DERR-2025-005170

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Ownership of Tanks
UTAH STATE FUEL NETWORK
4315 S 27oO W
SALT LAKE CITY UT 841't9
Tanks lnstalled. Use additional pages as needed.
UST lnstallation lnspection
4002024
N
U
ew Installation or Upgrade
L Number
WESTVALLEY CITY UT 84,I.I9
Tank No. f Tank No. 2 Tank No. 3 Tank No.
,l/ovi
6-38u,i4a ts o^ 3*n+lota 678
GRANITE SCHOOL DISTRICT
3OOOW PARKWAYBLVD
2o25
Location of Tanks
BUS FUEL FACILIry
K
l, Composite, etc.)
Substance to be stored
Capacity
Date installed
Pre-installation pressure test date or vacuum date (dry
Reading of pressure or vacuum for pre-installation test
Type of overfill prevention device (shutoff or alarm)
9tes*l25 lL
Pu.6d7'?''t/ftan '\
;
interstice)
(dry interstice)
Overfill alarm has sign and is visible and audible to driver (RP100)
Type of spill prevention device (single or dw spill bucket, sump, etc)
Amount of tank deflection readings (initial)
Amount of tank deflection readings (hold down straps)
Amount of tank deflection readings (backfill top of tan
Piping lnformation
k)
Material of construction (Flex plastic, F RP, etc)
Type (Pressure, Suction, Safe Suction, Gravity)
Date pre-installation air test passed
Pressure for pre-installation air test
lnstallation Specifi cations
t?3s/En tOZlt 7q2h)'
t 23 slb ,t lO2 " 7( 3/g it
lb.9 #5
Do you have a copy of the tank manufacturer's in
Certified tank installer Z qnZ Ch f ;'3L€n5en
CertifiedlnstallationCompany L5e4eO
Visual inspection of tank(s) reveals it is free from damage
Visual inspection reveals no brine on either the inside or outside of the tank(s) (from interstitial space of brine tank)
Damaged components have been repaired by the manufacturer
Cert. #: TL Ot15 b
Cert. #: rc t bq 7
Fg a
@No NA
_Exn. D3!e, A- t- Z026
No NA
No NA
,o llE
No NA
E
Yes
@Tank and piping excavations are free of debris
Depth of backfill bedding for tank(s) (must be at least one foot) ) ?tl *
Type of backfill material (clean, free flowing, etc.) (Sieve report should match installation manual):
Geotextile fabric used along sides of excavation (recommended)
eaP NA
Geotextile fabric separates any secondary backfill (required)No NA
Estimated depth to groundwater 4/ 5 /
Tank(s) are placed at sufficient depth for traffic
Tanks are outside the shadow of the 45 degree factor of a structure's footing (PEl RP100 Fig -2)
Distancefromtank(s)tonearestpropertyline: '3o'S Distancefromtank(s) toneareststructure: tu lor@ruo
Nn
Anchoring method is adequate for groundwater co-nsiderations. Note method here: 4AA) nan @f.fo f.fn
Hold-down straps are in place according to manufacturer's specifications (check installation minuil ilclamps are used) f$) ruo ruA
1@"
requirements, groundwater conditions (check installation manual) @ No NA
NA
Yes
Tank spacing is at least 18" between tank(s) and excavation wall (stable wall) or 18" between tank(s) and 112 times tank
diameter excavation wall (unstable wall)
Tank is level or sloped toward interstitial monitor probe
Backfill has been adequately compacted for full suport along tank length at 5 and 7 o'clock
pressure test after backfill to top of tank (before piping is installed)t gun f ltor med facility on (date): 7-7 ZOE
lnspector's Signature
@
NA
No
No@
Date of
l(name
,)?
Ver.101512018
o Wafi^42
certify that I inspected the above-na
Cert.#: Tl 2
Utah Department of Environmental Quality
Br inc
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il
Utah Department of Environmental Quality
UST Facil Site PIat
NORTH
4002024
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