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Home My WebLink AboutDERR-2025-004452EZY 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# : 02/17/2025 4000408 Harts #90 335 W. 7200 S Midvale, UT Zak Goldberg UT-435 50 Psi Reg E. 0 67 15 66 -1 .0037 .0148 30 65 -1 .0037 .0148 Pass Reg W. 0 55 15 54.5 -.5 .00185 .0074 30 54 -.5 .00185 .0074 Pass Prm E. N/A Prm W. N/A Dsl 0 35 15 34 -1 .0037 .0148 30 34 0 0 0 Pass Dye Dsl 0 27 15 26 -1 .0037 .0148 30 25 -1 .0037 .0148 Pass 02/17/2025 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 )DFLOLW\1DPH2ZQHU $GGUHVV$GGUHVV &LW\6WDWH=LS&RGH&LW\6WDWH=LS&RGH )DFLOLW\,'3KRQH 7HVWLQJ&RPSDQ\3KRQH'DWH 7KLVGDWDVKHHWFDQEHXVHGWRWHVWPHFKDQLFDOOLQHOHDNGHWHFWRUV0//'DQGHOHFWURQLFOLQHOHDNGHWHFWRUV(//'ZLWKVXEPHUVLEOH WXUELQHSXPS673V\VWHPV6HH3(,536HFWLRQVDQGIRUWHVWSURFHGXUHV /LQH1XPEHU 3URGXFW6WRUHG /HDN'HWHFWRU0DQXIDFWXUHU /HDN'HWHFWRU0RGHO 7\SHRI/HDN'HWHFWRU 0//' (//' 0//' (//' 0//' (//' 0//' (//' 0//' (//' 0//' (//' MLLD (ALL PRESSURE MEASUREMENTS ARE MADE IN PSIG) 673)XOO2SHUDWLQJ3UHVVXUH &KHFN9DOYH+ROGLQJ3UHVVXUH /LQH5HVLOLHQF\POOLQHEOHHGEDFNYRO XPHDVPHDVXUHGIURPFKHFNYDOYHKROG LQJSUHVVXUHWR]HURSVLJ 6WHS7KURXJK7LPHLQ6HFRQGVWLPHWKH 0//'KHVLWDWHVDWPHWHULQJSUHVVXUH EHIRUHJRLQJWRIXOORSHUDWLQJSUHVVXUH DVPHDVXUHGIURPSVLJZLWKQROHDN LQGXFHGRQWKHOLQH 0HWHULQJ3UHVVXUH673SUHVVXUHZKHQ VLPXODWHGOHDNUDWHJSKDWSVLJ 2SHQLQJ7LPHLQ6HFRQGVWKHWLPHWKH 0//'RSHQVWRDOORZIXOOSUHVVXUHDIWHU VLPXODWHGOHDNLVVWRSSHG 'RHVWKH673SUHVVXUHUHPDLQDWRU EHORZWKHPHWHULQJSUHVVXUHIRUDWOHDVW VHFRQGVZKHQWKHVLPXODWHGOHDNLV LQGXFHG" <HV1R<HV1R <HV1R <HV1R <HV1R <HV1R 'RHVWKHOHDNGHWHFWRUUHVHWWULSZKHQ WKHOLQHSUHVVXUHLVEOHGRIIWR]HURSVLJ"<HV1R <HV1R <HV1R <HV1R <HV1R <HV1R 'RHVWKH673SURSHUO\F\FOHRQRIIXQGHU QRUPDOIXHOV\VWHPRSHUDWLRQFRQGLWLRQV"<HV1R <HV1R <HV1R <HV1R <HV1R <HV1R $´1RµDQVZHUWRHLWKHURIWKHDERYHTXHVWLRQVLQGLFDWHVWKH0//'IDLOVWKHWHVW ELLD (ALL PRESSURE MEASUREMENTS ARE MADE IN PSIG) 673)XOO2SHUDWLQJ3UHVVXUH +RZPDQ\WHVWF\FOHVDUHREVHUYHG EHIRUHDODUPVKXWGRZQRFFXUV" 'RHVWKHVLPXODWHGOHDNFDXVHDQDODUP"<HV1R <HV1R <HV1R <HV1R <HV1R <HV1R $´1RµDQVZHUWRWKHDERYHTXHVWLRQLQGL FDWHVWKH(//'IDLOVWKHWHVW 'RHVWKHVLPXODWHGOHDNFDXVHDQ673 VKXWGRZQ" <HV1R 1$ <HV1R 1$ <HV1R 1$ <HV1R 1$ <HV1R 1$ <HV1R 1$ Test Results 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO Comments: 7HVWHU·V1DPH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HVWHU·V6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc.801-886-9224 Harts #90 335 W. 7200 S. Midvale, UT 4000408 02/17/2025 1 Diesel VR PLLD 4 30 2 4 4 4 2 Dye Dsl VR PLLD 4 29 2 4 4 4 3 Premium VR PLLD 4 29 2 4 4 4 4 Regular VR PLLD 4 27 2 4 4 4 Zak Goldberg UT-435 PEI/RP1200-12 pei.org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´1RµRU/LQHLV´<HVµWKHV\VWHPKDVIDLOHGWKHWHVW Test Results 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO Comments: 7HVWHU·V1DPHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HVWHU·V6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc.801-886-9224 Harts #90 4000408 02/17/2025 1 Diesel VR TLS 350 11627 92 4 4 4 4 4 76 7/8 10435 89 4 4 4 4 2 Dye Diesel VR TLS 350 11627 92 4 4 4 4 4 76 7/8 10435 89 4 4 4 4 3 Premium VR TLS 350 11627 92 4 4 4 4 4 76 7/8 10435 89 4 4 4 4 4 Regular VR TLS 350 20168 92 4 4 4 4 4 101 3/4 18151 90 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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´1RµWKHV\VWHPKDVIDLOHGWKHWHVW Test Results 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO Comments: 7HVWHU·V1DPHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HVWHU·V6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc.801-886-9224 Harts #90 4000408 1 Diesel VR TLS 350 11627 92 4 4 4 4 76 7/8 4 2 4 4 2 Dye Diesel VR TLS 350 11627 92 4 4 4 4 76 7/8 4 2 4 4 3 Premium VR TLS 350 11627 92 4 4 4 4 76 7/8 4 2 4 4 4 Regular VR TLS 350 20168 92 4 4 4 4 101 3/4 4 2 4 4 Zak Goldberg UT-435 02/17/2025 PE I / R P 1 2 0 0 - 1 2 pe i . o r g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´1RµDQVZHUVLQGLFDWHVWKHVHQVRUIDLOVWKHWHVW Test Results 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO 3DVV)DLO Comments: 7HVWHU·V1DPHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HVWHU·V6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Precision Testing Technologies Inc.801-886-9224 Harts #90 4000408 02/17/2025 Dsl STP Diesel 4 4 4 4 4 4 4 4 Dye Dsl STP Dye Diesel 4 4 4 4 4 4 4 4 Prm STP Premium 4 4 4 4 4 4 4 4 Reg STP Regular 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 2/17/2025