,782 7,901 10,420
2. Tank Diameter, inches 118.4 118.4 118.4
3. Overfill alarm activates in the test mode at the
console? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
4. When activated, overfill alarm can be heard or seen
while delivering to the tank? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
5. After removing the probe from the tank, it has been
inspected and any damaged or missing parts replaced? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
6. Float moves freely on stem without binding? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
7. Moving product level float up the stem trigger
alarm? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
8. Inch level from bottom of stem when 90% alarm is
triggered? 99.125 99.875 98.5
9. Tank volume at inch level in Line 8. 17,800 7,184 9,378
10. Calculate (Line 9 / Line 1) X 100 90% 90% 90%
11. Is line 10 less than 90%? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
12. Fuel float level on the console agrees with the
gauge stick reading? ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☐Yes ☐No
13. Overfill alarm activates at any product level above
90% tank capacity? ☐Yes ☒No ☐Yes ☒No ☐Yes ☒No ☐Yes ☐No
If any answers in Lines 3, 4, 5, 6, 7, or 11 are "No," or Line 13 is “Yes,” the system has failed the test.
Test Results ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail ☐Pass ☐Fail
Comments:
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature

WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

SPILL BUCKET INTEGRITY TESTING HYDROSTATIC TEST METHOD
SINGLE- AND DOUBLE-WALLED VACUUM TEST METHOD
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to test the leak integrity of single- and double-walled spill buckets. See PEI/RP1200 Section 6.2 for hydrostatic test
method, Section 6.3 for single-walled vacuum test method and Section 6.4 for double-walled vacuum test method.
Tank Number 1 1 2 2
Product Stored RUL RUL PUL PUL
Spill Bucket Capacity 5-Gallon 5-Gallon 5-Gallon 5-Gallon
Manufacturer OPW OPW OPW OPW
Construction ☐Double-walled
☒Single-walled
☐Double-walled
☒Single-walled
☐Double-walled
☒Single-walled
☐Double-walled
☒Single-walled
Test Type
☒Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
☒Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
☒Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
☒Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
Spill Bucket Type ☒Product
☐Vapor
☐Product
☒Vapor
☒Product
☐Vapor
☐Product
☒Vapor
Liquid and debris remove from spill
bucket?* ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No
Visual Inspection (no cracks, loose
parts or separation of the bucket from
the fill pipe.)
☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No
Tank Riser cap included in test? ☒Yes ☐No
☐NA
☒Yes ☐No
☐NA
☒Yes ☐No
☐NA
☒Yes ☐No
☐NA
Drain valve included in test? ☒Yes ☐No
☐NA
☒Yes ☐No
☐NA
☒Yes ☐No
☐NA
☒Yes ☐No
☐NA
Starting Level 9 1/8” 8 7/8” 9 1/2” 10 15/16”
Test Start Time 11:30 11:30 11:30 11:30
Ending Level 9 1/16” 8 7/8” 9 1/2” 10 7/8”
Test End Time 12:30 12:30 12:30 12:30
Test Period 1-Hour 1-Hour 1-Hour 1-Hour
Level Change -1/16” 0” 0” -1/16”
Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 1/8 inch; Vacuum single-walled only: Maintain at least 26 inches water
column; Vacuum double-walled: maintain at least 12 inches water column.
Test Results ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail
Comments:
*All liquids and debris must be disposed of properly
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature

WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

SPILL BUCKET INTEGRITY TESTING HYDROSTATIC TEST METHOD
SINGLE- AND DOUBLE-WALLED VACUUM TEST METHOD
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to test the leak integrity of single- and double-walled spill buckets. See PEI/RP1200 Section 6.2 for hydrostatic test
method, Section 6.3 for single-walled vacuum test method and Section 6.4 for double-walled vacuum test method.
Tank Number 3
Product Stored RUL
Spill Bucket Capacity 5-Gallon
Manufacturer OPW
Construction ☐Double-walled
☒Single-walled
☐Double-walled
☐Single-walled
☐Double-walled
☐Single-walled
☐Double-walled
☐Single-walled
Test Type
☒Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
☐Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
☐Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
☐Hydrostatic
☐Vacuum
☐Double-walled
☐Single-walled
Spill Bucket Type ☒Product
☐Vapor
☐Product
☐Vapor
☐Product
☐Vapor
☐Product
☐Vapor
Liquid and debris remove from spill
bucket?* ☒Yes ☐No ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No
Visual Inspection (no cracks, loose
parts or separation of the bucket from
the fill pipe.)
☒Yes ☐No ☐Yes ☐No ☐Yes ☐No ☐Yes ☐No
Tank Riser cap included in test? ☒Yes ☐No
☐NA
☐Yes ☐No
☐NA
☐Yes ☐No
☐NA
☐Yes ☐No
☐NA
Drain valve included in test? ☒Yes ☐No
☐NA
☐Yes ☐No
☐NA
☐Yes ☐No
☐NA
☐Yes ☐No
☐NA
Starting Level 10 7/16”
Test Start Time 11:30
Ending Level 10 3/8”
Test End Time 12:30
Test Period 1-Hour
Level Change -1/16”
Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 1/8 inch; Vacuum single-walled only: Maintain at least 26 inches water
column; Vacuum double-walled: maintain at least 12 inches water column.
Test Results ☒Pass ☐Fail ☐Pass ☐Fail ☐Pass ☐Fail ☐Pass ☐Fail
Comments:
*All liquids and debris must be disposed of properly
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature

WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

CONTAINMENT SUMP INTEGRITY TESTING
HYDROSTATIC TESTING METHOD
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to test the leak integrity of containment sumps. See PEI/RP1200 Section 6.5 for the inspection procedure.
Containment Sump ID UDC 1/2 UDC 3/4 UDC 5/6 UDC 7/8
Containment Sump Material Poly Poly Poly Poly
Liquid and debris removed from sump?* ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No
Visual Inspection (No cracks, loose parts or separation of
the containment sump.) ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No
Containment Sump Depth 10.20 12.36 12.12 12.00
Height From Bottom to Top of Highest Penetration 3.60 6.00 5.52 5.40
Starting Water Level 8.76 11.04 10.92 12.00
Test Start Time 10:40 10:40 10:40 10:40
Ending Water Level 8.76 11.04 10.92 12.00
Test End Time 11:40 11:40 11:40 11:40
Test Period (Minimum test time: 1 hour) 1-Hour 1-Hour 1-Hour 1-Hour
Water Level change 0” 0” 0” 0”
Pass/fail Criteria: Must pass visual inspection. Water level drop of less than 1/8 inch.
Test Results ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail
Comments:
*All Liquids and debris must be disposed of properly.
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature

WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

CONTAINMENT SUMP INTEGRITY TESTING
HYDROSTATIC TESTING METHOD
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to test the leak integrity of containment sumps. See PEI/RP1200 Section 6.5 for the inspection procedure.
Containment Sump ID UDC 9/10 RUL STP PUL STP DSL STP
Containment Sump Material Poly FRP FRP FRP
Liquid and debris removed from sump?* ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No
Visual Inspection (No cracks, loose parts or separation of
the containment sump.) ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No ☒Yes ☐No
Containment Sump Depth 12.00 43.80 45.00 45.60
Height From Bottom to Top of Highest Penetration 5.40 21.60 21.60 22.20
Starting Water Level 11.64 28.20 26.16 27.84
Test Start Time 10:40 43.80 45.00 45.60
Ending Water Level 11.64 28.20 26.16 27.84
Test End Time 11:40 11:40 11:40 11:40
Test Period (Minimum test time: 1 hour) 1-Hour 1-Hour 1-Hour 1-Hour
Water Level change 0” 0” 0” 0”
Pass/fail Criteria: Must pass visual inspection. Water level drop of less than 1/8 inch.
Test Results ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail
Comments:
*All Liquids and debris must be disposed of properly.
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature

WESTECH EQUIPMENT
195 WEST 3900 SOUTH • P.O. BOX 57307 • SALT LAKE CITY, UTAH 84157-0307
801-266-2545 • TOLL FREE 800-433-8831 • 24 HOUR FAX [phone]

PIPING SECONDARY CONTAINMENT INTEGRITY TESTING
Facility Name: Smith’s 65 Owner: Smith’s Food and Drug Centers, Inc.
Address: 8055 West 3500 South Address: P.O. Box 305103
City, State, Zip: Magna, Utah 84044 City, State, Zip: Nashville, Tennessee 37230
Facility I.D.#: 4002491 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date: 5/21/25
This procedure is to test the integrity of the interstitial space of double-walled piping. See PEI/RP1200 Section 5 for the test procedure.
Tank Number 1 2 3
Piping Run Only Only Only
Piping Material Flex D/W Flex D/W Flex D/W
Product Stored RUL RUL RUL
Test Start Time 10:40 10:40 10:40
Initial Test Pressure, psi (test procedure specifies 5 psi.) 5 PSI 5 PSI 5 PSI
Test End Time 11:40 11:40 11:40
Final Test Pressure, psi 5 PSI 5 PSI 5 PSI
Pressure Change
(No reduction in pressure allowed for pass.) 0 PSI 0 PSI 0 PSI
Test Results ☒Pass ☐Fail ☒Pass ☐Fail ☒Pass ☐Fail ☐Pass ☐Fail
Comments:
Tester’s Name Taber DeHart, UT-0394 Tester’s Signature