DERR-2025-004237

UST Annual Compliance Inspection
Facility Information
Name:Fast Stop 1102 Certification/Inspection #:62640
Address:5150 W OLD HWY RD., Mt Green, UT, 84050 State ID:1200458
Phone Number:Form Completed By:Larry Vasquez Date:05/16/2025
Tank Information
State Tank ID T4 DSL T3 PUL T1 RUL T2 RUL
Facility Tank # or ID (designation used by facility)T4 DSL T3 PUL T1 RUL T2 RUL
Tank Capacity 4218 gal 7950 gal 7950 gal 7950 gal
Product Name (describe in comments if not listed)Diesel Premium Unleaded Unleaded
Compartment Only (mark only if NOT the entire tank)
Manifolded Tank (mark for true siphon manifold ONLY)
Tank Status*
if Tank Status = TC:IU IU IU IU
Date in TC (assessment & OPS extension required > 1yr)
Emptied to 1" or less? (release detection required if not)Y N
NA
Y N
NA
Y N
NA
Y N
NA
Date emptied to 1" or less
Tank Release Detection Method*ATG-CSLD ATG-CSLD ATG-CSLD ATG-CSLD
Tank Corrosion protection*None None None None
Tank Wall Type*FRP FRP FRP FRP
Tank receives > 25 gallons at a time?Yes No Yes No Yes No Yes No
Spill Bucket? (required where UST receives >25 gallons at a time)Yes No Yes No Yes No Yes No
Spill Bucket Size 5-gal 5-gal 5-gal 5-gal
Spill Bucket Wall Type*SW SW SW SW
Overfill Protection? (required where UST receives >25 gallons at a time)Yes No Yes No Yes No Yes No
Overfill Protection Type*Drop Tube
Flapper valve
Drop Tube
Flapper valve
Drop Tube
Flapper valve
Piping Corrosion protection*0 N/A 0 0
Flexible Connection - Tank* None None
Flexible Connection - Dispenser*
Piping Wall Type*DW DW DW DW
Piping Delivery System*Pressure Pressure Pressure Pressure
Line Leak Detector Type (required for PR system)*Electronic Electronic Electronic Electronic
Piping Release Detection Method*Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
STP (Turbine Pump) Containment Sump?No No No No
STP Containment Sump Wall Type*NA NA NA NA
UDC (Under-dispenser) Containment Sump?No No No No
UDC Containment Sump Wall Type*NA NA NA NA
Piping Transition Sumps?No No No No
Transition Sump Wall Type*NA NA NA NA
Inspection Checklist
For each facility, complete the Annual Compliance Inspection Checklist below by answering the questions. If the facility contains more
than 5 tanks or 8 dispensers, additional copies of this form must be completed. Questions are designated as either a mandatory
compliance item(●) or a recommended practice item(®). If an item is identified as mandatory and recommended, further information is
provided in a note following the question. If "No" is the answer for any mandatory compliance item(●) question, an associated entry must
be made in the Return to Compliance Plan with documentation of the date when the issue was brought back into compliance. The State
must approve all compliance plan schedules. If "No" is the answer for a recommended practice item (®), it is strongly suggested that the
deficiency be corrected.
Tank Information
Inspection Item T4 DSL T3 PUL T1 RUL T2 RUL
Fill Equipment
●1 Is there a product tag on the fill riser pipe or are the lids painted in
accordance with a posted product code color chart?
Y Y Y Y
®2 Does the fill cap have adequate clearance between the cap and the manhole
cover?
Y Y Y Y
●3 Does the tank have a drop tube that extends to within 6 inches of the bottom
(if no diffuser is present)?
Y Y Y Y
Spill & Overfill Protection
●4 Is each UST that receives more that 25 gallons of product at any one time
equipped with spill and overfill prevention?
Y Y Y Y
●5 Is the spill bucket free of fuel, water or debris?Y Y Y Y
●6 Is the spill bucket in good condition and free of damage?Y Y Y Y
®7 Does the drain assembly work?NA NA Y NA
●8
Is the tank(s) equipped with an overfill device (e.g. overfill alarm, automatic
shut-off device or ball-float valve) and is the device installed according to
manufacturer's specifications to allow proper functionality?
Y Y Y Y
●9 Is the tank overfill alarm mounted near the fill port where it can be seen or
heard by the delivery person?
Y Y Y Y
Temporary Closure
●10
If the tank is in temporary closure and contains greater that 1 inch of
product, is approved release detection performed and maintained? NOTE:
OPS recommends that a tank in temporary closure be emptied (contains <=
1 inch of fluids).
NA NA NA NA
●11 If the tank is in temporary closure, is corrosion protection maintained?NA NA NA NA
●12
If the tank has been in temporary closure for greater than 3 months, is the
vent line open and has the piping, pumps, manways, and ancillary
equipment been capped and secured?
NA NA NA NA
Vapor Recovery (if Required)
●13 Are the vapor recovery adaptor and cap present and free of damage?NA NA NA NA
®14 Does the vapor cap have adequate clearance between the cap and the
manhole cover to enable hook-up?
NA NA NA NA
®15 Is the vapor cap in good condition with a gasket?NA NA NA NA
®16 Is the vapor recovery lid painted orange?NA NA NA NA
Submersible Turbine Pump (STP) Sump
®17 Are the external and/or internal lids easily removed for inspection?Y Y Y Y
®18 Are the sump lid, gasket and seals present and in good condition?Y Y Y Y
●19 Is the sump free of fuel, water or debris?Y Y Y Y
●20 Is the sump free of cracks, holes, bulges, or other defects?Y Y Y Y
●21
If the system contains secondarily contained piping with release detection
consisting of sump sensors installed in the sump, is the interstice open to the
sump?
Y Y Y Y
●22 Is the sump sensor properly mounted at the bottom of the sump and
operating according to the manufacturer's specifications?
Y Y Y Y
●23
Are penetration fittings and entry boots intact, secure and free of damage?
NOTE: If the sump was installed prior to 8-1-08 and is not used for interstitial
monitoring, this is a recommended item.
Y Y Y Y
®24 Are junction boxes sealed and free of corrosion?Y Y Y Y
●25 Are the STP components, piping and flex connectors free of leaks or seeps?Y Y Y Y
●26 If no sump is present, are metal components that are in contact with the soil
cathodically protected?
NA NA NA NA
●27 Are piping and flexible connectors installed according to the manufacturer's
specifications (not kinked or twisted)?
Y Y Y Y
●28
Did the mechanical and/or electronic line-leak detector pass its annual
functionality test which includes a leak simulated in the line as part of the
functionality test?
Y Y Y Y
®29 Is the mechanical leak detector properly vented? (vent tube not kinked or
twisted)
NA NA NA NA
ATG Port
®30 Is the manhole cover in good condition and is there adequate clearance
between the ATG probe cap and the manhole cover?
Y Y Y Y
®31 Is the cap in good condition and does it seal tightly?Y Y Y Y
®32 Are the probe wiring hole, electrical junction box and conduit sealed and in
good condition?
Y Y Y Y
●33 Are the probe, floats, and water/product warning alarms operating according
to the manufacturer's specifications?
Y Y Y Y
ATG Console
●34 Does the ATG console have power?Y Y Y Y
●35 Have all ATG leak alarms been properly addressed?Y Y Y Y
●36
Is the console programmed correctly for the tanks found at the site (e.g.
product, capacity, points, overfill alarm, in-tank test, line-leak detector test,
etc.)?
Y Y Y Y
●37 Is the sump sensor properly mounted at the bottom of the sump?Y Y Y Y
●38 Are the sensors functioning according to the manufacturer's specifications?Y Y Y Y
Tank Interstice
●39 Are the interstitial sensors placed correctly in the tanks?NA NA NA NA
●40 Are the interstitial sensors functioning according to the manufacturer's
specifications?
NA NA NA NA
Cathodic Protection
●41
Are all system components that routinely contain product (tanks, lines, and
other metal components) and that are in contact with the soil properly
cathodically protected?
NA NA NA NA
●42
Has your cathodic protection system (galvanic anodes or impressed current)
been tested within 6 months of installation/repair, and every 3 years
thereafter?
NA NA NA NA
●43 Has the impressed current system (rectifier) been inspected for proper
operation at least every 60 days?
NA NA NA NA
●44
If you have an internally-lined tank without additional cathodic protection,
has it passed and internal inspection within 10 years after installation of the
lining and every 5 years thereafter?
NA NA NA NA
®45 If the system is equipped with impressed current, there are no damaged,
frayed or exposed wires?
NA NA NA NA
Vent Piping
®46 Is the vent cap present and is it the correct type?Y Y Y Y
●47 Is the vent piping of correct height and above obstructions?Y Y Y Y
●48 Are diesel and gasoline tanks vented with separate piping?Y Y Y Y
Unattended Fueling
●49
Is one or more clearly identified emergency shutoff devices located not less
than 20 ft. or more than 100 ft. from the dispensing devices, readily
accessible to patrons?
Y Y Y Y
3
●50 Is a working telephone or other approved, clearly identified means to notify
the fire department provided on the site, and readily accessible to patrons?
Y Y Y Y
●51
Is a fire extinguisher with a minimum rating of 40-B, a maintenance
inspection not older than 1 year, and located no more than a 30 ft, travel
distance from the dispensing devices, readily accessible to patrons?
Y Y Y Y
Monthly Inspection
●52 Have all Monthly inspections been performed and documented, and have all
deficiencies noted during the inspections been corrected?
Y Y Y Y
Dispenser Information
Inspection item D1 D2 D3
●53 Is hanging hardware free of visible signs of leakage or damage?Y Y Y
●54 Are all components of hanging hardware of the proper type and size?Y Y Y
●55 If applicable, is fuel product, safety, octane, diesel sulfur, ethanol, signage present and correct?Y Y Y
●56 Is the under-dispenser containment(UDC) sump free of fuel, water or debris?Y Y Y
●57 Is the UDC sump free of cracks, holes, bulges, or other defects?Y Y Y
®58 Are penetration fillings and entry boots intact, secure and free of damage? NOTE: If the sump was installed prior to
8-1-2008 and is not used for interstitial monitoring, this is a recommended item.
Y Y Y
●59 If the system contains secondarily contained piping with release detection consisting of sump sensors installed in
the sump, is the interstice open to the sump?
NA NA NA
●60 Is the sump sensor properly mounted at the bottom of the sump?NA NA NA
●61 Are junction boxes sealed and free of corrosion?Y Y Y
●62 Are meters, piping and flexible connectors free of leaks or seeps?Y Y Y
●63 Are piping and flexible connectors installed according to the manufacturer's specification? (not kinked or twisted)Y Y Y
●64 If no UDC, are any metal piping components in contact with the soil properly cathodically protected?NA NA NA
●65 Are the shear valves operating according to the manufacturer's specifications?Y Y Y
●66 Is at least one fire extinguisher with a minimum rating of 40-B, and a maintenance inspection not older than 1 year,
located within 100 feet of each dispenser and tank fill opening?
Y Y Y
●67 Is an emergency stop button present and operable?Y Y Y
Note:
Operator Certification
By signing below, the operator certifies that the answers above are accurate and based upon performance of associated inspection
activities, and that the facility owner has received a copy of this inspection form.
Contractor Printed Name:Larry Vasquez Contractor Company Name:CGRS, Inc.
Certification Number:
Contractor Signature:
A or B Operator Printed Name:A or B Operator Cert. No.:
A or B Operator Signature:Date:05/16/2025
Automatic Tank Gauge Inspection
ATG 1
ATG 1663
Facility Information
Name:Fast Stop 1102 Certification/Inspection #:62641
Address:5150 W OLD HWY RD., Mt Green, UT, 84050 State ID:1200458
Phone Number:Form Completed By:Larry Vasquez Date:05/16/2025
ATG Console Inspection
Tank Level Monitor Brand :Veeder Root
1.Status upon Arrival:All Functions Normal
2.Status upon Departure:All Functions Normal
3.Is the display in good
condition and functioning?:
Yes
4.Is the keypad in good
condition?:
Yes
Tank Level Monitor Model :TLS-450 Plus
5.Are all indicator lights
functional?:
Yes
6.Is printer functional?:Yes
7.Back-up battery tested? (if
applicable)?:
Yes
8.Back-up battery voltage (if
applicable):
3.6
Tank Information
Probe and Programing Inspection:
9.Tank # T4
DSL T2 RUL T1 RUL T3 PUL
10.Tank Facility ID T4
DSL T2 RUL T1 RUL T3 PUL
11.Tank # per ATG T4 DSL T2 RUL T1 RUL T3 PUL
12.Product:Diesel Unleaded Unleaded Premium
13.Tank Volume, gallons 4218 7950 7950 7950
14.Tank Dia/depth, inches 91 91 91 91
In-Tank Setup Parameters:
15.Thermal coefficient .000450 .000700 .000700 .000700
16.ATG Programmed Diameter 91 91 91 91
17.Number of points on profile 4 4 4 4
18.Full volume on profile 4218 7950 7950 7950
Pass/Fail Criteria: if any of questions 19, 20 ,21 & 22 are No, then the system has failed the test.
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
19.After removing the probe from the tank, it has been inspected and any
damaged or missing parts replaced?
Yes Yes Yes Yes
20.Do floats move freely along the stem without binding?Yes Yes Yes Yes
21.Does product level match console value?Yes Yes Yes Yes
22.Does water level match console value?Yes Yes Yes Yes
23.Water warning (inches)(1")1.5 1.5 1.5 1.5
24.High water limit (inches)(1.5")2 2 2 2
25.Does console water alarm trigger at programmed level?Yes Yes Yes Yes
26.Programmed Overfill Limit (90%)90 90 90 90
27.Does console overfill alarm trigger at programmed level?Yes Yes Yes Yes
28.Programmed High Product Limit (95%)95 95 95 95
29.Does console high product alarm trigger at programmed level?Yes Yes Yes Yes
30.Low Product (15% of tank volume or 15" whichever is greater)15 15 15 15
31.Tank test program enabled?Yes Yes Yes Yes
32.Tank Test Method?CSLD CSLD CSLD CSLD
33.Tank Test Rate 0.2 0.2 0.2 0.2
34.Test duration (hrs)CONT CONT CONT CONT
35.12 months of tank test history present?Yes Yes Yes Yes
Lines:
36.Electronic Line Leak Type PLLD PLLD PLLD PLLD
37.Line # and label in ATG (Q1, Unleaded)Q3 DSL Q1 RUL 1,
RUL2
Q1 RUL 1,
RUL2 Q2 PUL
38.Line Test Rate 3 GPH 3 GPH 3 GPH 3 GPH
39.12 months of line test history present?NA NA NA NA
40.Test Result Pass Pass Pass Pass
Automatic Tank Gauge Sensor
ATG 1
Facility Information
Name:Fast Stop 1102 Certification/Inspection #:62642
Address:5150 W OLD HWY RD., Mt Green, UT, 84050 State ID:1200458
Phone Number:Form Completed By:Larry Vasquez Date:05/16/2025
Sensor: #
Brand:Veeder root Veeder root Veeder root Veeder root
Model:208 208 208 208
Type:Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Location:STP STP STP STP
Test Liquid, Fuel(F) and/or Water(W):F F F F
Is the ATG console clear of any active or recurring warnings
or alarms regarding sensor?
If sensor is in alarm and functioning indicate why below:
Y Y Y Y
Is the sensor alarm circuit operational?Y Y Y Y
Has the sensor been inspected and in good operating
condition?
Y Y Y Y
When placed in the test liquid does the sensor trigger an
alarm?
Y Y Y Y
Sensor removed for testing?Y Y Y Y
When an alarm is triggered, is the sensor properly
identified on the ATG console?
Y Y Y Y
Sensor returned to proper placement and verified to be
functional after testing?
Y Y Y Y
Any "No" answers above indicates the sensor fails the test.
Test Result Pass Pass Pass Pass
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
Leak Detector
Facility Information
Name:Fast Stop 1102 Certification/Inspection #:62638
Address:5150 W OLD HWY RD., Mt Green, UT, 84050 State ID:1200458
Phone Number:Form Completed By:Larry Vasquez Date:05/16/2025
Tank Information
Tank #:T1 RUL T2 RUL T3 PUL T4 DSL
Capacity:7950 7950 7950 4218
Product:Unleaded Unleaded Premium Diesel
Line #:RUL PUL DSL
Line Type:Pressure Pressure Pressure
LD Brand:Veeder Root Veeder Root Veeder Root
LD Model:PLLD PLLD PLLD
Serial #:0 0 0
Associated Tank:T1 RUL ,T2 RUL T3 PUL T4 DSL
Resiliency (ml):NA NA NA
Check Valve Holding PSI:18 51 19.5
Opening Time:NA NA NA
Result:Pass Pass Pass
Test Equip. Mfg.:Vaporless, LDT-890 Vaporless, LDT-890 Vaporless, LDT-890
Notes:
Tested per manufacturer specifications.
Contractor Signature:Printed Name:Larry Vasquez
Line Test
Facility Information
Name:Fast Stop 1102 Certification/Inspection #:62637
Address:5150 W OLD HWY RD.State ID:1200458
Phone Number:Form Completed By:Larry Vasquez Date:05/16/2025
Tank Test Information
Tank #:T1 RUL T2 RUL T3 PUL T4 DSL
Capacity:7950 7950 7950 4218
Product:Unleaded Unleaded Premium Diesel
Line Test Information
Line #:RUL PUL DSL
LineType:Pressure Pressure Pressure
Line Material:DW Flex DW Flex DW Flex
Line ID Size (in):2 2 2
Line Length (ft):200 200 200
Pump Type:Red Jacket Red Jacket Red Jacket
Associated Tank:T1 RUL ,T2 RUL T3 PUL T4 DSL
Test Equip. Mfg.:Triangle Triangle Triangle
Test Pressure (PSI):50 50 50
Initial Cyl. Level:400 420 450
Final Cyl. Level:400 420 450
Change in Time (mins):15 15 15
Change in Vol:0.0000 0.0000 0.0000
Change in Temp (F):0 0 0
Coeff. Of Thermal Expansion (g/F):0.00070 0.00070 0.00045
Line Vol (gal):32.62 32.62 32.62
Leak Rate (GPH):0.0000 0.0000 0.0000
Result:Pass Pass Pass
Notes
TIGHTNESS TESTING CERTIFICATION
CGRS certifies that the systems in the above table have been tested utilizing leak detection methods which meet the prescribed leak rate testing
standard of 0.10 gph with a minimum probability of detection of 95% and a 5% probability of a false alarm. CGRS further certifies that the protocol for
each test method was strictly adhered to, and that all precision tightness testing performed by CGRS was conducted in accordance with EPA 40 CFR
parts 280.43(c) and 280.44(b) and the National Fire Protection Association, Bulletin NFPA 329 criteria.
Contractor Printed Name:Larry Vasquez Contractor Signature:
Certification Number:TMI-301,TL-2025-T-002
Spill Bucket Test
Facility Information
Name:Fast Stop 1102 Certification/Inspection #:60963
Address:5150 W OLD HWY RD., Mt Green, UT, 84050 State ID:1200458
Phone Number:Form Completed By:Larry Vasquez Date:04/02/2025
Spill Bucket Information
Tank #Spill Bucket T1
RUL
Spill Bucket T2
RUL
Spill Bucket T3
PUL
Spill Bucket T4
DSL
Tank Facility ID:T1 RUL T2 RUL T3 PUL T4 DSL
Product:Unleaded Unleaded Premium Diesel
Spill Bucket Capacity:5 gal 5 gal 5 gal 5 gal
Manufacture:EBW EBW EBW EBW
Construction:SW SW SW SW
Spill Bucket Type?Product Product Product Product
Liquid and debris removed from spill bucket?Yes Yes Yes Yes
Visual Inspection (No cracks, loose parts or separation
of the bucket from fill pipe)
Pass Pass Pass Pass
Tank riser cap included in test?Yes Yes Yes Yes
Is drain valve included in test?Yes Yes N/A Yes
Start Level 14.87 6.5 12 13.5
End Level 14.87 6.5 12 13.5
Test Duration (hh:mm)01:00 01:00 01:00 01:00
Level Change 0.0000 0.0000 0.0000 0.0000
Pass/Fail Criteria (Test Method):Hydrostatic: level
drop less than 1/8
inch
Hydrostatic: level
drop less than 1/8
inch
Hydrostatic: level
drop less than 1/8
inch
Hydrostatic: level
drop less than 1/8
inch
Test Result:Pass Pass Pass Pass
Comments
Operator Certification
Contractor Printed Name:Larry Vasquez Contractor Signature:
Certification Number:DS-CGRS-17
PEI/RP1200 -19
pei.org52
APPENDIX C-3
SPILL BUCKET INTEGRITY TESTING HYDROSTATIC TEST METHOD
SINGLE- AND DOUBLE-WALLED VACUUM TEST METHOD
Facility Name:Owner:
Address:Address:
City, State, Zip Code:City, State, Zip Code:
Facility I.D. #:Phone #:
Testing Company:Phone #:Date:
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
Product Stored
Spill Bucket
Capacity
Manufacturer
Construction Single-walled
Double-walled
Single-walled
Double-walled
Single-walled
Double-walled
Single-walled
Double-walled
Single-walled
Double-walled
Single-walled
Double-walled
Test Type Hydrostatic
Vacuum
Single-walled
Double-walled
Hydrostatic
Vacuum
Single-walled
Double-walled
Hydrostatic
Vacuum
Single-walled
Double-walled
Hydrostatic
Vacuum
Single-walled
Double-walled
Hydrostatic
Vacuum
Single-walled
Double-walled
Hydrostatic
Vacuum
Single-walled
Double-walled
Spill Bucket Type Product
Vapor
Product
Vapor
Product
Vapor
Product
Vapor
Product
Vapor
Product
Vapor
Liquid and debris
removed from
spill bucket?*
Yes No Yes No Yes No Yes No Yes No Yes No
Visual Inspection
(No cracks, loose
parts or separa-
tion of the bucket
from the fill pipe.)
Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Tank riser cap
included in test?
Yes No
NA
Yes No
NA
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
Yes No
NA
Yes No
NA
Starting Level
Test Start Time
Ending Level
Test End Time
Test Period
Level Change
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 Pass Fail Pass Fail
Comments:
*All liquids and debris must be disposed of properly.
Tester’s Name (print) ___________________________________ Tester’s Signature _________________________________
Fast Stop 1102
5150 W Old Hwy Road
Mt Green, UT, 84050
1200458
CGRS, Inc.04/02/25
T1 T2 T3 T4
RUL RUL PUL DSL
5 gal 5 gal 5 gal 5 gal
EBW EBW EBW EBW
14.87 6.5 12 13.5
14.87 6.5 12 13.5
1 hr 1 hr 1 hr 1 hr
0.00 0.00 0.00 0.00
Larry Vasquez