DERR-2025-005665

Tank # / Tank Facility ID / ProductLeak Detection:
UST Monthly Compliance Inspection
Facility Information
Name:Fast Stop 1117 Certification/Inspection #:63250
Address:416 N Washington Blvd State ID:1200664
Phone
Number:Form Completed By:Larry Vasquez Date:06/03/2025
T4 DSL
T4 DSL
Diesel
T3 ETH
FREE
T3 ETH
FREE
Ethanol Free
Unleaded
T2 PUL
T2 PUL
Premium
T1 RUL
T1 RUL
Unleaded
Tanks:
1 Is release detection equip. operating w/o alarms or unusual conditions? Y N
NA Y N NA Y N NA Y N NA
2 Is tank free of water? Y N
NA Y N NA Y N NA Y N NA
3 Primary Tank Release Detection Method Inspected:Interstitial
Monitoring
Interstitial
Monitoring
Interstitial
Monitoring
Interstitial
Monitoring
4 Date of last passing result:06/03/2025 06/03/2025 06/03/2025 06/03/2025
5 Are Inventories reconciled daily and are the variances within the guideline set by the
facility owner?
Y N
NA Y N NA Y N NA Y N NA
Lines:
6 Are line leak detectors present? Y N
NA Y N NA Y N NA Y N NA
7 LD s operating properly (no slow flow)? Y N
NA Y N NA Y N NA Y N NA
8 Primary Line Release Detection Method Inspected Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
9 Date of last passing result:06/03/2025 06/03/2025 06/03/2025 06/03/2025
Fill/Overfill:
10 Fill caps, adapters, gaskets in good condition? Y N
NA Y N NA Y N NA Y N NA
11 Fills properly marked? Y N
NA Y N NA Y N NA Y N NA
12 Spill bucket free of liquid/debris? Y N
NA Y N NA Y N NA Y N NA
13 Spill bucket free of damage/drain work correctly? Y N
NA Y N NA Y N NA Y N NA
14 Does the spill bucket drain assembly work correctly? Y N
NA Y N NA Y N NA Y N NA
15 For double wall spill bucket, is the interstitial monitoring equipment functioning, in
good condition and not in alarm?
Y N
NA Y N NA Y N NA Y N NA
16 Fill cap in place and sealed tightily? Y N
NA Y N NA Y N NA Y N NA
17 Overfill drop tube free of obstructions? Y N
NA Y N NA Y N NA Y N NA
Vapor:
18 Vapor cap in place and sealed tightly? Y N
NA Y N NA Y N NA Y N NA
19 Vapor recovery adapter intact? Y N
NA Y N NA Y N NA Y N NA
20 Vapor recovery lids painted orange? Y N
NA Y N NA Y N NA Y N NA
21 Is Vapor Bucket free of damage and free of liquid/debris? Y N
NA Y N NA Y N NA Y N NA
STP Secondary Containment:
22 Sump containment free of water/fuel/debris? Y N
NA Y N NA Y N NA Y N NA
23 STP and piping free of leaks and seeps? Y N
NA Y N NA Y N NA Y N NA
24 Sump containment free of damage? Y N
NA Y N NA Y N NA Y N NA
25 For DW containment with Brine, are levels correct? Y N
NA Y N NA Y N NA Y N NA
6
26 Sensors located @ lowest point in containment? Y N
NA Y N NA Y N NA Y N NA
Dispensing Equipment:Qty:Facility Notes:
27 UDC free of water/fuel/debris? Y N NA
28 All meters/ piping free from leaks and seeps? Y N NA
29 UDC in good condition & free from damage? Y N NA
30 For DW containment with Brine, are levels correct? Y N NA
31 Sensors located lowest point in UDC? Y N NA
32 Shear valves properly set and secured? Y N NA
33 Nozzles, swivels, hoses and connectors free of
leaks? Y N NA
34 All product and whip hoses in good condition? Y N NA
Cathodic Protection:
35 Rectifier is on? Y N NA
Deficiency Information
Rec Item Item ID Equip ID Description Remedy Date Image
®12 T2 PUL premium, unable to remove liquid in spill bucket, containment is full
®12 T3 ETH FREE ethanol free, unable to remove liquid in spill bucket, containment is full
®21 T2 PUL premium,unable to remove liquid in vapor spill bucket, containment is full
®21 T3 ETH FREE ethanol free, unable to remove liquid in vapor spill bucket, containment is full
®22 T1 RUL regular unleaded, unable to remove liquid in stp sump, containment is full
®22 T4 DSL diesel, unable to remove liquid in stp sump, containment is full
Contractor Signature:Date:06/03/2025
Printed Name:Larry Vasquez Certification Number:
UST Operator Inspection -Utah
VEAR ~C)!Jt:,
~,~-Facility Name fo.~+ str~ n 1111 Facility ID
C4 ! Address l/ /Ill t J 0--<; V\ \ V\ ~+ ()I/\ "R \\Jr\ Primary Class B Operator
' NAME(S) AN~NITIALS OF PERSON{Si' CONDUCTING MONTHLY INSPECTIONS:
I {~ v-Y Vt>-S<ll..t-i-; l ~
Please respond to ALL of the following questions with a Y (Yes), N (No), or NA (Not Applicable) answer.
Months of the Current Year J F M A M J J A s 0 1N
Monthly Inspection -Release Detection
1
Release detection equipment is operating with no alarms or other unusual y \l ''I y y
operating conditions. ... ~
2 Records of release detection (tanks and piping) are reviewed and current. V y y V IY y ,
Monthly Inspection -Spill Prevention Equipment -'\ I \
3 Equipment is undamaged, intact and free from defects. y y '{ I ):
I•
4 Equipment is free from debris, water, or product. '{ !\, / ,, I , n ,
N' I . I ' V 5 Fill Pipe is unobstructed.
6 Fill cap is un-broken and is securely on the fill pipe.
,, ' I ' :{
7 Double walled spill prevention equipment -Interstitial area is free from leaks. 'i \ ' y
Initials of person performing Inspection. Lv-U/ i.JI Lv [jJ LU
Annual Inspection -Containment Sumps I Date of annual lnspection.fi-J-~
8 Secondary Containment Sumps Visual Inspection of sump indicates no damage and it is free from debris, water and fuel.
(STP, Dispenser and Transition) The penetration fittings for conduits and piping entering the STP Sumps are intact.
:,
. ,; 9 Double Walled Sumps Interstitial area is free from leaks .
,J •
Hand-held release detection Hand-held release detection equipment (bailer, gauge stick, etc.) is serviceable and
10 equipment operable.
D
(
y
V
~
I certify under penalty of law that I am the Class B Operator referenced above and that I am familiar with information on this form
and that it is true, accurate and was completed in accordance with R311-203-7.
Signature of the Primary Class B Operator (Sign this document after the last inspection of the Current Year) Date
B Operator#
Comments/Follow up:
-Turn over for record of Interstitial Monitoring visual inspections and Impressed Current rectifier checks.
ere
rN
Utah -Page 2 of 2
lJST Operator Inspection •
If ou rform Interstitial Monitoring on your tanks and/or piping and use a visual check rather than sump or
Y pe for your monthly leak detection, complete the table to document the monthl 1 1 h t· interstitial sensors Y v sua c eeks.
Months of the Current Year J F M A M J J A 5 0
. f th ·nterstitial space of the double-walled tank Indicated no
N D
Visual check o e 1 . .
1 release or unusual operating conditions.
. k f •p·ng (STP dispenser and transition) containment sumps
Visual chec o P1 1 ' 2 . . 1 function and no indication of water or leaked product.
indicates norma
Impressed Current 60 Day Rectifier Check
Months of the Current Year J F M A M J J A s 0 N D
Show the date the Impressed Current
~k het hu. n(A f\~ system "ras inspected to ensure the h\A _equipment is n1nnin2 properly
Amperage reading from impressed h~ tt~ ntA. t\"'-V\~ (\lA.
current rectifier
Voltage reading from impressed current f\~ (\CA... "~ n(A n~ t\c._
rectifier
INSTRUCTIONS
l . The monthly UST system inspections must be conducted by or under the direction of the Primary Class B UST Operator.
~-2. The Primary Class BUST Operator must alert the UST Owner or Operator of any condition discovered during the monthly visual
..... inspection that may require follow-up actions.
3. The UST Owner or Operator must maintain a copy of the monthly inspection reports for the most recent 12 months. The records
shall be maintained on-site or off-site at a readily available location.
Ver. 4/14/2016
I
UST Annual Compliance Inspection
Facility Information
Name:Fast Stop 1117 Certification/Inspection #:63244
Address:416 N Washington Blvd, Ogden, UT, 84404 State ID:1200664
Phone Number:Form Completed By:Larry Vasquez Date:06/03/2025
Tank Information
State Tank ID T4 DSL T3 ETH
FREE
T2 PUL T1 RUL
Facility Tank # or ID (designation used by facility)T4 DSL T3 ETH
FREE
T2 PUL T1 RUL
Tank Capacity 4873 gal 4873 gal 4873 gal 15094 gal
Product Name (describe in comments if not listed)Diesel Ethanol Free
Unleaded
Premium Unleaded
Compartment Only (mark only if NOT the entire tank)
Manifolded Tank (mark for true siphon manifold ONLY)
Tank Status*
if Tank Status = TC:IU IU IU IU
Date in TC (assessment & OPS extension required > 1yr)
Emptied to 1" or less? (release detection required if not)Y N
NA
Y N
NA
Y N
NA
Y N
NA
Date emptied to 1" or less
Tank Release Detection Method*ATG-
Interstitial
Monitoring
ATG-
Interstitial
Monitoring
ATG-
Interstitial
Monitoring
ATG-
Interstitial
Monitoring
Tank Corrosion protection*DW FRP-N/A DW FRP-N/A DW FRP-N/A DW FRP-N/A
Tank Wall Type*FRP FRP FRP FRP
Tank receives > 25 gallons at a time?Yes No Yes No Yes No Yes No
Spill Bucket? (required where UST receives >25 gallons at a time)Yes No Yes No Yes No Yes No
Spill Bucket Size 5-gal 5-gal 5-gal 5-gal
Spill Bucket Wall Type*DW DW DW DW
Overfill Protection? (required where UST receives >25 gallons at a time)Yes No Yes No Yes No Yes No
Overfill Protection Type*Drop Tube
Flapper valve
Drop Tube
Flapper valve
Drop Tube
Flapper valve
Drop Tube
Flapper valve
Piping Corrosion protection*Flex-N/A Flex-N/A Flex-N/A Flex-N/A
Flexible Connection - Tank*Containment
(NC)
Containment
(NC)
Containment
(NC)
Containment
(NC)
Flexible Connection - Dispenser*Containment
(NC)
Containment
(NC)
Containment
(NC)
Containment
(NC)
Piping Wall Type*DW DW DW DW
Piping Delivery System*Pressure Pressure Pressure Pressure
Line Leak Detector Type (required for PR system)*Electronic Electronic Electronic Electronic
Piping Release Detection Method*Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
STP (Turbine Pump) Containment Sump?No No No No
STP Containment Sump Wall Type*NA NA NA NA
UDC (Under-dispenser) Containment Sump?No No No No
UDC Containment Sump Wall Type*NA NA NA NA
Piping Transition Sumps?No No No No
Transition Sump Wall Type*NA NA NA NA
Comments
Inspection Checklist
For each facility, complete the Annual Compliance Inspection Checklist below by answering the questions. If the facility contains more
than 5 tanks or 8 dispensers, additional copies of this form must be completed. Questions are designated as either a mandatory
compliance item(●) or a recommended practice item(®). If an item is identified as mandatory and recommended, further information is
provided in a note following the question. If "No" is the answer for any mandatory compliance item(●) question, an associated entry must
be made in the Return to Compliance Plan with documentation of the date when the issue was brought back into compliance. The State
must approve all compliance plan schedules. If "No" is the answer for a recommended practice item (®), it is strongly suggested that the
deficiency be corrected.
Tank Information
Inspection Item T4 DSL T3 ETH
FREE
T2 PUL T1 RUL
Fill Equipment
●1 Is there a product tag on the fill riser pipe or are the lids painted in
accordance with a posted product code color chart?
Y Y Y Y
®2 Does the fill cap have adequate clearance between the cap and the
manhole cover?
Y Y Y Y
●3 Does the tank have a drop tube that extends to within 6 inches of the bottom
(if no diffuser is present)?
Y Y Y Y
Spill & Overfill Protection
●4 Is each UST that receives more that 25 gallons of product at any one time
equipped with spill and overfill prevention?
Y Y Y Y
●5 Is the spill bucket free of fuel, water or debris?Y Y Y Y
●6 Is the spill bucket in good condition and free of damage?Y Y Y Y
®7 Does the drain assembly work?NA NA NA NA
●8
Is the tank(s) equipped with an overfill device (e.g. overfill alarm, automatic
shut-off device or ball-float valve) and is the device installed according to
manufacturer's specifications to allow proper functionality?
Y Y Y Y
●9 Is the tank overfill alarm mounted near the fill port where it can be seen or
heard by the delivery person?
Y Y Y Y
Temporary Closure
●10
If the tank is in temporary closure and contains greater that 1 inch of
product, is approved release detection performed and maintained? NOTE:
OPS recommends that a tank in temporary closure be emptied (contains <=
1 inch of fluids).
NA NA NA NA
●11 If the tank is in temporary closure, is corrosion protection maintained?NA NA NA NA
●12
If the tank has been in temporary closure for greater than 3 months, is the
vent line open and has the piping, pumps, manways, and ancillary
equipment been capped and secured?
NA NA NA NA
Vapor Recovery (if Required)
●13 Are the vapor recovery adaptor and cap present and free of damage?NA Y Y Y
®14 Does the vapor cap have adequate clearance between the cap and the
manhole cover to enable hook-up?
NA Y Y Y
®15 Is the vapor cap in good condition with a gasket?NA Y Y Y
®16 Is the vapor recovery lid painted orange?NA Y Y Y
Submersible Turbine Pump (STP) Sump
®17 Are the external and/or internal lids easily removed for inspection?Y Y Y Y
®18 Are the sump lid, gasket and seals present and in good condition?Y Y Y Y
●19 Is the sump free of fuel, water or debris?Y Y Y Y
●20 Is the sump free of cracks, holes, bulges, or other defects?Y Y Y Y
●21
If the system contains secondarily contained piping with release detection
consisting of sump sensors installed in the sump, is the interstice open to
the sump?
Y Y Y Y
●22 Is the sump sensor properly mounted at the bottom of the sump and
operating according to the manufacturer's specifications?
Y Y Y Y
●23
Are penetration fittings and entry boots intact, secure and free of damage?
NOTE: If the sump was installed prior to 8-1-08 and is not used for
interstitial monitoring, this is a recommended item.
Y Y Y Y
®24 Are junction boxes sealed and free of corrosion?Y Y Y Y
●25 Are the STP components, piping and flex connectors free of leaks or seeps?Y Y Y Y
●26 If no sump is present, are metal components that are in contact with the soil
cathodically protected?
NA NA NA NA
●27 Are piping and flexible connectors installed according to the manufacturer's
specifications (not kinked or twisted)?
Y Y Y Y
●28
Did the mechanical and/or electronic line-leak detector pass its annual
functionality test which includes a leak simulated in the line as part of the
functionality test?
Y Y Y Y
®29 Is the mechanical leak detector properly vented? (vent tube not kinked or
twisted)
NA NA NA NA
ATG Port
®30 Is the manhole cover in good condition and is there adequate clearance
between the ATG probe cap and the manhole cover?
Y Y Y Y
®31 Is the cap in good condition and does it seal tightly?Y Y Y Y
®32 Are the probe wiring hole, electrical junction box and conduit sealed and in
good condition?
Y Y Y Y
●33 Are the probe, floats, and water/product warning alarms operating according
to the manufacturer's specifications?
Y Y Y Y
ATG Console
●34 Does the ATG console have power?Y Y Y Y
●35 Have all ATG leak alarms been properly addressed?Y Y Y Y
●36
Is the console programmed correctly for the tanks found at the site (e.g.
product, capacity, points, overfill alarm, in-tank test, line-leak detector test,
etc.)?
Y Y Y Y
●37 Is the sump sensor properly mounted at the bottom of the sump?Y Y Y Y
●38 Are the sensors functioning according to the manufacturer's specifications?Y Y Y Y
Tank Interstice
●39 Are the interstitial sensors placed correctly in the tanks?Y Y Y Y
●40 Are the interstitial sensors functioning according to the manufacturer's
specifications?
Y Y Y Y
Cathodic Protection
●41
Are all system components that routinely contain product (tanks, lines, and
other metal components) and that are in contact with the soil properly
cathodically protected?
NA NA NA NA
●42
Has your cathodic protection system (galvanic anodes or impressed current)
been tested within 6 months of installation/repair, and every 3 years
thereafter?
NA NA NA NA
●43 Has the impressed current system (rectifier) been inspected for proper
operation at least every 60 days?
NA NA NA NA
●44
If you have an internally-lined tank without additional cathodic protection,
has it passed and internal inspection within 10 years after installation of the
lining and every 5 years thereafter?
NA NA NA NA
®45 If the system is equipped with impressed current, there are no damaged,
frayed or exposed wires?
NA NA NA NA
Vent Piping
®46 Is the vent cap present and is it the correct type?Y Y Y Y
●47 Is the vent piping of correct height and above obstructions?Y Y Y Y
●48 Are diesel and gasoline tanks vented with separate piping?Y Y Y Y
Unattended Fueling
●49
Is one or more clearly identified emergency shutoff devices located not less
than 20 ft. or more than 100 ft. from the dispensing devices, readily
accessible to patrons?
Y Y Y Y
6
●50 Is a working telephone or other approved, clearly identified means to notify
the fire department provided on the site, and readily accessible to patrons?
Y Y Y Y
●51
Is a fire extinguisher with a minimum rating of 40-B, a maintenance
inspection not older than 1 year, and located no more than a 30 ft, travel
distance from the dispensing devices, readily accessible to patrons?
Y Y Y Y
Monthly Inspection
●52 Have all Monthly inspections been performed and documented, and have all
deficiencies noted during the inspections been corrected?
Y Y Y Y
Dispenser Information
Inspection item D1 D2 D3 D4 D5 D6
●53 Is hanging hardware free of visible signs of leakage or damage?Y Y Y Y Y Y
●54 Are all components of hanging hardware of the proper type and size?Y Y Y Y Y Y
●55 If applicable, is fuel product, safety, octane, diesel sulfur, ethanol, signage present and correct?Y Y Y Y Y Y
●56 Is the under-dispenser containment(UDC) sump free of fuel, water or debris?Y Y Y Y Y Y
●57 Is the UDC sump free of cracks, holes, bulges, or other defects?Y Y Y Y Y Y
®58 Are penetration fillings and entry boots intact, secure and free of damage? NOTE: If the sump was
installed prior to 8-1-2008 and is not used for interstitial monitoring, this is a recommended item.
Y Y Y Y Y Y
●59 If the system contains secondarily contained piping with release detection consisting of sump
sensors installed in the sump, is the interstice open to the sump?
Y Y Y Y Y Y
●60 Is the sump sensor properly mounted at the bottom of the sump?Y Y Y Y Y Y
●61 Are junction boxes sealed and free of corrosion?Y Y Y Y Y Y
●62 Are meters, piping and flexible connectors free of leaks or seeps?Y Y Y Y Y Y
●63 Are piping and flexible connectors installed according to the manufacturer's specification? (not kinked
or twisted)
Y Y Y Y Y Y
●64 If no UDC, are any metal piping components in contact with the soil properly cathodically protected?NA NA NA NA NA NA
●65 Are the shear valves operating according to the manufacturer's specifications?Y Y Y Y Y Y
●66 Is at least one fire extinguisher with a minimum rating of 40-B, and a maintenance inspection not
older than 1 year, located within 100 feet of each dispenser and tank fill opening?
Y Y Y Y Y Y
●67 Is an emergency stop button present and operable?Y Y Y Y Y Y
Note:
Operator Certification
By signing below, the operator certifies that the answers above are accurate and based upon performance of associated inspection
activities, and that the facility owner has received a copy of this inspection form.
Contractor Printed Name:Larry Vasquez Contractor Company Name:CGRS, Inc.
Certification Number:
Contractor Signature:
A or B Operator Printed Name:A or B Operator Cert. No.:
A or B Operator Signature:Date:06/03/2025
Automatic Tank Gauge Inspection
ATG 1
ATG 1742
Facility Information
Name:Fast Stop 1117 Certification/Inspection #:63245
Address:416 N Washington Blvd, Ogden, UT, 84404 State ID:1200664
Phone Number:Form Completed By:Larry Vasquez Date:06/03/2025
ATG Console Inspection
Tank Level Monitor Brand :Veeder Root
1.Status upon Arrival:All Functions Normal
2.Status upon Departure:All Functions Normal
3.Is the display in good
condition and functioning?:
Yes
4.Is the keypad in good
condition?:
Yes
Tank Level Monitor Model :TLS-450 Plus
5.Are all indicator lights
functional?:
Yes
6.Is printer functional?:Yes
7.Back-up battery tested? (if
applicable)?:
Yes
8.Back-up battery voltage (if
applicable):
3.6
Tank Information
Probe and Programing Inspection:
9.Tank # T2 PUL T4 DSL T3 ETH FREE T1 RUL
10.Tank Facility ID T2 PUL T4 DSL T3 ETH FREE T1 RUL
11.Tank # per ATG T2 PUL T4 DSL T3 ETH FREE T1 RUL
12.Product:Premium Diesel Ethanol Free
Unleaded Unleaded
13.Tank Volume, gallons 4873 4873 4873 15094
14.Tank Dia/depth, inches 96.6 96.6 96.6 96.6
In-Tank Setup Parameters:
15.Thermal coefficient 000700 000450 000700 000700
16.ATG Programmed Diameter 96.6 96.6 96.6 96.6
17.Number of points on profile 4 4 4 4
18.Full volume on profile 4873 4873 4873 15094
Pass/Fail Criteria: if any of questions 19, 20 ,21 & 22 are No, then the system has failed the test.
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
19.After removing the probe from the tank, it has been inspected and any
damaged or missing parts replaced?
Yes Yes Yes Yes
20.Do floats move freely along the stem without binding?Yes Yes Yes Yes
21.Does product level match console value?Yes Yes Yes Yes
22.Does water level match console value?Yes Yes Yes Yes
23.Water warning (inches)(1")1.5 1.5 1.5 1.5
24.High water limit (inches)(1.5")2.5 2.5 2.5 2.5
25.Does console water alarm trigger at programmed level?Yes Yes Yes Yes
26.Programmed Overfill Limit (90%)90 90 90 90
27.Does console overfill alarm trigger at programmed level?Yes Yes Yes Yes
28.Programmed High Product Limit (95%)95 95 95 95
29.Does console high product alarm trigger at programmed level?Yes Yes Yes Yes
30.Low Product (15% of tank volume or 15" whichever is greater)15 15 15 15
31.Tank test program enabled?Yes Yes Yes Yes
32.Tank Test Method?Interstitial Interstitial Interstitial Interstitial
33.Tank Test Rate
34.Test duration (hrs)CONT CONT CONT CONT
35.12 months of tank test history present?Yes Yes Yes Yes
Lines:
36.Electronic Line Leak Type PLLD PLLD PLLD PLLD
37.Line # and label in ATG (Q1, Unleaded)Q2 PUL Q4 Eth
free Q3 DSL Q1 RUL
38.Line Test Rate 3 GPH 3 GPH 3 GPH 3 GPH
39.12 months of line test history present?NA NA NA NA
40.Test Result Pass Pass Pass Pass
Automatic Tank Gauge Sensor
ATG 1
Facility Information
Name:Fast Stop 1117 Certification/Inspection #:63248
Address:416 N Washington Blvd, Ogden, UT, 84404 State ID:1200664
Phone Number:Form Completed By:Larry Vasquez Date:06/03/2025
Sensor: #
Brand:Veeder Root Veeder Root Veeder Root Veeder Root Veeder Root
Model:208 208 208 208 208
Type:Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Location:UDC UDC UDC UDC UDC
Test Liquid, Fuel(F) and/or Water(W):F F F F F
Is the ATG console clear of any active
or recurring warnings or alarms
regarding sensor?
If sensor is in alarm and functioning
indicate why below:
Y Y Y Y Y
Is the sensor alarm circuit operational?Y Y Y Y Y
Has the sensor been inspected and in
good operating condition?
Y Y Y Y Y
When placed in the test liquid does the
sensor trigger an alarm?
Y Y Y Y Y
Sensor removed for testing?Y Y Y Y Y
When an alarm is triggered, is the
sensor properly identified on the ATG
console?
Y Y Y Y Y
Sensor returned to proper placement
and verified to be functional after
testing?
Y Y Y Y Y
Any "No" answers above indicates the
sensor fails the test.
Test Result Pass Pass Pass Pass Pass
Sensor: #
Brand:Veeder Root Veeder Root Veeder Root Veeder Root Veeder Root
Model:208 208 208 208 208
Type:Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Tri-State Single
Float
Location:UDC STP SUMP STP SUMP STP SUMP STP SUMP
Test Liquid, Fuel(F) and/or Water(W):F F F F F
Is the ATG console clear of any active
or recurring warnings or alarms
regarding sensor?
If sensor is in alarm and functioning
indicate why below:
Y Y Y Y Y
Is the sensor alarm circuit operational?Y Y Y Y Y
Has the sensor been inspected and in
good operating condition?
Y Y Y Y Y
When placed in the test liquid does the
sensor trigger an alarm?
Y Y Y Y Y
Sensor removed for testing?Y Y Y Y Y
When an alarm is triggered, is the
sensor properly identified on the ATG
console?
Y Y Y Y Y
Sensor returned to proper placement
and verified to be functional after
testing?
Y Y Y Y Y
Any "No" answers above indicates the
sensor fails the test.
Test Result Pass Pass Pass Pass Pass
Sensor: #
Brand:Veeder Root Veeder Root
Model:
Type:Non-
discriminating
Non-
discriminating
Location:INTERSTITAL INTERSTITAL
Test Liquid, Fuel(F) and/or Water(W):F F
Is the ATG console clear of any active or recurring warnings or alarms regarding sensor?
If sensor is in alarm and functioning indicate why below:
Y Y
Is the sensor alarm circuit operational?Y Y
Has the sensor been inspected and in good operating condition?Y Y
When placed in the test liquid does the sensor trigger an alarm?Y Y
Sensor removed for testing?Y Y
When an alarm is triggered, is the sensor properly identified on the ATG console?Y Y
Sensor returned to proper placement and verified to be functional after testing?Y Y
Any "No" answers above indicates the sensor fails the test.
Test Result Pass Pass
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
Leak Detector
Facility Information
Name:Fast Stop 1117 Certification/Inspection #:63246
Address:416 N Washington Blvd, Ogden, UT, 84404 State ID:1200664
Phone Number:Form Completed By:Larry Vasquez Date:06/03/2025
Tank Information
Tank #:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Capacity:15094 4873 4873 4873
Product:Unleaded Premium Ethanol Free
Unleaded Diesel
Line #:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Line Type:Pressure Pressure Pressure Pressure
LD Brand:Veeder Root Veeder Root Veeder Root Veeder Root
LD Model:PLLD PLLD PLLD PLLD
Serial #:0 0 0 0
Associated Tank:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Resiliency (ml):NA NA NA NA
Check Valve Holding PSI:22 22 22 20
Opening Time:NA NA NA NA
Result:Pass Pass Pass Pass
Test Equip. Mfg.:Vaporless, LDT-890 Vaporless, LDT-890 Vaporless, LDT-890 Vaporless, LDT-890
Notes:
Tested per manufacturer specifications.
Contractor Signature:Printed Name:Larry Vasquez
Line Test
Facility Information
Name:Fast Stop 1117 Certification/Inspection #:63249
Address:416 N Washington Blvd State ID:1200664
Phone Number:Form Completed By:Larry Vasquez Date:06/03/2025
Tank Test Information
Tank #:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Capacity:15094 4873 4873 4873
Product:Unleaded Premium Ethanol Free
Unleaded
Diesel
Line Test Information
Line #:T1 RUL T2 PUL T3 ETH FREE T4 DSL
LineType:Pressure Pressure Pressure Pressure
Line Material:DW FRP DW Flex DW Flex DW Flex
Line ID Size (in):2 2 2 2
Line Length (ft):200 200 200 200
Pump Type:FE Petro FE Petro FE Petro FE Petro
Associated Tank:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Test Equip. Mfg.:Triangle Triangle Triangle Triangle
Test Pressure (PSI):50 50 50 50
Initial Cyl. Level:400 400 270
Final Cyl. Level:360 360 250
Change in Time (mins):15 15 15 15
Change in Vol:-40.0000 -40.0000 -20.0000
Change in Temp (F):0 0 0 0
Coeff. Of Thermal Expansion (g/F):0.00070 0.00070 0.00045
Line Vol (gal):32.62 32.62 32.62 32.62
Leak Rate (GPH):-0.0423 -0.0423 0.0000 -0.0211
Result:Pass Pass Pass Pass
Notes
TIGHTNESS TESTING CERTIFICATION
CGRS certifies that the systems in the above table have been tested utilizing leak detection methods which meet the prescribed leak rate testing
standard of 0.10 gph with a minimum probability of detection of 95% and a 5% probability of a false alarm. CGRS further certifies that the protocol for
each test method was strictly adhered to, and that all precision tightness testing performed by CGRS was conducted in accordance with EPA 40 CFR
parts 280.43(c) and 280.44(b) and the National Fire Protection Association, Bulletin NFPA 329 criteria.
Contractor Printed Name:Larry Vasquez Contractor Signature:
Certification Number:TMI-301,TL-2025-T-002