DERR-2025-005085

Date:
-Exp 03/15/2026-Exp 09/
- Exp 02/11/2027
Petro Mechanical (385)-312-5851
6haXn *illett
Petro Mechanical [phone]
%$77(5< 2.
Shaun Gillett
�-Facility Name:
Address:
City, State, Zip Code:
Facility I.D. #:
Testing Company:
LIQUID SENSOR FUNCTIONALITY TESTING
Owner:
Address:
City, State, Zip Code:
Phone#:
Phone # Date:
This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel. See PEI/RP1200
Section 8.3 for the test procedure.
Sensor Location
Product Stored
□Discriminating □ Discriminating □ Discriminating □ Discriminating □ Discriminating □ Discriminating D Discriminating
Type of Sensor □Non-discrimi-D Non-discrimi-□Non-discrimi-□Non-discrimi-□ Non-discrimi-□ Non-discrimi-D Non-discrimi-
nating nating nating nating nating nating nating
Test Liquid □Water D Water □Water □Water □Water □Water D Water □Product D Product □Product □Product □Product □Product D Product
Is the ATG console clear of any active
or recurring warnings or alarms
regarding the leak sensor? If the □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No
sensor is in alarm and functioning,
indicate why.
Is the sensor alarm circuit □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No operational?
Has sensor been inspected and in □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No good operating condition?
When placed in the test liquid, does □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No the sensor trigger an alarm?
When an alarm is triggered, is the
sensor properly identified on the ATG □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No
console?
Any "No" answers indicates the sensor fails the test.
Test Results □Pass □Fail □Pass □ Fail □Pass □Fail □Pass □Fail □Pass □Fail □Pass □Fail □Pass □Fail
Comments:
Tester's Name (print) ,, Tester's Signature
-0m:::::::0 -0 ~ 0 0 I �
I.O
07-08-2025985-312-5851
SHAUN GILLETT
PETRO MECHANICAL [phone]
%<8 %ROA'CA6TIN*
1550 N 600 E
PROVO UTAH 84602
07-08-2025
1/2
DSL
3 GAL
OPW
9 1/2"
11:30 am
9 1/2"
12:30 am
1hr
0 ''
1000879
SHAUN GILLETT
Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities
APPENDIX C-4
CONTAINMENT SUMP INTEGRITY TESTING
HYDROSTATIC TESTING METHOD
Facility Name:
Address:
City, State, Zip Code:
Facility I.D. #:
Testing Company:
Owner:
Address:
City, State, Zip Code:
Phone#:
Phone # Date:
This procedure is to test the leak integrity of containment sumps. See PEI/RP1200 Section 6.5 for the test
method. Containment Sump ID STP STP UDC TRANSITON TRANSITION
Containment Sump Material FRP FRP POLY FRP FRP
Liquid and debris □Yes □Noremoved from sump?* □Yes □ 0 □Yes □No □Yes □No □Yes □No □Yes □No
Visual Inspection (Nocracks. loose parts □Pass □Fail □Pass □ Fail □Pass □Fail □Pass □ Fail □Pass □ Fail □Pass □Failor separation of the containment sump.)
Containment Sump Depth
Height From Bottom to Top of Highest Penetration
Starting Water Level
Test Start Time
Ending Water Level
Test End Time
Test Period (Minimum test time: 1 hour)
Water Level Change 0 0 0 0
Pass/fail criteria: Must pass visual inspection. Water level drop of less than 1/8 inch.
Test Results □Pass □Fail □Pass □Fall □Pass □Fail □Pass □Fail □Pass □Fail □Pass □Fall
Comments:
*All liquids and debris must be disposed of properly.
Tester's Name (print)_SHAUN GILLET T____________ Tester's Signature - ------------
pei.org •
1000879
1550 N 600 E
40 40 24
12 12 8
24 24
12:30 12:30
24 24
1:30 1:30
1HR 1HR 1RH 1HR
30 30
25 25
29 2918
1:30
18
2:30
1:45 1:45
28 28
2:45 2:45
1hr
0
BYU BROADCASTING
PROVO UT 84602
07-08-2025PETRO MECHANICAL
3853125851