DERR-2024-006014

Page 1 of _2_Utah Department of Environmental Quality 2000712
APST Equipment Verification Inspection
Ownership of Tanks Location of Tanks
FAST STOP 1113 FAST STOP 1113
P.O. BOX 150545 400 N 300 W
OGDEN UT 84415 SCIPIO UT 84656
Contact Name:#/Email:
SPCC Plan?: Yes No Last Fire Marshal Insp:ATG Info:
Financial Responsibility (State Use Only)
FR Method:_____________Method OK?Yes No by:____________
Signatures
I ________________________________ Inspected this facility on________.
Signature:TI
O/O Signature:
Attach Tank Info Sheet to Inspection with any edits.
Complete for each tank.######
Capacity of tank (gallons):
Orientation of tank:
Bottom of tank in contact with (soil,
gravel, concrete, not touching):
Substance stored:
Date last used/depth of product:
Type of spill prevention device:
Type of Piping (Pressure or Suction):
Does pressure piping have LLD:Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Spill bucket is clean, intact, etc.:Yes No Yes No Yes No Yes No Yes No Yes No
Type of overfill Prevention device:
Overfill alarm (audible or visible) is properly located so delivery driver can hear or see it, and is clearly identified:Yes No NA
Pipe trans flex protection method
(Sump, CP, Isolated, Booted):
Containment sumps dry:Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Sump comments:
Stage 1 Vapor Recovery: 2pt Coax None 2pt Coax None 2pt Coax None 2pt Coax None 2pt Coax None 2pt Coax None
Pressure Vent Valve is on vents:Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Secondary containment area
comments:
Complete for each dispenser ######
Flex protection method (UDC,
Cathodic Protection, Isolated, Booted):
UDC sump dry:Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Fire valve anchored, located below
grade, and without ball valve:
Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Comments:
Additional dispenser questions ######
Flex protection method (UDC,
Cathodic Protection, Isolated, Booted):
UDC sump dry:Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Fire valve anchored, located below
grade, and no ball valve:
Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Comments:
Additional Comments:
1 2 3
12000 12000 12000
North South Middle
NT NT NT
REG PREM DIESEL
SB/ VAULT SB/ Vault SB/ Vault
Pressure P P
X X X
OA OA OA
X
X X X
B B B
X X X
X X X
X X X
Concrete Vault
1,2 3,4 5,6 7,8
B B B B
X X X X
X X X X
Phillip Lundell 4/10/24
293
FUND X
Page 2 of _2_Utah Department of Environmental Quality 2000712
APST Facility Site Plat
NORTH
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 (S), tank fill (F), ATG probe (A), interstitial probe (I), vapor recovery (V), capped plug (C), other
(specify).
Comments: