HomeMy WebLinkAboutDERR-2025-004281EZY 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
0 0.0037 0.0000 0.0000 0 0.0037 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
0 0.0037 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 0.00370.0037 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#
:
03/05/2025
Harts #80232
5175 W. 9600 N.
Elwood, UT 84337
801-592-5948
John Hreinson
Zak Goldberg
UT-435
50 PSI
Regular
0 59
15 59 0 0 0
30 59 0 0 0
Pass
Prm
0 47
15 47 0 0 0
30 47 0 0 0
Pass
Diesel, Sats 11-14
0 34
15 34 0 0 0
30 34 0 0 0
Pass
03/05/2025
Zak Goldberg
UT-435
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
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Precision Testing Technologies Inc.801-886-9224
Harts #80232
5175 W. 9600 N.
Elwood, UT 84337
0100640
Harts Gas & Food LLC
P.O. Box 418
American Fork, UT 84003
801-592-5948
03/05/2025
1
Regular
VR
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4
30
16
120
2
10
6
4
4
4
4
2
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VR
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4
31
14
140
2
12
4
4
4
4
4
3
Diesel
VR
FX1DV
4
31
15
190
2
11
6
4
4
4
4
Zak Goldberg UT-435
pei.org 47
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities
APPENDIX C-7
AUTOMATIC TANK GAUGE
OPERATION INSPECTION
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Precision Testing Technologies Inc.801-886-9224
Harts #80232
0100640
1
Regular
VR TLS 350
19951
119.82
4
4
4
4
100
4
1
4
4
2
Premium
VR TLS 350
15104
119.82
4
4
4
4
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4
1
4
4
3
Diesel
VR TLS 35-
19951
119.82
4
4
4
4
100
4
1
4
4
Zak Goldberg UT-435
03/05/2025
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Precision Testing Technologies Inc.801-886-9224
Harts #80232
0100640
03/05/2025
Reg STP
Regular
4
4
4
4
4
4
4
4
Prm STP
Premium
4
4
4
4
4
4
4
4
Dsl STP
Diesel
4
4
4
4
4
4
4
4
Zak Goldberg UT-435
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
Harts #10
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
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