DERR-2024-005937

.. Q ........ _, •· . ~tah Department of Environmental Quality Facility ID \ \ 1~ '\ f '; . .
UST Installation Inspection
. .
• ... , /
Paae \ of
Ownership of Tanks Location of Tank•
OwnerName ~'""'}~~ \\I"(\ Q..,":J Location Nemo s--,\1,,5 ;l\y
Address \ ~O i" \)..$) Address q('R) JJ \\i~½V".,, '()
Citv S \ l. -State l) ZiE.._ ti,~\ Cl l~ City \,t State UT ~ipjYo'p
Contact ~'1f -v· 600 Phone~ \C\74 \'1 ';>t\ Contact Phone Tanks Installed. Use •ddltlonal oaaea for 1ddltton1I tanks. Tank No.1-~ Tank No.'l,t\ Tank No.~A' I TanlcNo.)R
New Installation or Uoarade N N AJ N
Tank is New or Used (must be re-certified by manufacturer if It is used) N tJ I\} N
Material of construction (FRP, Steel, Composite, etc.). ... " Cv1,,, f-vVJ f,(r,
n'--1 fZ.1~, D1.v
. JJ N 1> Sincile-walled or Double-walled (if OW, indicate if drv or liquid-filled) {] D\,.J
-c::;:t
.
fi,~\Q~, f'v-tvY'. Substance to be Stored be .... <
Caoacitv ') {\ M() Q, 0()0 \C, ,uc 0 Cc (iC/) l
V
'1/q/-:-> t.f 4;qp 'I t l/1/.f'J~ Date Installed ~ht :7"\
Oate~re-installation Air Test passed ~-vii '111 {1/.:( 'lh. '1/r J/., ;'
Pressure for pre-installation Air Test ~•._ I 5~ '7µ S"ff :-,_ ..
['r''.,....,' • . , Leak Detection Method to be used
Tvoe of Overfill Prevention Device to be used (shutoff, ball float, etc.) ~t . .i .•. rJ s 0 <; {) <:;o I
Type of Spill Prevention Device to be used (spill bucket, sump, etc.) s~ ,s".,...\' .~R Sv""° WJ w..-fr'\ ~i? .c.,-o I
PIDlna Information . , . I
Material of Construction (Flex Plastic, FRP, etc.) y\Q.,l (\t'1-f \-f)+ t\t
Type (Pressurized, Suction, Safe Suction, Gravity, etc.)
Leak Detection Method(s) to be used .
Date pre-installation Air Test passed
Pressure for pre-installation Air Test
Installation Soecfficatlons. Resnond to the followlna auestlons. Explain anv •No" answers In the "Comments" section on D, 2.
Certified Tank lnstaller'tL ,i.-. r"~ \)\J(~~..., Cert.#: TL 'J\S Exp. Date: 'ij\l) 1-N
Certified Installation Company "D'f' ( Cert.#: IC 1\n \, -.
Equipment used to lift and lower tank is of adequate size t<{ey No n/a
Visual inspection of tanks reveals no damaqe <JP No n/a
Any damaqed components have been repaired Yes No @)
Tank and piping excavations are free of debris ?f~ No n/a fS, y1, -Estimated depth to qroundwater:
Tanks are placed at sufficient depth for traffic requirements, qroundwater conditions, and adeouate pipinq slope & No n/a
Depth of backfill beddinq for tanks (must be at least one foot): I TYPe of backfill material:
Backfill has been adequately compacted for full support alona tank lenath at 5 and 7 o'clock Yes No n/a
Anchoring method is adeauate for groundwater considerations. Note method here: 'Pt4: J V°"fJ V\ No n/a
Hold-down straps are in place accordinQ to manufacturer's specifications Q No n/a
Distance from tank(s) to nearest property line).D r=e,e,.Y I Distance from tank(s) to nearest structure: ;D6 ,H'~~ Io lue~ Spacing between tanks is acceptable (at least 18 inches between tanks for stable wall conditions or at least 1/2 times the tank diameter for unstable wall conditions) (!§;; No nla
Anodes have been checked to determine that the plastic wrapper has been removed Yes No
Tank and/or pipinQ cathodic protection system has been checked to determine that it is worklno properly Yes No A
Initial e.,,(1 'l Si u{After backfillina 1......---' Amount of tank deflection meets specifications. Readinqs: Final: Yes No Corrosion Protedlon Uoarade .... ____ -;;d to the followlna auestlons. Exnlaln anv "No" answers In the -Comments• section.
Field-installed cathodic protection system is desianed by a corrosion expert (Includes sion-off by corr. exoert) Yes No nla
Protected system components are properly isolated from non-protected comoonents, disoensers, structures, etc. Yes No nla
Electrical continuitv between anodes and protected components is verified Yes No nla
Rectifier is proper1y installed on a circuit that always has power (not shut off when facilitv oower Is off) Yes No n/a
I (name) /11//1,D t~J,. I/ certifv that I lnsoected the above-named facility on (date): L//!/:) (./
~J _:~~ Inspector SiQnature: -,-:;.~ Cert.#: Tl JC/1 -
lnstal•nsp0908.doc
I Utah Department of Environmental Quality
UST Facility Site Plat
1A 1 (3
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B,y,l t~
NORTH
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Facility ID\\ 001 f1
Pa_ge of d
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t3, •"1.t.
o b t O 9 ~(JbO oo(i;
lo~Jr Sub Pump
Tank Fill
ATG Probe
s
F
A
Inter. Probe I
Vapor Rec. V
capped C
UTM Northing: Easting: Other s eci 0
Show locations of all buildings, streets, tanks, piping, and dispenser islands. Indicate the product in each tank. Show locations of tank manways and identify each:
submersible pump, fill, ATG probe, vapor recovery, etc. For closures: Indicate the type (soil, GW, USC), location, and depth of each sample collected by the certified
sampler or the inspector. Indicate the locations of an re orted PIO or FID readin s. Show locations of otential rece tors.
Comments
1.
.,
S1teplat0908.doc