DERR-2024-005839

aaly ,t
;
Fonn Approvcd. OMB No. 2050-006S.Approvrl erplnr 1/31lrs
,a
t. -
A.
B.
c.
oate Entered lnto Conpurer
Oaia Enty Clerk lnitiajs
Owner Was Contadad to
Clan? Responsas. Commens
Please &!e 6r onnr h ink a[ iterns .Eapt'Eigns, e'ln scctbn v. This tormrilJst be cornc€t€d lof eacn tocstirr a[aining unaerErors0 rbrage tanks. ttaEre t'ra1 fve (5) tanks 8re oyflr€d d tris telon, phit^c pythe 6rc*ngsha€ts, and staple cantiruation sheas to the brm.
. Xoil,lqtlar h -qsltd !y F.d.El f- b. dr uid-grqrt. trrt lrrh.n l{t ur< to .ta rtgclt.a acil.,E. uE &nrE? t, lt a,l,ld
T-1":!. grqrEd - ot U.y t, ttaa. r trr.a n rq{tt L!t. s dr, L, l.1taai. Th. Harnrbn oqr-rd b rcrdrri ty Sratn fGl d tr nrcici(b^Er!.En fts Fm u- .pCilAl r axL
Tlu oa:ury DuEa of ae rzgfq.ur oqrri a E t cE lr<t GnrrdauneGErF€ tnrs Etat ara s iava 3ra<t cno!86 O' tr;!t rDlt SlElrr.i: 6 e!-cr€ :rrt Eta rnldilrB Et ErcEta i Ba qEr on ,r:flgytEnaDli r.erE I n Eta r,.+ ot s.tt trg=r. !q, IJ.r-ge. Fi.aa. o,te<Dri*!o1L
v/ha ll.rr Ho(ltf Saoqr E? ot RCRA G rare6. ,Err- nd. un!-srsnaxE. m-= ot ulE-getrE lrils lral aga EflDd cJnslJEai tttutt.c:!y esgtlt- Sala or ier. $rcG ol tt sEaq d c!, rnE O.rI,,iIr
. a) ir6torsrolrnt,ldrllqrf se.Eihl.6.qr l{oants!. lgga.strir.EFt 6E E dr !E ctt. .rr, t-to! rlrr
-! !r udallqJfi, ErCaE,rr 15.€ tsr na faqr. !E . d caEllan, ot lfgtg6 ---.-1 j,g
- -
b) h t!. ae ot rr"7 ut TrqJr! srlea Err n rD i{E. l{orrnts t,198a. tsrr m tfig- a rr.6 Elrrdar. G, lllEn ft ari 3Jcn aflFfie<iDrv b.hn gta dE€rur.aD.t oi iE lla.
. c, i, n .Sn. .g.rr7 E ruir. eI €ry lrG,r.r urn-!qr. e, crrrle-
'.? lchty irbdnaEn q Ert 3r-aa cr!!3 (quy aJ"id E u nE fraH rr-rio Da ncruod).
Wlul irntr An hcfrded? LlarE:a:rd s!q. afr E d.fol- !s e, ar.d moru.El 0l arE nar (1) 3 r.€&t E cErra,n n tcEjmrrto ol tsguarrt&carr.'l! (z) r*ur voerrr fna.<rrg sraa uEtEraJrt EEhg, 31* q' 66 ErrEt tr. gBrE Sdu-enE- 6 sE .!p!i11 rnr ErrO:1. Grsorr u=.nol.6dea fd sra 2- irElrr EirE--.d+h.luo<ir cr irrg6!E_
Itfltr Trnfe l[ Etdr.re? Trnc 6nq^.- t=r ,r grqr! n naartifa rcsfcr.ot Otrrln:sscr.d torn aogh.sirlt. '
1. E rr d rGgrtal rrE, ol t,.l CO gilb.r s E --^V E- b Et lmoE i{l brngromnrort BJtEaj;
2- lrE tJsd b aE'rrg tllrp od br cOrrrnrpvr s qr frr ,rrI,rfiac 3D.E:
t.t.rarE:
a. !t9-a hdio- ,t dr&rg !.A-!ne h-) rBrrbE r,!c t r. HalJ[l G6Fifo SrJrry lc cl l$8, or G. li:rrro{.. I *,dpioair s.hry A€ ot f 97!, o,rri<n i m nFrEEa rtaair kiv rTut-t uE , SEa rES.s.rb morrra.nt gtt Erar 61'h!..g,r3:
6. EDffi Er C rGt. iEar crEr SlrEltrnr;
7. tl*arllEn fE, arirs:
t. li!€ *rs a r-ocr!&r gs:r.mg l(E drEy,elrled E ori , Brspr€J46 s€ istr.mg ocr}G:
t. EtEa E rt stuJil-, n u ul! .graJrE rr- (36 ts a ocr-i.,rL crB .mrcs!. grlL aian a i:E) d tra 3D.Ea afl ., ssJtD cEpn c Ea m
s:Jrt€a ol h. A€r.
tYtrr Srbreru An Carod? Tlrr rr:llcr-n ,ErurffiE rDcly E srr,gtq,t€ CD.f a E/nrB fiat CCfian racurt Xt a€k ThS rre.dC nny:r.G..ra oiru as nrrrltEB n aErr lot (!f ] o, fi. Ccnf.losrE+rrs;=rl 8.:rrr. Cq:rrsEr d ti)frr/Ada, t6BO(C€Rq-rJ. ingr cor] o, lE gJ*rr nlrrrcrt - ,rralEEr.a Eata l'f &n6. C olRCa/\ t lro .E-r, !r:!rJfi. lg- aJO oi or aJTy IrFr firrrd riilr rlO.d rt Crarg odEilo, llirtufl. arld EtEJn (60egilFdrr.rU
rrt€ l a.7 EE Os fH t.rrra tEr a.tri.Ua).
Wha fo,aanl/" S5a EiEf,r- balE D:
DL' AI.3,{ A\T O F *l/IR O }}{ E\iTAL Q UA UTY
DT!1SION OF Ei1/IRO\VE\TAL RESPONSE
t68 SOR.::ji t9J0 *Tsi tsT FiroR
SAl-: ltK: C=:'. LTA: 3..115
Yr.}rfi fo Xdt/4 l. Oarr oiurtrgrii su.!g. rnts 6 sqrr8ttfrba-l a[.r *1 oi oaa.tE\ atDr Ja.iJrty t. l g7t. nrf sdl a !r grEjtt als tE
Dy lL, I, l9€5- 2- Oa- rO CrrE u76(g,qrr6 BD11€a lrnxS nD E ahr ya,
g, 1986. mLr no?,y rrn x aF o, tsiqt t3 ar E ts tlto r.lsr. i t nr Sr-rrurc lEgb.D.l ol rry rnrgnrnrr D krq t.rld nbnnan D Sta rFrrTnilrc-t-
- Frnatlr: &ry *rrlr€ ?.rE.Lrgty rdL b rultyc gtn& lbti#r dl.f b. rdaGt b . c*ilt F.latt rE to .rE d j!O.Af, tr.drflr lrrtEt ndlctsr b tEr llEa a kri&i t h. ldilrbr taffi.d-
/--
d
Notification for Underground Storage Tanks STATE USE ONLY
IoNUMEER 9000018
f! n ru=w FAclLny -E-='Yry?---tr1-"ig'u,=_ No. ol ccnururation she€rs anacieda No.of ranks dtaciiry
l. OWNEiSHIP OF rAr\KrS)
fE si i-€iliEa r >re94q. aqr !ay1 _Maverr-K uounEry stores, Inc.
S-1014 South Washington
E#a?ri::rEffi :f ' Eat"etrr mT'in'E!r
Afton,83110
Cra-€€ErLctutm [ )
Fdfl.arc*;6ltttu acktt
Marrcrik Store lll42
-.-a-e-O.kEEitsl
EPA Form 7530-r (Rcv. 2.92)
Pnmed on Rqctd Paper
.\
l)( OESCRImON OF UNOaCGf,CUNO STOaAGE TANKS (Corqngle lor cdr tank a tfiis locaioo.)
Tank ldentification Nurter Tank r,lo. 1 Tank nro. 2 Tank No. ? Tank No.
-
Tank No.
-t. Stalrs sl Tank
(rnark ordy one) Cunendy in Use
Terporadty OUt oi Use
lh-.asEtt
Perrranendy Ogt oi Use
(-r.Is61l
Amndmsrt sl lnformation
2 Date ol tnstaltation (rtEJyear)
3. Estinaad Total Cap*ity (gallors)
4. Mstena.l ol Consruairo
(f.{art all trA appty)
Asphait (bated or Eare Steel
Cathodicdly Protecred Ste€t
Epoxy Coated Steel
Conposile (Se€{ witr Fiberglass)
Fiberglass Reintorced Plastic
Uned lrnenor
Double Waild
Pclyetny'ene Tank Jaciet
Consete
Excarratiqr Uner
Ur*nom
Otter. Please sp€crfy
Has lank been repaired?
xx
ii
5. Piping (Ma6naJ)
(Matt al tltat spply) Eare Sraet
Gairanizec Seei
Fiberglr.. Re,inlorcad Ptastc
Copper
Cathodcalty ProrEted
- Oor.Ole Wdled
Secondary Gontainment
Ur*rrcwr
Otrer, Please specify
6. PipinE fiy'pe1
(llerk 8! tha apply)
Suclion: no valve at tank
Sudion: valve al tank
Pressure
Graaty Feed
Has piping been repaired?
EPA Fortn 753G1 (Rat. 2-921 Pagn 3
J,D. # Qoooolg ^4
xt. CEFTIFICATION OF COIvIPLI NCE (COMPLETE FC,R AtL NEV{ ANO UFGMDED TANKS ATTHIS LOCAflOTg
Tril ldrntilicrtqr Mrrt .T.r*ttb. 1 TrI(No.J-T.ri( t{o.J-Tenl No.T.na( t{o. _
l. hnallaion
A. lnttallr certitlcd by lenk end
plpng mrnd&!,rrr
B. lnsaler certified or licersod by the
imCem.nting eg.rEy
C. lnsullatrn in+.ciod by a
reg$ecd enginoe
O. lnstalathn hspecled .nd
aotrov.d by inplearntirg agerry
E. Manutadref s irrldl.tim
dr€ctdists haw b€qt @.npl3t€d
F. Ano0rr method dlomd by State
agmcl. Please spcily.
2. Release Oetrton (Mark all that apply)
A. Manual lank gauging
B. Tarrf tjghtness lening
C. lnventory controls
O. Aromatbtankgaqirp
E Vaec nrnitcirlg
F. Grqlndwaer rnonitoring
G. lntrstitid rnoiltoring double watled
ta/wpitrng
H. lnterstitial nrcnitaing/secondary
cotrlainnEnt
l. AdDmatic line l€d( d€tElors
J. Unc tiglfiess t$tirE
K. Crfier rrthod dlouad by
lrnfl om€nting eg€n€y. Please
sp€crfy.
TANK
EirtrEEE
t_l
E
E
E
PIPING
tlE
t-.-l
EEE
TAI{K
EEEEEtln
E
[]
E
PIPING
tItlE
E
EtlE
TANK
EtItlEtltltl
f:l
E
E
PIPING
EEE
EDE
T
TANK
t_lEtIEtltrE
E
E
E
PIPING
tltlEr
EEE
TAAIK
EiIEEEEtI
tl
E
E
flEfl
E
EEE
PIPING
3. Spill and Qerfi! Proteaion
A. Ovrtill darbo hstall€d
B. Sptl device innalled
OATH: I cenify the inlorfidoo enceming instdlation thal is prwUed
lnstallec DeVerl- Stoddard
NrnrBuild ing Representat ive
Pcirbn
W"*,II-,
ffrrtl uaa'Maverik Countrv Stores. Inc.
CorryanY
EPA Form 7530-l lB.t. 2-921 Prgr 5
-l}flrG
Fonn Approvcd.
'--
OllB No.205o'00G8.
STATET'SEONLYNotification for Undetground Stoqge Tanks
TYPEOF I{ONFICATION A. Dato Erilered lnbCorPuter
B. DeEntyClerk hitials
C. Olner Was Confacfed b
Claity ResPonses. Conrnents
J4 tto.oltanksdla<i[ty No. olconfrudon sh€€ts ata.fi€d
Please @ggiolhjoB, aI ilerre er(cagt :candre' h secliotl v. Tltis torm
nr,st Ue coftA--tocain onflrlnhg undeqtotnd sbragetanls. I
rnore g'an fvb (O tanls are orvn€d d 6ft lclion. photocopythe blouuitp
sh€€ts, arO stail'e contrualion sheG b fi€ lorm.
tldrlcdoo b t!$*td b, ffid t.r lo? dur{eryund oilr trrr
h; b; ,rl.d t" rirr rgrirra rutnlp .LE &ao-y 1. lill'.tfrd -r. h rh. orqtnd r d tlhr-!. f tac a rl5 rt D.o.N[tt h ro dl* Bt/ t'
igra-iii. -*.Crbn rrqrirfta r-nqr*rc b, E cdoo t@ ol &o Brouo
Co.Dwii.n d nronef e4 GCnA r drd.
Th. D.irnary qrca d tr3 nodcain mrllr b E bo rid t'*rD
utddtd,rd 6l! ita rro or trevr orc ftoloum or lurrhs eEur
tt C iffaeO t a o. itilo.tisfun Fo pruiOc re ue usca on lerUy -iralrli"rrorus. oth rh..b..6oiandl rcoae pr lmdedgc. bcicl.or
re@Lcliott
fYho Lrr Idfy? Sccnn $dl ol RGRA eeenrgrde4 m*ie nd"'ds
eremood. olrrs oi unarc.urn E *s lrlE 8a rgLrd orEro- rrrlEl
rptty'O+mrea SrF or tid {gltis ol rrc si*rcr ol trci hts. Orilr
llr-lE-
e) h thc casc ol rn tttds.l.ltnd 6D.{. rnJ< h cc qr ililut$" !. tS'. a
uo,riu ito,se Arr tnar. lty prrtor rlto ilL.t utaLyqrrdautg'
ulri-tsea tr t c rr,l.. uer. or d6pl:irg ot rgdod eaonc. od
b) h rre ca$d.r'ty inde.gtuntd.tne. grkhur brbrol{ovcaDr8.
rssa. hrt t! h,Er = rie q, drrOaL. tlty-DGon rlD iln d 3'Idl tut(
immc&rlybeSo tie Gcotttrrirn diE Ee
c) i, nr. SED .egrcr.o tqliE. .ny Hty fid hGUId.tEst n, futels
o a,fuyltrrnetoi cL*s1&m aot 1ortf mmaoa uu<hb.tn Joo n"6
b b. irdod.dl
l{traTulr An hdudod? thdernrund orae tr* bdoftrdG !'tysr'
orcomtinlionoltrrbnd0) bG.db omrn m ecam*ton ollogda!'d
e.&rcs.i rt (4 xtc. idrme (ndfie onn*rd rnlgetqt'f eih-d !ro*scro.r bendahn groutd So.tL omf,crnmd.pltr Erl.3'Ehe:
t. cash.. us.d ol. 6&l trl. md z hdrsrl chtgl* pcaaoc'
hrtiddescin(1rc.
Whr Trtb Alt Erdrdrd? Tar& Ignor,rd llur trc arund re mlsrtica
o not'ficain Ois rrts scfud ton noti[cadtn rr:
1. hntr d tElrmLl rnts o, I J (E g.lo.c o. lc c.FdV l. d b..Ehe
mob. txa b. tiql.DrunrdC FlrP€aq'-Z ;t*s-rla-ft.rr*re *air a br corsnptfir cr cr thc itrtb
urhere sor:d:
!.teflhina.s:
a ;;St h&d- (rrctdog g$..ine tiG) ret'd rlla' nre Naurd Gls
piii['s.i*, ea a r*8. ot 6-]E 6tr tiqru Pip.&r s'ldy A't ol 1979' o'
r*o, i., iis nboar hc*y reuua urder 9rr *:
5. rrtrE in9q,rfi.Ir. Pn* Pottth c rgodE;
a onr rti c g ffi cdLclio.r a,tr.tE
7- ltos{rcrEh Dlo6 tl8:
i. rclid ;ddas6octd"d garrerirg rs eecdy lrht'd D ol aees
drcEm adodshc ofdiril8;- -i. irt-.-diG sairdo n an unce.grunrd ln (sudr rs e basornt oelh"'
rni.-nd-cit, ctdt c rrno0 t lre .Dra. rrr( bdtrr uFtt d tbon 0t'
erlro olfie iot
sta &i.t..E At Conld? Ih. mtficetbn re$irrslts'PCy b utder
*;i.D,{" E {. tt tcoa!fi .qud arElm rhb ittdrb rny
IEiE O.:tr,.a as nrzrrtoss ir ricton tot (1'l) ol lr. Cong't\ftCw
Bn h;;d Rer.. Co.trrEail rtd tLt-ry f.td lso H*,19!-t--crOct of dr siilEa tt3rrod r tpioqs P rn'f &fr' C
RCRAf&o ddE e*dm. d. cnro oa o. rry tcut |tr'8fufti,l'E
liliirirnalt'olld[onotririuro aa prsrn (to doeoc Frtndnit
eia rl.zporn6 pee cqlac hdl rDoolrr).
wlrr.! To lldlY? S..d cqtrPlod ft.tns E:
IDEO'DENN
r ss ilomH l9s0 xGgB llHoonsAftl l(Eclil.lrill rl$
Itlrrn To lorly? t. Orngs ol undcOrulnd argc-lrnfs pucc or thrt hrw
b;';;';e;iilidqt arg &tuv i. rcrr. hr afl h irergrum( ma noo!
E n"t a icta z ifrnsc rtr trip urilorgouno olry tlrfs io rrc rhr l*rv
( iilil.-"irirs noty-tttin o arc d uirpfr tre s-1P E 3' I lt' $io
;ii; ffi1-i.6 o( rny lrrfoncos 6 l*ty elra ionuon o Str rgmcv
inme<loly.
hnJdo: Arw ornr rllo fnilhgfy * 5 ody c a&n*. tdl
rr.iilrf J.i't roi.a r. ata iirrv u s osea 50,rn0 !ot'dil"-lrlie.d.dji f na ctri c toirtHr t-o Hordbo b
ltbaJord.
OrD-s.aanl.loctro I t1014 South liashington
831 10
Q|:tt .r. P!.trrraq Hrifr4 PtaErtncr. a OOr. Eifrl
EPA Form 753G1 (RcY. 2-92)
tr l{ANo oELIVERED
@ ea,rrca*RrYdedPaPer
tv.tilot Nlll{os
tr FcdGorurrr:il E CocmdJ
EI St&Gcrmirnt E$ Am"
tr LocCGoyururrrt
Tr*r ar localrd m lrd rUft rr hdrtRsv{boamdrrturthda
Tglec rc orrcd !f ndw Amodcryr
ndlon.tte.chdtddnl.
Sebct lhe Appropdd. facfs DcctpOo
)L\cassdon
-Famhnrttt5rtr
_FcdrC-tto*nry UI!e.
Vt CONIACf PERSOiI N C}|AFGE CTArr[(S
ffit. F.urrav fiH.or of Store 93#ttf center st.Ptm ]ln$r (loclrde Atr Code)
80L-295-55s7DevelopmentNo. Salt Lake Ut
840s4
Vlt Fr{ANCIAT RESPCINSAI.JTY
I tru. rrf ttfimdd rcpon$nyrot;furr:rnshamdaorlh4OCFRStprtH
Glt.*tl|hdAppl,
f-X.fi S1hsr'o
I-l coomodd harrr
t-] Ecrnaedonenp
l-1 GcrrreI-1 sr{ya'..,
l-]sa r.r"l-lrnnrn o
l-l omr iletrod Alorred seedf
YUt CEHflFlCATP}l G.d rrd dgn Aroaqil-E { rodonr)
Icrlfr,t * Ftalyof }rwta lhautprrcrefysarir..l6crl:t. rdn I DG..t o my iqiyd tan ilIvurt SrtheHrmdon a.olidhthbnd C d:l
anclled Hrmdon b trr"srO. ltd ecftae.
rcpoorDb b oti**rg tr. hrlndon, I b.fin ftc $c
]lartrrdffi0rdar
a ortrt efioftrd rpcsrndr @ttg
Dan L. l{.urrav/Director of Store
EPA ectnales Ftac r4ofirg hrdm fcn& 6flr b anrqe $ nlnrbo
gailtEhg &d ttdtei*p ne dda noeded errd €flddtg -td rcYiatp tre Cni Seml conrrsts rogaerg til-Urrden sGnrae o
Cttd. tib4ndon Fo[cyBnndt Pf,tr223, U.S. Enniwrrltd Amaq-&qrcy. rt0l U Sueet, Wastrdgim D.C. Z0t6O. rrslrd
'A&nton DeC( Offi6r ia EPA'TIIs hm anrends lhe prorrlorrs nmcifoi mir as printed h iO CFR Prt 280, Appandr t Prerdos
odlms d 0ls nfficdoo bnn rry be ured untile sr4Cc last
EPA ForE 75!Gf (F3r. 2€2)
--t
D( DESCRImON OF UNOERGROT ND STOR GE TANG (Comdae br edr rr{< d lhls locdon.)
Tar*ldentfcdonNunter Tart(t{ol Tert,}s. Z TdNo._S Td(nb.- Tar*tlo.:-
l.StatlgorTr*(mrta{yar) Orennyht.bo
Terpcadyotltof Use
Gl-.aarat -l|
Pernanenty otn ol use
ah..a--ll
Amendmgtcf lnbrmlion
II
2. Da0ool lrts[don (npJyear)
3. Esfrn$dTotd Capdty 6anons)
,[. ilatsial d Corsfirclbn
(tlad( Ctrtd apply)
Asphd Coded or Bare Steel
Cdtodcdy ftorecred Seel
EPoryCod€d St€el
Coqosm (Sed rft medass)
Flbetglass Re*nlorced Plastic
Lin€d lnterkx
DodleWalled
_ Polyefiy,leieTankJad<et
Cmcrsb
Ercryd*m tiner
t t{(llown
Odrer. Pleasespedry
Hasiankbeen repdrd?
5. Pipir€ Uareriar)(tttlskalthdapdD Barc S:teel
Gahranlzed Steel
Fibeglass Rdnlorced Plaslic
Copp€r
Cafiodcdly Ptotecied
DottleWaled
Secondary Contahment
' t r{apwn
Otrer. Please spe<ify
6.frhgfiype)
(Urkdtte[8pply,
Sucton: m v*o attank
Sucdon: valve d tart(
Pressure
GrdilyFe€d
Has piphg been repaired?
EPA Forn 75i3o-t (BGY. 242)F.g: 3
Tar* ldsnt0cdon]{untr Td(]5J T.ra(t\b.J:Tar*ilo. <Tar*nb.-Tar*Itb.
7. $Detmo Aneiily c trrt SorodhGraaqrrttybyvofnm
Geso*re
Dled
Gcotrol
l(socene
. HedngOfl
Used Ol
Odrer, Pleasespedly
I-r
tt tt
llazardous &rbstalp
CERCI-Ananr edlcr,
CASrurter
It/bttrc of Srrbetzrcis
Please specifr
TANIGOUTOF USE ON CHANGI INSERVICE
l. ClosLrg dTank
A Eslimaled dale last used
@otdrflyeag
B. Esfimdeddetankdos€d
(rrrc..r@l
C. Tartc was renrvedlronrgrornd
D. Ta* ras dced h grurrd
E Tar*fifl€drfllhhstmdild
D€scribe
F. Ctragnhrsrrlce
rt EI
2. Sile Asscsnrril ConptaeC
I
Bddence d a teCr detecfed
EPA Forn 75tO.1 lkt.2.C!21 F.go a
'+
A,
x[ CERnFEATION OF @iipuANOE (COMpt ErE FOR At I- NEW AND UFGRADED TANKS AT rHE LOCAIIOT\0
Tar*ldefficdooNnflfur r8r*No.l Tar*t'h2 Tad(ltn* 5 TarI( l,lo._Tar*ttb._
1. hsiddion
A. hsilaler cerdfi€d by tank and
dphg rtarxrta.t ras
B. hstaller certfisd or Icensed by lhe
lmplementirB {€ncy
C. hsiildim lupected by a
rcSsrrcaeqgeree
D. hsilaldon hspecfed and
appoved by lrplemeotrB agpncy
E ilanufac0rer's kstdldon
cfteddsts hane be€n @flplst€d
F. Andrer meftod dhred by $are
ageioy. Pleasa sp€dty.
2. Rslease D€toctim (Mafi a[ trat apply)
A" iraualianftsaugns
B. TarI( tigtriness testing
C. hu€nbryconfob
D. AnUndictar*Saqgins
E Vapormonlbdng
F. Groundrraiermornodng
G" hersfilid nuriloring do$le walled
ta*e.{P.ng
H. h€rslilial monitodqg/s€condary
@nEinflEnt
l. Arbmdctne ledrddecbrs
J. LJnetgtfiesstesfing
K OftermehodalloilBdby
lmfl etnerdng Agoncy. Please
seedry.
TAi.IK
tlEE
CKtltlE
tl
E
tl
TAI{K
DEtl
Eflfl
E
E
tl
TAT{K
tlEtlg
EE
tf
t_l
tl
TAT.IK
EEEflflEEn
E
E
PIPING
tlEE
tl
tltlE
TAI.IK
tlEEul
t_lEE
t:]
E
fl
PrPrNc
EflE
ErfflE
rtrtN(i
t_lflE
E
wtlfl
flflN{.,
t_lEE
fl
wEE
rtrtNrs
EEE
L]
wrlE
3. Spill and overfl Prdecilon
A" ovqfifldevtehfifi€d fur7f" U
B. Spldevlcahstalted Br*ldS
OATk lcertfrthehhrrralion
hsrare' //"-t'. ,
@.Eetntng hsnildionthdls puddedh cedionXlbtrrotofto bostd mybeldandlcrwledgs.
i-reZ L
EPA Form 75So.l (Rcv. 2€2)P.gs 5
Urc.InClrF,raHrEitt lrretlUQ
' lrlotltlcatlon for U nderground Storage Tan ks STATE USE OT.ILY
D NUUBER ?COrt; t (
TY?E OF T{OTIFICATION DAIERECEITED --> -2_> -"1 t
-Eltq:gg1--tr-i{ElDe@l_-No ot r"trkr
"r
r*tfiry - -
=ffi.?
Fm-lnrI'lo7rE-"fr,m-*-['"c-
t 3tr:I#JH,,ffiflHocEssr$€
"ffifllffiJ,",f,l*dffiINSIRT'CTIONS
Please all h.ems excefl-.slgndure.ln sec,lloo V. Thls lorm
more than llve (S) tanks are owned a thiillrj-".1n1llrye_(5) ranks are owned a thb bcdbn, phiioJpylneetr, and slapte conllnualbn sheetg to lhe form.
mustbecolnplffi F''bcaiil-;;d[idi,d;,srfi-#;;s;r#rr.r
lf:",I::.1Y:-l^r,ltTl:-:::-:qdlt,a.plon,phorocopyrhetb[owrns
I -,[:ffi?"H:I$,ffilxs*ffi,ffi,lH
lffififfi.rffiffiHft]##,ms$*
._-lhe eilnry purpo0e ol fii! mtficedon progrun h to bcete,r., clnhr.bL tr#r''4q6r,**nm,HJn*F#F.
ffi.,,,.r r*, or h rrre oon&-;;d;;ffiffi"i""r,"dr". hi[a, o,
-_-!PIl,.t l{or[y? Seaion 9Oo2 ot BCRA, a! amerdod,,egulre! rret, unle3s
fi ['',lStHlH',9,:T:'H'l,'"ff S:]tf f.l3l5iT#l$f H*il,-mean!-
o rn fia c*e of ,' undergrornd rorege nnr rn urc on t{ovcmbcr g. tooa, o.uouehr hD u.. rtbr trer aai. eny p*;;rh" ;ffiiil.,o.rg.,rd .br"e.trnt uscd hr fie rorage, ,r,'oi,iirftoiiruiiffit lloo.r,"".. rllab) ln fia case ot rny uirdorground lbrag€ tud( h ule bolore t{onnt , t.rsr. bur ,D.tonee' rr tire m dai ciie, ;d'ffi;;;il;"d .udi hnhIrnnrediebt, belore he dilcontinue&rn'oi,nffi. " ""- -'
,,"3'|'yTr?'ffrffi i:ilgH';#,t;;iy.ffi giHffi fl l,"mTb bc lndudsdl,
ffiffi,H$
,,][[lITE#Hfl fffi]mffigm:: s nnd ae noudrrea
t. fam a ,eCdend"t **.-:lr:!p edtom o, lc!! capsdly ulcd h, tbrhe,my frre! b mncom,norciet purpole!:
*"riffi?,brrrdng hiadn! dl'hconrr.rvlpdn urem 0re pordset
t. rcpdc Erlrr;,,"i#g[]H,fi#ffiffifls3
rhldtbrllnralUfolocin
t. rurhce tnpqnirrnu,ptr, iryr&-. ornffiii-!. lDrm weto? c rrde ttr @lLftn arirrnr:-
7, fiil-fircugtr p'oou drt;t. thuid rapr q rltodoa.ffretq fro *tcif, daDd b ol c guprodudiut.ill edh.rire ernlinr: t ---- -q, reEr
,. lEr.gc tank! dn ard h u r,rrte'lrornd ror (edr !t e bcrelrrnf. oia,m{n*oil,ng. drrr, oor. or rmr1it ta'runeci&.ilftir rpon c rbon horurlace olfie lloor.
Whrt Sub.t rE.. Arr Gornnd? Thc nodltcadon requlrem.ntr lpdy b unda?ground ltorase hnh! trarconbtn,.crtabd Jhn"-,rcr:ili, h.,,rA;;i- .'-.
rubsrance detined as nazeraour fr sicion ro, diffiil'C*rpretrenrtwEnvilonmenbt Relponre. cc,D.il.tla, rd uii,iirv iJi rro tcencr-rl, rru,mnmm.muulffiis_ffi#,
.nd 14.7 pounds - *; ilflffi,T'nd Dttro po cce'rr ritiiniriiirr
Whrn To llotlfi? Send conplered bm! b:
UTAH DEPARTMENT OF HEALTH
BUREAU OF ENVIRONMENTAL RESPONSE O ""'"O. I288 N. t460 w., P.O. BOX 16690 l
SALT LAKE CITY, UTAH 84I ,16-0690
Iqilfi,'i#i'&hm3:,m.ffi,?i;i rn" a m r,"- I
b, MEy t, i986. 2 Oumerrrtra,re{rtr,,ix',ii;i'ry;O*U'*.Id lrequirs_s nodrrcrdbn ol any enrrrinrnrr dtih]ry ;;fi;;tnrir"iiirii --" -' o'ov rrilorleoll D llcrlt, tend lnfunuqr b SlaD *.*,
I
Prmnhr: Any ornorrho b
:hffiTtH,n r: Hriffiffi[j#ffiffiiHilffi I
l. owNERSHtP oF TANK(S)
Latitude
P.O. BOX 457
louTH HTGHWAY 89
rc 83110
[phone]
Lonollude
([t.,rl.S.dbr t.rrr*Ocfr.lr I t
Or'rr Ne,tl (C4oahn. hdtvhrC, Atilc feDncy. , Oh.' Enfltr)
Frlty llemorCcrperrySi. ftidth. r. Sb-|,
8t,raraon0tpo.eqEffii
Page I
III. TYPEOFOWNER M.r]( ,{ LANDS
El FederalGovernment El Commerclal
tr State Govemment El Ptvae
tr localGovemment
Tanks are bcated on land wlthln an lndlan
Reserualbn or on other trust landc.
Tanks are owned by natlve Amerlcan
nalbn, trlbe, or lndlviJud.
Trlbe or Natbn:I
I
I
I
tr
tr
V. TY?EOF FACL.IrY
-Trud<ltEfrrlnlPolt
. :.;
Solq* hc.Approprlale Faclllty thscriflbn
t'"
.3 Gas Stabn _ Rallrcad
-Pdmleum
Distributor
-Federd-
l{on-Mllhary
-tltllltler
-
Ah Taxl (Airline)
-
Federal ' Mllliary
-
Resldenthl
-Akaafl
Orrner
-lnduatdd
Fam
_Aulo Dealershlp Coilraaor
-Otrer(Eplaln)
VI. @NTACTPERSON IN C}IABGE OFTANKS
Phono Number (lrr{ude Area Code)
260 (801) 295-s5s7
exr. 11742
Name
JOSEPH SHAI{
JobTltle
EXECUTIVE SALES
Address
380 No . 200 I'les t , sulte
Bountifrrl, Utah 84010
DIRECTOR
vil. FINANCIAL RESPOI-|S|BIrY
I haro met the llnarrlal responslblfi requlremenls ln
acordance wlth rO CFR SubPart H
Guaranlee
Surety Bond
Letto ol Ctedh
_I
It_
I I lstalcFunds
I f-lTrust Fund
I I-loher Merhod Albwed speclfy
I
Ched( A[ thal Apply
lTl Seil lnsurance
t_l
-;;
doc,menrs, and rhar based on my trqutry ot rtri; ffii;ffi;t-ffi;naeii r"spontible lor obtalnlru the lnlomdbn, I belleve thd he
cnbmllled lnlormation b true.accurate, ald complete.
Name and oll'rcialtitle ol owner
or owne/a aulhorized representative (Prlnt)
JOSEPII SHAI,I
EXECUTIVE SALES DIRECTOR
Signature Dale Slgned
y',r/r,
2
EPA estimates public reporting burden lorlhis lorm l'o ave
;ilh;til il niaintalning thetata needed and completln
E[ft, iliotm abn Pollcy -Branch PM-223' U'S' Erwironme
'Atr"irion Oesk o{licer ior EPA.'This lom amendslhe.pt
;'id;;;ihil nottixtton lorm mav be used while supplk
rre 30 mlnutes Der response indudlru time br ieviqdng lnstruclbnr, -
il;9rri&iryg_t:rysendcommdnt.,*"tl3.3:r$fol'lr?fl 5'"fod Prctecllon-lgency, /tot M Stre.t W99!!rptt
JrliuJ *m""rtri torrir-ai p1nfu tn iO Cfn Fail 280, ApPendh l. Prevbus
rs lasl.
Pege
lx. oEScRlPTtoN oF Uly'rRGRouND sToMGE TANKS (Comptere b' l rank atthb locdon.)
Jank Hdntilication Numbet Tank No.J- Tank No. z Tank No. 3 Tank l{o. _ Tenk No. _
l. Status of Tank
(mart only one) Gunently h Ure
Temporarlly Orrt ol Uro
lhihbara-rtl
'"-T'iI"T1l:
Amendmentd lnlomabn
2. Datc ol hslallallon (mo./year)
3. Esilmated Total Capacity (gallons)
4. Materlal of Constnr.tbn
(llatk a[ that apply)
Asphah Coated or Bare S:teel
Cethodlcally protecied Steel
Epoxy Coated Steel
Composile (Steel with Fbergfass)
Fiberylass Relnlorced phstic
Lined lntedor
Double Welled
Polyethylene Tank Jdtet
Concretc
Excavation Llner
unrnorm ]
other, please.p*fyl
Has tank been repalred?
l-
5. Plping (Materlat)
(Mafi ell that apply) Bare Steet
Galvanked Slcd
Fbeqlass Belnlorcrd phstk
Coeeer
Carhodhally Potacted
Double Walted
Secondary Conlainmenl
Unknown
olher, Please spedfy
8. Pplng Oype)(Matt all that apply)
Suclbn: no valve at tank
Suctbn: valve al trank
Prelrurl
Gravity Fccd
Has pi,plng been repaired?
Pagn 3
Tank Henllllcation Number Tank No. I
7. Subatance Cunently or Last Slored
kr Greatest Quantity by Volume
Gasollne
Dbsel
Gasohol
Kemsene
Heatlrg Oil
Used Oll
Hazadous Substance
CERCI-A name and/or,
CAS number
r=-lr--lr--lr--lr----lt--lr-1
:::-
-
r-l
X. TANKS OUT OF USE, OR O}IANGE IN SEBVICE
:
lr-l
T---_l
[f
l[-r
I r----r
Il--
Ilr-l
rr
-
=
==r---l
[-r
r--__-]
t-----l
--r-l
l. Cbslttg ol Tank
A Estlmated date last used
(mo./daY/Year)
B. Estimate date lank closed
(mo./dayfiear)
G. Tank was removed lrcm ground
D. Tank was closed in ground
E. Tank lilled with lnerl materlal
Describe
-lr-l
2. Sile Assessment GomPleted
EvHence ol a leak detectcd
' \ xt. cERTtFtcATtoN oF cotirpL'-tE GoMplETE FoR ALL NEw AND upcR-D TANKS AT rHts LocATtoN)
Tank Hentifpation Number ?aao/t I fant No. I
l. helallalbn
A lnrtaller ertiriod by tank and
pplng manulclurers
B. hdellel certilled or llceneed by tho
lmplementlng agency
.C. lnstallatlon lnspected by a
leglslered engineer
D. lnslallation lnspec,led and
appoved by implementing agency
E. Manulaclurer's lnstallation cher*-
llsls have been completed
F. Another method allowed by State
agency. Please specily.
f_t
2. Release Deteclion (Mark ail that apply)
A. Manualtank gauglrB
B. Tank tightness testing
C. lnventory ontrols
D. Anlomatic tank gauging
E. Vapor monitoring
F. Groundwater monitoring
G. lnterstitial monitoring double walled
tanUpiping
H. lntsrstitial monitoring/socondary
conlainmenl
l. Automatic line leak deteclorc
J. Llne tightness testing
K. Olher method allowed by
lmplementing Agency. please
speclfy.
P!PING
rtl
[]
tIrtztl
il
t_lr
flrtErl
PIPING TANK
t!Erflflfl
r_l
L:J
[]
fl
tlflflrrEfl
TANK
tltlEtlflt:]E
t:]
tl
tl
Eflfl
fl
fltltl
PlPltrlc
Etltf
tl
fltlE
3. Spilland Overlill Protectbn
A. Overlill device installed
8. Splll device instailed r-:l
oATH: I ceriily the inlormation corrceming tngtallalbn thet b povued in sectlon Xl rs true lo fte best ol my bellcl ud kmu6dge.
Paee 5
FOR
TANKS
IN
UT
RETURN
COMPLETED
FORM
TO
Kenneth Alkema .
Division of Environmental Health
P.O. Box 45500
Salt Lake City, UT 84145-0500
STATE USE ONLYr.D Number ?nOOfi
Date Received
N-otificrlion is requircd by Fedcrrl le* for elt undcrground tanks lhrt hevc bccn
uscd to .slore rcgulelcd substrnccs sinc€ Jrnurry l. 197{-, thrt rrc in thc ground rs of
Mey t. 19t6. or thet ere-brought into use rftcr MiJ. t. 19t6. Thc informtti6o requcsted
is rcguired by Scction 9002 ofthc Resource Conscrvetion rnd Recovery Act.(RiRA).
rs rmcndcd.
The priman'purpose ofrhis norification proliram is to locateand c\aluate under-
ground tanks that stort or have storcd pctrolcunr or harardous subshnccx. lt is
erpccted that the informarion 1'ou prolide will bc bascd on rcasonabll arailable
rr'cords. or. in thc abscnce ofsuch records. lour kno*lcdge. bclief. or rccoilection.
Who Musr Notify? Section 9ffi2 ol RCRA. as amcndcd. requircs rhar. unlcss
excmpted. ou'ncrs ol'underground tanls that slorc rcgulated sub\lanccs must notif\.
dcsignatcd Statc or ltlcal agencics o[ rhc cxisrcnce oi thcir tanks. Olncr mcans-
(a) in thc casc ofan underground sroragr. tank in use on NorcmbcrE. 1984. or
brought into use after that datc. anl person uho ou'ns an underground storagc tank
used lor thc storagc. usc. or dispensing of regulatcd substances. and
(i,) in the casc ol'anl underground srorage tank in use before Novcmber 8. 1984.
but no longer in usc on that dale. anr';rrson u ho ou ned such tank immediatc'tv belbre
the discontinuation of its usc.
ll'hrt Trnks Are lncluded? U nderground storage ra nk is defincd as an) one or
combination of tankr that ( | ) is used to conrain an accurnulation of'rcgulated sub-
sta nccs." a nd ( 2 ) u hose vol ume ( includ ing con nccred undcrground piping) is l09i or
more beneath the ground. Some esamplcr are undcrground ranks storing: l. gasolinc.
used oil. or dicscl fucl. and 2. industrial sol\ents. pesricides. hcrbicides or fumigants.
lVhrt Tenks Are Excludcd? 'Ianks rc'mored lrom rhe ground arc not subject to
noiification. Other tanks ercluded l'rom notificarion are:
t. fa rm or residential ta nks of I .100 ga llons or lesr capacirv used for storing moror l'uel
for noncommcrcial purposes:
2. tanks used for storing heating oil for consumptire use on the premises uhcre stored:
3. septic tanks: '
1.. piFtclinc-lacilitics (including gathcring lincs) regularcd undcr thc Narural (ias
Piptlinc Safctl Act ol. 196ll. or rht' Harardour l-iqui-rl lrir^-linc Salc(\ Acr ol 1979. or
u hich ir an int rarta tc piplinc facilirr rcgularcd undcr Sri rc la s s:
5. sudacc impoundmcnts. pits. ponds. or lagoonr:
6. storm uatcr or u'astc natcr collcclion svstcms:
7, flou -through proccss tanks:
t. liquid traps or associarcd garhcring lines d ircct 11' relarcd ro oit or gas prod ucr ion and
Sathering opcrations:
9. \torasr'tankr sitr
surface of thr: lloor
I._.rnrr['iankr.siruarerJ in an undcrground arca (such as.3,JralE'ifurr. ct'llar
mineuorling. drilt. shali. or runncl)it rhc storagc (ank ir r.Uuatid upon o&borc rh,ir r.Uualtd upon orlborc rhc
tYhrt Substrnccs Arc Covcred? The nlrri,ifalion
Eround ilora8c tanks rhat contain rc)$r!16i1 \uhrtanc
defined as hirardous in rccrion,16[ ilal ol' rh.'l
I
trf,undcr.
.u 8.tr,r..
Rcspon:r. Compr:nsat ion a n{. ftia bi
nr ironmcntal
u ith thc cxccption ol
[llr.l]]ii'.i]lT[ixiTrHffiHH:il[ir*ffi ,!l]rsil
squarcrnchabsolutr'). (gRP - 1.ft 1
-,,:"Yi;1.il""J1';1,;;|i''.'"0notiricarionlB?irrshorrltrbc^9rtt3-Y6tn'grren ar rhc rop ot lhrs pagc.
^ta\@
r/r !\O'or-'
,"#I:il:,:"JIIi,,l;*ll::li:lf i:,f ,t$ilst\:.iXlgn*f:*l,ni.t,:,lx
Ma1'tl. 19E6. 2. Ouncrs uho bring unde rgroullf,stq(g[}]]. into usc alicr Mar l{.
19116. must notifl u ithin .10 da) s of bringinS $($*\\ri='ro u.c
Penrltirs: Any owner who knowingly frillfo notify or submits felse informrtion
shell bc subjecl to e civil pcnrlry noi to .xcerd Slo.fix) for erch irnk for which
notificrtion is not given or for which frlsa informrlion is submitted.
lndicate number of
continuation sheets
altached
Please t1'pe or print in ink all items except *signature'in Seoion V. This form must by compleled for
erch location containing underground storage trnks. lf more than 5 tanks are owned at this location.
photocopl'the reverse side. and staple conlinuation sheets to this form.
Owner Name (Corporation, lndivldual. Public Agency. or Other Entily)
(.ou;to ^ E, * &",nt-* s anc .
(lf same as Section 1, mark box nere [ 1
Facility Name or Company Site ldentifier, as applicable
Vernol /Vlo*J,k &,^"Jt,* \tr. - ttlL
Street Address
?.o.Bax VSf - H*q89
County
A.^o^ 1.,-
Slreel Actdress or State Road, as applicable
Y9o a)c-s* Aai"-
City Stare ZIP Code
0-f*t-. te.lv. 8311o
County/l-i^1"-L
Area Code Phone Number3ar- gS6- 386(City (nearest) State ZIP CodeV-""rnl /-/tt. Bvoll
Type ol Owner (Mart ail thet applyfi )
filcurrent E st"t" or LocarGov't [[ ttJfii"r"%! Fo,."'. tr [SgX?:S3,,f,.o "o tr 9#?ffi1]i,
)
lndicate
number of
lanks at this
location
Mark box here it tank(s)
are located on land within
an lndian reservation or l-l
on other lndian lrust lands
Name (ll same as Section l, mark box hereOr.*. 0.r."..
tr Job Title
S,.qatuiso'c
Area Code Phone Number
60\-?1g7-5)b1
tr Mark box here only if this is an amended or subsequent notification fcr this location.
I certily under penalty of law that I have personally examined and am lamiliar with the inlormation submitted in this and all attached
documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the
submitted information is true, accurate, and complete
Name and oflicial title ol owner or owner's authorized (eoresentative
Za,^rvr-vr 4e C- \"A..'t lF\v.O"J:+^r ffi,,, L}'.,a-,,,r,*
Date Sioned/:t o-96
EPA Form 7530-1 (11-85)_+€*- -Page1
ownerName(lromSecllon,rMLocatlon(lromSeclionll)
?too o /8
V.rn*'t'tr Page No. I ot I t"nl.
Tank ldentilication No. (e.9., ABC-123), or
Arbitrarily Assigned Sequential Number (e.9., 1,2,3...)
Tank No.
l- R
Tank No.
A-rut
Tank No.
3- lV L
Tank No.Tank No.
1. Status ol Tank
(Mark att thal apptyg) Currently in Use
Temporarily Out of Use
Permanently Out of Use
Brought into Use atter 5/8/86
.x1 rFt
2. Estimaled Age (Years)
3. Estimated Total Capacitv (Gallons)l2r.oOO B ooo 8.aoo
4. Material ol Construciion
(Mark oneg) Steel
Concrete
Fiberglass Reinforced plastic
.,' unknown
.. Other, Please Specify
rrr t--st
5. lnteinal Prolection
(Mark att lhat apptylil : Cathodib Protection
,,. i lnterior Lining (e.9., epoxy resins). None
Unknown
Other, ptease Specify
r:v-t rxr ryr
6. External Prolection
(Mark ail that apptys) ,.,:;Iij; ::"fi:li:J:' Fiberglass Reinforced plislic Coated
None
Unknown
Other, Please Specify
[x-l f3 rrl rr
D
7. Piping
(Mari att that apptyg) Bare Steel
Galvanized Steel
Fiberg!ass Rei nf orced Plastic
Cathodical ly Protected
Unknown
Other, Ptease Specify
rrl r-rJ rYr
8. Substance Currently or Lasl Slored
^increatestoui"iiiiu=vt;iril -- a' Emptv
(MarkaltthatapplyLi b' Pelroleum
Diesel
Kerosene
Gasoline (including alcohol blends)
Used Oil
Other, Please Specify
c. Hazardous Substance
Please lndicate Name of Principal CERCLA Substance
OR
Chemical Abstract Service (CAS) No.
Mark box E if tank slores a mixture of subslances
d. Unknown
rKt r-xt
tr
9. Addilional lnlormation (lor tanks permanently
taken oul ol service)
a. Estimated date last used (mo/yr)
b. Estimated quantity of substance remaining (gal.)
c. Mark box E if tank was f illed with inerl material
(e.9., sand, concrete)
EPA Form 7530-1 (11-85) Reverse t U.S. Govcrnmcnt Printing Otllc.: I tt6--{96.735 Page2
(Revised 01/01/97)
FacilitY lD #?oooo t I
Closure Notice prepared at the request of the owner/operator (identified-below) by / r lll{'F [ 'nt t<rs^>( ,t
of (companyname) n4av(r\Y Co"'ltY S'lorcs ' f,nc' Phone *tno\ lic'Sssl
Address itv N' r<lt L"tc State r'df Zip $4os4
FACILIW INFORMATION . I
Tank owner m^*lf Ct " "tf St' "t Phone * t go tt l jL ' ss S 7
[ ] sole proprietorship I I partnership fitcorporation
nooress €g0 t^legf &,.*tc S*r;i -. - ...- CiVJ,5-t-&-State-!LZp grlogrl
tes to LUST aeview TllQloL
aooress 490 Wcs+ Main City- vtrntt DtaleJlL,v-s-
contact person |p'rnts 2irll^q Phone * t golt olito' 5957
Jr^-- ^taarrra. 3
Number of regulated tanks at the lacility before closure:3
Number of regulated tanks at the facility fl@g closurei-q-
TANKS CLOSED
unleaded' diesel' waste oil' etc')
rar.iknenaovenName Ti,n AcI c.jl^*';i:::Y_
TANKREMOVERName I l7v\ nr e
phone *( Aoll g77- Ol9l
Company L -1 ' Ib\ful'cc, f,^c'
Addr"., 3 65 G Utrt ltoo to state-[f,- Zip 3{l 1 o
soruGRouNDwArER SAMPLER Name '
'{u
yE '
'c
1^"t'+'-' ^ "":1"
Company
Address @state t,tr zip g4o5'l
CLOSURE INFORMATION
ly'l Fuelwas empried g{ Stuoge was\cfioved
Tank was: [ ] Purged ffi lnerted. Method Use
Location of Closure Records
(lTank was cleaned.
Method Used:
For ln-Place Closure: tanks lilled with
For Change'ln'service: S.ubstance lo be stored
DISPOSAL SITES USED:
Location Name Contact
Name
Phone *Date Amount
rJ rfi 19s
'7 71-.i115 Vs/"a Tank f f-!
Tank(s)$s,rten (uycl;1
6/sf oz So gal
Produci From Tank(s)$.lbo L'w,
torr,,-rrr,Ll s/oz 3oo gal
Contiaminated Water From Tank Cleaning t)lL. tnt
Llg/,2 5 gal
Sludge f).^lL" "[ac
gal
Contaminated Water From Excavation AlA
175,(q. (,olt bls - clt SOO Yds
Conlaminated Soil $l*t^ln Lr"Jf,l!
excavateO still on'site?
Was Free product encountered during closure activities? AJ o
Yes / No
lf yes, please indicate thickness'
Not apPlicable
lnches
SITE ASSESSMENT
comptete the Facility site plat (closure Notice) and sample lnformation Table (closure Notice) on pages 3 and 4 to show
the locations, depths, and other intormation;;;ll soiuiroundwater samples iaken lor closure' The samples must be
consistentty ideniifieib, sampfe lD * on the site plat, table, and lab analysis report'
[X] Compteted Facility Site Ptat (Closure Notice) is attached' ...^ ,r, c E r^,r rram rha ar
The fo,owing must be incluoeo (enter ine 0i.1"n.., and direction (N,s,E,w) lrom the area of contamination or' where applicable'
use oH for overhead, NP for notpresent): - - ain Tereohone
-
Erectricit -)/ eroperry Line * Buildings
Water Un" _ie*er Une -,L_Natual Gas
-
Storm Drain
-Telephone -tX Compteted SampiillnformationE-ble (Closure Notice) is attached'
ixl clnifi.Jl.o ...rvt,.al environmental sample results are attached'
iQi u;iil s"iicr"iiirication (usc) sample resutts are anached.
i|i Cnain of Custody lorm is at99-h9d:.
samptes werepioperty: fdl cottected txl Labeted [d] Packaged txl rransported
[]l Samptes were in.-ighitot the person in custody it atltimes or in a secured locked place'
I certify under penalty of law that theclosure site assessment at this facility was conducted in accordance with R31 1'
202 (parts zso.szand280.72) and R31.rlii;'i,;;ill*g^:lv.oJiti6n"r sampres required bv R311-202 parts
ffi .i;;1;;; ;"; ng i r'ios-z(a)(l ) were p rope rrv corl ected'
t
Signature of Certified Groundwater/Soil Sampler
Futt name of certiried Sampler Ma* f ' ( hri<i( nq 'A
oate - bf to f o?,
rf contamination at the tacirity is confirmed, any person grgvioino remediar assistance ror a fee must be a certilied UST
b"".rii"^t. rne cenirieJusT consultant providing assistance is: r r AA Evn rra?eCert. *4 ExP' date
CERTIFIED UST CONSULTANT Name .r tr(t I rw rru;'r v - -
? 'l ttr I Phone*(to() qo-?o('o
i::::' state tr\r ziP ${ lo to
A'ddress
The site plat must be drawn to an aPpropriate scale. lt must show actual sampling loo^ons, substances stored in lankS, and
othdr retevant inrormation. Tank and sample iu.,ltilication numbers must be consistent with th. -,,lormation given on p. 1 and 4 ol the
closure notice
Facility lD n loooo t$_ Drawn By Date
fI
NORTH
P(rose *L e^doscl erTe fll^* I
SCale: 1. = _Feet
x ' Samgle location! (SS'1. ws'r. USC'I)
' Monitoring WolB ([0/V'r.l
O . Soil bodnE (SB'r). or Geogtobo Boting (GP'l)
a = WalerWells (domestic' livastck, clc')
itope ot Sur{ace iogography: (N. NW, w. Sw' S' SE' E' NE)
LnOUa" Ar Sire:
-Resld€n$al -
Commeroal -
lndusrrial
SurrounOing LandI-Resi<tentiat - Commercial -
lnduslrial
Sit Pl.t tilu3t lndlc.ta Actull Locrtion3 O':
/ CurGnt a lo,mer tank3, piping & dispensers ,. -y licaratims. ew monito'lng we'1t g 361 slockgiles
r/ Localion & dcph ol a[ samplcs taken
r/ Buildings. letrces. & p,oPeny boundaties
/ Utility ionduits (sewerr. 9a3' water' slorm
drains, elecrtical elc.)
r/ Oepth to groundwater (il encountered)
'^-r.h*'-?l*t'jint,'*B;::{ic*H*'#;j'::l*tauemusrbeconsrsrenrwithComplete table tor all samples thalwel:^
-r-r ra,. ra rha tatr analvsls reoort.[""1:.;;,:"il;LH;;ii"n on the site prat and ln the lab analvsls ]eport'
Analysls method(s)'Depth2 Compounds!
SamPle I/Lab lD
t{I ss-
lqI se-
I
L
Substance
stored in
tank
Sample
type'
€lA gori b a^l €14 8?6u E
Gos 5s j.e'T f lr, tII#t
/5s \ ,s'/T
Ittt4'
\
(.{r s1:jl
l,{I 55-L{5s lLl
\tLtl s5-l \t,ft
_llqI 95- t 95 t4t
Gotoq is+ r,llvl
<+,
tt{) uSc- |-
t4r usc - -}
\l<c,1.5 '
\r'sr
I\fd
ffi"dt "t , pw1, or unified soil ctassification (usc)'
; ;;i;6th (n teet) uerow srade at which *Il!1"-Y^tl9F,i"3;="
3 Efi#:P':"iHffi'"ffiib'ffiil'ffi"''';;'p'' rpx' BrExN' o*o''13b,,
mod.,8020,4r3.r, etc).
4 Appropriate analysis ttiioOtJ6' contaminant compound(s) in each sample ( ''t'
state certifieo uaooratory useo: /4o.rur+"ln S*ilr s Ant\y*l r" (
,
noo,ess (tr{5 w*t ra o o ?*+!. -1 *v}ell h?L State uT zip (4111
Phone *($all q1'' Oo€o
Contact Person K-o I \ Yn' r<'t
prease exprain any unusuar or extenuating circumstances encountered during the site assessment or closure:
heownerofthetank(s)describedaio.veandthatlamfamiliarwiththe
intormation on this torm and that it i" trr", ...urate and .orpiJil "iJ irril'r.r, $rrt $r" pti""oures described herein
were foltowed during tank closure' , ^ n /'
Signature ol UST Owner
Return completed Closure Notice form' Factrtry orru 'ar '"- ;;',ih; SO Oayt of UST Closure to:
analysis results' USC-samii" ttt'ttt' and Chain of Custody lon
State ol U!e! D.eP!'-ol EnvironmentalQualitYrediation UST Section6[ff; 6iEnriionmental Response anc' r'
P.O. Box 144840 .
l'"i, U# .1&:?.,9f; t-' 1 4'4840
4
samPle
3
#E
o
BI|6
9
E-
E
o
q.
F
a
T
IIa
t-
c
-------1
--u-lT---ir-------'lJUST!__-_---J
Li--v:t----r
MAVERIK #142
:X-'o*l+J
t+JE.Fa
z.
=
DISPENSER
ISLAND
t12 USC-I
r12 SS-r
CONCRETE PAD
NOTE: LOCATIONS ARE APPR0XIMATE
North
SCALE IN FEET
UST CLOSURE DOCUMENTSEXPLANAIION
-.-.--_ NATURAL GAS LINE
f, r+z s-o S0lL SAMPLE L0CATI0N
SITE MAP SHOWING
SAMPLE LOCATIONS
Aormlrrmn's Flnsr Smp
WEn[(
MAVERIK COUNTRY STORES, INC.
880 West Genter Slreet
North Salt Lake, UT 84105/-.2913
Phone: (801) 93&5557 e)d.405
Fax (801) 93&1406, (801) $e0496
E-mail : [e-mail]
RE: USC Soil Sample Description (Geologist Evatuation)
Maverik Country Store #142
490 West Main, Vemal, Utah
Facility lD# 9000018
142-USC-1
Poorly graded sand with clay; approximately 5o/o gravet, 1}o/o sitt and clay
(predominantly clay), mostly fine- to mediumgrained sand, dark brown, moist (SP€C).
142-USC-2
Silty sand; approximately 75o/o fine- to mediumgrained sand, 25% silt and clay
(predominantly silt), brown, moist (SM).
Dennis Riding, PE & PG
Environmental Manager
Professional Geologist (\A/Y PG-3436)
Utah Certified UST Consultant (#CC41)
a
-
16,45 Wcst 2200 Sou& . Salt Lakc City, Utsh 84119 . 800-973-6724
Analytical Repofl .#
Ivne20,2002
Mr. Dennis fuding
Maverik Country Stores
880 West Center Steet
North Salt Lake, uT 84054-2913
[phone] Fax: [phone]
Project:Vemal 142 Work Order: 0206040
Purchase Order: UST Removal
Dear Mr. Dennis Riding,
Thank you for using Mountain States Analytical, Inc. (MSAI) as your environmental
infonnation resource. Our reports are designed to meet the Certified Laboratory Reporting
Requirements of Utah Administrative Code Ft444-14-12(10) and the National Environmental
Laboratory Accreditation Program (NELAP), Section 5.13.
This is Report Number 0206040-1 and contains l8 pages of information for the 6 samples
submitted to MSAI on Thursday, June 06,2002. Any sample receipt documentation detailed in
the Work Order Receipt Summary of this report (e.g., Chain-of-Custody, Work Order
Authorization, etc.) and/or analytical results noted as "see attached " are included by reference
as attachments following page 18. For regulatory compliance reporting, individual pages or
portions of this report may not be separated.
If you have any questions regarding the information contained in this report, please feel free to
contact me at [phone] ext.3026 or by e-mail at [e-mail].
Mountain States Analytical, Inc.-&@
Rolf E.Iarsen
Senior Project Manager
Client: Maverik Cormtry Storcs
Project Vemal t42
Project ID:
Lrb Sample ID Client Semple ID
Sample Summary
Report Number:
Drte Reported:
WorkOrder:
Addidonel Semple Information MatrL
Analyticat Reporl W
0206040-l
06t20t02
0206M0
Date Collected
1645 Wcst 2200 South . Saft kkc Ciry, Utah 84119 , 8o&1973472/
0206040-0lA
0206040-02A
0206040-03A
0206040-04A
0206040-05A
0206040-06A
142 SS-l
142 SS-2
142 SS-3
142 SS-4
142 SS-5
142 53-6
06t05t02
06t05t02
06t05102
06t05/02
06t05t02
06t05102
Soil
Soil
Soil
Soil
Soil
Soil
Individual pagcs or portioos ofthis rcpct may oot be scparated aod prescoted for regulatory complianca
\
Holding Time Summary
Client: Mavcrik C,ountry Stores
Projech Vemal 142
Project ID:
SemplelD ClientSemplelD
16{5 Wcst 2200 South . Salt kte City, Utah t4l 19 . t&9734724
Analytical Reporl,#
Rcport Number:
Dete Reported:
WorkOrder:
020604G1
06t20t02
0206040
Date Collected
0206040-0lA 142 ss-t
Peremeter
Total Volatile Hydroca6ons
Leechate
Strrt Date End Date ET Prep Dete
06/0510215:20
IIT Analysls Date HT
0611310213:52 14
0206040-02A 142 SS-2
Pmmeter
Total Volatile Hydrocarbons
Leechete
StertDate End Date EI Prep Dete
06lO5lO215:45
HT AnelyrlsDete ET
0611310220:56 14
0206040-03A 142 SS-3
Peremeter
Toal Volatile Hydroca6ons
Leachete
Stert Date End Date HT Prep Date
06105t02 t53a
IIT Analysis Dete HT
0611310214z18 14
0206040-04A 142 SS4
Paremeter
Total Volatile Hydrocarbons
Leachete
Strrt Date End Date IIT Prep Date
06/05/02 l5:10
HT Anelysis Date IIT
0611310214:.45 14
0206040-05A 142 SS-5
Perameter
Toal Volatile Hydrocarbons
Leachate
Start Drte End Dete Ef Prep Dete
06105102 15:15
ET Andysfu Date HT
06il8t02 t9;t9 t4
0206040-06A 142 55-6
Peremeter
Total Volatile Hydrocarbons
Leachate
Stert Date End Date IIT Prep Date
0610510215:25
HT AnatysisDate HT
0611310215:39 14
' - The rpcommendedholding time was exceeded
Individual pages or portions ofthis rcport may not b€ s€parated and presented for regulatory compliancc.
Client: Mr. Dennis Riding
Maverik Country Stores
880 West Center Steet
North Salt Lake, UT 84054-2913
(801) 936sss7 Fax [phone]
Projecfi Vemal 142
Project ID:
PurcheseOrder: USTRemoval
020604G1
06t20t02
0206M0
020604G0tA
142 SS-l
06105t02
0610610208:20
Soil
24916
1645 Wcst 2200 South . Salt Lrkc Ciry, Urah 8r'-llg . EW973-6724
Anatyticat Reporl,#h
Report Number:
Drte Reported:
WorkOrder:
Lab Samplc ID:
Client Semple ID:
Date Collected:
Date Received:
Matrir:
COC ID:
Peremeter Result MDL PQL Units DF Dete Andyzed Analyst
sw-t46 5035/8260&UT-DERR:
TPH-GRO C6-Cl0
Benzene
Ethylbenzene
Methyl tert-butyl ether
Naphthalene
Toluene
m+p-Xylene
o-Xylene
Surrogetes
Bromofluorobenzene
1,2-Dichloroethaned4
Toluened8
Totd Voletile Hydrocerbong Solid" Medium Level
159 3u 0.05
0.651 0.05u 0.1
2.63 0.05
0.14 J 0.05
I1.8 0.1
3.49 0.r
0611310213:52 DJH
0611310213:52 DJH
061t310213:52 DIH
0611310213:52 DJH
0611310213:52 DJI{
0611310213:52 DJH
0611310213:52 DJH
0611310213:52 DJH
l0
0.5
0,5
2
0.5
0.5
I
0.5
mgKc
mgKc
mYKs
mgKs
mg/Kg
mS/Kg
mgKc
mg/Kg
100
100
100
r00
100
100
100
100
128
102
132
Recovery Range
32-t63
48-161
42-165
% Recovery
% Recovery
% Recovery
100 06113t0213:52 DJH
100 0611310213:52 DJH
100 06113102 L3:52 DJH
U - Not detected above the MDL
J - Andyte detectcd below the PQL
| - Result is greata thao the associated action level
B - Analyte detected in the associarcd Method Blank
E - Result is outside ofquantiution rangs
S -Results outside normal recovcry limits
R - RPD outside normal prccision limits
Individual pages or portions ofthis report may not be scparated and prcsentcd for regulatory compliance.
Client: Mr. Dannis Riding
Mavedk Cormtry Storcs
880 West Centet Strect
North Sdt Lake, uT 84054-2913
(801) 9365557 Fax [phone]
ProJect Vemal 142
ProJcct ID:
PurchrseOrder: USTRemoval
0206040-l
06n0t02
0206040
020604G02A
142 SS-2
0610s102
0610610208:20
Soil
249t6
1645 Wcgt 2200 South . Salt kkc City, Utah E4l 19 . E00-97r4724
Anatytical Repo.IW
Report Numbcr:
Dete Rcported:
WorkOrder:
Leb Semple ID:
CIIeut Srmple ID:
Dete Collectcdl
Dete Recelved:
Medr:
COC ID:
Penmeter Result MDL PQL Unitg DF Dete Analyzcd Anelyst
SW{46 5035/t260B.UT-DERR: Totd Yolatile llydrocerbong Solid, Medium Level
TPH€ROC6.CIO
Benzene
Ethylbenzene
Methyl tert-buryl ether
Naphthalane
Toluene
m+p-Xylene
o-Xylene
Surrogates
Bromofluorobenzene
1,2-Dichloroethaned4
ToluenedS
2r: Surrogate spike recovery was outside acceptable limits due to dilution
7420
l4J
l15
U
34.6
351
623
223
7.ls s (2r)
3.13 S(20
4.59 S (2r)
150 500
2.5 25
2.5 25
5 1002.s 25
2.5 25
550
525
Recovery Renge
32-r63
48-l6l
42-165
mg/Kg
mg/Kg
mglKg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
% Recovery
% Recovery
% Recovery
5000 0611310220:56 DIH
5000 06/1310220:56 DJH
5000 0611310220:56 DJH
5000 0611310220:56 DJH
5000 0611310220:56 DIH
5000 0611310220:56 DJH
5000 061t310220:56 DJH
5000 0611310220:56 DJH
5000 0611310220:56 DJH
5000 06/1310220:56 DJH
5000 06113t0220:56 DJH
U - Not dacctedabovc the MDL
J - Analye detected below the PQL
r - Rcsult is grcatcr than the associated action lcvel
B - Analytc detectcd is ths associ6tcd lvlethod Blank
E - Result fu outsidc ofquantitation range
S -Results outsidc normal recovcry limits
R - RPD outside normal prccision limits
Iadividual pagas or portions ofthis repct may not be separatcd and prcsentcd for rtaulatory compliancc.
d'r-!l*.JJil$*ri8a.
a
Cllent: Mr. Dennis Riding
Maverik Country Stores
880 Wcst Ccnter Sueet
North Salt Iake, uT 84054-2913
(801) 9365557 Fax [phone]
Projecfi Vemal 142
ProJect ID:
PurchaseOrder: USTRernoval
0206040.1
06t20t02
0206040
0206040-03A
t42 SS-3
06t05102
0610610208:20
Soil
249t6
16{5 f,icst 22(X) Soulh . Srlt Idtc Crty, Utah t4l 19 . 800-9736724
Analfiicat Reporr#
Report Number:
Dete Rcportcd:
VYorkOrder:
Leb Srmple II):
Cltent Srmple ID:
Dete Collected:
Dete Received:
Matrh:
COCID:
Peremeter Result MDL PQL Unih DF Drte Amlyzcd Anelyst
TPH-GROC6-Cl0
Benzene
Ethylbenzene
Methyl tert-butyl ether
Naphthalene
Tolueire
m+p-Xylene
o-Xylene
Surrogetes
Bromofluorobenzane
1,2-Dichloroethane{4
Toluened8
SW{45 5035/8260B-UT-DERR: Totel Voletile Hydrocarbons, Soli{ Medium Level
l5
0.25
0.25
0.5
0.25
0.25
0.5
0.5
Recovery Renge
32-163
48-l6l
42-165
2r: Surrogate spike recovery was outside acceptable limits due to dilution
r390
U
14.1
U
15.6
10.3
ll6
41.9
29.7 SQr)
23.3 S (2r)
30.0 S (2r)
mgKS
mgKs
mgKg
mg/Kg
mg/Kg
mYKg
mgKs
mC/KS
% Recovery
% Recovery
% Recovery
50
2.5
2.5
l0
2.5
2.5
5
2.5
500
500
500
500
500
500
500
500
0611310214:18 DJH
0611310214:18 DJH
0611310214:18 DJH
0611310214:18 DJH
0611310214:18 DJH
06/1310214:18 DJH
0611310214:18 DJH
05/13/02 14:18 DJH
0611310214:18 DJH
0611310214:18 DJH
06fi3102 L4:.18 DJH
500
500
500
U - Not detectcd abovc thc MDL
J - And)te det€cted bclow thc PQL
' - Rcsult is grcater than thc associated action lcvel
B - Amlytc detected in thc associated Method Bla*
E. Result is outside ofquantitation range
S -Rcsults outsidc normal recovcry limits
R - RPD outside aonnal precision limits
Individual pages or portions ofthis report may not bc separated and prcsented for regulatory compliance.
Cllent: Mr. Dennis Riding
Maverik Country Storcs
880 West Center Strect
North Sdt Lake, UT 84054-2913
(801) 93655s7 Far (801) 9361406
Project Vemal 142
Project ID:
PurcheseOrder: USTRemoval
020604G,1
06t20t02
0206040
0206040-04A
t42 SS-4
06t05tu
0610610208:20
Soil
249t6
1645 Wcat 2200 Solilh . Sdt klc City, Utah t4l 19 ' t0n.9734724
Anatyticat RepotI#
Report Number:
Drte Reported:
Work C)rder:
Lab Semple ID:
Cllent Semple ID:
Date Collected:
Date Recelved:
Metrir:
COC ID:
Prremeter MDL PQL Dete Andyzed Analyst
SW{45 5035/82608-UT-DERR: Total Yoletile Eydrocerbom' Soli{ Medlum Level
TPHCROC5-Cl0
Benzene
Ethylbcnzene
Methyl tert-butyl ether
Naphthalene
Toluene
61p-Xylenc
o-Xylenc
Surrogetec
Bromofluorobenzetle
1,2-Dichloroethaned4
Toluene-d8
44.5
U
0.33 J
U
l.l8
0.ll J
2.27
0.67 J
60.9
57.4
65.7
6200.r I
0.1 I
0.2 4
0.1 I
0.1 I
0.2 2
0.2 I
Recovery Range
32-163
48-161
42-165
% Recovery
% Recovery
% Recovery
06113102 14.45
0611310214:45
06113102 14:45
0611310214t45
06113102 t4:45
06113102 14:45
0611310214:45
0611310214:45
0611310214:45
0611310214t45
o6tr3t02 t4|45
DJH
DJH
DJH
DJH
DJH
DJH
DJH
DJH
2N
200
200
200
200
200
200
200
mgKS
mC/KS
rnglKg
mg/Kg
mC/KS
mgKg
mgKg
mgKs
200
200
200
DJH
DJH
DJH
U. Not detccted abovc the MDL B ' Analyte detected in the associated Method Blank
J - Analye dctected bclow thc PQL E - Result is outside ofquaotitation range
. - Rcsult is greater than thc associatcd actioa lcvel
S -Results outside normal recovcry limits
R - RPD outside normal prccision limits
Individual pages or portions ofthis report may not be separated and presentcd for rcgulatory compliancc.
Clleut: Mr. Dcnnis Riding
Maverik Country Storcs
880 Wcst Center Steet
North Salt Lakc, UT 84054-2913
(801) 93C5557 Fa* (801) 93Gt406
Projecfi Vemal 142
ProJect ID:
PurcheseOrder: USTRernoval
020604G1
06120102
0206040
020604G05A
142 SS-5
06t05t02
0610610208t20
Soil
24916
1645Wcst2200South . Saltl*cCity,Utah 84119 . 8W971-6724
Analyticat Reporl#
Rcport Numbcr:
Drtc Reportcd:
WorkOrder:
LebSuple ID:
Client Srmplc ID:
Date Collected:
Detc Recelved:
MaHr:
COC ID:
Peremeter Rerult PQL Dete Anelyzed Anelyst
SW-846 5035/8260B-UT-DERR: Total Volatile llydrocarbong Solid, Medtum Level
TPH-GRO C6-Cl0
Benzene
Ethylbenzene
Methyl tert-butyl ether
Naphthalene
Toluene
m+p-Xylene
o-Xylene
Surrogates
Bromofluorobenzene
1,2-Dichloroethaned4
ToluenedS
38.4
U
0.15 J
U
0.567
U
r.62
0.848
l16
107
135
310
0.05 0.5
0.05 0.5
0.1 2
0.05 0.5
0.05 0.5
0.1 I
0.1 0.5
Recovery Range
32-163
48-l6l
42-t65
100 06/18/02 19:19 DJH
100 0611810219:19 DJH
100 06/18/02 19:19 DJH
100 06/18/02 19:19 DJH
100 06/18/02 19:19 DIH
100 0611810219:19 DJH
100 06ll8l02l9tl9 DJH
100 0611810219:19 DJH
100 06118102 t9:19 DJI{
100 0611810219:19 DJH
100 06/1810219:19 DJI{
rngKe
mgKs
mgKg
mgKg
mgKg
mgKE
mS/KS
mgKs
% Recovery
% Rccovery
% Recovery
U - Not daected above the MDL
J - Analyte detectcd bclow thc PQL
t - Result is grcat€r thau thc associatcd action lcvel
B - Analyc daected in the associatcd Method Blank
E - Result is outsidc ofquantitation rangc
S -Results outside normal recovery limits
R - RPD ouside normal precision limits
Individual pages or portions ofthis rcport may not be scparatcd and prcscntcd for regulatory complianca
1
Cllent: Mr. Dennis Riding
Maverik Country Stores
880 West Center Street
North Salt Lake, LII 84054-2913
(801) 9365557 Far (EOl) 9361406
Prolect Vemal 142
ProJect ID:
PurchaseOrder: USTRemoval
020604G1
0il20t02
0206040
020604G,06A
142 55-6
06t0st02
06/06/02 08:20
Soil
249t6
16,45 Wcst 2200 South . Sdr r -r.c Ciry, Utah E4l 19 , E00-973-5724
Analytical ReprdW
Report Number:
Drte Reported:
WorkOrder:
Leb Semple ID:
Cllent Semple ID:
Date Collected:
Drte Received:
Metrir:
COC ID:
Prremeter PQL Units Dete Analyzed Anrlyst
SW-845 5035/82608-UT-DERR: Total Yotattle Eydrocerbonq Solid, Medium Level
TPH€RO C6-CIO
Benzene
Ethylbenzene
Methyl tert-buryl ether
Naphthalene
Toluene
mrp-Xylene
o-Xylene
Surrogetes
Bromofluorobenzene
1,2-Dichloroethaned4
Toluened8
2r: Sunogatc spike recovery was outside acceptable limits due to dilution
6@
U
6.86
U
t2.s
0.80 J
56.0
22.8
26.1S(2r)
19.3 S(2r)
26.8 S(2r)
15 50
0.25 2.5
0.25 2.5
0.5 l0
0.25 2.5
0.25 2.5
0.5 5
0.5 2.5
Rccovery Renge
32-t63
48-l6l
42-t65
mg/Kg
mglKg
mg/Kg
mg/Kg
mg/Kg
mgKg
mgKg
mgKs
% Recovery
oZ Recovery
% Recovery
500
500
500
500
500
500
500
500
0611310215:39 DJH
061t310215:39 DJH
0611310215:39 DJI{
0611310215:39 DJH
0611310215t39 DJH
0611310215t39 DJH
0ilt310215:39 DJH
0611310215:39 DJH
0611310215:39 DJH
0611310215:39 DJH
06113/0215:39 DJH
500
500
500
U - Not dctccted abovc thc MDL B - Aaatyte detectcd in thc associatcd Method BlaDk
J - Analytc detectcd below the PQL E - Result is outside ofquaotitation range
' . Rcsult is grcater rhan thc associatcd action levcl
S -Results outsidc aormal rccovery limits
R - RPD outside normal precision limits
Individual pages or portions ofthis rcport may not bc scparated aad prcscntcd for rcgulatory compliance.
1
Quatity Control Summary
Anatyticat Report W
ReportNumber: 0206MGl
Dete Reported: 06120102
Work Order: 0206040
Cllent: Maverik Country Stores
ProJecfi Vemal 142
Projec't ID:
I 645 Wcrt 2200 South . Salt ldtc City, Ut8h t4 I t 9 . t0&971-6724
SW{46 565A260BUT-DERR: Totd Yoletlle Eydrocerbons, Solid, Medlum Level
QC Type: laboratory Control Spike
Semple ID: 020612sm14
Run ID: HP4-020612E
Peremeter
Benzene
Chlorobenzene
l,l-Dichloroethene
Trichloroethene
Toluene
Surrogetes
Bromofluorobenzene
l2-Dichloroethaned4
ToluenedS
Analysis Dete: 06112102 19,,31
Prep Batch ID: R31237
Spike True PercentParent Value Recovery
SeqNo: 352684
Duplicete RPD
Prrent RPD Llmit
Low High
Limit LtmttResult
5240
5530
6020
6090
5330
6500
8040
7180
5000
5000
5000
5000
5000
5000
5000
5000
105
lll
t20
t22
107
130
l6l
t4
134
130
160
134
137
r63
l6l
r65
45
48
9
39
45
32
48
42
U -Not daectcd abovc thc MDL
J - Analyte detectcd bclow thc PQL
B - ADalytc detected ia the associatcd Mcthod Blalrt
E. Result is outside ofquantitatioo rangc
S -Results outsi& oormal rccovay limits
R - RPD oueidc normal prccision limits
NC - Not Cdculatcd: Duplicatc valuds) are lcss than the MDL l0
Individual pages or portioos ofthis report may not be scparatcd and prcsented for rcgulatory complianca
1
Quality Control Summary
Anatytical Reporl ,#i
ReportNumber: 020604O.1
Date Reported: 06120102
WorkOrder: 0206040
Client: Maverik Country Stores
Projecfi Vemal 142
Protect ID:
16,45 Wcst 22m South . Salt lakc City, Ur.h t4t t9 . t00.97t-6724
QC Type: Method Blank
Semple ID: 020612smb4
Run ID: HP4-020612E
Premeter
TPH-GRO C6-Cl0
Benzene
Ethylbenzene
Methyl terrt-butyl ether
Naphthalene
Toluene
m+p-Xylene
o-Xylene
Surrogates
Bromofluorobenzene
lp-Dichloroethane-d4
Toluened8
ResuIt
Sptke
Parent
0
0
0
0
0
0
0
0
0
0
0
Analysis Date: 06112102 19:58
Prep Betch ID: R31237
Units: pelKg
SeqNo: 352685
Hlgh Dupllcete RPDLlmit Perent RPII Limit
20
0.5
0.3
0.7
0.6
0.4
0.7
0.3
163
l6l
165
True Percent
Vdue Recovery
Low
Limit
U
U
U
U
U
U
U
U
6600
6950
74/;0
0
0
0
0
0
0
0
0
5000
5000
5000
0
0
0
0
0
0
0
0
t32
139
t49
32
48
42
U - Not detected above tbe MDL
J - Aaalye dctected bclow the PQL
B - Amlyte dctected in thc associarcd Method Blank
E - Result is outside ofquantitation range
S -Results outsidc normal recovcry limits
R - RPD oucide aormal precision limits
NC - Not Calculated: Duplicate valuc(s) arc lcss than the MDL
Individual pagcs or portions ofthis rcport may aot bc s€parated and prcscntcd for regulatory compliance.
1
Quality Control Summary
Anatyticat Repot! #
ReportNumber: 0206fiG1
Drte Reportedr 06120102
Work0rder: 0206040
Client: Maverik Country Stores
Project Vemal 142
Proiect ID:
16,45 Wcst 2200 Sorth . Sdt I -Lc Crty, Utlh t4l 19 . 8m"973{724
QC Type: Matrix Spike
SampleID: 020606G,06ams
Run ID: HP4-020612E
Paremeter
Benzenc
Chloroberuene
I , I -Dichloroethene
Trichloroethene
Toluene
Surrogates
Bromofluorobenzene
lp-Dichloroethane-d4
Toluened8
45
48
9
39
45
Result
4820
5210
4850
5590
5050
5910
6070
6740
Spike
Perent
U
U
U
U
U
0
0
0
AnelysisDete: 06l0lD20t52
Prep Betch ID: R31237
Units: qE|KS
SeqNo: 352687
High Duplicate RPD
Llmtt Perent RPD Limit
134
130
160
134
131
163
l6l
165
True Percent Low
Ydue Recovery Limit
s000 96.4
5000 105
5000 97.1
5000 ll2
5000 l0l
5000 I 18
5000 l2r
5000 135
32
48
42
QC Type: Matrix Spike Duplicate
SempleID: 020606G06amsd
Run ID: HP4-0206128
Perrmeter
Benzene
Chloroberzene
l,l-Dichloroethene
Trichloroethene
Toluene
Surrogetes
Bromofluorobenzene
1,2-Dichloroethancd4
Toluene-d8
Analysirllrte: 0611210221:18
Prep Betch ID: R31237
Units: pgKC
SeqNo: 352688
Eigh Duplicrte RPI)
Limit Parent RPD LimitResult
4750
5270
4990
5430
4990
5890
6550
6900
Spike
Parent
U
U
U
U
U
0
0
0
4820
5230
4860
5590
5050
True Percent
Vdue Recovery
5000 95.0
5000 105
5000 99.9
5000 109
5000 99.9
5000 ll8
s000 131
s000 138
Low
Ltmit
45
48
9
39
45
32
48
42
134
130
160
134
t37
163
l6r
165
1.4 34
0.73 24
2.8 32
2.7 4l
l.l 43
U - Not detected above the MDL
J - Analytc detectcd below the PQL
B - Aralyte detected ia the associarcd Mcthod Blatr&
E - Result is outsidc ofquaatitation range
S -Results outsidc normal rccovery limits
R - RPD outsidc normal precision limits
NC - Not Cdculated: Duplicate valuc(s) are less than tbe MDL
Iodividual pages or portions ofthis rcport may not bc separated and prese'otcd for regulatory compliancc.
t2
:. .,. . : ,-..r--\,.., i..; j:;.r.,L,.\!d$.r+.$&riEAfll4llia
8W9734724
Analytical Reporl #
ReportN.nber: 0206MGl
DeteReportedz 06120102
Work Order: 0206040
Quality Control Summary
Client: Mavetik Country Stores
Prolect Vemal 142
ProJect ID:
1645 Wcst 2200 Sourh . Salt l,,lc Ciry, Utah 84119
QC Type: Iaboratory Control Spikc
Srmple ID: 020613s14
Run ID: HP4-0206138
Peremeter
Benzene
Chlorobenzene
l,l-Dichloroethene
Trichloroethene
Toluene
Surrogrtes
Bromofluorobenzene
1,2-Dichloroethane-d4
Toluene-d8
Anelysis Dete: 06113102 16:6
Prep Batch ID: R31240
UniB: pgKe
SeqNo: 352717
High Duplicate RPDLtmit Perent RPD Limit
134
130
160
134
t37
163
l5l
165
Spike
Parent
True Percent
Value Recovery
5000 89.0
5000 105
5000 95.5
5000 to7
5000 l0l
5000 t20
5000 109
5000 138
Low
Limit
45
48
9
39
45
Result
4450
5260
4770
5330
5050
6020
5460
6910
32
48
42
U - Not detected above the MDL
J - Aaalyte detected bclow the PQL
B . Analye detccted in thc associatcd Method Blank
E - Result is outside ofquaatitation raage
S -Results outside normal rccovery limits
R. RPD outside normal precision limits
NC - Not Calculatcd: Duplicate valuds) arc less than the MDL
Individual pagas or portions ofthis rcport may not bc separatod and preseorcd for rcgulatory compliancc.
l3
1
Quality Control Summary
Anatfiical Repor{ W
ReportNumber: 020604G1
DeteReported: 06120lD
Work Order: 0206040
Clienfi Maverik Cormtry Stores
Proiece Vemal 142
ProJect ID:
l645wcrtzt00sou6 . Sdrt k city,utah 84119 . 8w9714724
QC Type: MethodBlank
Srmple ID: 020613sM
Run ID: HP4-020613B
Peremeter
TPH€ROC6CIO
Benzene
Ethylbcnzene
Methyl tert-buryl cther
Naphthalene
Toluene
trt'pxylene
o-Xylene
Surrogetcs
Bromofluorobenzsne
l2-Dichloroethaned4
ToluenedS
Andysis Date:
Prep Betch ID:
Spike
Perent
0611310216:33
R31240
True Percent
Value Recovery
00
00
00
00
00
00
00
00
5000 t24
5000 ll4
5000 t4
Units: trgK1
SeqNo: 352718
Duplicate RPD
Perent RPD Llmtt
Low Hlgh
Limit LinitResult
U
U
U
U
U
U
U
U
6220
5700
720o
0
0
0
0
0
0
0
0
20
0.5
0.3
0.7
0.6
0.4
0.7
0.3
163
16t
165
32
48
42
0
0
0
U - Not dctcctcd abovc thc MDL
J - Analyte detccted below the PQL
B - Atralyte detected in the associatcd Method Blant
E - Rcsult is outside ofquaatitation range
S -Results outside normal recovcry limits
R - RJD ouEidc nomal prccision limits
NC - Not Calculatcd: Duplicate valuds) srp 16s thqn the MDL
Individual pagcs or portions ofthis rcpct may not be scparatcd and prcseirted for rcgulatory compliancc.
l4
Quatity Control Summary
Analytical Reporl #
ReportNumber: 020604G'l
Drte Reportedt 06120102
Work Order: 0206040
Cllent: Mavcrik Country Stores
Projecft Vernal 142
Project ID:
1645 Wcst 2200 South . Salt IrlG ciry, ut& E4l t9 . E0[-|9734724
QC Type: Matrix Spike
SrmpleID: 0206080-0lcms
Run ID: HP4-020613B
Peremeter
Benzene
Chlorobenzene
l,l-Dichloroethene
Trichloroethene
Toluane
Surrogrtes
Bromofluorobenzene
1,2-Dichloroethane-d4
Toluened8
Anelysis Drte: 06113102 l9:@
Prep Betch ID: R31240
UniB: ttgK9
SeqNo: 352720
True Percent Low High Duplicete RPD
Value Recovery Ltmtt Linit Perent RPD LtmitResuIt
3630
4620
3670
4500
4420
5600
4810
6170
Spike
Parent
U
U
U
U
U
0
0
0
5000
s000
5000
72.7
92.4
71.4
90.0
88.4
tt2
95.2
123
5000
5000
5000
5000
5000
45
48
9
39
45
32
48
42
134
130
r60
t34
t37
163
l6l
165
QC Type: Matrix Spike Duplicate
SampleID: 0206080-0lcmsd
Run ID: HP4-0206138
Paremeter
Benzene
Chlorobenzene
l,l-Dichloroethene
Trichloroethene
Toluene
Surogete3
Bromofluorobcnzene
1,2-Dichloroethane-d4
ToluenedS
Anelysis llete: 06113102 19:,36
Prep Brtch ID: R31240
Unltr: ltgK9
SeqNo: 352721
True Percent Low Eigh Duplicete RPD
Velue Recovery Limit Llmit Parent RPD LlmitResult
3660
4480
3910
4540
4420
Spike
Parent
U
U
U
U
U
0
0
0
5000 73.t
5000 89.5
5000 78.1
s000 90.8
5000 88.4
5000 104
s000 95.1
5000 ll9
45
48
9
39
45
32
48
42
t34
130
160
134
137
163
l6l
165
3630
4620
3670
4500
4420
0.62 34
3.2 24
6.3 32
0.86 4l
0.050 43
5210
4750
5930
U - Not dctected abovc the MDL
J - Amlyc daectcd bclowthc PQL
B - Analyte detected in thc associated Method Blank
E - Result is outsidc ofquaotitation range
S -Rcsults outside uormal rccovcer limits
R - RPD outside normal prccision limits
NC . Not Calculatcd: Duplicatc valuc(s) arc lcss than the MDL
lndividual pages or ponions ofthis rcport may Dot bc separated and pres€nted for rtgulaory compliancc.
l5
Quality Control Summary
Analyticat Reporl W
ReportNumber: 0206040-l
Dete Reportedz Ml20l02
Work Order: 0206040
Clienfi Maverik Country Storcs
ProJecft Vemal 142
ProJect ID:
1645 Wcst 2200 Sou6 . Salt t*c Crty, Utah t4l 19 . t00-973{724
QC Type: [aboratory Control Spike
Semple ID: 020618$nl
Run ID: HP{-020618C
Peremeter
Benzene
Chlorobenzene
l, l-Dichloroethene
Trichloroethene
Toluene
Surrogetes
l2-Dichloroethaned4
Toluened8
Analysis Dete: 06/18/02 17:58
Prep Batch ID: R31314
Sptke
Perent
5000
5000
5000
Units: trgK9
Seq No: 353846
True Percent Low Eigh Duplicate RPD
Value Recovery Limit Ltmlt Plrent RPD Limit
45
48
9
39
45
5000
5000
5000
5000
5000
ResuIt
5030
5440
5050
5530
5270
l0l
109
l0t
lll
105
124
t22
t4
t34
130
160
t34
t37
163
l6l
165
6210
6100
7180
32
48
42
U - Not detected abovc the MDL
J - Analyte detcctcd bclow the PQL
B - Anatf,tc daccrcd in thc associaed Method Blank
E - Result is outside ofquantitation rangc
S -Rcsults outsidc normal rccovcry limits
R - RPD outside normal precision limits
NC - Not Calculatcd: Duplicatc value(s) arc lcss than tte MDL
Individral pages or portions ofthis rcport may not be s€parated and prcscnted for regulatory compliance.
l6
84u9 .t00-973-5724
Anatyticat Reporl .#i
ReportNumber: 020604G'l
Dete Reported: 06120102
WorkOrder: 0206040
Quatity Control Summary
Clicnt: Mavcrik Country Stores
Project Vemal 142
Project ID:
1645 Wcat 2200 Sou6 . Sah I*c City, Utrh
QC Type: Method Blank
Semple ID: 0206l8smM
Run ID: HP4-020618C
Paremeter
TPH€ROCGCIO
Benzene
Ethylbenzene
Methyl tert-butyl ether
Naphthalene
Tolucne
m+p-Xylene
o-Xylene
Surrogetes
Bromofluorobenzene
1,2-Dichloroethaned4
ToluenedS
Andysis Drte: 06/18/02 18:25
Prep Betch ID: R3l3l4
True Percent
Vdue Recovery
Units: pgKS
SeqNo: 353847
Iluplicete RPI)
Perent RPD LimttResult
Spike
Perent
0
0
0
0
0
0
0
0
0
0
0
Htgh
LtDit
20
0.5
0.3
0.7
0.6
0.4
0.7
0.3
r63
l6l
165
U
U
U
U
U
U
U
U
6500
5710
7470
0
0
0
0
0
0
0
0
5000
5000
5000
0
0
0
0
0
0
0
0
130
u4
t49
Low
Ltmit
32
48
42
U - Not detected above thc MDL
J - Atrdyte detcctcd below thc PQL
B - Analytc detectcd in the associatcd Method Blank
E - Result is outsidc ofquantitation raogc
S -Rcsults outsidc lormal rccovery limits
R - RPD ou6idc oomral prccision limits
NC - Not Calculated: Duplicarc value(s) are lcss than thc MDL
Individual pagcs or portioN ofthis re?ort may not be separated aod prescnted for rcgulatory compliancc.
t7
. .-r .-i -.-t.- r.,r{r,i;fu
Quality Control Summary
Analyticat ReporI #
ReportNumber: 020604S.1
Drte Reported: 06120102
Work Order: 0206040
Client: Maverik Country Stores
Projecfi Vernal 142
Project ID:
1645 Wcst2200South . SaltlakeCtty,Utah 8/.llg . 9W973-6724
QC Type Matrix Spike
SemplcID: 0206M0-05ams
Run ID: HP4_020618C
Paremeter
Benzene
Chlorobenzene
I , l -Dichloroethene
Trichloroethene
Toluene
Surrogetes
Bromofluoroberzene
1,2-Dichloroethane-d4
Toluene{8
Analysis Dete: 06118102 19:45
Prep Betch ID: R3l3l4
True Percent
Vdue Recovery
5000 81.1
s000 88.6
5000 78.7
5000 95.0
5000 92.5
5000 I 13
5000 103
5000 130
Uni6: IL/KE
Seq No: 353849
Duplicete RPI)
Perent RPD LimttResult
4050
M30
3930
4750
4620
56/,0
5170
6520
Spike
Perent
U
U
U
U
U
0
0
0
Low
Limit
45
48
9
39
45
32
48
42
t34
t30
160
t34
t37
163
l6l
165
High
Limit
QC Type: Matrix Spike Duplicate
SampleID: 0206040-05amsd
Run ID: [IP4_020618C
Parameter
Benzene
Chlorobenzene
I , I -Dichloroethene
Trichlorocthene
Toluene
Surrogatec
Bromofluorobenzene
1,2-Dichloroethane-d4
ToluenedS
AnalysisDete: 06/1810220:12
Prep Batch ID: R3 l3l4
Spike Truc PercentParent Value Recovery
Units: ttElKE
Seq No: 353850
Duplicate RPI)
Prrent RPD Limit
Low High
Limit Llmit
45
48
9
39
45
U
U
U
U
U
Result
4440
5020
4320
5270
5000
5000 88.7
5000 100
5000 86.3
5000 105
s000 99.9
5000 I 19
5000 106
5000 136
9.0 34
t2 24
9.3 32
l0 4t
7.8 43
134
130
160
134
t37
163
l6l
165
4050
M30
3930
4750
4620
5950
53 t0
6790
0
0
0
32
48
42
U - Not detected abovc the MDL
J - Analye detccted bclow the PQL
B - Analyte detected in the associated Method Blank
E - Result is outside ofquartitation range
S -Rcsuls outsidc normal rccovcry limits
R - RPD outside normal prccision limirc
NC - Not Calculated: Duplicate value(s) arc less than the MDL
Individual pages or portions ofthis rcport may not bc sepanted and prcseated for rcgulatory compliance.
l8
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'
q &{t{o
o.o.dq,o
1t
0)x
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T B (
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ooI oo =o I ot
,o ==oc EI tD
00
N
o
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o
o
(,
l
a
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o!3 ?.o o.aIt!df
!3.ocl zo:.s\A-l E!
tf port
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.9
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an T 9la*It
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{B30
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A\
l.lountaln States Analydcal, Inc.
F Sample Rccdpt Ch€ddlst
OlentNam:
ffier:
lVort Order ltlo.alc/.fiqo
Grler Number;
CoolerlnformaUon: fon-nray' rsn*O whlblo YdlowuO Y.llorflIltq ALAM: c-lo
I
lutlun ltlodcl 3 scrld tLA-;- Udlum l,lodc zl29 scalerserld ,-
smearnesus: aftLty- tnncrPltg: o-t1- srmplec: d- tg.
Tnnsport tndex readkpbrYellowll&Itronly) mR/fr
Goolcr l{umlerl P, -antl-
CmdUon of Shlpping Contalner: W/
@der Sealed (hped): Yes El l$y
o'todyse*hesent lil" I:r"
Codanh le[ Blrc le O None0 Otrcr:
Stah of Coolant: Fozen Cl Partally FmIrJl'/ MelH o
;;w;;J/- rher716m€r3rtoi ZXit conectonFffiz ,? TempBanktnduded: vesy' ttoo
Suface Ra<tloac0vlty RFidlrE
Falr Q Damaged (cxPhln)
(lf requlred) - mffi
ilotApploHco PID Readlng--PPnt
tlotAppllcableCl
Seal Number:
Paddng Desolfrm:
@C Pr€sent:
G)C Number(s):
@C dgned (relinqd$Ed and received):
@C agr€€s wlth sample labels:
'tst t{oo ourcr:
-
&?q
Yfsgl I{o o ltlot Apdcaue a
Yes'o No tr Not Apollcable o
Sample lnformaUon:
sampleslndudedlncooler: /4dSS't ,2.3ru,5, t' (att v'\
Cu*ody Seals Present:
Samde ontshers lntact:
Samples in proper @rtalner:
Suficlent sample volume:
All samfles recelved ln hold Ume:
Water - \rOA's har/e zero hea@ace:
Pepresencd with ll0: O
tl,ot Apdlcable O OUterYes O
IntxtQ
vtsd
Y6'F
'taEY6f,
NOF
BrokenEl
NoO
l,loO
tloO
NoO
Seal Number(s)
lbtss:
Yes q NoO t'lotApflicable/
Prcar€sen ed wllh tb29o3: 6 Non-Pr€ser'\r€d: O
Water - pH acceptable upon rccdpt Yes Q Mrred (see ommanB below) O Net Appllcablg/
tlNO! - HrS& =NaOH = ZnAC/NaOH =
SlaEr - pH adjustrd: (MSAI Traddng No.)
nNO!HISO{
Narsoor Othel
HCL=-
ac
NoES:
Cont nt! Inspcctcd tYerlllcd By:
oro.t]l.)bJ2A- n'",:0053- Rwrcwod bv,# o.u, 6f4/oe-
9EPA
DMSION OF EiMRONiiENTAL RESPONSE ANO REMEOhNON
IEE NORTH I95O WEST
SALT I.AI(E CTTY. UTAH O''I16
United States
Envl ronmental Protec'tion Agency
Washington, DC 20460
E l. ruew FAcrLtrY
0 ruumuer of tanks
at facility
E e. aNaeNoeD iE c. ct-osune
O Number of continuation sheets attached
Please tvoe or print in ink. Also, be sure you havesignatures in ink for
sections-VlllEndFl. Complete a notification form for each location
eontaining underground storage tanks. lf more than 5 tanks are owned at
this location, you may photocopy pages 3 through 5 and use them for
additional tanks.
The primary purpose of this notificatio! Program is to locate and evaluate
unddrgrourid'storage tank systems (USTs) that store or have stored
oetroldum or hazardous substances. The information you provide will be
based on reasonably available records, or in the absence of such records,
your knowledge or recollection.
Federat law requlres UST owners to use thls notlfication form for all
USTs storlng regulatod substances that are brought lnto use after tlay
8, 1986, or USTJIn the ground as of May 8, 1986 that have stored
regulated cubstances at any tlme rlnce January 1, 1 974. The
lnformatlon requested ls roqulred by Sectlon 9002 of the Resource
Congervatlon and RecoveryAct (RCRA), as amended.
Who Must Notlffi Section 9002 of RCRA, as amended, require-s owners of
USTs that store iegulated substances (unless exempted)!q I'^o]ify -^
designated State o-r local agencies of the eistence of their USTs. 'Ownef
is defined as:
. ln the case of an UST in use on November 8, 1984, or brought into use
after that date, any person who owns an UST used for storage, use, or
dispensing of regulated substances; or
. ln the case of an UST in use before November 8, 1984, but no longer in
use on that date, any person who owned the UST immediately before its
discontinuation.
Also, if the State so requires, any facility that has made any changes to
facility information or UST system status, must submit a notification form
(only amended information needs to be included).
What USTc Are lncluded? An UST system is defined as any one or
combination of tanks that (1) is used to contain an accumulation of
requlated substances, and (2) whose volume (including connected
un?erground piping) is 107o.or more beneath the ground. Regulated USTs
store petroleum or hazardous substances (see the following 1l/hat
Substances Are Covered').
What Tanks Are Excluded From Notlffcatlon?. Tanks removed from the ground before May 8, 1986;. Farm or residential tanks of 1 ,1 00 gallons or less capacity storing motor fud
for noncommercial purposes;. Tanks storing heating oil for use on the premises where stored;. Septic tanks;. Pipeline facilities (including gathering lines) regulated under the Natural Gas
Pipeline Safety Act of 1968, or the Hazardous Liquid Pipeline Safety Act of
1979, or wtrich is an intrastate pipeline facility regulated under State laws:. Surface impoundments, pits, ponds, or lagoons;. Storm water or waste water collection systems;. Flow-through process tanks;. Liquid trapi or associated gathering lines directly related to oil or gas
production and gathering operations;. ianks on or above the floor of underground areas, such as basements or
tunnels:. Tanks with a capacity of 110 gallons or less.
What Substances Are Covered? The notification requirements apply to USTS
containino oetroleum or certain hazardous substances. Petroleum includes
gasoline,-uied oil, diesel fuel, crude oil or any fraction thereof which is liquid at
itandard conditions of temperature and pressure (60 degrees Fahrenheit and
14.7 pounds per square inch absolute). Hazardous substances are those
found in Section 10'l (14) of the Comprehensive Environmental Response,
Compensation and Liabiiity Act of '1980 (CERCLA), with th_e e_xge^p_lign of those
subsiances regulated as hazardous waste under Subtitle C of RCRA.
Where To Notlfi? Send completed forms to:
STATE OF UTA}I DIVISION OF ENVIRONMENTAL RESPONSE
{68 NORTH 1950 WEST
PO BOX I'14840
SALT LAIG ClrY, UTAII 8/'.l1+1840
When To Notlfy? 1. Owners of USTs in use or that have been taken out of
operation after January 1,'1974, but still in the ground, mlst notify by l4ay 9: .
1irS6. 2. Owners wtro bring USTs into use after May 8, 1986' must notify within
30 days of bringing the UST into use. 3. lf the State requires notification of any
amendments to facility, send information to State agency immediately.
PenalUee: Any owner who knowingly fails to notify or submits false information
shall be subjeit to a civil penalty not to exceed $11,000 for each tank for which
notification is not given or for wtrich false information is given.
lf required by State, give th€ geographic location ol USTS by degrses, minutes, and
seconds. Example: Latitud€ 42" 36' 12" N, Longitudo 85" 24' 1T w
Facility Name or Company Site ldentifier, as applicabl€
(Wutif f,o*^tfy Sfrtc # /'{ e
o tf address is the same as in SecUoJ I, check th€ box and proco€d to section lll.
tf address ls difforent, enter addre$ b€low:
StrBet Addr€ss
440 VJt* llruiq
cnv I strat€ I zio coo"/grnal I hT | $Llo?t
Owner Name (Corporation, lndividual, Public Agenry, or Olher Entity)
/VlaWlY C.ou,rtry S*tcc9 t f Ac ,
Str66t Addr€ss
3go ulcst Center S*cqf
county DnVlgcitv I sr"r" lzip coa"' TVorrh Sall L^Vt I ,f t quo7(
Phon€ Numb€r (lnclude Ar€a Cod€)
Lqot) Q?t - SEiT
EPA Form 7530-l (Rev. 1 1-98) Eloctronic and paper versions acceptablei I
Provious editions may b6 used whil6 supplles last.t^ ' jl./Pag€ 1 of 5
9EPA Unlbd Strt s
Envlronmental Protectlon Agency
Walhhgbn, OC 204{,0
Notlllcatlon for Underground Storage Tanks
E reoerat Govemment
E g"t"Government dcorr"r.xd
E] r-o""r Govemment E prir","
USTs ale located on land withln an lndian -ReservaUon or on trust lands outside U
rEservation boundades.
USTs ale orivned by a Native American trnaton or tlbe.
Tdbe or Nation wtrere USTs are locatod:
E frucringffransport
E utniu".
E Residential
fl r"-
d cas statlon
E P"t ot*,, Distributor
E nirroi(Aidine)
E nircrait O,vner
E mto Deatership
El n"im"o
E feOerat - Non-Mititary
El reoerat- Mititary
EI tnd*tri.t
E cont"ao,
Dc,rrri5 R;J:I
Job Title:
f,adronw,*4 XBe vJes+ Qnt<c St.
Phone Number (lnclude Area Code):
G't) 1sc'csSz
have met the financial responsibility requirements (in accordance with 40 CFR Subpart H) by using the following mechanisms:
Check All that Apply
E s"r tnrr."n."
E commer<;ial lnsurance
E ni.r Retention Group
E Guarantee
El surety eono
E tetterof Credit E Otno U"ttrod (descrtbe here)
E lo""fGovemmeotFinancialTest E eonORailngTest
I ceflify unde penally of law that l.have personally eremined and am familiar with ths information submitted in Sec{ions I through Xl of this nolmcafion formand all attached documenb, and that based on my inquiry of those individuals immediately responsible for obtaining the informition, I believ6 that th6
submitted information is truo, accurato, and complete.
Name and ofiicial title of own€r or owne/s
authorized r€prosentaWo (Print)
{!\arts Ch"ir*,o$eq
eaul. Comflla^{c Offccr.
EPA estmates publlc roporting burdon hr thb bfm b av6rag6 30 mlnutos per rsspons€ lncludlng ume for revlewing instructlons, gatherlng and maintaining the data need€d end
of thb nofrlcatm to{m imy be usod while suDDll€s hst
EPA Form 7*ll).t (Rou ll-9E) Ebcfonb end paper versions a6ept8bl6.
Prevbus editiom may be used whlle supplie3 le3t
Page 2 of 5
9EPA Unlbd S-bb.
Envlronmental Prctectlon Agency
Wr$hgbn,OCa).q)
Notlflcatlon for Underground Storage Tanks
Tank ldentifi catlon Number
1. Sbtl.ofTank(checkonlyone) CunentlylnUse
Temporarily Closed
Permanently Closed
2. D.to of lnrtalldlon (month/year)
3. ElUmatod Total Gapaclty (gallons)
4. llaterlal of Conrtnrctlon (check all that apply)
Asphalt Coated or Bale Steel
Cathodically Potected Steel
Coated and Cathodically Protected Steel
Composite (Steel Clad with Fiberglass)
Fiberglass Reinforced Plastic
Lined lnterior
Excavation Liner
Double Walled
Polyethylene Tank Jacket
Concrete
Unknown
lf Oher, please specfi here
Check box lf tank has ever been repaired
5. Plplng talerlal (check all that apply) Bare Steel
Galvanized Steel
Fiberglass Reinforced Plastic
CoPPer
Cathodically Protected
Double Walled
Secondary Containment
Unknown
Other, please specfi
6. Ptplng Typo 'Safe'Suction (no valvo at tank)
(Check all that apply) 'U.S.'Suction (valve at tank)
Pressure
Gravity Feed
Check box ll piping has ever been repaired
Tank No. I
{d
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
d
tr
tr
E,d
tr
tr
tr
tr
Etd
tr
tr
tr
Dtd
lctl8
(,?
dd
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
d
tr
tr
v
tr
tr
tr
tr
?
tr
tr
TankNo. -
tr
B,d
\ ql8
gF
{d
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
d
tr
tr
"d
tr
tr
tr
tr
*
tr
tr
Tank No.
-
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
Tank l,lo.
-
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
EPA Form 75ltGl (Rcv. ll-98) Electronicand paper versions acceptable.
Previous editions may b€ used while supplies last.
Page 3 of 5
\.,\./
9EPA Unltod Stat€s
E nvl ron menffir$egfign Asen cy
Notiftcatlon for Underground Storage Tanks
Fom
OMB No.
Tank ldentification Number
7. Subrtance Cunently Stored (or lad
rtored ln the case of cto$d t nkr)
( Check all that apply)
rank No. -f- I rank No. --L I rank No. l- I rank No.
-
I rank No.
-Gasorine I d d
tr
tr
tr
tr
tr
{
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
Diesel | tr
Gasohol I tr
Kerosene I tr
Heatins Oil I tr
Used oil I tr
lf Oher, please specify here
Ha'ardous Substance
CERCLA name and/or
CAS number
tr tr tr tr tr
Mixture of Substances
Please specify here
tr tr tr tr tr
8. Release Detoctlon (check all that apply)
Manual tank gauging
Tank tighhess testing
lnventory Control
Automatic trank gauging
Vapor monitoring
Groundwater monitoring
lnterstitial monitoring
Automatic line leak detectorc
. Linetightnesstesting
No release detection required (such as some types of
suction piping, emergency generator tanks or field
constructed tanks)
TAtlIK
tr
tr
d.
{
tr
tr
tr
TAI{K
tr
E/
d.d
tr
tr
tr
TANK
tr
a,
*
tr
tr
tr
PIPE I TAI{K PIPE I TAIK
d
tr
tr
?
tr
tr
d
tr
tr
tr-d
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
D
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
trtrtr
tr
tr tr tr tr
orhermerhod alo,v€d by,rr"r"il*flr.n$i{, I tr tr tr tr tr
Please specifo other method here
9. Spll! and Overfll Protectlon
{
Overfi ll devlce lnstalled
Spill device lnstalled
dr
{
tr
tr
tr
tr
tr
tr
tr
EPA Form 75ilGl (Rev. ll-98) Electrcdc and paper vercions acceflable.
Prevlous editions may be used wtrile supplies last.
Page 4 of 5
.-" ..,..-i.-r'.r-d! ria*-;a - -. *. - - &''..
United Stateg
Envlronmental Protection Agency
Notlfication for Underground Storage Tanks
rank No. t I Tank No. ? | Tank No. -3- I rank No.
-
lTank No.
-
1. Clooure or Change ln Servlce
Estimated date tre UST was last used for storing regulated
substances (montlVdayfear)
Check box if this is a change in s6rvic6
Estimated date tank closed (month/day{par)
(check all that apply below)
Tank was removed from gnound
Tank was closed in ground
Tank filled with inort matsrial
Describe the inert fill material here
Slte Arse$menl
Check box il the site assessment was completsd
Check box if evidence of a leak was detected
t/,^i '
tr
cl; {,t
d
tr
tr
tr
tr
a lEf ,t
{
tr
tr
tr
tr
\1fi l"l
tr
b/q/ot
d
tr
tr
tr
tr
lnclallsr Of Tank And Plplng Must Gheck Al That Appl$
lnstaller c6.tifi6d by tank and piping manufac{urers
lnstaller certified or licensed by the implementing agency
lnstallatlon inspec{ed by a registered engineer
lnstallation inspocted atrd approved by implementing agency
Manufac{ure/s installation drecklists havo boen comploied
Anothor method allowod bv State agency
lf so, Pleaie sPeciff here
tr
tr
tr
tr
tr
D
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
Signature of UST lnstaller Cediling Props lnstallation of UST System
EPA Form 753G'l (Rev. ll-98) Electronic and paper ve6ions acceptable.
Provlous editions may be used wttile supplies last
Page 5 of 5
UTAH UST PHOGRAM
Permanent Closure lnsor
Facility lDNo.loooo/{
n
l. Ownershio of Tank(s)[. Location of rank(s] / ht"
o*n",*^*" Mave, ) k Grfr,, g"oZ,Facility Name M.,, ,e r) kooo'""' tgo ,v"rf c -to / .d .f
citv S.L r- state qf ,,pffiof,V l|'""'ooo'""" qqo \n/.sf /vl"r;\ s+..f
citv ur .n, / state aJ- ZiP code ou. *
Area Code Phone Number Contact Persontot q?A- s.tr>Srtto,
_ residential giindustrial/commercial Other
TANXS eLOAEO Tank No. J Tank No. 4 Tank No. ?Tank No.Tank No.
1. Estimated Capacity (gallons)12 ooo {Ooo {oan RF \FII
'EN2.Type (Steel, FRP, Composite)ft,1 l*ee I 9*o. I ME JE' V ].JJ
3. Substance Stored fitt e 0.o*. o.qdt JU l2 5 2m2
4. Date last used
<,Uf. b 2-oo a h.h Zrtn')0Eo
4. Date Closed 6 /.r/a t 5/r/ot e /r/os tuluvtrtrEnl
5. How closed (Rmvd, inplace, CIS)[2 ,- -,K. ,^.r/k ^^-/
Orioinal #oftanks ? -Closedtanks 3 +NewtanksA =#of tanksremaininn O
TANK C.LEA}IIHS AIIB EEiIQY,AL:
GW & SoilSampler:Cert. #: GS Expiration Date:
uSr Remover: k;,"^ #e -.ino t^)a\,/ cert. #: TRg g5:/Expiration Date: Ao^ I . 2na I
1. Owner/Operator has
'.)/
an approved closure plan:N Copy of closure plan is on Site: @ N
2. Product removed: @ N By: O - ilo Disposed at: [)* il, M n, no, , {)i, nn*- /
3. Sludge removed: Y (O By : 0 o ll-U
Disposed at:
4. Tanks cleaned: @N By:0u l/,,,Rinsate disposed at: Mu rro,.. O;to,u . /
5. Non-explosive atmospheie inside tank obtained by:
-
Purging X tnerting. LEL or v" (xygenootlneo: m" q Z t 2
7. Tank disposal site:T- Vus* " Verno/ e.soir disposatsite: O;r-frA C-A, L.^Jtil/
IS'ITE ASSESST|ENT: t
PlDorFlDmeterreadings(indicatelocationonthesiteplat'):-
Meter Type:Gain or span:_ Calibration specs:
1. Soil contamination is evident: z(fl N Depth of contaqination: 0 - 3 feet X greater than 3 feet _)a
3.#of samplescollected:-cW JtSoit 2USC 4.CertifiedLab: Mo__7dln S7r/., 4rr r/,r/_;../
s. enatysis trletnoos: ,@ gtex GEID o&c rRH Hoc other:/
6. lnspector observed collection of samples: Y @ lndicate location and depth of samples on the site plat.
7. lnspector collected duplicate samples and submitted them to the State Lab for analysis: y (D
8. Contaminated soil overexcavated: @ N N/A lf yes, confirmation samples were collected: y ft)
t
""tottsign ruu-? : ' .4.1 -- c"r.t* a4-rc Date: r / s,/o z
Distribution: White-DERR, Yellow-lnspector, pink-Facility/Owner Revised 12\95
GLOSURE INSPECTION SITE lD No.
Io [^"/Tr [a*/
location of anv reoorted PID or FID readinos
PotentialReceptors:Distance(infeer)totheneares..
Residences .tC Commercial buildings t C Property tine 5 Active water welt rU4
Surface water /y'A Underground: Sewer -CO watertine 3O Naturatgastine /
Telephone tine UF Etectricat tine Lt r( Stormdrain fZ Other(specify)_
.f
6
o
Dlstribution:White-OERR, Yellow-lnspector, pink-Facility/Owner Revised 5/98
"-: . .^,!,.r:* 4. i.Ji-_\ ,i- 1: -.:-: t .:- -/ {-l- l.'i.1* i
Michael O. Lravitt
Governor
Dianne R. Nielson, Ph.D-
Executive Director
Kent P. Cray
Dircctor
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box lzl48zl0
Salt hke Ciry, Utah 84114-4840
(801) 5364100
[phone] Fax
[phone] T,D.D.
www.deq.state.ut.us I ILE
Apil 17,2002
COPY ERRU-058-02
Mark Christensen
Maverik Country Stores, Incorporated
880 West Center Street
North Salt Lake, Utah 84054
RE: Closure Plan Approval for Underground Storage Tanks (USTs)
Located at Maverik Country Store #142, 490 West Main, Vernal, Utah
Facility Identification No. 900001 8
Dear Mr. Christensen:
The Closure Plan for the above-referenced facility, received by the Division of
Environmental Response and Remediation (DERR) on April ll, 2002, has been approved
subject to the noted modifications, if any. The DERR office and the local fire department must
be notified ?2 hours before beginning closure activities. Local agencies may have additional
requirements for closure or may charge inspection fees. Please be sure the DERR office and
the Tri-County Health Department is contacted at least 72 hours before the closure takes
place.
The Closure Plan Approval is effective for a period of one year from the date of approval.
If closure does not take place within one year, submittal of a new Closure Plan will be required,
unless otherwise approved by the Executive Secretary (UST).
Any change to the approved Closure Plan must be submitted, in writing, and approved by
the Executive Secretary (UST) before implementation. If contamination is suspected or found
during closure activities, you must report it to the DERR at [phone] within 24 hours of
discovery.
Enclosed is a copy of the Closure Notice form, which must be completed and submitted
to the Executive Secretary (UST) after the closure is performed. Please submit the
environmental and Unified Soil Classification sample analysis data and Chain of Custody forms
with the Closure Notice as soon as possible, but no later than 90 days after tank closure.
\-,\./
Secretary (UST)
Haiardous Waste Control Board
Facility ID+t 9000018
Page#2
If during upcoming Flgsgp activities, it appears that a confirmed petroleum release has
occurred, then the conditions, as e{plained in the attached notice, may apply to your site
provided all the applicaUle tules dnd n0gulations are complied with.
If you have any questions, please contact William Moore at [phone].
KPGAfrIEIWhSp
Enclosure
Joseph B. Shaffer, M.A., M.B.A., E.H.S., Director, Tri-County Health Department
John Harlan, John Harlan Construction
UNDERGROUND STORAGE TANK CLOSURE PLAN (rev. 10/04/99)FAcrlrry !D# 9 OoOo lg
Closure Plan prepared at the request of the owner/operator (identified betow) ov /l/lA,fk C lrct shn<U
A Contractor may prepare this Closure Plan as the owner/operator's agent. ln preparing the Closure Plan, the Contractor
must act with the owner/operato/s knowledge and approval. The owner/operator must sign the Closure Plan.
This Closure Plan is submitted in compliance with the requirements contained in 40 CFR 280 Subpart G and R311-204
(u.A.c.)
FACILITY INFORMATION
Tank Owne, (WAvCck Cr"n\u S*"rrc I phone # (Tot \ qgb - ?ES 7,,
[ ] sole proprietorship [ ] partnership [Xlcorporation
Address ?to \"Jrl* cxnJ<c S*rtt*civ fi)orh Sil* Loh state tl7 zip a4o5/
of(companyn^e1 /l4avffik Cpnt^fiV Shas,Tac. phone #(got\ q36-Sss7
Address nTo u)ett kn*tc C*u+ ( ciry Nor'rh <.1] hle State UT zip 8.{osi/
Facirity name (Ylau$iY c,.,n+rv S#Q, # t4?
ooor"r, 4qo GJtq+ Moirl ' city \,/e rnal state [lT zip tYo78
contact o"rron Dronis P,liat phone # (Xo\ \ q%'€Ss 7
Total number of regulated underground taiks at this site 3
Received
LHD Approved
mailed to State
Total number of regulated underground tanks at this site to be closed
TANKS TO BE CLOSED
Tank #I ?3
Type (Steel,FRP,etc.){'lte I
Date lnstalled w8
Capacity 17K qY 8F
Substance stored'Nt-?rru f\jL Arr I tuut
Date last operated
Removed/ln Placel
Chanse in Service?knno,l,;fl
' lndicate the specific substance stored in each tank to be closed (regular, unleaded, diesel, waste oil, etc.)
For waste oi! tanks: Have degreasing or other types of solvents been stored or mixed with the waste oil?
Yes (identify if known)No_ Not known
Analysis for lead or other contaminants may be required priorto disposal of contaminated soil or other material. (Check with
your disposal facility.)
. Review/Date YKA U I l2-l o
TANK REMOvER Name Sohn [|r, tlo n Cert. # rR Ool O exo. aae 7f tf,f oS
Company Joh( l{rr [n,\ Con:*r,^o*io r,l phone #(q35 ) ,lB - ?%s
Address ?.0.6"Y tott City /crnrI State-lzll zip S{07 8
SOIUGROUNDWATER SAMPLER Name Cert. # GS o r{tr
=xp. aate bft 9
phone#(got | 156-sss7
9go L)as* Ctr*p e S+cect
)
Company
Address City State f zip 84oSq
Before the closure plan is submitted for approval, the local health and fire departments where the facility is located
must be contacted. lf the facitity is in Beaver, Carbon, Emery, Gaiietd, Grand, tron, Kane, Satt Lake, San Juan, Wasatch, or Washington county
contact DERR (UST) at [phone] instead of the local health district You still must contact the local fire department in these counties.
coNrAcr LocAL HEALTH DrsrRrcr Name or Dist. Tl,- Co-n+.{ (lr t+h oate 1f I f oa
contact l\trcl^ B co,^rn ' Ti l"
-Pho*
# Qyffils
CONTACT LOCAL FIRE DEPT. Name of Dept. Co',"U[ Rr.il,ftt fn.fe.tf""s oate-IJ8Jo-:l-
contact Do^ Alon, p Tiue phone *(_{fS) 1tr. 6ta{
DISPOSAL INFORMATION
Tank(s) will be disposed at: Facility LCqt f SCrop
466r"., (ratl So"r l^ 'tSoo En:t city U?rhe ( state_ltT_ zip Stlo?8
Contactperson Horry EscC Phone#(q9s)?81-EltT
Product lines will either be: X removed or
-
cleaned, secured in place, and capped.
Vent lines will either be: X removed or
-
cleaned and secured open.
As abotzPiping will be disposed at: Facility
Address City.
Contact person
State_ Zip
Phone # (
Phone#(gol \ qlb'E567
Phone # ( )
Tank(s) will be emptied by: company
Tank(s) will be cleaned by: company
Contaminated water in the tank/rinsate will be disposed at: Facility To\rr,, [krtr"^ (ou,,st: w>t4oa
Contact person Tohu,,,$a.l^,n Phone n, {lr r f)$- zoE3
Tank(s) will be: purged o, * rendered inert by the following method:
Residual sludges will be disposed at the following taclfity: 5o\r\ krtq\ Cr.^fu;ct{f a
Address /r< aLo.le City
Contact person
State_
Phone # (
Zip.
)
[ ] Approvarfor in-prace crosure n". o"" *-"n,.
Fire Dept.Phone#_ Contact Date
[ ] Approval for in-place closure has been granted by the Local Health Department.
Health District_Phone#_ Contact Date
co*ror,*or=o ruer=*,ots trusl= olsposeo o, ott occeptlrte rl^-,r",
All materials generated from UST closures must be managed and disposed in a mannerthat does not place those materials
in direct contact with the environment. On-site stockpiling of contaminated soils may be required prior to any soil
management activities. Any person providing remedial assistance for a fee, including aeration and over-excavation (of more
than 50 yd), must be a Certified IJST Consuttant.
Contaminated soils generated as part of tank removal are to be disposed at the following facility:
Address tl,ot E Soo AJ City l)t t n.l
State Ull-o?Contact person Phone # (935\791- 6ot 8
SITE ASSESSMENT
A site assessment must be performed for all UST closures and change-in-service. Site assessments must be
performed as outlined in 40 CFR 280.72 and R311-205 (U.A.C.). lf contamination is suspected. additional samples
must be collected at the location where contamination is most likely to be present. lf oroundwater is encountered.
a soil sample must be collected. in the unsaturated zone. in addition to each groundwater sample. Soil and
groundwater samples must be analyzed for the compounds shown in the following table, using appropriate lab
methods.
A. Dual column confirmation may not be required for TPH & BTEXN/MTBE analysis.
B. A micro-extraction or scale-down technique may be used for aqueous samples.
C. Hexane may be used as an extraction solvent.
NOTE: The sample preparation method and any modification(s) to a certified method must be reported by the laboratory on the
final analyical report.
2 Methods or test procedures allowed for Oil and Grease (O&G) or Total Recoveiable Petroleum Hydrocarbons (TRPH) are 5520(b) or 5520(0
respectively.
Complete the Facility Site Plat and Sample lnformation Table on pages 4 and 5 to provide site assessment
information.
CONTAMINATION I NFORMATION
lf contamination at the facility is susoected or conf irmed, the information must be reported to the Executive Secretary (UST)
at [phone] within 24 hours. The Division of Water Quality must be notified at [phone] if Free Product is
encountered or if surface water has been impacted. lf contamination is confirmed, any person assisting in the remediation
process for a fee must be a Certified UST Consultant.
Contaminant Compounds to be AnalyzedSubstance or
Product Type
Soil, Groundwater
or Surface Water
Total Petroleum Hydrocarbons (TPH); 4g! Benzene, Toluene,
Ethyl benzene, Xylenes, Naphthalene, (BTEXN) and MTBE
EPA 80158 t and EPA
80218 ' or 82608
Total Petroleum Hydrocarbons (TPH); 4{ Benzene, Toluene,
Ethyl benzene, Xylenes, and Naphthalene (BTEXN)
EPA 8015B and EPA
80218 or 82608
EPA 1664 or 5520 2
and EPA 8021B or
82608
Oil and Grease (O&G) or Total Recoverable Petroleum
Hydrocarbons (TRPH); and for Benzene, Toluene, Ethyl-
benzene, Xylenes, Naphthalene (BTEXN) & MTBE; and
Halosenated Volatile Orsanic Comoounds (VOC's
Oil and Grease (O&G) or Total Recoverable Petroleum
Hydrocarbons (TRPH)
EPA 1664 or 5520
Total Petroleum Hydrocarbons (TPH); and Benzene, Toluene,
Ethyl benzene, Xylenes, and Naphthalene (BTEXN); and
Volatile Organic Compounds (VOC's)
EPA 80158 and EPA
80218 or 82608
I The following modifi'cations to these certified methods are considered acceptable by the Executive Secretary (UST):
The site plat niust be drawn to an
ln tanks, and other relevant lrrlon
given on p. 1 and 5 olthe Closure P.,l{t.
Facility lD #{Oooo lt Drawn By Dr.[ Ur/risr (n bo r ^DatE-
1I
NORTH
f(t grlg\,{[ qi+e
Scale: .1
= -[Feet
?[,or.o tr.f (
\.
X = Sample locations (SS-#, WS+' USC+)
e = Monitoring Wells (MW-#')
O = Soit boring (SB-#)' or Geoprobe Boring (GP-#)
| = Water Wells (donrestic, livestock' etc.)
Stope of Surface Topography: (N,I{!V,W'SW|'S-E'F NE)
Land Use At Site:
-Residential -Comnrercial
Industrial
S urroundi ng Land:
-Res
identiat
-Commercial -Industrial
Site Plat Must Indicate Approxlmate Locations Oft
y' Current & former tanks, piping & dispensen
y' Location of all samples to be taken
y' Buildings, fences, & property boundaries
/ Utility conduits (sewers, gas, water, storm drains,
electrical, etc.)
Sample *Analysls method(s)'
Itlt ss - t
l,{t gs - {
ASAMPLE INFORMATION TABLE
Complete table for allsamples to be tqkr...lorclo60ie.
Soil (SS), Groundwater (GW), or Unilied Soil Classification (USC)'
Approx. depth in feet betow irade. ttre required minimum site assessment samples must be taken at 0'2 feet below the backfill/native soil interface'
Contaminant compounds to be analyzed for each sample (from table on p' 3)'
Appropriate analysis methods for contaminanl compound(s) in each sample (from table on p' 3)'
1
2
3
4
Approximate depth to groundwater in the vicinity of the tanks: t feet.
Regional groundwater flow direction:Ssa
State Certified Laboratory to be used:
Address t(rt(5 LJ<f Jloo (o,^Th citv gtlt Lak-
Contact person Phone # (4ol \ 471' 0o5o
please explain any unusual or extenuating circumstances expected regarding the site assessment or closure:
( 0lrfrr,.,. oL,(r - t
UI
! certify under penatty of law that I am the owner/operator of the tank(s) referenced above and that I am familiar with
the lnformation on this lorm and that it is true, accurate and comptete, and further, that the procedures described
herein will be followed durlng tank
Signature of tank owner
Full Name of tank owner
ln
t,"r" (41 zip
re.
oate 4 (tof ,7
-H*;?Mll-2ot) -l
wrsl {''oT'
BUITDING
Iw-Jo
PRODUCT
ASPHALi
urY-5o
N0TE: LOCATIONS ARE APPR0XIMATE
EXPLANATION
MONIIORING WELL LOCATION
ESTIMATED GROUNDWATER
FLOW DIRECTION
:ll: :.i^- ,/
",'a-lL
LOcAil0Ns
LrJttJu.
U)
z
MW-{
DISPENSER
ISLAND
CONCRETE PAD
North
SCALE IN FEET
urY-2o
,
T-------'',ItUSTIL-_____-lT------
--____J
Ll !:l---r
VENTS
MAVERTK #142
SUBSURFACE INVESTIGATION
FIGURE 3
-{-{-s- NATURAL GAS t_rtrrr
tllmefifiGoumy
Smrcshc Maverik Country Stores Inc.
Phone: [phone] xl22
FAX: (80r) 936-1406
e-mail [e-mail]
Tuesday, June 5,2001
BiIl Moore
Utah Department of Environmental Quality
168 North 1950 West
Salt Lake City, Utah 84114
Re: Compliance of Southern Utah Maverik Stores
Dear Bill:
RECEIVED
a,
DEO
Hilr0morltal Eosgonso & Romeolaho
I have listed below several sites under your jurisdiction that required additional
information to maintain compliance with Federal and State Rules and Regulations:
Vernal #142 (FID #9000018)
1. A three year Cathodic Protection Test is enclosed.
2. An annual functionality test on the leak detectors is not enclosed. I wilI send this to
you as soon as possible.
3. A copy of the System, tank, and leak test setups is enclosed.
St. Georee #229 GID #6000471)
1. A 0.2 gph montNy leak test on the lines since its changeover is enclosed.
St. Georee #241 (FID #6000193)
1. A 0.2 gph monthly leak test on the lines since its changeover is enclosed.
St. Georee #242 GID #6000194)
1. A 0.2 gph monthly leak test on the line since its changeover is enclosed.
Hurricane #243 (FID #6000192)
1. A 0.2 gph monthly leak test on the lines since its changeover is enclosed.
St. Georse #261 (FID #6000696)
1. A 0.2 gph monthly Ieak test on the lines since its changeover is enclosed.
1 -\
I hope this satisfles your request for additional compliance documentation for the above
sites.
If you have any questions or concerns, please call me.
Sincerely,illilw
Mark Christensen
Environmental Technician
Compliance Ofiicer
a
Veeder-Root Site ID:124400
Alternate Site ID:142
Site: Maverick Country Store
490 W. Main
Vernal, UT
84078
Period: 0U0112001 to 0610412001 Customer: Maverik Country Str
880 West Center Street
North Salt Lake City, UT
840s4
Report Created: 0610512001 04:50 PM
In-Tank Results
Line Leak Detection Results
Line Product
1 UNLEADED 12K
2 PREMIUM
3 UNLEADED8K
1 UNLEADEDl2K
2 PREMIUM
3 UNLEADEDSK
1 UNLEADEDl2K
2 PREMIUM
3 UNLEADEDSK
1 UNLEADEDl2K
2 PREMIUM
3 UNLEADED8K
1 UNLEADEDl2K
2 PREMIUM
3 UNLEADEDSK
Tank
I
2
3
1
,
3
1
2
3
I
,,
3
-t
",
3
Date
01-31-2001
01-31-2001
_0.L-1s"2001---
Results
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Results
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Product
UNLEADED 12K
PREMIUM
UNLEADED 8K
Test Tvpe
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 cPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
Test Tyne
0.1GPH Annual
0.1GPH Annual
0.1 GPH Annual
0.1 GPH Annual
0.1 GPH Annual
0.t GPH Annual
0.1 GPH Annual
0.1 GPH Annual
0.1 GPH Annual
0.1 GPH Annual
0.1 GPH Annual
0.1 GPH Annual
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
UNLEADED 12K
PREMIUM
UNLEADED 8K
UNLE'ADED 12K
PREMIUM
UNLEADED 8K
UNLEADED 12K
PREMIUM
UNLEADED 8K
UNLEADED 12K
PREMIUM
UNLEADED EK
02-07-2001
02-07-2001
.L2^']47:2001
03-0s-2001
03-05-2001
o-tat?Q9_1_
04-05-2001
04-05-2001
04-05-2001
05-24-2001
05-24-200t
05-24-200r
Date
01-11-2001
01-11-2001
0t-29-2001
01-11-2001
01-11-2001
0t-29-200r
01-11-2001
01-11-2001
0t-29-2001
01-11-2001
01-11-2001
0l-29-2001
05-13-2001
05-01-2001
05-01-2001
vEEEDEFI-FI(CD(EDT
Fue I lVfartagert,ent S ervice
veeder-Root company 125 Powder Forest Drive Simsbury, cr 06070-2003 l-goo-gg7_7725
>
l
a
A -. Appiieri
H -. EnrrirormrerrtalE ,Semices, LC.
F.O,8u,18tr
trrr,Ilhh S{067
(&r) s{&?Er6
Wotftd.r _* .0JS_IlrtaTerhd 4-30-ml
RESIJI,TS OF CATIIODIC PROTECTION TESTS USING
A COPPER SUI,PHATE HALF-CMLL
SihAd&rrr:
rfiaYEnm #r42
490 UmST M*IN
VENNAI",IITAE
4IA$$ MEAhIS A RSADING Otr'-.8St mv Otrl BET'TEfi.WAS MEASURED
Ilorcr 6t
ItqII, ul[lsT PART OTLINE
ST]L FANT OTUIVE
PTA.T OTLINE
IBI
ffi1
Tr3
Tr{
Ir5
IXt 6
IFCI Crdtrdic[lrntor{ftrn
Il*str# fi*{01
CmmTT; STEEL TA}II{S AT{D SIEEL PROnUCT LIHETi TmoIEcTgD uIfftr IIITpRassED
(-]uBfir:Ul'. IIETAIJC SWII\IG IOINTS AT PUMP & fJISPHNIIER. .dIJ". TEST pOINTs I]*IIII, sOil.
TpI --9-c4 -.${8, Tpz -1.002 -.981, Tp3 -l.l6i -1.t24,Tp4 -l.ffi -.m, r}5 -1.201 -l.lg7,
1?6 -1.1$.4 .I.tr/?, Tr? -r.m8 -1.026, fFg -.86'/ -.859, Trg...$33 -.9.29, Trrt0 -.9?0 -.961
II:ROM T}IE TOLLOWING EQUIPME${T;
}AfT OTLTNE
r.AnT orunrs
R/T]LEAST i PIS5
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Michael O. Leavitt
Governor
Dianne R. Nielson, Ph.D.
Executive Director
Kent P. Gray
Drector
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box 1,14840
Salr Lake Ciry, Urah 841l4-4840
[phone] Voice
[phone] Fax
(801) 536-,t414 T.D.D.
TO:Mark Christensen
Maverik Country Stores Inc.
880 W. Center St
North Salt Lake, Utah 84054
DATE: 3l2ll20ol
FROM: William Moore
tll
t2)
t3l
RE: NON-COMPLIANCE OF UNDERGROIIND STORAGE TANKS AT MAVERIK #142,490
W MAIN, VERNAL, UTAH; FACILITY ID# 9000018.
To continue to maintain a valid Certificate of Compliance, the facility must be in compliance with Federal and
StateRulesandRegulations. AninspectionofyourfacilityonFebruary2T,200l,andareviewofourrecords
has shown that the following information is lacking:
Your last Cathodic Protection Test on your Impressed Current System on file was performed
6130198. Therefore, ensure another is performed on or before 61301200I and submit to DERR.
Submit a copy of an annual functionality test for proper operation of the Yeeder Root Simplicity
Electronic automatic line leak detectors on the pressurized lines associated with the three
UST(s), performed within the last year. PCS has been doing on your other sites using Simplicity.
The inspection documented you are using a Veeder Root TLS-350 Simpticity Automatic Tank
Gauging (ATG) System using CSLD Test Mode to monitor the Tank portion of the USTs, since
January 2001. However, the following Problems have been documented in you use of this system:
Submit a copy of the System, Tank, and Leak Test Setups for the Tanks and Lines.
The Line Leak Detection does not indicate passing 0.2 or better tests for February 2001.
There are no 0.2 or better tests for the Tanks for January 2001.
The above information must be submitted to this office by 613012001. If it is not received by the date
specified, we will commence the revocation process of your Certificate of Compliance. Continued non-
compliance will result in the fees on your Certified USTs to be increased from $75 per tank to $ 150 per tank
and failure to pay the additional fee can result in lapsing of your UST Certificate of Compliance. If you have
questions concerning this matter or need any assistance, please contact William Moore at [phone].
a.
b.
c.
c
UTAH UST PROGRAM Facirity ,r11o.?Og"qOl8
Release Detection lnspection Checklist
I. Ownership of Tank(s)l!. Location of Tank(s) t' *
o*"".*","
/i,t +ttq rt K fn,, , -[n,,,f{ort.l FacilityName
/\^\A^,i€nr K + t f:.ooo'"" &f,O ,.., C, ^J*" ' *.,i,^1::. ^/fi U /vta i^ ,fT
lnlN'-*k .Ioff" hat(t Zip Code trrtnrv citv r/en.^.f stateu- Zipcode ?q0Td&{o,le'dde Phone,ryt4rY- f9l -
Number
?.7L . 5St7 E* /1-2-
countY U ,.n{,r. h
Contact Person At UST Location Phone #Certificate of Compliance on sitef@ No Certificate y""r, 2 erc I
lll. Tank lnformation Complete for each tank. lf facility has more than 4 tanks, complete information for additional tanks on separate form.
Number of tanks at facility:Tank 1 Tank 2 Tank 3 Tank 4
Current year tag is displayed @d No a'fE9 No /qd No Yes No
Tank presently in use fds ) No dE No
^q
No Yes No
lf not in use, date last used
lf not in use, depth of product in tank (in inches)
Month and year tank installed iqr0 /qrD /qrD
Capacity of tank (in gallons)/2L Y r r K
Substance stored /-, A)(>.+t C>*J
Material of construction of tank (steel, FRP, etc.)I s7!-^+)/
Material of construction of piping (steel, FRP, etc.).fr 9r ST
Piping type (pressure, suction. gravity, etc.)Dr'0f af
tV. Release Detection For Tanks lndicate the method(s) used for each tJnk. Complete the {ppropriate checkfisffor eaoh method used.
Method used (enter method used and complete appropriate form)476 4T6 47-la
Emergency Generator tank (leak detection deferred)
V. Release Detection FOr Piping lndicate method(s) used and complete appropriate tank checklists where applicable.
Method used (complete separale form where applicable)
Automalic Line Leak Detector type and model ,€e D /C.L'Z<)
Date of last Leak Detector performance test t -/l..al rt-tl.-/\l / -1q-n I
Test result (pass/fail)o&vl "4/r.,|.'J .O/+.4-i
Date of last Line Tightness Tesl 't-24- o /' /-2 4-o t / -t4- ot
Test result (pass/fail)P+s t Dnr/o4sl
Name and company ol certified tester ,$p fie ) *tt//rotne,afr/ -t?,.r,ief _{/vl Cert. No. UT O /2 /
No leak detection required (must answer "yes" to all questions below)
Operates at less than atmospheric pressure Yes No
Slope of piping allows ALL product to drain into tank when suclion is released Yes No
Has only ONE check valve, located directly under pump Yes No
Above information is verifiable; use comments section below to document how it is verifiable Yes No
Comments:
ic rL T/o/68' j -'"{rr[ that I have inspected the above-named |acitity o" J -tJ - O /
lnspector's Signature:Date:
(monlh, day, year, time)
J 47-O /
Signature of Owner or Owner's Representative Present During lnspection: f
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner LDchecklist.wpd 2/99
UTAH UST PROGRAM Facnrty r,xo. ?0gOo /8
Automatic Tank Gauoinq
Manutacturer, name and modet numbe , ot "y.t ^, EuCo r+tp *ul {/il - 7/a0
Plaase cirele Yes or No lor each questlon for each tank
lf taelllty has morc than 4 tanks, complste lnformatlon tor addltlonal tanks on separete torm.
Tank 1 Tank 2 Tank 3 Tank 4
Device documentation is available on-slte (e.o.. ownar's manuall-G Yes )ld Yes -il6 Yes W Yes No
Records on sate document that the system was properly instaled and calibrated
(system and tank setup report).
a Yes X Yes ,X6 Yes y Yes No
System is maintalned in accordance with manufacturer's inslructions (rccords are
available on site).
G Ves ,DG Ves ,Xd Yes yd Yes No
The probe is tocated at rhe cenler of the tank. !l no, Indicate tllt corectlon ,r* nffi
the tank setup report.
Yes @Tlli:
Yes @
Tllr:
ves @Tilr:
Yes No
Tllr:
Devace can nleasurc the height of the product to the nearest il8 of an inch d"a No ffi) No 6A No Yes No
Device monitors the in-tank llquld levels over the lull range ol the tank,8 internal
helsht @No @No -Yes \ No Yes No
A monltoring box ls present and there ls evidenco that the devlce ls worklng (i.e.,heO
devlce ls equipped wlth roll of oaoer for resulls documentatlonl
Yee .y Yes y{Yes jtd Yes No
Documentation is avallablo demonstratlng that the Automaflc Tank Gauge prtormeaA
a valid leak test at loa3t once a month tor the last 12 months
Yes @ Yes @ Yes @ Yes No
lf no, for which months was a valid test not portormed? (speclfy months and year, use
space below if necesaary)
2./oo's/oo 2/@,3/e
.t ./ttt
z/ao' s/oo
t / at
The tank was filled to at Ieast the minimum level requlred by the manufacturer's
equlpment protocol to ensure a valid leak test
a Yes / No Yes / No Yes /No Yes No
The tank capacity ls wlthln the upper and lower slze limits requlred by the
manufacturer's equipment protocol to ensuro a valld leak test @No @*"@No Yes No
Have any of the leak test reports indicated a lalled test? tf yes, speclfy ln the space
below the month, year, and what follow-up actlons have been taken.
Yes @ Yes @ Yes @ Yes No
Documentation of perlormance claims for tho automatlc teak test reature ls available
and shows the ability io detect leaks of 0.2 gph wlth 95% or greater probabllity of
detection and 5o/" or less DrobablliW of false alarm (3rd Dartv certlflcrilonl-
@Ho @*o e) *o Yes No
lndicate month(s) ol invalid or massing test:
lndicate month(s) ol any falled test:
^.{ro,^,r{ *1t
f 7 ;4.'/,
.rrto * f 4.*,,Oc-/ tr/ar/ )e<2coo
Tei Ean/lt / ,tJ /yo/To<a/rttfr*< f S;uo4.
l)rlv\?r/ ",t/KrtOt l,{ (5a r*Tnc4ry€.y7
Tat4J ,+re /.o n7 e:- Ay*r/*s/e . Et/€l/,'"E /o/.1 6 €^/co.?/ -
ASI .ft llJo AttAL|*al ARe -1_+Esr Ral " tlS
lnspector's
Signature of Owner or Owner's Representatave present During
r(!)
Dlstrlbutlon: WhlteOERR, yellow.lnspector, plnk-Faclllty/Owner R.vbcd A8\gg
UTAH UST PROGRAM Facility lD
SPill, Overfill, and Corrosion Protection lnspeqtion Chectilist
Please complete all intormation for eac-ll tank. Use additional torms as nec€ccary it the facillty tr"" ,rr. it "il tar*".
-ETITILL TrIE,YEII I IL,N
Tank 1 Tank 2 Tank 3 Tank 4
ls the UST system is filled by transfers of 25 gallons or less? lf yes, spill
and overfill prevention is nol required.Yes @ Yes @ Yes @ Yes No
ls there a spill containment devir
lhe environment? lndicate type:
Containment sump at tank fill.
ease of product into
ill bucket >5 gal.,@No @) to @.) No Yes No.
ls there an overfill prevention device installed on the tank? lndicate type :
ffi:ffi
(in vent line), AutorQaliTfficitrmDe), Alarm, or other @No Q9 No (g No Yes No
For overfill alarm only: ls the alarm located where it can be easily seen
and heard by ihe delivery driver?Yes No Yes No Yes No Yes No
For overlill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?Yes No Yes No Yes No Yes No
CORROSION PROTECTION
Tank I Tank 2 Tank 3 Tank 4
lndicate the type of corrosion protection: Non-metallic (NM), Composite
steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacrificiat Anode
(SA), or Not protected (NP).
Tank/c Tank
/.
Tank/c Tank
Piplng/c PipinO
/a Plping/c Piping
lndicate the type of corrosion protection on Flex connectors and/or Swing
joints: Booted (B), Total containment (TC), Not in contact wilh soil or
water (NC), Cathodically protected (CP), Non-metailic (NM) and Not
Protected (NP)
Sub-Pum9iL ""o.rjz Sub-PumpiL Sub-Pump
Disp6nsrlr Dispenser/c Olsp€n$r
IO Oiamnset
rf tank or piping has been Tank lining
upgraded, indicate date Tank cathodic protection
upgrades were performed:
Piping cathodic protection
CATHODrc PEOTE{'TION,?ESTS fiscErd resukof the mqrt*eoaot.sanoaUt Ae r,lest., Reeord*lrelO**t'iffi
The results of the last two cathodic protection tests are available. (within
6 months of installation and every 3 years thereafler).Yes No Yes No Yes No Yes No
rank. rester- , r^,Date AIZ:lq<volts volls volls volts
Pipins. r""r", 0il4'\' ,^" 6lfl19(volls volts volts volts
Flex. Tester Date
Sub.Pump
volts
Sub-Pump
volts
Sub-Pump
volls
Sub.Pump
volts
Disp6n$r
volls
Oisponsr
volls
DlsF@r
volls
Dispen$r
volls
For impressed current system: The results of the last three equipment
operation checks are available. (Equip. check required every 60 days.)@) No @No @No Yes No
Comments:
O
lnspector's Signature: A.
'L/
/-,-
Signature of Owner or Owner's Representative present Durinq lnspection:
i'ri-:r,*i-'t I
Distribution: White-DEFlR, Yellow-lnspector, pink-Facility/Owner
Ldspillover.wpd 2/gg
1
ilIilorfiGormy
mrcsha Mavorik Cnunlry StorgN trtc.
Phoae: (!01)9f,{66? r12x
FAX (80r)9:r6.140e
6ln!il: mdrrlstenson@Et{v?rik.Corn
Famimile
to:
@Fax:
From:
Datc:
Re:
Pages:
Rick,
I have been out of the office for the past several days. Howcver, I did get your rlessage.
Encloscd you will find Encompass Automatic Tank Gauge results from April through Dec:mber 2O00
The Encompass System was not tcsting January through March 2000,
A Veeder Root ATG has beon rnstalled at this site in January 2001. You will find January and
February tank rhd linc leak detection results.
The lmprossed Current Cathodic PrOtection System Rectilier readingi can be oi,tained at
tha rndividual storss, lt you have any question or concerns, please give mc a call.
Sirrcerely,
rts-J
Rick Hallmark
435 722 0t43
l\'lar'k Christensen
Tuesday, February 20, 2001 @ lC:4IAM
Vernal lnspection
4, including this
I,IAR I 9 2001
Mark Christensen
Environmental TeC h aicia n /
Compliance Aficer
enclosures
I ""t'I,,,,,,,RoNMEr,llAL i?ESP0Nsl g iiIfili1] i;' i r'''i'
I ENIIRED
10'd 60 r-l 90, i 988 108 '3it 's3uols lxlilnm )itut^Yfi-urorl 9t:0r 10-02-u0
MAV142
Tank Test History OZI2:O1ZOOI tO:33:O0 AM
1?.91-00 o4:01;00 TANK 1 : Unteaded Reoular12-03-00 03:59:00 TANK 2: FrCmiurn -"
12-92-OO 02:'12:OO TANK 3: Unteaded Resutar
1 1-30.00 OO:54:00TANK 1: Unleideo ReE
1 1.28-0O 03:59:0O TANK 2: premium --
11-27-OO 04:0O:OO TANK 3: Unteaded Requtar1O-27-o0 00:0BrOorANK 3: UnleaiiA ni[urar
L.R. = O.O1 oph
t .R. =0.oo dbh
L.R. = 0,02 gph
L.R^ = -0.03 ooh
L.R. =0.00 oUh
t-.R. =O.oo 6bh
L.R. = o.06 sph
L.R. =O.OO sph
(0.2 cPH)(o.2 GPH)(0.2 GPH)
(CSTT)
(0.2 GPH)
(0.2 cPH)
(0.2 GPH)(o.2 GPH)lO-27-O0 03:59:OOTANK 2: premium
i^*(
PASSED.
PASSED.
PASSED.
PASSED
PASSED.
PASSEf,.
PASSED.
PASSED.1o-27-. =0.O9
O9-25-OO 23:42:OOTANK 2: premiurn ' --
Og 25-OO O4:OO:OO TANK 1: Unteaded Regutar
L.E. = -o.o2 sph
L.B. =0.09 gph
(0.2 cPH)(0,2 GPH)(0.2 cpH)(o.2 GPH)
(csTT)
(csTT)
(0,2 GPH)(0.2 GPH)
(CSTT)
(0.2 GPH)
(CSTT)
(0.2 GPH)
(0.2 GPH)(0.2 GPH)(0.2 GPH)(0.2 GPH)
PASSED.
PASSED,
PASSED,
PASSED.
PASSED
PASSED
PASSED.
PASSED.
PASSED
PASSED.
PASSED
PASSED.
PASSEO,
PASSED,
PASSED,
PASSED.
08-28-OO 02:3O:OOTANK 1: unreadid heiurerOE-27-OO 02:37:OOTANK 2: premium
08-22-OO 22:28:QQTANK 3: Unteadsd ReoO7-O9-00 12:26:O0TANK 3: unreaasd neE07-08.00 O3:59:O0TANK 2: premium
06"27-00 03:59:OOTaNK 2: Prerrium06-27-00 AZA2:OO TANK t: Unleaded Reo06-26-00 03:59:OoTANK 3: Unteaded Hi6urar05.27.00 04:45:OOTANK l: UnriaAed RtE05.26-00 01:53:00TANK 2: premium
()5'??-00 o3r59:0oTANK 3: Unteaded Requtar
o,4-27-OO 03:35:00TANK 1; Unteaded Re6utir
04"26-oc- o2r49:OO TANK 3; Unteaded nsiutir04.26-00 23:43:0OTANK 2: premium
L.R. =-o,06 riph
L.R. =0.04 gph
L.B. = 0.03 eph
L.R. = -0.02 sph
L.R. =0.02 ooh
L.R. -6.62 [i6
L.R. =-O.O9toh
L.R. =0.92 n16
L.R. =-O.Og sph
L.R. =.0.03 gph
L.R.:O.OO g-plr
L.R.:0.04 gph
L.R. =0.OO gph
L.R. -0.00 gph
ftg-J t0/20'd 80 t-l 90t:9t8t08 '3NI S3UOLS rUltlfl0i )lU3AYll-urrrl gtr0t l0-02-10
Page I ofl
Q uor $ffitffiffii$iffi
ilffi
reEEffi nffiffiffiffi[ ffiffiffiruimm ffiffi{irlffiffiiltumt
ItMli $iite Compliance .[tepori
ncportinlPc.iodr i2l200l Curtomo'r Mrvcril l'-ouotry Sc
8E0 W (1111c3 51
Norrh snlr L[kc city, UT
S,l0S4
l'eerter.Rout Sitc lD: l2,l{t 0
Alt rrrrt( Siit. IDi 142
In-Tank Results
I-e.!r.k Produat
T UNLEADEDI2K
2 PREMIUM
3 UNLEAI)ED 8K
Line Leak Dctectlon Rcsults
!..iae Producl
I UNLEADED I2K
2 PREMIUM
J UNLEADEDEK
Sltc: Mavcrick Country Store
490 W. Main
Vernal, UT
84078
D.3!p
02-t7-2001
0,1-07-2001
v2{7-2001
Dr.te
0r-ll-2001
0r.lt-2001
0r-29-2001
TcstBps
0.2 CPH Moathll'
0.2 GPH Monthly
0.2 GPII Monthly
Tcst_IvJtc
0.f GPH Annuil
0.1cPI{ Annurl
0.1 GPH Annual
&errrltr
Passed
Pessed
Parscd
Rssults
Perscd
Pessed
Prssed
r89-l t0/80'd 80t-l 90ri9e8108 '3N! S3XoIS rXlilnoJ )tUl^Yll-uro]j gt:0t t0-02-20
0e-e3-0 r 08:37
n -v()rcri rcDrlri[iti$ :
lI^\rE:fJlU . -r\l l;ar(I/ 13J"11)l::$rVlf iyr;.i\tf . ,rJUurr\I !r. ".rlU-J
3{i0r"'€ ; I i:EivIi-lq
li()HT[i :,. ci,.I lJtl{k,. :JrAl.i t[4064
I
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e
4i
TAHK I,,flSATKIN:
MAr.tI{F, #{42
.tiifi V,,fiSIl{AlN
lrlijrth],qf ... IJI.AH
From-llAVERlK COUiITRY ST0RES. ltlC,1 8019! i .406 T-l18 P.02/C? F-782
,rutipt,u ffi$ p)!il Y$lttN M.H:tu'I'At^ s uavtcBs, Lo.c.
pt) Elilx 'r6it tttov. t fdiH s4lsffr 0s0t {i4{i,.rdi"esi
!"=h.l*-S.y-l[J]h*mdf gg.l-r.,H"!""t$[.L!,,!".S,Jlu'r{:\"rt'
pi:til::fiiiii()N TANK & l-li.l[: "iL,S f Rt :titii.-'l': SiLJMMAHY
Vi nffl{ f}filt}l-.;tl 6 tit0fr8
"lllClllUfil*.$l: {3M
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TIM[: SY$Tfihi I ILLEU Erft 'f$l'ftfiD:
't!"il!{ Iftil!{ Pfifif}rJg'f Tr\hlK Flt"t. YEltIf $rR(}0i.!ff;' !..!trlh t"Hl![t WATEI ! ltrl
.----,--r;Sltztfftv --vAP"ffL-----tHl;--**.llE:[gg-!'({lt- LAltti-".. -"
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I.SHL ($Ilt:!t.
rt r'#f:-arr r t 1L.,.{;ff{f!fjtEl} THCTS${]ffiH $Ki!!AIl,!ftE:;ii.4.?rrfi1
Michael O. Leavitt
Govcmor
Dianne R. Nielson, Ph.D.
Executivc Dircctor
Kent P. Gray
Dircctor
TO:
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box 144840
Salt Lake City, Utah 84114-4840
[phone] Voice
[phone] Fax
[phone] T.D.D.
:ll
Paul Weissenborn, P.G.
Maverik Country Stores, Inc.
880 West Center Street
North Salt Lake, Utah 84054
DArE: ocgbel 1?,]P9',,
-EROM: WiltiamMciore
J
J
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE TANKS AT MAVERIK #142,490
W. MAIN, VERNAL, UTAH; FACILITY ID# 90m018.
Tocontinuetomaintain avalidCertificateof Compliance, thefacility mustbe incompliance withFederal and
State Rules and Regulations. An inspection of your facility on September 22, 1999, and a review of our
records on October 19,1999, has shown that the following information is lacking:
t I ] Document that you have inspected the Impressed Current Rectifier at least every 60 days to ensure
proper operation.
12) Submit a copy of a precision line tightness test for the lines associated with all three UST(s),
performed within the last year.
t3l Submit a copy of an annual test for proper operation of the automatic line leak detectors on the
pressurized lines associated with all three UST(s), performed within the last year.
L4) The inspection documented you failed to obtainEncompass LeakTests forthe #l-12,000 gallon UST
for the months of 9/98 and 8/99; and for the #2-8,000 gallon UST for the monthsof 9198,10/98,
I li98; Ensure a back up Permanent Release Detection method is performed for any month where
you fail to get proper release detection results.
The above information must be submitted to thi s offrceby l2ll9l99. If it is not received by the date specified,
wewill commence the revocation process ofyourCertificateofCompliance. Continuednon-compliancewill
result in the fees on your Certified USTs to be increased from $75 per tank to $150 per tank and failure to
pay the additional fee can result in lapsing of your UST Certificate of Compliance. If you have questions
concerning this matter or need any assistance, please contact William Moore at [phone].
J
ACILITY NAME St tbn: Vernsl #142
TANK
LOCANON
Addrur: 490 lVest Maln
Vernal, UT t40?t
Phono: t0tl7t9-57t7
County:
TANK OWNER
Nrno: Meverlt Couatry Siorce
Addts: tto West CenierSl
North Srlt LeIe, UT t4054
Phono: (t01) 295-5557 f,742
Gounty:
Statistical Inventory Reconciliation (SIR) Monthly Report
Maverik
August 1999
Quantitative Methods:
1' A leak threshold, minlmum detectable leak rate, and calculated leak rate must be provided for each tanlr. If no! then the
tank failed the SIR tesl
2. If the calculated leak rate for a tanl is greater than or equal to the leak threshold, the tanl thlled the sIR tesL3' If the minimum detectable leak rate for a tank is greater than the certified performance standard (02 gph) and the calculated
leak rate is less than the leak threshold, the test is inconclusive for that month.
USTMAN Contact John Hoover
Slgnature (optlonal)Date: aglrctl9gg
SIR Provldcr:USTMAN Irdustrl6,Inc.Phonc: (303) 9t6-mlf
SIR Vcralon:95.2a Roport Dato: Wlt6ll999
Pcrlod Covcrcd:August, 1999 | nqurrco numbcr ol ureblc tnvcnrory dryr p.r rerrk 30
OurnUtrtvc ilcthod Thls [onth Lart llonth Two llonthr
Ago
Tank
Numbcr
Tank
Contcnts
Tank
Cap!dty
Lcek
Thrcehold
Crlculatcd
Lcak Ratc
MDL Par, Frll,
lnconcludvc
Pass, Fall,
lnconcluslvc
Pass, Fall,
lnconcluslvc
OAIJITONA OPE oPg OPE PF!PFI PF!
t2l Unladcd 120r0 0.1 0.01 0.10 x x x
20t Prcmium t020 0.1 -0.tx)o.t2 x x x
322 Midgrede &m0 0.1 -0.03 0.m x x x
Statistical Inventory Reconciliation (SIR) Monthly Report
Maverik
November, 199E
Quantitative Methods:
1' A leak threshold, minimum detectable leak rate, and calculated leak rate must be provided for each tank. If no! then thetank failed the SIR tesl
2' If the calculated leak rate for a tank is greater than or equal to the leak threshold, the tank failed the SIR test3' If the minimum detectable leak rate for a tank is greater than the certified performance standard (0.2 gph) and the calculatedleak rate is less than the leak threshold, the test is inconclusive for that month.
Addrusg: 490 West Main
Verual, UT t4078
Phonc: 80ll7E9-S7Bj
County:
TANK OWNER
Nanrc: Maverif Country Stores
AddEqs: EtO West Center SL
North Salt Lake, UT E4054
Phonc: $ot)295-ss57 f,742
Counly:
USTMAN Industrieg Inc
Requlred number ol usable lnvontory days pol tank:
Ouantltatye Method Thls Month Last Month Two Months
Ago
Tank
Number
Tank
Contents
Tank
Capadty
Lcak
Threshold
Calculated
Leak Rale
MDL Pass, Fall,
!nconcluslve
Pase, Fall,
lnconcluslvc
Pass, Fall,
lnconcluslve
CIAI]LONS OPE GPE GPE PFI PF!PF!
t2t Ualadcd 12010 0.1 -0.05 0.07 x x x
20t Prcmium 8020 0.1 -0.01 0.u x x x
322 Midgrade 8000 0.1 -0.23 0.05 {x x
Monthly Staustical Inventory Reconciliation (SIR) Report
October, 1998
Maverik Country Stores
Quantitative Methods:
1' A leak thrcchol4 mi[imum detectable leak ratg and calculated leak rate must be provided for each tank If no( then thetank failed the SIR test.
2' If the calculated leak rate for a tank is greater than or equal to the leak threshold, the tank failed the SIR test3' If the minimum detectable leak rate for a tank is grcater than the certilied performance standard (0.2 gph) and the calculatedleak rate is less than the leak threshold, the test is inconclusiye for that month.
FACILITY NAME Statlon: Vemal #142
TANK
LOCATION
Addresr: 490 TYert Main
Verual, III E4ffiE
Phone: B0[ngg-'7E7
County:
TANK OWNER
Name: Maverik Country Stores
Address: 880 West Center St
North Salt Lake UT 84Ut4
Phone [phone] x2742
County:
SIR Provlder:USIMAN Indurtrier, Inc Phone: (3(B) 936{011
SIR Version:95.2t Report Date: ,In6frS
Period Covered:October,1998 Required number of usable lnventory days per tank: 30
QUANTITATIVE METHODS
Tank
Number
Tank
Contents
Tank
Gapacity
Leak
Threshold
This Month Last Month Two Months
Aoo
Galculated
Leak Rate
Min. Detectable
Leak Rate
Pass, Fail,
lnconcluslve
Pass, Fail,
lnconclusive
Pass, Fail,
lnconclusive
GALION GPE GPE GPE P F I P F I P F
l2l ,nladed 12010 0.1 0.07 0.08 x x x
201 Premlum 8020 0.1 -0.03 0.11 x x x
322 Vlldgndc 8000 0.1 -0.01 0.05 x x x
John Eoover
Monthly S'-tistical Inventory Reconciliation (sIR) Report
September, 1998
Quantitative Methods:
l' A leak threshold, minimum detectable leak ratg and calculated leak rate must be provided for each tank rf not, then thetank failed the SIR test.
2' If the calculated leak rate for a tank is greater than or equal to the leak threshold the tank failed the sIR tesl3' rf the minimum detectable leak rate for a tank is greaterthan the certitied performance standard (0.2 gph) and the calculatedleak rate is less than the leak threshold, the test is inconclusiye for that month.
Maverik Country Stores
490 West Main
Vernal, UT g407g
TANK OWNER
Name: Maverik Country Stores
880 West Center SL
North Salt Lake UT 84054
Phone: [phone] fl742
SIR Provider:USTMAN Industrier, Inc Phone: (303) 9S6{0tf
SIR Version:95.2a
Report Date: ,J,ng9g
Period Covered:1998 Required number of usable lnventory days per tank:
QUANTITATIVE METHODS
Tank
Number
Tank
Contents
Tank
Capacity
Leak
Threshold
This Month Last Month Two Months
Aoo
Calculated
Leak Rate
Min. Detectable
Leak Rate
Pass, Fail,
lnconclusive
Pass, Fail,
lnconclusive
Pass, Fail,
lnconclusive
GALLON GPE GPE GPE P F I P F I P F !
t2t Jnlcaded 12010 0.1 0.05 0.09 x x x
201 tcmlum 8020 0.1 -0.05 0.05 x x x
322 Vlldgmde 8000 0.1 -0.09 0.09 x x x
Tracer Tight@
Precision
Tank,
Pressurized
Line Tighhess
and
Leak Detector
Test
Certification
Prepared for:
Maverick Counfiy Store #142
490 West Main Street
Vernal, Utah
Prepared by:
John Labrum
Precision Testing Specialist
I I 149 Sandy Gulch Road
Sandy. UT 8.1094
John Labrum
Pre c is i on T esti n g S pecial ist
I I 119 Sondy Gulch Roud
Soniv, UT EJ091
E0 I -J95-2606
E0l-57G9925 fitr
Certification
Date: 05116199
Facility ID: 9000018
ldaverick Cntry Store #142
490 West IVIain Street
Vernal, Li"I 84078
Test Date: 04117199
Test Number 041799-2
Operator: John Labrum
Utatr Certificate No.: UT0148
Pressurized Product Lines
The above location has lsen tested using the ACURITE ru Pipeline Tester (model 00-16102). This
pipeline leak detection system meets all requirements set forth by NFPA 329-87 and USEpA 40 CFR
Part 280 and has received third party certification.
Please see the enclosed Third Party Certificatiol fel dstails.
Tlre rnechanical linc leak detectors at
CFR 280.44(a).
Line Leak Detectors
the above location were tested in accordance with USEPA 40
Unleaded Reg. E
Unleaded Reg. W
Unleaded Prem.
Tokheim
Tokheim
Tokheim
50 psi
50 psi
50 psi
.000
.000
.002
Pass
Pass
Pass
Unleaded Reg. E
Unleaded Reg. W
Unleaded Prem.
Vaporless Mfg.
Vaporless Mfg.
Vaporless Mfg.
LD2000
LD2000
LD2000
Functional
Functional
Functional
Certified f*t*,
^^TRACER TIGHT@ TEST RESULTS
Prepared for:
Shirley Enviro Testing
P.O. Box 219
Nebraska City, NE 68410
Testers St Lic. No:N/A
4n,0199
Job No: 113056
Maverick Country Store #142
490 WestMain
Vernal, UT 84078
SYSTEM#PRODUCT slzE TRACER LEAK STATUS
TAI\IK LINE
Tank I
Tank 2
Tank 3
Unleaded
Premium
Unleaded
12,000
8,000
8,000
N/A
N/A
NIA
Pass
Pass
Pass
c
D
A
Soil permeability is greaterthan 18.2 darcys.
SYSITM#
AT INOCUI"ATION
04117199
H2O PROI)
(in) (in)
AT SAMPLING DEPTH XROM GRADE
O4N5I99 TO WAIER TO TANKTABLE BOTTOM
PROI)
(in)(in)
820
(in)(itr)
Tank 1
Tank2
Tank 3
0.00
0.00
0.00
38.75
34.50
46.38
0.00
0.00
0.00
39.88
31.25
59.13
t27
127
127
132
132
t32
Submiued by:
/e.^^\ h lqL
rtls f lt
lz
Itt f tt
f z' ltt
oA
0rn
0r'1
k"+r{ir c (-e^Jt 1s
3.5 q*p5
tl qrr( s
j a,v^(S
{fuN- e-ee rrJE 9:42 CPS-BILLINGS1
UTA}I TIAI/EHIK STORES
UST CATT{OOIC PROTESTION SYSTEM
SYSIEM ENERGIZAflON
cATTtoDto PHOIECflON S€nWCES
P. A4
#1 Upperht 0.92#2 0.s5#a 0.34#4 0.59#s 1.26
#5 TOP BT. 0.54#? 0.98#E 0.64#9 0.42#10 0.84 J.BOX SHU}.ITS
RECNHEH INFOBMATION
UNI\ERSAL EI.EOTRONICSModel UST ES
SettalNumber 970679
Volts D.C.20 RAflNG
Arnpe D.C.10 MTING
A.G.lnput 12oCoarsc g
Finc 2
MeterVolts
MeterAmps
Ac'tualVolts
ActualAmps
16
7
14,27
7,1 (HEctlflershun$
Michael 0. Leavitt
Govemor
Dianne R. Nielson, Ph.D.
Executive Dircctor
Kent P. Gray
Director
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box 144840
Salt Lake City, Utah 84114-4840
[phone] Voice
[phone] Fax
[phone] T.D.D.
TO:Paul Weissenborn, P.G.
Maverik Country Stores, Inc.
880 West Center Street
North Salt Lake, Utah 84054
DATE: October 19,1999
FROM: William Moore
tll
I2l
t3l
RE: NON-COMPLIANCE OF UNDERGROUND STORAGE TANKS AT MAVERIK #142,490
W. MAIN, VERNAL, UTAH; FACILITY ID# 9000018.
To continue to maintain avalid Certificate of Compliance, the facility mustbe in compliance with Federal and
State Rules and Regulations. An inspection of your facility on September 22,1999, and a review of our
records on October 19,1999, has shown that the following information is lacking:
Document that you have inspected the Impressed Current Rectifier at least every 60 days to ensure
proper operation.
Submit a copy of a precision line tightness test for the lines associated with all three UST(s),
performed within the last year.
Submit a copy of an annual test for proper operation of the automatic line leak detectors on the
pressurized lines associated with all three UST(s), performed within the last year.
The inspection documented you failed to obtain Encompass Leak Tests for the #1 - I 2,000 gallon UST
for the months of 9/98 and 8/99; and for the #2-8,000 gallon UST for the months of 9198, 10/98,
lll98: Ensure a back up Permanent Release Detection method is performed for any month where
you fail to get proper release detection results.
The above information must be submitted to this offtceby l2ll9l99. If it is not received by the date specified,
we will commencetherevocationprocess of yourCertificateofCompliance. Continuednon-compliance will
result in the fees on your Certified USTs to be increased from $75 per tank to $150 per tank and failure to
pay the additional fee can result in lapsing of your UST Certificate of Compliance. If you have questions
concerning this matter or need any assistance, please contact William Moore at [phone].
t4l
UTAH UST PROGRAM
Release Detection lnsoectio
Facility ID
Checklist
/oooo /t
l. Ownership of Tank(s)ll. Location of Tank(s) ".{/\
ownerName /l,quenK Grrrt, Sl.rt Facilitu Name /wAt/€.e/ K
^rrr"""prE;; iST streetAddress 4qo h/. Mz r"t 57-
Citv A t, / State Zio Code' /-frroM nJ utstrlta1 7 3 t ro "'' l,b.rr./ "'^i"J- Z'"Yrtn rn
Area Code tnone,"rrre, -countY o, n/-o- 4
Contact Person At UST Location Phone #{t-lsn^,, l'<-tzc)-=a.e -.t7Qz
Certificate of Compliance on site?[ej No Certilicate year:
ll!. Tank lnlofma{ion Complete brTachtank. ll facility has more than 4 tanks, complete information for additional tanks on separate form.
Number of tanks at facility: 3 rant()Tan@ Tank@ Tank 4
Current year tag is displayed esl No fi".t No Gi No Yes No
Tank presently in use 6$ No f€$ No 6"d No Yes No
lf not in use, date last used
lf not in use, depth of product in tank (in inches)
Month and year tank installed ES*t rr,ta_/</qrc lqR/)/q9 0
Capacity of tank (in gallons)/9. K y/<r/<
Substance stored . rr{yt (>xJ 6nt 6n<
Material ol construction of tank (stee[F*, ]t"] t"-A-T s7-S7-
Material ol construction ol piping (steel, FRP, e!9J-..-'..--"-t ,T <7-5T
Piping type (56@E, suction, gruitiil itc.t Pr<7K ?,<
lV.BeleaseDetectlonForTankshoicae$emettI@.6dft}reachtank.@,ropriatechecklistforeachmethodused.
Emergency Generator tan[ (leak dltection defened)
Method used (enter method used and complete appropriate form)
V. Release Detection For Plplng lnoicate method(s) useo and comptete appropriare tank checklists where applicable.
Method used (complete separate lorm where applicable)
Automatic Line Leak Detector type and model /Z€ A t a. r (P','-t r
Date of last Leak Detector performance test 9-30-qo <J 8- go-c/6 8-30 "ge
Test result (pass/tail)0d/ul nn)/1 odLr
Date of last Line Tightness Test r:70 -q9 ?- zt"qa I tr-a-qQ
Test result (pass/fail)Alnn NUUJ p it4
nameandcompanv otc'nitiedtester fl f kD €flttrr,nutt,a/J t,n/ i/tc(r ffi op )
No leak detection required (must answer'ye6.'to all questions below)
Operates at less than atmospheric pressure Yes No
Slope of piping allows ALL product to drain into tank when suciion is released Yes No
Has only ONE check valve, located directly under pump Yes No
Above information is verifiable; use comments section below to document how it is verifiable Yes No
€T 47- J, /c
'41"A/14,R,havo inspecled the above-named lacility on
lnspecto/s
Signature of Owner or Owne/s Representative present During lnspeclion:
2-
Distribution: White-DERR, Yellow-lnspector, pink-Facility/Owner Revised 2/4/99
UTAH UST PROGRAM
Automatic Tank Gauoin
Faclrty ,r*r. 7c00o t 6
Manufacturer. name and model number oI svstem:€n/C 0 ntp 4 sJ )
Please circle Yes or No for each question lor each tank I laclllty has more than 4 tanks, complete lnlormatlon tor addltlonal tanks on
separale form,
Tank 1 Tank 2 Tank 3 Tank 4
Device documentation is available on-site (e.o.. owner's manual).6) r.ro rG-i No rG) uo Yes No
Records on site document that the system was properly installed and calibrated (system
and tank setuD reDort),@*o @to @No Yes No
System is maintained in accordance with manulacturer's instructions(records are
available on site).
?Yes No Yes No Yes No Yes No
The probe is located at the center of the tank. lf no, indicate tilt correction lactor lrom
the tank setuD reDort.
Yes No
Ti[: -3
Yes No
Tilt: - I S
Yes No
Tilt: A.
Yes No
Tilr:
Device can measure the heioht ol the Droduct to the nearest 1/8 of an inch 6Ho 6) ruo 6) No Yes No
Device monitors the in-tank liquid levels over the lull ranqe of the tank's internal heioht lf€A No 6"; No ,f.3 No Yes No
A monitoring box is present and there is evidence that the device is working (i.e., the
device is equipped with roll of oaoer lor results documentation)@O Ho @No @") No Yes No
Documentation is available demonstrating that the Automatic Tank Gauge performed a
valid leak test at least once a month for the last 12 monihs
Yes flil Yes G)(7-@to Yes No
ll no, for which months was a valid test not performed? (specity months and year, use
space below if necessarv)-B'
Lous
The tank was filled to at leasl the minimum level required by the manufacturer's
equiDment protocol to ensure a valid leak test @No @to @*o Yes No
The tank capacity is within the upper and lower size limits required by the
manufacturer's equipment protocol to ensure a valid leak test @No @No @No Yes No
Have any of the leak test reports indicated a failed test? lf yes, specify in the space
below the month, year, and what follow-up actions have been taken.
Yes €A Yes @ t"" @ Yes No
Documentation of performance claims for the automatic leak test leature is available and
shows the ability to detect leaks of 0.2 gph with 95o/o or greater probability of detection
and 5/o or less probability ol false alarm (3rd partv certilication).
@No eNo @No Yes No
lndicate month(s) of invatid or missing resr, O q -?B , 8-qq @ ? 78, /098. //-?g
lndicate month(s) ol any failed test:
'u-*L
Signature of Owner or Owner's Representative present During lnspection:
Distribution: White-DERR, Yellow-lnspector, pink-Facility/Owner Fevised 12\95
UTAH UST PROGRAM
ll. Overfill. and Corrosion Protections
Facirity ,orr,70000 {a
Checklist
Please complete all information for each tank. Use additional forms as necessary il the facility hae more than 4 tank$.
SPILLIOVERFILL PREVENTION
Tank 1 Tank 2 Tank 3 Tank 4
The UST system is filled by transfers of 25 gallons or less. 11 yes, spill
and overfill prevention is not required.Yes @ Yes @)Yes @j Yes No
ls there a spill containment device that will prevent release of product into
the environment? lndicate type: Spill bucket <5 gal., Spill bucket >5 gal.,
Containment sump at tank fill.
e9 No eNo e, No Yes No
ls there an over ention device installed on the tank? lndicate type :
Balllloat(invenr .,), @arm, orother
lspecriy; V e) No e) No (3, *o Yes No
For overlill alarm only: ls the alarm located where it can be easily segn.
and heard by the delivery driver? ' 4 Yes No Yes No Yes No Yes No
For overfill alarm only: ls the alarm clearly marked to indicate whdt is
meant when the alarm sounds?Yes No Yes No Yes No Yes No
CORROSION FROTECTION
Tank 1 Tank2 Tank 3 Tank 4
lndicate the type of corrosion protection: Non-metallic (NM), Composite
steel (CS), Internal lining (lL), lmpressed Current (lC), Sacrificial Anode
(SA), or Not protected (NP).
6
Tankt(-Tank
1(
Tankic Tank
Pipingi(PiplngIL Piping Piping
lndicate the type of corrosion protection on Flex connectors and/or Swing
joints: Booted (B), Total containment (TC), Not in contact with soil or
water (NC), Cathodically protected (CP), Non-metallic (NM) and Not
Protected (NP)
Sub-Pump
IC
Sub.Pump
i1-
Sub-Pumpia Sub Pumo
lc.
Dispenser
/C
Dispenser Drspenser
rf tank or piping has been Tank lining
upgraded, indicate date upgrades Tank cathodic protection
were performed: /;-
Piping cathodic protection 19,
CATHODIC PEOTECTIOH TE$TS Hecord results ot the most recent cathodic prstection tes! Record the lorarest reading tor each $n*pipirrg/flex sei
The results of the last two cathodic protection tests are available. (within
6 months of installation and every 3 years thereafter).Yes No Yes No Yes No Yes No
rank. rester- r^r" 6lq1 /-v6€
volts volts )volts
Piping.Tester-o"r. {( \volts volts
-)"<'
volts
Flex. Tester- Date _
Sub'Puorp
-volts volts
Sub Pump
volts
Sub-Pump
volts
Dispenser
volts
Drspenser
^ott"
Dispenser
volts
Dispenser
volts
For impressed current system: The results of the last three equipment
operation checks are available. (Equip. check required every 60 days.)Yes N>/Y", No 'r"" *" )Yes No
"o^^"n.rtrVoT TnK,.,f {tla.te /AC
"{ ,^'tt/ace S'g H.4)( An.?olrf
A//t< 3 - ?>
U*€ec*ticr iAa<ciLt;d( - Ao6tL -zr
rnspector's siqnature: ' RL AJ^?/*-4-et-frT)ala
signature of owner or owner's Representative "r"""nffi/ Wh
Distribution: White,DERR, Yellow-lnspector, pink Facility/Owner Revised 2/4/99
try a€{.o* t'"'fuy o. i[So"
Area Code Phone Numbsr
Contact Person At UST Location Phone #
Facilitv Name
t l€v^,rrcr I tUo.ve,rt K
StreotAddrcsa-. ^ , r-- tq, O L) n^c.t "zt S tt\a",r,r"( o* r.i'b9?h
Cortificate of Compliance on site? Yo6
Sttntdf.e >
Signature of Owner or Owner's Representative Present During lnspoction:
cortify that I have inspected the abovo-named on 3- )-
Distribution: White-DERR, Y
X
SIR as a method ol leak detection refers only to monthly monitoring ueing SlR. An annual test performed using SIR is considered a tank
tightness test and should be reported on the tank testing and inventory control torm.
Name and address ol SIR vendor:U5T/4AN
i.iiiiLii:ii::i:li;iiiiilsi,iri iii tii4itjiriri:*ii.lts iHi
ffii:i i*|ii :,friffii2i fi{
lnventory recordg lor product inputs, withdrawals, and the amount still
remaining in the tank are avallable for each operating day.@6)6?'rfi0 (tr4 @ Yes No
Records include correct # of monthly water monitoring readinge..(G) N"rA No (f"Dr.ro Yes No
Tank inventory is measured and recorded belore and after each fuel
delivery.
@*o @n"@No Yes No
Appropriate calibration chart is used for converting product level
measurement to gallons and ig available lor review.
@No ANo @*o Yes No
Dispenser pump has a curont calibration sticker oi appropriate calibration
documentation. -)@No @No @ro Yes No
The drop tube ln the fill pipe extends to within one foot of tank bottom.)ves fo)Yes 7ffi)ves (ff)Yes No
SIR monitoring recordr are available for the part 12 months. lf no, indicate
which months are missing in the comments section below.yes @)ves (Q ves @o)Yes No
Are any months results reported as 'tail"? lf yes, specify which months in
comments section below,
ves @ Yes @ vesG'o)Yes No
Are any months resulis reported as "inconclusive"? lf yes, specify which
months in comments section below.@to @No @No Yes No
Documentation of perlormance claims for the SIR method is available and shows the ability to detect leaks ol
0.2 gph with a 95o/o or groater probability ol detection and a 5olo or less probability of falee alarm (3rd party
certification).@ No
3rd party certilication indicates the method has been approved for both tanks and lines.€o No
The volume of product in the tank is measured using a:ATG '
ll a gauEe stick is used, it is long enough to reach the bottom of the tank.(r"",No
lf a gauge stick is used, the bottom oI the gauge stick is:
_--,-------:-.-
rf,e-ceptable _Worn
lf a gauge stick is used, it is marked legibly and the product level can be determined to the nearest 1/8 of an
inch over the full range ol the tank's internal height .
No
1 Complete to appropriate sections of tf6 Af,G checklist.- ,
comments, INVE^{T\AV / e lrto el,Tor r utq flrcopd J //on, 6er,,r l{ttn /a t r d
J Y\ere '?e.Ponfr"S
'-- Arl Pii" t f O ^tSra R.nr*( J -Ta..st * [ ]c" 9b -TZ,.K {+ 5 5en qb + be. qL
@4Ts ARd rv,aT A/ark//< ,qa LrsT 5,,{* -t f,.ro,.dr),^;r;,drr)
bv /Lhr,aei( 6,i)o< 1fi51-ts1,) c,*tl. 51'< /^rfL* Or /nst 71rge,+el? ; /%T T
---f . I
lnspector's Signature:-ru.nr -,/<Date: 3 *t0 -9'7
signatureofowne]o]owner.aRep'esentatlvePre3entDuringtnspec,,onM
Distributlon: Whii&DERR, Yellow-lnspector, Pink-Facility/Owner
iiiriii4lir ;iini i it! ! iii:IiinRrjji:ili\jL;jm4 in ii ! ti | 1 t; | | 1 1 : | 1 : 1 : : | |iii,.1,,i'.i,i#
t
pMiEl.,i i i:t-l.Liniii..::liiiiri*iii:t rla:iij,.,,,,
ffiSEfl;,fri#]iffiAli SrnNii$rllltl*.rlIilql+i- .
ji,Ifffl Sf
E;#,::iiliir.Fii!
i,..?!if E:iiii,iniiiii!;iriilii
f,,{G[lliiiiiiiiiii.i,!]
Tanlr I Tank 2 Tank 3 Tenk d
The UST system is filled by transfers of 25 gallons or less. lf yes, spill
and overfill prevention is not required.
Yes @ Yes O Yes @ Yes No
ls there a spill containment bucket or another device that will prevent
release of product into the environment?
Yes @ Yes @ Yes @)Yes No
ls there an overfill prevenlion device installed on the tank? lf yes,
indicate the type of device: Ball float (in vent line), Automatic shutotf
(in fill pipe), Alarm, or Other (specify)
Yes (}Yes (@ Yes @ Yes No
For overlill alarm onty: ls the alarm located where it can be easily
seen and heard by the delivery driver?
Yes No Yes No Yes No Yes No
For overlill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?
Yes No Yes No Yes No Yes No
$1i-#t1i.g$ffinifIffi
Tank 1 Tank2 Tank 3 Tank 4
lndicate the type of corrosion protection: Noncorrodible material (FRP),
Composite steel (CS), lnternal lining (lL), lmpressed Current (lC),
Sacrificial Anode (SA), or Not protected (NP). f FRP or CS do not
complete the remainder of this section.
'fr,1p ,t7p iP Td
Um
Al /)
um
A,/ P /vP tlm
lf the UST is not protectsd, was the tanMine installed belore May 7'
1985? lf yes, corroeion Protection is not required until Dec. 22,
1998; do not complete the remainder of this section.@No @No t@ No Yes No
The results ol the last two cathodic protection tests are available.
(within 6 months of installation and every 3 years thereafter)'
Yes No Yes No Yes No Yes No
Results of the most recent cathodic protection test.
Name ol tester:
Test Date:
Ta*
volts
Td
volts
Tank
volts
Tank
volts
ure
volts
Llm
volts
Llm
volts
Ure
volts
For impressed current system: The results of the last three
equipment operation checks are available. (Equip. check required every
60 days.)
Yes No Yes No Yes No Yes No
lf the tank has been retrofit (lined or cathodically protected), indicate
the date the retrofit was completed.
Ml "zC -SqJle'q /-,'( l)ft)(?Jt df fia1ns rntha / /1 d
UPGRADE NOT.IFIOffiION
't.rL't €-t ) CtLl C- J.=(=!=!,1{'t cc < understand that the following marked items must be co+pleted by
December 22, lgg|in order to meet the 1998 upgrade reQuirements: fSr,', prevention for tank(s)#
->)t. z-l
Ffconosion
protsction for piping assoc. with tank(s) #Z
Signature ol Owner or Owner's Representative Present During
Facilitnmeets 1 998 upgrade requirements.
Distribution: White-DERFl,
,<
Set 1 Tank I Tank 2 Tank 3 Tank 4
Automatic Flow Restrictor (if yes, indicate model in comments section below)uf.c s UeJ (t e-r
Automatic Shut-otf Device (il yes, indicate model in comments section below)tr'? o J
Continuous Alarm System (if yes, indicate model in comments section below)no
Records of last Line Leak Detector performance test available on-site Yes No Yes No Yes No Yes No
Date of last Line Leak Detector performance test
Result of last Line Leak Detector performance test Pass Fail Pass Fail Pass Fail Pass Fail
Set 2
Records of last Line Tightness Test available on-site .6 No @ No 6)No Yes No
Date of last Line Tightness Test '1-r-?b a-r-7[7- I,-7L
Result of last Line Tightness Test 60 r^it ffiA Fair ,,fdB) Fail Pass Fail
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklist)
Statistical lnventory Reconciliation tslRl (if yes, use SIR checklist)
/Othe, approred method (if yes, use other msthod checklist)
Records of last Line Tightness Test available on-site Yes\ No Yes No Yes No Yes No
Date of last Line Tightness Test
Result ol last Line Tightness Test Pass Fail \".. Fail Pass Fail Pass Fail
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklist)
Statistical lnventory Reconciliation [SlRl (if yes, use SIR checklist)
Other approved method (if yes, use other method checklist)
No tsa*::oataetloh:Boqillrad,tmutti{fiawer Vsr'td elt::ol::fts,,Iotlowlng quortlons}J:::N
Operates at less than atmospheric pressure Yes No
..-llco"No Yes No Yes No
Slope of piping will allow ALL product to drain into tank when suction released Yes No Yes No )ls- No Yes No
Has only ONE check valve, located directly under pump Yes No Yes No Yes No hNo
All above information on suction piping is VERIFIABLE, use comments s€ction Yes No Yes No Yes No Yes N>
Comments:Ze e(EaT I€r /e s 5 rl,laa,tQc tun -It/(
s4r
rnspecror'ssisnature: V/(\ J. \1, [ (*r^-,^--h - - o^r.; 3-7-97
Signature of Owner or Owne/s Representative Present During l-t:4. .t /
Distribution: White-DERR, Yellow-lnspector,
June 8, 1999
Mr. William Moore
Utah Department of Environmental euality
Division of Environmental Response and ilemediation
168 North 1950 West
Salt Lake City, UT 84116
RE: Non-Compliance, Maverik #142, Verna!, Utah (FlD #90000iS)
880 west Center St.
North salt Lake, Utah 84054
801-295-55 57
Dear Mr. Moore:
We are in receipt of your memorandum dated May 4, 1999. ln that letter you requested information
related several items of non-compliance. These items are described below.
1. MTCF report is enclosed.
2. Design Evaluation documentation is enclosed.
3. The 3 to 6 months testing data are not on file and their performance may have been overlooked by
Corrpro. The most recent test (performed by AES) is enclosed.
4. A site plat is included with the MTCF report. lnformation regarding anocje placement will be
obtained, at latest, upon our next trip to the site (for groundwater monitoring activities).
We appreciate your continued assistance as we seek to comply with all applicable regulations. lf you
have any questions, or require additional information, please feelfree to call Mark Christensen (x122)
or me (x102) at 801/936-5557.
Sincerely,
Maver'fi Country Stores, lnc.6tZ;
Paul R. Weissenborn, P.G.
Environmental Manager
Utah Certified UST Consultant #CC0086
cc: Project Files .lll-9m
[ffi
MAVERJK COI.JNTRY STORES, INC.
uteh site LD.* ?o@o | 8
Date of Site Assessment:
Date of Tightness Test:
Date of CP Sytem energized:
Date of post-activation potentials:
ASTM ES 40.94 UST T]PGRADE
COMPLETION REPORT
June 4, 1997
Jvrc2Z,1997
June 16, 1997
Corrpro
Companies,
Inc.
"A commiment to Excellence"
505 North 24th Street
Billings, Montana 5910L
Tel 406-24&7 17 0 c 8Cf-IAA7 L7 0
Fax40G248-73M
The following is a summary of the results of ASTM ES 40-94 testing used for the upgrade of
existing UndJrground Storage Tanks, in accordance with state of Utah ruling on ES 40 procedures
as provided by Corrpro Companies, Inc.
UST Owncr:Maverik Counby Stores, Inc.
880 West North Center Steet
North salt Lake, UT 84054
Maverik CounfiY Stores, Inc.
Maverik Store #142
490 West Main
Vernal, UT 84078
lvffcfo Mean Time to Corrosion Failure
Site Name:
Approved Method:
Section I Pemits
The following permits were obtained in accordance with Utah state regulations prior to
commencing with the UST upgrade(s):
companylnstallationPemitHolder: Maverikcountrystores-
company Permit #z 4El_Expires: 7lt7l98-
Tenklnstatlation fermit*;l8i-14 Dete of Issuez-4llll97-
Local Permi(s) & #: N/A
Date of notilication of DERR for Site Assessment:Tt"fu
Date of notification of DERR for CP Upgrade: . N/A
AaoariKr submitte.d the required amended UST notificatiot /2 -/b
signed by the Certified Installer who perfomred the work.
1997 . The form is
Section 2 Corrosion ExBert Certification
All phases of work were conducted under the responsible supervision of a qualified corrosion
e*pert. The corrosion expert certified to the UST owner that all personnel performing the
assessment were qualified to do so.
Corrpro's corrosion expert did certifu to the UST owner that all work was performed in strict
a"coidance with Corrpro Protocol, the ASTM ES 40-94, and the Utah state approval.
Corrpro notified the O/O of the requirement for a permanent form of release detection (not
inctuding Inventory Contol with tightress testing) and the owner has implemented the
-PAM I ATG method. A copy is attached on Appendix II.
Section 3 Safetv & Resulation
All Corrpro personnel and their subordinates have complied with all applicable federal, state, and
local healttr, safety codes and regulations'
Section 4 PreSitc Assessment
prior to upgrading the UST's were tested for tightness in accordance wittr Utah regulations, at the
.1 gallon pk hour rate. Testing was conducted by a Utah state certified Tester'
The UST information was obtained by a Corrpro c€rtified corrosion tester working under the
direction of a certified conosion expert. If site work not done by a certified corrosion tester,
person was Corrpro certified by ttrJCorrpro Corrosion E*pert, to conduct MTCF Site
Assessment.
(r
Corrosion Expert ry4CE #:.
Corrosion Tester:
-.lono
Kellercman m- NACE #:
-N/A-The site specific information includes, but is not limited to; ntune, address, phone number of
location; o*r, address, phone number of owner/operator(s), number and capacity of tanks
teste4 the location and ilirnensions of the UST's, age and material construction, product(s) stored
in eactL type of filI around tanks, leak and repair histories, where available, and site plans and
insallation spec's. where available. Where rite pl*t/ spec's. are not available, Corrpro personnel
have made rsite sketch. Alt information is presented on Appendix I, MTCF Report data.
lnformation was obtained from the strnounding area, such as foreign structures, utilities, existing
waterways, lakes, sfieams, etc. See Appendix I, MTCF Report Data'
Section 5 Site Asspssment
Alt testing was conducted under the responsible supervision of Corrpro's corrosion expert.
Sray cunent/ interference corrosion was tested for during the site assessnent. See Appendix I for
results.
Tark backfill resistivity was measured using a Nilson model 400 soil resistance meter coupled to a
single calibrated resistance rod. Resistivity measurexne,nts were conducted in each soil bore, at two
foot increments to the bottom of each bore. See Appendix I for results.
Structure-to-soil potentials were measured with reference to a coppo-copper sulfate electrode
coupled to a digital volt meter. See Appe,ndix I for results.
The presence of corrosion directly below the fill riser was tested using a mechanical probe. The
probe was equipped with a measuring device capable of detecting pits to a minimum resolution of
1/16 inch.
Pitting was not detected.
The extent of piuing was: <.0625"
2 Borehole tests were conducted in the tank backfill material.
Soil samples were sent to Warren Rogers Associates in Providence, Rhode Island where they
were tested in accordance with ASTM ES 40-94 and industry standards.
The results of all test methods used are included in the MTCF report.
Soil pH was measured.
Soil moisture content was measured in the backfill.
Electrical continuity tests were conducted.
Chloride ion conce,ntratiorU sulfide ion concentration, and sulfate ion concentation were tested for
at the lab.
All pertinent datais presented prreview on Appendix I, MTCF Report Data.
Hydrocarbon concenfration, REDOX potential, current requirernen! coating resistance, coating
efficienry, and wall thickness tests were not required using the MTCF method. The results of any
of these tests, if accomplishe4 are prese,nted on Appendix [V. Not Included
One soil sample of every ten is subjected to an independent QC analysis. If not passing, all
samples collected since last successful QC me re-analyzed. The results of such testing, if
accomplishd is presented on Appendix V. '
Field testing was conducted by.John Kellersman IIL who is certified by Corrpro Companies,
Inc.'s corrosion expert as competent to conduct MTCF field data collection.
No suspected corrosion activity was noted on the UST's.
All structural and electrochemical characteristics measured or observed in field or lab testing
results were compatible with tho effective use of corrosion protection. These tanks &\S the
ASTM ES 40-94 analysis.
Any significant evidence of corrosion activity was documented by the corrosion expert.
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Section 6 Model Analvsis
The statistical malysis model was based on a sufficient sized database with various factors that are
accounted for statistically to reach a confidence level of .99.
The procedure is based on an evaluation of all data gathered insitu.
The mathematical formulation of the procedure conforms to accepted physical and
electrochemical charactoistics of the tank corrosion process, wittr independent validation.
Parameter estimates are based on a minimum of 100 sites where a minimum of 200 tanks were
excavated and evaluated by a qualified corrosion e>Qfi.
The current database contains not less than 50 sites where the Site Assessme,lrt was performed and
a Mean Time to Corrosion Failwe was calculate4 thar are within the geographical region of Utah
and surrounding Intermountain States. Additional sites are added to the database regularly, to
continuously upgrade the predictive model.
This procedure meets the standards of statistical and elecrochemical admissibility.
The database contains representative samples of both leaking and non-leaking UST's.
This model is specific as to soil type and incorporates the depth of ground water and rainfall in the
immediate geographic area of the testing.
The standard deviation of predicted mean time to corrosion failure is less than or equal to 1.5
years.
This model generates a probability of corrosion failure based upon a comparison of actual tank
age versus expected leak-free life. See Appendix I, MTCF Data
The conclusiotrs are based upon the expected leak-free life of a tank at the specific site, as
determined by the data analysis.
The report provides the expected leak-free life and present and future probabilities of corrosion
failure for all tanks investigate{.
The report includes a listing of'tanks whose age is more than the expected leak-free life, where the
probability of corrosion perforation is less than .05.
The tank is currently leak-free. The ability to detect is )95o/o_. Thresholds of the tightness
test used are_.l (See Appendix ltr.)
Hydrocrbon tests were not conducted, as they were not necessary.
The tank age is not less than the expected leak-free life of the tanks.
The present probability of corrosion perforation 11tess than .05.
Cathodic Protection data is presented on Appendix IV.
Section 7 Exuerb Detemination
The analysis was reviewed and the final upgrade determination made by the corrosion expert on
each tank tested for upgrading.
The corrosion expert submitted a copy of the report to the owner/operator after reviewing the
analysis, which includes a determination of the upgrading suitability made for each UST that is
signed by the iqn expert who is listed with DERR as allowed to sign for Corrpro.
tr
Signed Date 2- f -fZ
iI ..ffa
l[r".;'6;;"a
'A Commltment to Excellence'
610 Bnndywine Perkwry
\(est Chcster, PA 19380
T el 6t0 / 34 +7002, Fa.r 610 / 3 4+7 092
CORROSION EVALUATION OF
UNDERGROUND STORAGE TANKS
(oNE 12,000 GALLON GASOLINE TANK AND
TWO 8,000 GALLON GASOLINE TANKS)
MAYERIK STORE VERNAL NO. 142
490 WEST MAIN
YERNAL, UTAH
JUNE 4,1997
On May 4'h lgg7, Corrpro Companies, Inc. performed an engineering analysis on underground
storage tanks at the above referenced location. There were ttuee (3) gasoline storage tanks
evaluated, one 12,000 gallon and trvo 8,000 gallon.
Aii resring anci anaiysis was pertbrmed in accordance with ASTM Standard ES 40-94 "Altemative
Procedures for the Assessment of Buried Steel Tanks Prior to the Addition of Cathodic
Protection" as outlined in EPA OUST Interim Guidance Memo on Integrity Assessment of Bare
Steel Tanks dated October 21,1996.
Based on the results of the corrosion evaluation recently completed on the underground
tanks, these tanks satisfy the requirements of ASTM Standard ES 40-94 and are acceptable
for upgrading with cathodic protection.
The following plan for upgrading ofthe tanks with cathodic protection is required.
The probabilitv of pittine corrcsion is less than 0.05.
l) Prior to any upgrade activities, assess the tanks using ASTM Practice E 1430 or a
method that has been certilied in accordance with Federal EPA requirements to
establish that the tanks are not leaking.
2) Install cathodic protection to provide corrosion protection to the exterior surfaces of
the tanks and associated steel piping.
3) Implement an approved monthly monitoring leak detection system.
4) Assess the tanks again, approximately six (6) months after the cathodic protection
system has been in operation, using ASTM Practice E 1430 or a method that has
been certified in accordance with Federal EPA requirements to insure the continued
leak free condition of the tanks.
5) Submit the corrosion evaluation report, evidence that the tanks have been properly
tested and are leak free and cathodic protection system test data to the regulatory
authorities as evidence that the tanks have been satisfactority upgraded with
cathodic protection
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Corrosion evaluation field testing at the underground storage tank location consisted of collecting
site information, performing soil borings and recording data relative to the electrical properties.
Chemical tests were conducted in the laboratory on the soil collected from the borings. AII data
were then analyzed by Corrpro Companies, Inc. and Warren Rogers Associates including the use
of a computer model to calculate and complete a Mean Time to Corrosion Failure (IvlTCFo)
analysis for the tanks.
Attached is a copy of all the test data obtained and analped during the corrosion evaluation and
the results ofthe MTCF analysis.
Since the tanks evaluated are older than l0 years old, in order to meet the regulatory requirements
for upgrading with cathodic protectiorq the tanks must be assessed for corrosion holes by a
method which is approved by the implementing agency. Corrpro Companies Corrosion
Evaluation which is performed in accordance with ASTM Standard ES 40-94 "Alternative
Procedures for the Assessment of Buried Tanks Prior to the Addition of Cathodic Protection" has
been approved by many of the implementing agencies. If using this method, to be acceptable for
upgrading with cathodic protectiort l) The probability of corrosion failure must be less than 0.05,
or 2) The probability ofpitting corrosion must be less than 0.05.
The following conclusion resulted from MTCF Analysis recently completed on the underground
tanks:
o The probability of pitting corrosion, based on the results of the corrosion survey on the
underground tanks, is 0.032.
NOTE: The results derived are entirely dependent on the assumption that the tanks
are leak free at this time. The calculation of the probability of pitting
corrosion is based on the assumption that a recently conducted test, whose
probability of detection is 0.99, found the tanks to be leak free. The leak free
condition of the tanks shou.ld be verified by the owner/operator prior to the
installation of cathodic protection.
Since the probability of pitting corrosion is less than 0.05, these tanks satisfy the requirements of
ASTM Standard ES 40-94 and are acceptable for upgrading with cathodic protection.
MrcF@ is a Sertice Mark of Corrpro Companies, Inc., Registered in the U.S. Patent and Trademark Afiice.
m l4206o4.rpt
Maverik Store Vernal No. 142
Vernal, UT Jvllre 4,1997
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CORROSION ENGINEERING EVALUATION
OF
TTNDERGROUND STORAGE TANKS
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TABLE OF CONTENTS
1.0 INTRODUCTION
2.0 DATA ANALYSE
2.1 Cathodic Protection
2.2 tnternal'Conditions
2.3 Corrosion Model
2.4 Probability of Corrosion
4.0 DISCUSSIONANDRECOMMENDATIONS
5.0 ECONOMTCS
APPEITTDIXA: TestProcedures
APPEIIIDD( B: Satisticd Model
Page I
Page2
Page 8
Page9
1.0
1
INTRODUCTION
Corrpro Companies, Inc. performed a corrosion engineering evaluation of
underground storage tanks. For the corrosion evaluation, soil boring tests, electical
field testing, and chemical soil sample analyses were performed to complete a Mean
Time to Conosion Failure (MTCFo) analysis, and to calculate probability of corrosion
failtue values. Site risk information was recorded with respect to adjacent utilities,
surrounding buildings and water supplies. The tanks were internally sticked to
determine the depth of the tank bottoms, the presence, if any, of internal water and the
degree of roughness on the internal tank surfaces immediately below the fill pipe.
Test holes were drilled within one foot of the side wall of the tanks to the depth of the
tank bottoms. Tank-to-soil potentials and soil resistivity measurements were recorded
in place at various depths within the borings. Soil samples were collected at trvo feet
below glade, mid-tank depth and at tank bottom. The mid+ank and tank boffom
samples were then sent to a soils laboratory for measurement of moisture content, pH,
chloride ion cbncentation, sulfide ion concentation, and conductivity. The aeration
of the soil was qualitatively asseised by type and texture.
All corrosion evaluation test procedues are firther described in Appendix A.
fr{ICFo b a Sert'ice Mark of Conpro Companies, Inc., Registered in the U.S. Patent and Trademsk Ofrc".
2.0
.a
DATA AI\IALYSIS
The data collected were evaluated by the Warren Rogers Associates computer model
to establish the Mean Time to Corrosion Failure (MTCF) analysis. Other significant
information, including age of the tanls, area classification and any indication of
internal corrosion should be used in the development of a tank management progam.
Cathodic Protection
Tank-to-soil potentials are obtained and recorded at various depths in each test
boring to establish the tank-to-soil potential profile from grade to below the
tank bottom. Reference cell placement is important when collecting data on
underground storage tanks especially when the area over the top of the tank is
covered with asphalt or concrete thereby limiting the areas available for cell
placement. In the test borings, the reference cell can be placed near the
tank/soil interface minimizing the enors which can be associated with the
reference cell placed on asphalt or concrete over the tank. These tank-to-soil
potentials are used to determine the existence and evaluate the effectiveness of
cathodic protection systems on the tanks being evaluated.
If no evidence of cathodic protection is found on the tanks, the tank-to-soil
potentials are used to evaluate the corrosion pattem on the underground tank.
Properly interpreted and'correlated with other measurements, tank-to-soil
potentials give an indication of the severity of both galvanic and electrolytic
corrosion cells.
In-situ soil resiitivity measurements of the tank backfill material in contact
with the tanks are also obtained at various depths within each boring'
Conosivity is often an inverse function of resistivity with tow resistivity soils
usually more corosive than high resistivity soils. However, serious corrosion
can also be associated with high resistivity soils, particularly where soil
composition is not uniform. Variations in resistivity indicate variations in soil
composition which are conducive to galvanic gorrosion.
2.1
2.2
In addition to being used along with soil characteristics in the corrosion
evaluation analysis of the tank, both resistivity and tank-to-soil potential data
obtained during the evaluation can be used in the design of a site specific
cathodic protection system for the tank systems if a cathodic protection system
is recommended for future installation.
Internal Conditions
Although the investigative procedures employed during the study are
primarily directed to site evaluations and underground corrosion, some
internal tank information is also collected. These data are gathered by sticking
the tank, through the fill, with a gauge stick equipped with water indicating
paste and a "feeler gauge" to determine the presence of intemal water and the
degree of roughness on the internal surface of the tank directly beneath the fill.
In underglound storage tanks, the area of the internal swface of the tank most
susceptible to internal corrosion is the area directly beneath the fill riser. The
presence of an electrolyte (water) in the tank is necessary for corrosion
activity to occur. Generally, if water is present at the bottom of a tank,
corrosion will occur on the internal tank surface beneath the water until the
corrosion cells become polarized, resulting in very slow rates of corrosion.
However, directly beneath the fill riser, the turbulence caused by product
deliveries and the daily sticking of the tank tends to disturb the polarized
corrosion cells, exposing new steel to the electrolyte and accelerating the
corrosion activity in this area. If the area of the tank beneath the fill is found
to be smooth and no water is present in the tank, this indicates in most cases
that internal corrosion is not occurring to any significant extent in the tank
being evaluated.
2.3 Corrosion Model
Following completion of the field survey and laboratory soil sample testing,
all information was evaluated by the Warren Rogers Associates computer
model to determine the Mean Time to Conosion Failure (MTCF). The MTCF
is the average age at which a steel tank with no corrosion protection would be
perforated from external conosion in the particular environment found at the
tank site. Input parameters include:
t Soil Properties
1. ResistivitY (conductivitY)
2. pH
3. Sulfide Ion Concentation
4. Chloride Ion Concentation
5. Moisnre Content
6. Aeration
* Stnrctue-to-Soil Poteritials
Each parameter is individually weighted in accordance with the significance
of the particular variable on the rate of conosion on underground storage tanks
(see Appendix A).
The presence and severity of stay DC earth currents are also atalyzed based
upon the electical measurements recorded at the site' Where noted" stray
currents will often accelerate the corrosion activity on the tank system and
have an adverse influence on the expected tank life'
2.4 Probability of Corrosion
The conosion of underground tanks falls into two general categories. The
first of tlrese two processes is uniform corrosion. This occurs when no
anomalies exist on the tank surface or in the backfill in immediate contact
with the tank. Corrosion thereby occurs uniformly over the tank surface,
without pitting, until the corrosion cells are polarized, resulting in very slow
rates of corrosion. Tanks with uniform corrosion will typically outlast the
useful life of the facility at which they are installed. This condition exists at
approximately twenty three per cent of all steel tank systems.
The second of these two processes is pitting corrosion. This occurs when
anomalies such as abrasion or mill scale occur on the tank surface, or exist in
the backfill in direct contact with the tanks, (e.g. cinders, clumps of clay,
unremoved shoring, depolarizing agents). In this instance, pitting corrosion
differs from uniform corrosion in that points of concenEated corrosion occur
on the tank surface. Pitting corrosion is not uniform and allows high rates of
corrosion to continue, until perforation of the tank ultimately results. This
condition is observed in seventy seven per cent of the systems evaluated.
Conditional probabilities of corrosion failure due to point (pitting) corrosion
are calculated for each tank site based on the MTCF and the actual age of the
tank(s). Based on the corrosion process information discussed above, an
initial probabitity of 0.77 is assigned to the occulrence of point (pitting), as
opposed to uniform corrosion on the underground tanks. Where soil moisttre
contents are found to be low at the time of the corrosion evaluation, a second
series of calculations is also performed assuming saturated soil conditions.
This is to account for seasonal variations in the water table and soil moisture.
Following the completion of the statistical modeling (see Appendix B) which
incorporates the corrosion characteristics of the soils in contact with the
underground tanks, the MTCF and the conditional probabilities that the tanks
would be leaking if pitting corrosion prevailed are calculated.
These conditional probabilities 6sume that there is no corrosion protection
being afforded to the external surfaces of the tank and that corrosion is
occgrring on the tank by the pitting mechanism (i.e. worst case). Since
trniform corrosion occurs on 23 percent of turderground tanks and pitting
corrosion o.n77 percent, every time a tank is tested and found to be tight, the
probability of uriform conosion increases by an amotutt determined by the
conditional probability of corrosion failure at that time, while the probability
of pitting corrosion decreases.
After the completion of a tightness tesl in which the tanks are reported as
tight, and when the conditional probability of conosion failure is at or near
unity (certain), the unconditional probability of pitting corrosion becomes
largely dependent on the accuracy of the test method used. If no additional
tightness tests axe completed and no corrosion protection is applied to the
tanks, the probability of conosion failure will gradually increase with time
until the tanks are tested again and found tight or corrosion protection is
applied to the tanks. The actual rate of increase in the probability of pitting
corrosion from the time of the test is dependent on how many years past the
Mean Time to corrosion Failure (MTCF) the age of the tank is at the time of
the tightness test. The firther that the age of the tank is past the MTCF, the
slower the probability of pitting conosion will increase after each test if the
tanks test tight.
Installation of a cathodic protection system on a tank system which is
presently tight will maintain the probability of corrosion failtre for the tank
system in the futue at the probability value calculated for the tanks at the time
the cathodic protection system was initially energized. The maintaining of
this probability of pitting corrosion value will occtr as long as the cathodic
protection system is properly installed, is adjusted to provide an adequate
level ofcorrosion protection to all external surfaces ofthe tank and associated
piping, is continually in operation and is periodically monitored, adjusted and
maintained.
/\
^
Implemenation of monthly monitoring lealc detestion utili-ing a volumertric
method on the tank systems in conjuction with the installation and operation
of a cathodic protection system will result in the lowering of the probability of
pitting conosion with time. The rate of decrease will depend on probability of
corrosion failure at the time cathodic protection was installed and placed into
operation.
t
3.0 DISCUSSION Ai\iD RECOMMENDATIONS
Not withstanding the Federal, State and Local regulations regarding undergrorrnd
tanks, the development of a comprehensive tank management program requires an
evaluation of both safety and economic considerations. The next phase of the tank
program should consist of the preparation of a tank management plan and a budget to
implement this plan based on the results, data and recommendations presented.
For owners with more than one tank site, priorities can be established in accordance
with the probability of corrosion failtre and all the additional information available
for the site including the data collected at the site for this corrosion evaluation. This
additional information would include, but not be limited to, future plans for the site,
stray current, internal conosion, environmental risks, etc. In all cases, good planning
will save considerable monies in the upgrade phase of the project through proper
staging and coordination.
If tightness testing has not been recently completed at each of the tank sites, tightress
testing should be undertaken to confirm if the systems are presently sound. If a leak
is detected, repair or replace, evaluate the degree of environmental contamination and
take appropriate action as required. If the system is sound, immediate upgrading
including rerofitting with external cathodic protection is recommended.
In the final tank management plan, consideration should be given to internal corrosion
protection (lining), monitoring w'ells, inventory contol systems and overfilVoverspill
protection. The decision as to whether or not these additional elements will be
included is largely based upon considerations for reducing exposure to public
liability, and regulatory requirements. By comparing the probability gf corrosion
failure values, planning and budgeting for upgrades can be spread over time to yield
the greatest return on the investnent.
1
4.0 ECONOIWCS
Cathodic protection is the only effective and economical meilul of conosion contol
for existing underground steel tank systems. Once integrity verificatiorS inventory
analysis, etc, is completed" a cathodic protection system strould be included in the
management plan for all tanls which are to be maintained. The instatlation of
cathodic protection should also be coordinated with other planned activities at the site
such as installation of overfill and overspill protection, leak monitoring and automatic
inventorY contol sYstems.
The application of a comprehensive corrosion contol system to existing tanks, where
the systems are presently tight or made tight by internal lining, is the most
economical alternative.
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TEST PROCEDURES
I,'IYDERGRO TJND TA}.IK SYALUATION
The collection of accurate corrosion data requires attention to test procedures
and equipment to ensure the recording of reproducible data. .Test methods
incorporated in the investigation for the evaluation of corrosion on underground
tanls and the design of cathodic protection systems include the following:
Soil Resistivity
Stnrcture-to-Soil Potential
Stray Current
pH
Chloride Ion
Sulfide Ion
Moisture Content
SOIL RESISTIVITY
Resistivity is a common parameter for evaluating the corrosiveness of soil.
Resistiviry is the inverse of conductivity and is measured in the units of ohm'
centimeters. Corrosivity is often an inverse function of resistivity with low
resistivity soils usually more corrosive than high resistivity soils. Serious
corrosion can also be associated with high resistivity soils, particularly where the
soil composition is not uniform. Variations in resistivity indicate variations in
composition which are conducive to galvanic corrosion.
Resistivity profiles in test holes are performed using a 318" diameter by 1 foot
long single probe. The length and dimensions of the probe ensure oPtimum
contact with the surrounding undisturbed soil which is often not accomplished
with using conventional single probe aPParatus.
1
u.
A Nilsson Soil Resistivity Meter, Model 400
measurements. The meter incoqporates a 97
interference from stray DC or 60 Hertz AC.
STRUCTI.'RE.TO. S OIL POTENTIAL
is used for direct resistance
Hertz generator to eliminate
Structure-to-soil potentials are DC voltages used to evaluate the corrosion
pattern along underground tanks. Properly interpreted and correlated with
other measurements, structure-to-soil potentials give an indication of the
severity of both galvanic and electrolytic corrosion cells.
Measurements must be recorded with a high input resistance voltmeter. The
negative terminal of the meter is connected to the tank and the positive terminal
to a saturated copper/copper sulfate reference electrode placed in contact with
the soil. Copper sulfate half-cells are used for underground corrosion testing
because they are stable and yield reproducible results.
'Cell placement is important when collecting the data. When test borings are
made, the reference electrode can be placed near the tanlr/soil interface.
[pically the test hole is drilled one foot from the edge of the tank to a depth of
two feet below the tank. Tank-to-soil potentials are then recorded at various
depths to establish the potential profile from grade to below the tank.
Structure-to-soil potentials are typically recorded with a Beckman, Model HD
110. This instrument is designed for corrosion testing and has an internal
resistance of. 22 megohms.
STRAY CI]RRENT
Stray DC earth currents can emanate from the operation of DC transit systems,
cathodic protection rectifiers, welding and DC motors. When discharged from
the surface of a steel tank, these curents will consume approximately 1 gram of
metal per ampere-hour. Concentrated electrolytic corrosion can cause rapid
deterioration of underground tanls.
uI.
w.
The presence of sEay current is detected through the use of structure-to-soil
potential measurements. The strucrure-to-soil potentials are taken and recorded
over a period of time, using a 516C Polycorder, microcomputer data logger
manufactured by Omnidata International, Inc. Fluctuations in potential indicate
the presence and magnitude of exposure to stray current.
oH
pH is the negative logarithm of the hydrogen ion concentration. For ferrous
materials of construction, pH in the range of 4 to L0 has little eflect on the rate
of corroiion under oxidizing conditions at ambient temperatures. Acid soils are
more conducive to ferrous corrosion because at pH values above 10, the steel
readily polarizei which tends to passivate the corrosion cells. At pH values
below 4, the rate of corrosion accelerates rapidly.
The method used to meastue pH is ASTM Standard Test Meth oaOZglF-ll with
an accuracy of t0.01. Soil samples are dissolved in distilled rvater and placed in
a centrifuge to remove the suspended solids. The supernatant is then tested with
a glass-calomel pH electrode in conjunction with an Orion Research Model 601
A meter. Liquid samples are tested directly without dilution.
CIILORIDE ION
Chloride ions are depolarizing agents and cause corrosion pitting of many
common materials of construction. ASTM Standard Test Method D512-81 is
used to measure the chloride ion concenration with an accuracy of t05 ppm.
This method utilizes an ion selective electrode and an Orion digital ionalper.
The chloride ion concentration for soil samples is measured from the
supernatant extracted for the pH testing. Liquid samples are tested directly.
v.
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I
i
vI.SIiLNDE ION
Sulfide ions present in the soil are indicative of anerobic conditions. Urider
these conditions, sulfate reducing bacteria can greatly accelerate the rate of
corrosion on ferrous materials. The bacteria reduce sulfates to sulfides and in
the process oxidize iron.' Soil samples are tested for the Presence of sulfide ions
to an accuracy of t1 ppb. The solution extracted from the soil sample is tested
through the use of a specilic ion probe (silver/sulfide electrode) in conjunction
with an Orion Research Digital Ionalyzer. The test procedure exceeds the
requirements of EPA Standard Test Method 376.L.
vII. MOISTT.'RE CONTENT
When soil sagples are'collected, they are immediately sealed in sample jars to
prevent evaporation and/or contamination. Moisture content of the samples is
determined using ASTM Standard Test Mbttrod D22-16-80. A part of the soil
sample is weighed, dried for 24 hours in an oven at 110oC, then weighed again.
The moisture content is calculated from the weight loss to an accuracy of
tO.LVo.
The moisture content is a significant parameter in defining the corrosivity of a
soil environment. For underground tank evaluations, test borings allow f9r a
determination of the variations in moisture content with depth. The depth of the
water table is also noted on the boring logs when encountered.
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STATISTICAL MODEL
UNDERGROT'ND TAIYK EVALUATI ON
Warren Rogers Associates (WRA) developed the procedures for defining site specific
leak probabilities for the American Petroleum Institute in 1979. At that time, the API
initiated a study of the problem of leaking tanks in order to address the concerns of the
major oil companies, who were experiencing leaks frequently and incurring substantial
remediation and clean-up costs.
Although the major oil companies were committed to upgrading their tank populations,
they recognized that they needed some means of prioritizing their actions. Because
such upgrading programs are expensive and time consuming, they are necessarily a
multi-year undertaking. Moreover, it was apparent that preliminary programs, which
involved replacement in descending order of age, were inadequate. In the course of
such a program, fifty five per cent of the tanks removed were sound, and many tanks
which were younger were leaking.
Data gathered by the API supported the conclusion that replacement by age was
inefficient. Leaks were found in systems as early as three years after installation, and
tanks over thirty five years old were excavated and found to be totally intact. In short,
the age at which tanks were discovered to be leaking was randomly distributed over
time.
Consequently, the API requested that *ne smtistically evaluate the physical processes
which affected the rate of deterioration of tank systems. Attention was directed to the
problem of external corrosion, which is the dominant cause of failure of unprotected
steel tank systems.
Physical examination of excavated tanls revealed that the process of external corrosion
proceeds in two distinct ways, with important consequences for tank life. The factor
which distinguishes these two processes is the presence or absence of anomalies on the
tank surface or in the backfill.
The first of these two processes is uniform corrosion. This occurs when no anomalies
exist on the tank surface, or in the backfill, in immediate contact with the tank.
Corrosion thereby occurs uniformly over the tank surface, without pitting until the
corrosion cells are polarized, resulting in very slow rates of corrosion. Tanla with
uniform corosion will typically outlast the useful life of the facility at which they are
installed. This condition exists at approximately twenty three per cent of all steel tank
systems.
The second of these two processes is pitting corrosion. This occurs when anomalies
such as abrasion or mill scale occur on the tank surface, or exist in the backfill in direct
contact with the tanks, (e.g. cinders, clumps of clay, unremoved shoring, depolarizing
agents). In this instance, pitting corrosion differs from uniform corrosion in that points
of concentrated corrosion occur on the tank surfac.e. Pitting corrosion is not uniform
and allows high rates of corrosion to continue, until perforation of the tank ultimately
results. This condition is noted in77 per cent of the systems evaluated.
The physical processes which cause corrosion are well known. They are
electrochemical in nature, can be chemically or biologically induced, or can be the
result of an externally generated DC current source. The most important soil variables
in determining the rate of chemically or biologically induced corrosion are electrical
resistivity, acidity, moisture content, chloride concentration and sulfide concentration.
What had not been established was the precise mathematical nature of the way in which
the process occurs. Once the rate of corrosion is established, then the Mean Time to
Corrosion Failure (trrITCF) could be determined.
To support the investigation, data was gatt erea on tank leak incidents by the API in the
United States and the Petroleum Association for the protection of the Canadian
Environment (PACE) in Canada. In all, data on tank leak status and the values of the
variables noted above were collected at over 2,000 facilities. A preliminary review of
the data, however, showed that none of the supposedly causative variables, taken
independently, bore any immediate obvious relationship to the age at which leaks were
observed.
The model which was developed from this initial data resulted in a procedure which
predicted age to leak within 2.5 years, when the values of the relevant variables at a site
are known. In addition, the probability of leak at any tank age could then be
established.
Subsequent controlled experiments with Corqpro Companies, Inc. permitted extensive
refinemens in both data gathering and analysis. While the original data was drawn
from a very limited geographical area, these later investigations disclosed that there
were important geographical effects to be accounted for. In addition, the effect of stray
DC currents was incoqporated into the model. This allowed refinements in the
estimation of the Mean Time to Corrosion Failure (MTCF), that reduced the estimated
error to 15 years when regional models were applied. The data base used in this study
includes test resultsfrom 70,000 tanks atzz,N}locations in North America.
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MAV142
: ICoMPASS MAV142
1^
PAIt'l 1: Ultrasonic
Lt/26/97 10:18:13 AI,l
7t/26/97 10:18
Page
Comm Port = 2
I Release:2.0b 8/t/97
PAM 1: Ultrasonic
Firmware Revision Level: 2.300
System Alarm
Normal
TAIiIK 1: Unleaded Regular
Site A1arm
Normal
Probe Status
Normal
Tank is sEab1e.
Tank Test Status
Tota1 Tank Tests this Month: 1
Total Tank Test.s last Month: 0
Failed on LL/3/97 02:55.
Product = Unleaded Regular
Inventory = 2880 G recorded at t/L/90 00:00
Product Depth = 27 5/8 in
Temperature = 53.90 F.
WaterDepth=0in
Wat,er = 0 G
capacity = ]-2032 G
Diameter = 95.0 in
Tank Description = UNLEADED
Inventory Probe = Ultrasonic: LT 96 in.
Tank Tilt Offset = -3 in
Dipstick Offset = -3 in
overfill Volume = 1-0829 G
Reorder Volume = (Disabled)
L,ow Inventory Volume = (Disabled)
Critical Water Level = 3 in
l-st Alert Water Level = (pisabled)
ANK 2: Premium
Site Alarm
NormaI
Probe Status
Normal
MAV142
Tank is stable.
Tank Test Status
Total Tank Tests this Month: 1
Total Tank Tests last Month: 0
Passed on tt/t/97 04:34.
Product = Premium
rnvent,ory = 3835 G recorded at l/L/90 00:00
Product Depth = 46 L/4 in
Temperature = 52.9o F.
WaterDepth=0in
Water = 0 G
capacity = 8020 G
Diameter = 95.0 in
Tank Description = PREMIUM
Inventory Probe = Ultrasonic: LT 96 in.
Tank Tilt Offset = -L 7/2 in
Dipstick Offset = -1 l/2 in
Overfill Volume = 7218 G
Reorder Vo1ume = (Disabled)
Low Inventory Volume = (Disabled)
Critical Water Level = 3 in
l-st Alert Water Level = (Disabled)
TANK 3: Unleaded Regular
Site Alarm
Normal
Probe Status
NormaI
Tank is stable.
Tank Test Status
Total Tank Tests this Month: l-
Tota1 Tank Tests last Month: 0
Passed on LL/2/97 03247.
Product = Unleaded Regular
rnventory = 2532 G recorded at l/t/go 00:00
Product Depth = 33 '7/8 in
Temperature = 55.70 F.
WaterDepth=0in
Water = 0 G
CapacitY = 8020 G
Diameter = 96.0 in
Tank Description = UNLEADED 2
InvenEory Probe = Ultrasonic: LT 96 in.
I
PAIv! 1: Ultrasonic
LL/26 / 97 1o :18 :13 AI"1
Page 2
^-
MAV142
PAI,I 1: Ultrasonic Page 3
LL/26 / 97 10 :18 :13 AIvt
Tank Tilt Offset = 2 inDipstickOffset=2in
Overfill Vo1ume = 72Lg G
Reorder Volume = (Disabled)
Low Inventory Vo1ume = (Disabled)
Critical WaEer Level = 3 in
1st Alert, Water Level = (Disab1ed)
"t,-;:i..j
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AppLrED EN-VIRONMEI\TTAL SERVICES, L. C.po Box ttz Roy, rrTAlt t{0tz oo{l ile75{5
T,E.f, SYSTEH {OOO
'T,EJ,
LT3
'T.EI.
T'LIIGE
PRECISION TANK & LINE TEST REs1'LTS St.,MMARI'
r 'l{VOrcE ADDRESS: TAI\IK LOCATTON: WOEK OFDER t 80288
i; RteRm COUNTTTy5:TORES MA\ERIK#i42
SSOWESTCENTER 49O'AESTIIAN TECHNIGIAN: STil
oRTH SALT L,/AlG, UrAH 840{t4 VERML, UTAII TECH 'gltzl
vAI{
'S(}2
STATE TEGH
'
UT(lI2t
DATE: &2+97 TmESTART: 2t}fll6lIl TIMEEM): 03:00024 GROUMIWATERDEPTH: l0'+
-lttlE S:YETEIf, FILLEO ORTOPPED: &?2-97
,TAI{K TA'.IK PRODUCT TANK FILL VENT PRODUCT LINE LEAI( WATER IN PUilIP TATIIK TTATERIAL
I crpecnv vapon Itte oErectoR mnx rwe
l-
r 12000 RruL PASS PASS PASS PASS 0.0' PRESS SV\fS
m00 snx- PAss PASS PASS PASS 0.0' PRESS Sli\E
3 8000 RruL PASS PASS PASS PASS 0.0' PRESS 31
'S
pRoDUCT LrNES TESTED AT 50 PSI FOR !! IullNuTES
hIE RATES (GPH)
I l2K R/tL-.000
8K S/IJL-.000
3 8K FUUL..(l()O
:
AT}OMOi{AL NFORMATION :
I
I
I(E
T}IIT $TSIEI AIIO IET}IOO IEETS Oi EXCEEOS TIIE CTITEiIA IX USEPA'0. CTR PAfiT 2IO.
trPA !a!fl. AIIO AtL APPLICIIL9STATE AIO tOGAt CT}0C3.
h>/ 6^8. E.,at\a
A
E
APPLIED
EilVIRONMEilTAL
S SERVICES, L.C.
P.O. Bor lE2
Roy, thh E40674{82
180,u f,i'.-716,6
T.E.I. ULI.^AGE TEST DATA SHEET
Site: i/lAVERlK rl42
4gO WEST MAIN
I/ERML, UTAI.I wro#80288
+todudrWc-ffige Size#Ctfib. Level:s.rr-;E=Jt1r-E Telt Start Timc Test End Time ifest Result
EPrsslFaiE
12K R/IJL 1838 1.5 02:16 O2:.17 PASS
8K SruL I 139 1.5 02:20 O2:,21 PASS
8K R/UL 1404 1.5 02:31 O2:32 PASS
I certiff thil the aboye ullage bsts uerc conducted on this date according to the equipment
manufactrrefr procedurcs and limitafionr and tfte rcsultr as listed are to rry lrnowledge tnre and correcL
Signaftrre:StaE Uc. fr uT 0121
The test datr colbction time period must be one ({l minute. The tffit parsfiail thresholtl i3 0.02 GPH ar
iderffied by a noi:e rignal ratio of 1to2 at a vlcuum of I pri.
P.O. Box 182
Roy,lJtch t4067
(E0{, *-7ffi
A Applied
E Envlrcnmental
E Servlces, L.C.
Frcilitv:
MAVERIK #142
AES FACILITY INSPECTION/AUDIT FORM
Tert Dde: E2tl-97
Wor[ * 8m88
490 WEST MAIN
\rEFlML, UTAII
Status
trl-Not Pre5enl
s-seflEfbctorJ
[FUnsAlfictory
Fil CoYer: S
Fl[ Cap: S
Fill Cap Seal:;[-
Drop Tr.rbe: S
V/R Cover: N
VIR Seal: N
VIR Dry Break: N
Sub Pump: S
Sub Pump Cover: S
Overfill: _-r
Trroe
C-Coaxlal FPrEE€um F-Flext>oual A-Angh Cnech i,l-Mdallc
IrFNo Slege I \l-Veillcitl Cneck S-Sucllon
Fill Tlpe: C
Product Une Type: P
Turk tiurfrrg Joint Tlpe: M
Disp Swing Joint Tlpe: M
Status
iFNol Pre6ent
S-SatlEtlclory
LJ-Un6ailsflctort
lmoact Valve: S
Vertical Check Valve: N/A
Fill Spill Containment:
-|Dispenser Containment: N
Sub Pump Containment: N
Staoe ll
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Al- AEElEt
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Number of
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Plus:
-
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Diesel:
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Cortlthd tltt.ll.a't on_Project, (Irlcluding subcont,ract,ed coqnnies covered under this permic andNane D,tvtrAl \Tlr^^qtb cerE. r ,,. dO-7 e*p. a"."
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trsl O. .r
Address P.O. BOX 8008 cicv AFTN sgug" W
conEacgp.r"orDNWW@ffi phone*(801 )295-5557
lrclllty COI]NTRY STORES . INC..,L
Addr
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Ins ca1 I /Upgrade Ub"*--+
Capacity (gallons)|2.000 8, ooD D.ooo
I)/?e (FRP, SE,ee1, ec,c.)9l
SubsEance t,o be SE,ored 6as ?1,.r (*s 9Lt^has in,
Piping I)1Pe (Press.
Sucsion, Gravity)F P P
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lTank, Lines, C.P.,..c/P Clp LlD#rPt
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Apprc'red * eq t-l/tt lQ7 App.
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UEah DeparEment, of EnvironatenEal Qualify
Division of EnvironmenEal Response and Remediac:on
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t. hnClstion
A. lffitelcr c.rtif.d by trnk t,ld
pgng rn nddJrIt
B. lnsuller cartifd or li<rnlc<t by the
imflcmcctilp .gcney
C. lnstallatiqr inspraod by a
rog:!ilafed cnginre
O. lnsulato hspocled and
aofw.d by implcmntq, ag.ncy
E. Manulararei's ilrsidlefpn
dl€dJisr haw bem completed
F. Arrofier m€thdl dlomd by Stete
egmcy. Please spcify.
2. Release Daecron (Mari .ll lhat apply)
A. Manual tank gaugirlg
B. T.ru( tightness tesling
C. lnventorl corools
D. tutornatic tank gauging
E Vapor ntnitcing
F. Grqrndflaor nrcnitoring
G. lnterstitial rnonitoring double walled
laf,rvPitrng
H. lntersttial nnnilcing/secondary
comainnEnt
l. Auomatic line leal d€telors
J. Unc tightress testirq
K. Cter nEthod dlouad by
lmpemerting egency. Please
spcity.
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A. Ovdill devica hsfalled
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OATH: tcrrtily the inlorntrton eraming insldladon h.t is ProrrU.d
lnsralec DeVerl Stoddard
NrnrBuilding Representative
Pcitbn
"iiirierik Country Stores. Inc.
CocPury
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EPA Fonn 753O,1 (R.v. 2€2)P.gr 5
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June 4, 1997
Maverik Country Stores, Inc.
880 West Center Street
North Satt Lake Crty, Uf 84054
C,orroro
Gom[ades
Incorporated
'A Commltment to Excelbnce'
610 Bnadlvinc PerLway
Vesit Chcstcr, PA 19380
T el 610/ 34*7002, Fax 610/ 34+7092
Attention:
Reference:
Mr. Dan Munay
Underground Storage Tank Conosion Evaluation
lqn1l4ry o_f Bgsults for Nine Stores
OgdenNo. 163,
Price No. 249
TremontonNo. l44,NorthOgdenNo. 153, W. JordanNo. 159,
Providence No. l8l, Cedar City No. 244, Cedar City No. 245 afi
Dear Mr. Murray:
Corrosion (Ir[TcF)evaluations in accordance with ASTM Standard ES 40-94 uAlternative
Procedures for the Assessment of Buried Steel Tanks Prior to the Addition of Cathodic
Protection" have been completed on underground storage tanks at the above referenced nine
locations.
Individual reports for each location are enclosed. A sumrnary of the resuhs for all nine locations
and the requirements for upgrading of the tanks with cathodic protection is as follows:
The probabilitv of corrosion failure or orobabilitv of oittine corrosion is less than 0.05.
Tanks satisfu the requirements of ASTM ES 40-94 and are acceptable for uosradins with
cathodic protection.
Vernal No. 142 I - 12,000 Gallon ard2 - 8,000 Gallon Gasoline Tanks
TremontonNo. 144 I - 12,000 Gallon and2 - 8,000 Gallon Gasoline Tanks
North OgdenNo. 153 I - 12,000 Gallon and I - 8,000 Gallon Gasoline Tanks
Cedar City No. 245 3 - 12,000 Gallon Gasoline Tanks
Price No. 249 3 - 10,000 Gallon Gasoline Tanks
l) Prior to any upgrade activities, assess the tanks using ASTM Practice E 1430 or a method
that has been certified in accordance with Federal EPA requirements to establish that the
tanks are not leaking.
2) Install cathodic protection to provide corrosion protection to the exterior surfaces of the
tanks and associated steel piping.
3) Implement an approved monthly monitoring leak detection system.
Chv€lad
oofdt
0hahrat
Ed.no.lhn
Andor4o Boshn
Alerta 4q8*en Chabfio
tlillnrgs O|bago
Geoova
llong Kottg
llqjsbo
J*ata
Lrarotto
Lisbon
Loodoo
Lo6 Ar@€s
l{daysia
lllwarkeo
Unncillis
t{ar Odezrs
Ocsar Oty
Phildolphia
Pft6{rir
Regina
Sar FEEbco Shgf,,!
SntDisgo SbctbnorTcSodo VrouYr
Shrid Wahineto, DC
\*-*
Mr. DanMurray
Maverick Country Stores, Inc.
June4,1997
Page2
4) Assess ttp tanks aga& approxirnately six (6) months after tbe cathodic protection systemhas be€n in operation, using ASTM Practice-E la30 oi a method that has been certified inaccordance with Federal EPA requirements to insure the continued leak free condition ofthe tanks.
5) Submit the corrosion evaluation report, evidence that the tanks have been properly testedand are leak fiee an{ clhodic protection qrstem test data to the regulatory authorities asevidence that the tanks have been satisfactorily upgraded with cathoiic proLction.
?
west Jordan No. 159 - 2 - 12,000 Gallon Gasoline Tanks
ogden No. 163 I - 12,000 Gallon and l -g,000 Gallon Gasorine TanlsProvidence No. l8l 2 - IZ,OOO Gallon Gaso[n; Taoks
cedar city No. 244 3 - 10,000 Gallon Gasoline Tanks
NOTE: Atl corrosion evaluation results derived are entirely dependent on theassumption that the tanks are leak free at this time. Thu ."l.ulation of theprobability of pitting corosion is based on the assumption that a recently
conducted test, whose probabitity of detection is 0.99, found the tanks to be leakfree' The leak free condition of the tanks should be verified by theowner/operator prior to the installation of cathodic protection.
Also enclosed is a copy of "Corrosion Engineering Evaluation of Underground Storage Tanks,,,which describes the corrosion evaluation test procedtres, analysis of thJdata and the results ofthe evaluation.
Please feel free to contact John Forsland (406-248-7170) or me at onr philadelphia office (610-344-7002) ifyou should have any comments, questions or require any additional information.
Thomas E. Mehalick
Manager, UST Services
cc: John Forsland
MTCF is asenice Mark of corrpro companies, Inc., Registered in the u.s. patent and rrademuk aflice.
mrc{60{.lE
CORROSION EVALUATION OF
UNDERGROUND STORAGE TANKS
(oNE 12,000 GALLON GASOLINE TANK AND
TWO 8,000 GALLON GASOLINE TANKS)
MAVERIK STORE VERNAL NO. 142
490 WEST MAIN
YERNAL, UTAH
Boston Cleveland Cieneva
Cdgry Defoil Hong Kong
Chadotte Dhahran Houston
Chaago Edrnonton Jakata
Lafayette Mdaysia Ooeat Ciity
Usbon Milrarke Philad€ldia
London Minneagolis Phoenix
Los Angoles i,lew orleans Regina
*A Cotnmlttnent to Excellence"
510 Brandywine Parkway
'West Che*er, PA 19380
T el 610 / 3447002, Fa,x 610 / 34+7092
Sar Frarcisco Sitlg4ote
Sauego SbcktonotTa
Seatte Vancouver
Shariah Washingbn, DC
Corroro
Comfianies
Incorporated
JUNE 4,1997
On May 4'h lgg7, Corrpro Companies, Inc. performed an engineering analysis on underground
storage tanks at the above referenced location. There were three (3) gasoline storage tanks
evaluated, one 12,000 gallon and two 8,000 gallon.
All testing and analysis was performed in accordance with ASTM Standard ES 40-94 "Alternative
Procedures for the Assessment of Buried Steel Tanks Prior to the Addition of Cathodic
Protection" as outlined in EPA OUST Interim Guidance Memo on Integrity Assessment of Bare
Steel Tanks dated October 21,1996.
Based on the results of the corrosion evaluation recently completed on the undelEround
tanks, these tanks satisfy the requirements of ASTM Standard ES 40-94 and are acceptable
for upgrading with cathodic protection.
The following plan for up$ading ofthe tanks with cathodic protection is required.
The probabilitv of pittine corrosion is less than 0.05.
l) Prior to any upgrade activities, assess the tanks using ASTM Practice E 1430 or a
method that has been certilied in accordance with Federal EPA requirements to
establish that the tanks are not leaking.
2) Install cathodic protection to provide corrosion protection to the exterior surfaces of
the tanks and associated steel piping.
3) Implement an approved monthly monitoring leak detection system.
4) Assess the tanks again, approximately six (6) months after the cathodic protection
system has been in operation, using ASTM Practice E 1430 or a method that has
been certilied in accordance with X'ederal EPA requirements to insure the continued
leak free condition of the tanks.
5) Submit the corrosion evaluation report, evidence that the tanks have been properly
tested and are leak free and cathodic protection system test data to the regulatory
authorities as evidence that the tanks have been satisfactorily upgraded with
cathodic protection
Ancho.4e
AUanta
Bahrain
Billings
Corrosion evaluation field testing at the underground storage tank location consisted of collecting
site informatio& performing soil borings and recording data relative to the electrical properties.
Chemical tests were conducted in the laboratory on the soil collected fiom the borings. All data
were then analyzed by Corrpro Companies, Inc. and Warren Rogers Associates including the use
of a computer model to calculate and complete a Mean Time to Corrosion Faftre (MTCFo)
analysis for the tanks.
Attached is a copy of all the test data obtained and analyzed during the conosion evaluation and
the results of the MTCF analysis.
Since the tanks evaluated are older than l0 years old, in order to meet the regulatory requirements
for upgrading with cathodic protectiorq the tanks must be assessed for corrosion holes by a
-.tnoa which is approved by the implementing agency. Corrpro Companies Corrosion
Evaluation which is lerformed in accordance with ASTM Standard ES 40-94 "Alternative
procedures for the Assessment of Buried Tanks Prior to the Addition of Cathodic Protection" has
been approved by many of the implementing agencies. If using this method, to be acceptable for
.rpgruding with cathodic protectioq l) The probability of corrosion failure must be less than 0.05,
or 2) The probability of pitting corrosion must be less than 0.05.
The following conclusion resulted from MTCF fuialysis recently completed on the underground
tanks:
o The probability of pitting corrosion, based on the results of the corrosion survey on the
underground tanks, is 0.032-
NOTE: The results derived are entirely dependent on the assumption that the tanks
are leak free at this time. The calculation of the probability of pitting
corrosion is based on the assumption that a recently conducted test, whose
probability of detection is 0.99, found the tanks to be leak free. The leak free
condition of the tanks should be verified by the owner/operator prior to the
installation of cathodic protection.
Since the probability of pitting corrosion is less than 0.05, these tanks satisfi the requirements of
ASTM Standard ES 40-94 and are acceptable for upgrading with cathodic protection.
MTC9 fs a Serttice Mark of Corrpro Companies, Inc., Registered in the U.S. Parent and Trademark Afice.
m l420604.rpt
Maverik Store Vernal No. 142
Vernal, UT lune 4, 1997
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Wort,Hrr 285 D*rTsted 6-30-99
RESULTS OF C.{THODIC PROTECTION TESTS USING
A COPPER,SULPHATE IIALF-CELL
f,itr Addr:rr:
MA\ERB,#142
49Q WE*cT r&IN
I/ERNAL, UTAH
A PASS MEAT{S A Tt3Af,Itr\..G OT -.850 MV OR BETTER. W-AS MEA,SURED
rRoM TrrE TOLLOI*:I}{G EQUIPMENT:
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I
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(:o,nrrnanl.! SI'EEL T.AIlfItii A}ID liT!:EL f'BODUCT LINXS PI(OTECT!:'D WI'[E IMPRE$SEB
CI.IRBJNT. ME.TALIC SWING IOINTS AT PI-MP .$. NISPEXVSL:-t.
I
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fa'f{f ra^}{. * J,l- f}-^r-arl n-rU L.l V,grr'kl 4 rVlalsuaa
Tcrt* # iSt{Ol Tertrr $ignat..x
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
Michael O. Leavitt .:., 168 North 1950 West
Govemor ,, P.o.Box 144840
Dianne R. Nielson, Ph.D. ,ii Salt Lake City, Utah 841 14-4840
Executive Director (g0l) 536_4100 Voice
Kent P. Gray [phone] FaxDircctor (8ol) 536-4414 T.D.D.
TO: Paul Weissenbom
Maverik Country Stores Inc.
880 West Center Street
Norrh salt Lake, utah 84054
DATE: 514199
FROM: William Moore
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE TANKS AT MAVERIK STORE
#142,490 W. MAIN, VERNAL, UTAH, FACILITY ID# 9000018.
To continue to maintain a valid Certificate of Compliance, the facility must be in compliance with Federal and
State Rules and Regulations.
The file on this facility indicates you installed impressed current on these USTs and lines, followed by a late
"MTCF" evaluationby CORRPRO. Wereceivedthe amendedNotifications fromMaverikforthe impressed
currentinstallations. However, areview of ourrecords has shown thatthe following information is STILL
lacking:
tll Submit a copy of the FULL CORRPRO "MTCF" reports in the format approved in the MTCF
approval in Utah.It should also contain:
Submit a site plat indicating where each anode was placed with reference to the USTs, piping,
buildings and other underground utilities for the impressed current system installed.
Submit a copy of the Corrosion Experts design evaluation and certification for the impressed current
system installed.
Submit a copy of the Corrosion Protection Tests that are to be performed between 3 to 6 months
from the date of install of the impressed current system.
The above information mustbe submitted to this office by 6/11/99.If itis notreceivedby the date specified,
we will commence the Revocation process of your Certificate of Compliance. Continued non-
compliance will result in the fees on your Certified USTs to be increased from $75 per tank to $150
per tank and failure to pay the additional fee can result in lapsing of your UST Certificate of
Compliance. If you have questions conceming this matter or need any assistance, please contact William
Moore at (801 )536-4121.
.+riat ,i* -$ ..i , .,i
k, ' +L , -. s* ru -" " -t - tr l .t qr'.r 4..:!,
=t,, I:,,idd-t ii t jli ls:..Egsr rix.r+{ +i. i$l.+i};i.
Michael O. Leavit
Govcmor
Dianne R. Nielson, Ph.D.
Executivc Director
Kent P. GrayDirtm
DEPARTMENT OF ET.IVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDI.ATION
168 North 1950 West
P.O. Box l,l4E4O
S'dt Irke City, Utah 841144840
(801) 53641(X) Voice
[phone] Fax
[phone] T.D.D.
TO: Dan Murray
Maverik Country Stores Inc.
880 West Center Street
North Salt Lake, Utah 84054
DATE: 116198
FROM: William Moore
RE: NON-COMPLIANCE OF T NDERGROT ND STORAGE TAI\KS AT MAVERIK STORE #142,
490 W. MAIN, VERNAL, UTAH, FACILITY ID# 9m0018.
To continue to maintain a valid Certificate of Comptance, the facility must be in compliance with Federal and
State Rules and Regulations.
The file on this facility indicates you installed impressed current on these USTs and lines, followed by a late
'MTCF'evaluation by CORRPRO. We received the amended Notifications from Maverik for the impressed
culrent installations. However, a review of our records has shown that the following information is still
lacking:
tl] Submit a copy of the CORRPRO "MTCF" reports and the evaluation.
l2l Submit a site plat indicating where each anode was placed with reference to the USTs, piping,
buildings and other underground utilities for the impressed current system installed.
t3l Submit a copy of the Corrosion Experts design evaluation and certification for the impressed current
system installed.
t41 Submit a copy of the Conosion Protection Tests that are to be performed befween 3 to 6 months from
the date of install of the impressed current system.
The above information must be submitted to this office by 316198.If it is not received by the date specified,
we will commence the revocation process of yourCertificate of Compliance. Continued non-compliance will
result in the fees on your Certified USTs to be increased from $75 per ank to $150 per tank and failure to pay
the additional fee can result in lapsing of your UST Certificate of Compliance. If you have questions
concerning this matter or need any assistance, please contact William Moore at [phone].
srat$lr Limh
DEPARTMENT OF EIWIRONMENTAL QUALTTY
DTVISION OF ET{VIRONMENTAL RESPONSE A}.ID REMEDIATION
MichclO. LcevinI Oolrlru
Dirnnc R. Niclso, Ph.D.
ErocrdvcDitcc
IGatP. GrayDirrri
l6E No(t l950w6r
P.O. nox 14484{l
Sa[ k&c Ctty, Ut$ t4l144t40
(t0l) 536.{l(X) Voie
(t0l) 359-tt53 kr
(tor) 5364414 T.D.D.
September 2,1997
TO: Maverik Country Stores
Dan Murray
880 West Center
North Salt Lake, UT 84054
RE: Non-compliance of underground storage tanks at Maverik Country Store #142, 490 West Main,
Vernal, Utah; Facility I.D. #9000018.
The Utah Underground Storage Tank (UST) Act provides that the Executive Secretary (UST) may
revoke a Certificate of Compliance if it is determined that a facility is not in substantial compliance with
all state and federal UST statutes, rules and regulations.
At the request of the Executive Secretary (UST), the Division of Environmental Response and
Remediation (DERR) performed a compliance review for the underground storage tanks at the above
facility. The compliance review, performed on March 7 , 1997, indicates you have not satisfied the
requirements of the Act and are out of compliance. To achieve compliance you must do the following:
1. Document that proper Statistical Inventory Reconciliation (SIR) is performed on USTs
#1 (12,000 gallon gasoline), #2 (8,000 gallon gasoline), and #3 (8,000 gallon gasoline)
by submitting monthly SIR reports for the following months: January 1997 through the
Present.
1
The above information must be submitted to this offrce by October 15, 1997. If it is not received by the
date specified, we will commence the revocation process of your Certificate of Compliance. If you have
questions concerning this matter or need any assistance, please contact Therron Blatter at (801) 536-
4t4t.
O9Ml9Il ll57ilta
'"i1";l*
EI xar,rooErm
I
'
2,,1:l
Cumulative (SIR) Summary Report
January, 1997 - July, 1997
Maverik
Trnk Jen Fcb Mer Apr Mry Jrnr ftt Au! Sep Oct Nov Dec
l20l0l
t2022t
P
P
P
P
P
P
PPPP
PPPP
l24l0l
t24221
t24302
P
P
P
PPPPP
PPPPP
PPPPP
P
INC
INC
t25tzt
12520t
rF.
P
P
P
PPPPINC
PPPPP
t27tot
127221
P
P
INC INC P
PINCP
P
P
P
P
INC
P
l30r2l
130201
130302
IFiINCPPPP
PPPPPP.F'PPPPP
INC
.F*
INC
l32l0l
132202
13232t
IFI ND ND
PNDND
INC INC P
ND ND ND ND
ND ND ND ND
PPPINC
t34t2t
t3420t
134322
INC INC INC INC PPPPPP P INC
PP
PP
l3512l
135201
PPINCPPPP
PPPPPPP
l36l2l
136201
136302
INC INC INC P
INC INC INC P
PNDNDND
P INC INC
PPP
ND ND ND
t37t2t
137201
INC INC P
PNDND
P
ND
P
ND
P
ND
P
ND
l38l2l
138201
PPPPPP'FT
PNDNDNDNDNDND
tcl2l
L{,2OI
t+n22
P
P
P
INCPP
INC INC P
PPP
P
P
P
P
P
P
P
P
INC
usrMAN Industries, Inc. * underground storage Tank Management
L2265W. Bayaud Ave. * Suite ll0 * Lakewoo4 co 80228 * l-800-253-8054 * [phone] * FAx [phone]
P .PASS
INC - INCONCI,USTVE
.F. - trAIL
ND -NODATASUBMITTED
0Et2st97 Dedicated to protecting the environment Prge:
Michael O. Leavitt
Govcmor
Dianne R. Nielson, Ph.D.
: ,.'.i'\,. !!1''fiiI ' ...:i ]i ,,:. ':t .,, !! :! iit!, ,, , .,,*;? ,E ,jli
DEPARTMENT OF ENVIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box 144840
Salt Irke City, Utah 841144840
Exeurirc Dirccttr t tgotl s:o+100 voice
Kent P. Gray iii [phone] FaxDircctor ii tgotl sroaal4 T.D.D.
September 2,1997
TO: Maverik Country Stores
Dan Murray
880 West Center
North Salt Lake, UT 84054
RE: Non-compliance of underground storage tanks at Maverik Country Store #142, 490 West Main,
Vernal, Utah; Facility LD. #9000018.
The Utah Underground Storage Tank (UST) Act provides that the Executive Secretary (UST) may
revoke a Certificate of Compliance if it is determined that a facility is not in substantial compliance with
all state and federal UST statutes, rules and regulations.
At the request of the Executive Secretary (UST), the Division of Environmental Response and
Remediation (DERR) performed a compliance review for the underground storage tanks at the above
facility. The compliance review, performed on March 7, 1997, indicates you have not satisfied the
requirements of the Act and are out of compliance. To achieve compliance you must do the following:
l. Document that proper Statistical Inventory Reconciliation (SIR) is performed on USTs
#l (12,000 gallon gasoline), #2 (8,000 gallon gasoline), and #3 (8,000 gallon gasoline)
by submitting monthly SIR reports for the following months: January 1997 through the
present.
The above information must be submitted to this office by October 15,1997. If it is not received by the
date specified, we will commence the revocation process of your Certificate of Compliance. If you have
questions concerning this matter or need any assistance, please contact Therron Blatter at (801) 536-
4141.
@l@l9l ll57am
Owner Name )...'re;
Addraesit'(', ?Y.r tfT
ciu .1\{ ro "n
tt\^ty I 3 f'f30"
Area Code Phone Number
Contact Porson At UST Location Phonc I
Facilitv Nama rtj?,f vTcr i M*Ve,f\ K
l"-"^--'"'+1t't r^l nnr, , * [, {
City. , r State Zo Codc\lcr"1 /,rI r rT 9U;\-7Cf.
Cartificat€ of Complirnce on site? Yes
1 +'r u,r,arJp b
Signature of Owner or Owner's Representative present During lnspection:
Distiibution: White-DERR, Yellow-lmpGctor, pink-Facility/Owner
,1 ff::l:.U-:
Trnk I Tzak )Trnlr I faak A
The UST system is filled by transfers of 25 gallons or less. ll yes' spill
and overfill prevention is not required.
Yes A"Yes I Yes @ Yes No
ls lhere a spill containment bucket or another device that will prsvenl
release of product into the environment?
Yes (D Yes @ Yes '[,Yes No
ls there an overfill prevention device installed on the tank? ll yes'
indicate the type of device: Ball tloat (in vent line), Automatic shutoff
(in fill pipe), Alarm, or Other (specify)
Yes @ Yes Qo)Yes tNe)Yes No
For overlill alarm only: ls the alarm located where it can be easily
seen and heard by the delivery driver?
Yes No Yes No Yes No Yes No
For overfill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?
Yes No Yes No Yes No Yes No
Tank I Taak D Trnk I faak A
lndicate the type of corrosion protection: Noncorrodible material (FRP),
Composite steel (CS), lntemal lining (lL), lmpressed Current (lC),
Sacrificial Anode (SA), or Not prot€cted (NP). l, FRP or CS do not
complete the remainder of this sectaon.
'7up ip ^rth
Td(
tJ.E
^/P
Ltr
^/P NT}
LIE
lf the UST is not protected, was the tanMine installed belore May 7,
1985? ll yes, corrosion protection is not required until llec. 22'
1998; do not complete the remainder ol this section.
.@ No @No tO
No Yes No
The results of the last two cathodic protection tests are available.
(within 6 months of installation and every 3 years thereafter).
Yes No Yes No Yes No Yes No
Results of the most recent cathodic proieclion test.
Name of tester:
Test Date:
Td
volts
ld*
volts
Ttr*
volts
Tr*
volts
h
volts
LkE
volts
LtE
volts
L.lE
volts
For impressed current syetem: The results of the last thr€e
equipment operation checks are available. (Equip. check required every
60 days.)
Yes No Yes No Yes No Yes No
lf the tank has been retrofit (lined or cathodically protected), indicate
the date the retrofit was completed.
comments: A fifi ?fi,v--J J < j ,7 j'J o,+r /4 rYal ?-rfu /tt-t* a / /t )
o*" 3.7, q 7
UPGRADE NOTIFICATION
t ')t.tLrL '),t
i,!-'!rt'understand that the lollowing marked items must be completed by
lL)
(Pndlm)
December 22, 1998 in order to meet the 1998 upgrade requirements:'p[Spirr prevention for tank(s)#
-?
fCorrosion protection lor tank(s) #
t1?l(-)YOverlill prevention tor tank(s)#-.,jr
fltonosion protection for piping assoc. with tank(s) #IZ -7 t-l Facility.meets 1998 upgrade rsquirements.
4 , , i.-+-Signature of Owner or Owner's Representative Present During lnspection:-l-.Q -, \.
Distribution: White-DERR, Yellow-lnspebtor, Pink-Facility/Owner
:
I
1
I
I
!
>:
-,.,,,',.ii',,,,,:.UTAH US-T PROGRAM,,,r,1,,,r.tlil RgteasC,,beiicuon,.,roi., plping
P.ressuiEed,PlplnU It itv
Set 1 Tank I Tank 2 Tank 3 Tank 4
Automatic Flow Restrictor (if yes, indicate model in commenE seclion below)llp ",!€:il e-r
Automatic Shut-off Device (if yes, indicate model in comments section below)
jtt o J
Continuous Alarm System (if yes, indicate model in comments section below)/?o
Records of last Line Leak Detector performance test available on-site u€;) No d./ No
(-)Yes No Yes No
Date of last Line Leak Deteclor performance test DY-tu1 il . 7 -9qa '7-f 7c 7 "e-?a
Result of last Line Leak Detector porformance test ,n t' (lllr't -rf*s Fait ,'P"ii Fail dJ Fair Pass Fail
Set 2 F't
Records of last Line Tightness Test available on-site ,--X'es, No ffei No 6J No Yes No
Date of last Line Tiohtness Test '7 t -it r1 /
," i_' / k7 ?" 3 -'./'/
Result o! last Line Ti-qhtness Tesl r?ass / Fail ^P6O Fait ,ftrSt Fail Pass Fail
Vapor Monitoring (if yes, use Vapor Monitoring checklist)Ii
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklist)
Statistical lnventory Reconciliation [SlR] (il yes, use SIR checklist)
Other approved method (if yes, use other method checklist)
Sucffi ,,ahd.',erati!t,,no*iPffi g,'!i
Records of last Line Tightness Test available on-site Yes'1 No Yes No Yes No Yes No
Date of last Line Tightness Tesl
Result of last Line Tightness Tesl Pass Fail \ass Fail Pass Fail Pass Fail
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklist)
Statistical lnventory Reconciliation [SlR] (if yes, use SIR checklist)
Other approved method (if yes, use other method checklist)
Iffiryiii:ffi,iixti;x
Operates at less than atmospheric pressure Yes No -Y€s- No Yes No Yes No
Slope of piping will allow ALL product to drain into tank when suction released Yes No Yes No *-tee- No Yes No
l{as only ONE check valve, located directly under pump Yes No Yes No Yes No YeL No
All above information on suction piping is VERIFIABLE, uss comments section Yes No Yes No Yes No Yes N-i.'
,r,,'J/)f "/n S J /'i.ia,., u fi, /- u,...14( v lfrr
--, t /.r J,'1 \() ' 1
Signature of Owner or Owne/s Representative present During
Date:_
1
7 -7 "i7
Distribulion: White-DERR, Yellow-lnspector, Pink-Facitity/Owner
: -. UTAH UST PBOGRAM Frcrrrty ,o*.-t?i"7%
llonth$ S-ta$$fical lntenloly Beconciliation (SlR}
SIR as a method of leak detection relers only to monthly monitoring using SlR. An annual test performed using SIR is considered a tank
tightness test and should be rePorted on the tank testing 8nd inventory control torm.
Name and address of SIR vendor:ill.'t J r/.!li/
,::i . .ri;:,:ii:lr :-:1rr::::ri:1t,. ,,t: .i,t ,, .. :, . . , ,.1i ., :.:: , '.. ...ii+:.q!.fffi1ffi$'f6ffire rlf.ltrorrttufi'foIitrnlttJ,
-Tml I T.r*2 Tenl $Tenk{
lnventory recorda lor product inPut!, withdrawals, and the amount still
remaining in the tank are available lor each oPersting dey'@,6),Gi}-o rfa (D Yes No
Record3 include correct * ol monthly water monitoring readinga..@Ho d.O xo fes) ruo Yes No
Tank inventory ig measured and recorded belore and after each fucl
delivery.
@no @no (3 *"Yes No
Appropriate calibration chart i3 used for converting product level
measurement to gallonr and ir availablc lor review.
r@ *o ,A No @*o Yes No
Dispenser pump hal a curcnt calib.ation sticker or appropriate calibration
documentatlon. -)(9 No @No @*"Yes No
The drop tubc in the ,ill PiPc ertends to within onc loot ol tank bottom.vea dD Yer fffl vea ifQ Yes No
SIR monitoring recordr arc availablc for thc p.tt 12 montht. ll no, indicate
which months are missing ln the comments section below.Yes (f[6)ves f)ves rtJ)Yes No
Are any months resulte rePorted as "tail"? ll yes, specily which months in
comments section below.
ves (@ v"" @ ves i.llD Yes No
Are any months results rePorted as "inconclusive'? ll yes' sPecily which
months in comments section below.Ito ,I9 NO (9No Yes No
--
:!Pl€ee tru ft*iore.qtt$tq$q!
Documentation of perlormance claims for the SIR method ig available and shows the ability to detect leaks ol
0.2 gph with a 957o or greatu probability ol detectlon and a 5% or lels probability ol false alam (3rd party
certificadon).
i9 No
3rd party certification indicater thc method has been approved lor both tankg and lines.v;?No
The volume ol product in the tank ir measured using a:6;,;;;a ATGl
.t-
ll a gauge stick i8 used, it il long enough to reach the bottom ol the tank. .".r,;,tr '8 i""-)No
ll a gauge stick is used, the bottom of the gauge stick is:, Acc6gilible Worn
inch over the full range ol the tank's internal height.
ll a gauge stick is used, it is marked legibly and the product level can be determined to ille nearest l/8Jf an ('t€)No
I Complete to appropriate sections of tf ATG checklist
^^mmanra.
!-' ,, . , ,,
-' ,- 11 {) ,:1 , i, ./ .. , ., f ,.,
!
4-i.it S ,:l-<r N
fl't II lu)
,..: . ( .i-. .,r;7 f'; )T ^t Drot e j :
Dete:
t -*^: -,) -7
/,i,,1
Signature of Owner or Ovvner'g Representative Present During lnspection:' ,l.f ;.1
Dirtrlbutlon: lthiteDERR, Yollow-lnsp6ctor, Plnk-Facllity/Ownol
3o l-b.^u^s
a (b'.,fawt
;)ECEIVE D-,
*taz Regor'Tt-t\ Qn- +\,, ^*$O
?rW:
-1,''J',','l-',I,',1"j,t#li,T*'Jii#fi :i*
The V€fft M,l,lEr,K (.*.^t,y J-tcu^e {t gOOOoigCo,agl.at,,: o'+
in Vernc^\..
p novr bEL
If6r LcrT
-I &potrg',1.
Be<,r 0rltsp [a.rg
":crJ proc es.i tt oxt
Ta^r dS S*/ qL
^c;*,^.t.rDr-\
vJ E n< l--rT
kcor,)l
r "fG
X ft-1p-,re
\,n {v\Aact{ . -t'^"-ItQ$'s"{" -G..^^s v,r€r<
hi,{k {* 0.;*.{"*[7 "* p";t b.rouu" +h"/€
Ttf PWkk S{o^e t{adM>srr k,es 7 r --I--Ll fa.Lt O+uJ .ayrs-5h Ls
& [(o*r et*-., -t. t- M*ua .f (b
AtUva p.rLs " P. ,n !- " GFt . Tt{e s E Ar< € Nic l.'os e'\.
. -6"**T_t-[e S t R 1 0or"t.^a'a,frs AA"E
Cr{\t€FfToY 4 u^or,f,ort ^J
f6r yo r e,^,tLe,t- \qq|
As Ctt"rr,
R.ecor\-l t"l+-rg
TRa Stto-,-., t(o,t{hr kreRE pep..dre\
:,1 i2apo.r -ti^k # | \a. gh
)? \.. gb.
s (R Re po^rs I.r{ not avo.ta[t. A-t
O trRce
t4eb.
bn [o.,
J
6"? (4rerr k
Qu +"k,. ,O
(^st- si+<.
tnct.,^.6Ef "-\ S iA
-(A
S^ i * U"Z, ldrt ,116r*.4u
!ll.Y -'i :t,']l
Q"-k-
\-
/
\
FACIUTY ID#
FACILITYNAI\,IE
FACIIITY ADDRESS
Check Only One
PETROLET]M STORAGE TANK
FINANCIAL RESPONSIBILMY DECLARATION
Complete one fom for each facility
Return completcd form by IVIay 1,1997
flq11e,,'l< e t'/ 2
4Qo n' 'n
I , LrT (1':7(
tr I choose to continue to participate in the PST Trust Fund.
O Submit this Financial Responsibility Declaration form by May l, 1997.
O Submit the Fiscal Year 1998 Facility Throughput Declaration (blue form) by May 1,1997.
O All tanks including aboveground storage tanks (ASTs) lobated at this facility maybe required
to participate in the PST Trust Ftutd.
O Indicate number of ASTs, if any, located at this facility
I choose another Financial Assurance Responsibility Mechanism(s)
Submit this Financial Responsibility Declaratiou form by May 1, 1997.
By June 15,1997, submit acceptable financial assurance documents and $1000 processing fee
per mechanism (Use the exact format required by federal regulation, 40 CFR Part 280,
Subpart H.).
O Indicate your Company's " Fiscal Yeat''ending date 3- sr
o
o
C .,, ,.
Print na:ne of owner/operator or
lrbr'bol?morrA/ /hf
PhoneTitle
b-b ^?7
authorized representative
Signature
* SEND NO PAYMENT AT TIIIS TIME *
FACILITY IDIf
PETROLET]M STORAGE TANK
FINANCIAL RESPONSIBILITY DECLARATION
Complete one form for each facility
Retun completed form by IVIay lrt997
FAC[ffYNAI\,IE
FACILITYADDRESS
Check Only One
VrzuBL , r,- F1o78
a
o
o
I choose to continue to participate in the PST Tmst Fund.
Submit this Financial Responsibility Declaration form by May l, 1997.
Submit the Fiscal Year 1998 Facility Throughput Declaration (blue form) by May l,lgg7.
All tanks including aboveground storage tanks (ASTs) located at this facility may be required
to participate in the PST Trust Fund.
O Indicate number of ASTs, if any, located at this facility
a
o
I choose another Financial Assurance Responsibility Mechanism(s)
Submit this Financial Responsibility Declaration form by May 1, 1997.
By June 15, 1997, submit acceptable financial assruarce documents and $1000 processing fee
per mechanism (Use the exact format required by federal regulation,40 CFR Part 280,
Subpart H.).
O Indicate your Company's " Fiscal Yeat''ending date
Etr. ',X 2?,r<rds Z
Title q
Phone
/-Scs -?"
X
hint name of owner/operator or
authori4ed representati ve
6rZil-*u
* SEND NO PAYMENT AT THIS TIME *APR 3 0 ,9e7
t \ r.r t.trlG
-USt' -.r.nsta11at,ion/Upgrade permr E
t I D.trlc, lodlllcrtlon
IB'ETl
Pho!. I
lacllity IDls(tf Dot . tr.r !.clil.ty)t V/ r^"rulJ./Replace fxt upsrade
Tt8I ol,a.s yA\TEQTL qnIINTRV ST
oUOr.".
contacE p"."orDN WM G N.S.L. OFFIC pnor,. * t.9LlZgt:riiT-
rrclllty MAVERIK STORES . INC. 'I'
subcont,ract,ed coqranies covered under this permic and insurtnce):
cert,. il v. dD7 Exp. dace
eert. * lfL Exp. date
Cerc. li TL E:<p. da
rorrrt *, 4.gl-14
-".".U@
Phone l*
Drt. rort 1111 cooa.. (. P. Pa.,.q
Addres CiEy.
Conl.act, per
\17(
UDuru8l or- axtasuat,lag clscuattsacaa arDccEld:Tnn-. L,^ - l-!a-.uri*'LILFC tr,-n-i;ruA
Total tallaEton ?ank Fee/permiE,
s
QwQ
Ccstltlad flrt.t'1.r.! on
-
Tut. IqvolvGd la f!.trllaclop / rrDgrad.
Tank *L 3
InsEaIl /Upgrade ),F+*.-->
Capacity (ga11ons)P.NDO 8, ooo 0,ooo
q/pe (FRP, St,eel , eEc. )rl +
Subscance Eo be SEored 6ss ?1,.,CtrS ?H.hes 3u,
Piping B@e (Press.
SucE,ion, Gravity)P P P
nsralI/Upgrade Whac?
Tank. Lines. c.P.,..C/P Clr LlD#.a Ft
i ,*trc.F I
Ir11 co5llotc6 torr tor
Strale Use Only: Dat,e
cK*
salE Lake ClE,y, gr.ah 84115
Appro,red a eq t-l/tt lQ7 App.z3Yloc /$Gco*
Utah DeparcmenE, of EnvironnenEal euality
Division of EnvironsrenEal Response and Remediac:on
158 NorEh 1950 West,, lst Floor
,v (NZ Dar,e ?ermir Maiied tiltdq-
Michael O, Leavitt
GolE mr
Dianne R. Nielson, Ph.D.
Exlcltive Dir€clot
Kent P. Grav
DirEctri
DEPARTMENT OF E}WIRONMENTAL QUALITY
DryISION OF ENIVIRONMENTAL RESPONSE AND REMEDIATION
l6E North 1950 Wesr
P.O. Box l,l484()
Salt Iake City, Urah E4l 14-4840
(801) 536-410 Voice
(801) 359-E853 Fax
(801) 5364414 T.D.D.
q -(l-q-?
'^.fl..- {q lL blc.t , uT ?4054
Dear Underground Storage Tank Owner/Operator:
The Division of Environmental
underground stgrage tanks (USTs
3nd Remediation (DERR) has received notification that one or more
associated lines / full systems ) will be ( installed lgorfr?Eftt+ , Vev*q\ , Utah, facility Iil+ r(
Before regulated USTs can receive deliveries of fuel and be put into operation, they must qualify for the
Petroleum Storage Tank (PST) Fund and receive a Certificate of Compliance. To qualify the tanks for the
Fund and receive a Certificate of Compliance or maintain your current Certificate of Compliance, you must
do the following:
1. Register the changes in the tanks using EPA form 7530-1, Notification for Underground Storage Tanks
(Enclosed). Tanks installed after December 1988 must have the following in place when installed: leak
detection on tanks and piping (including automatic line leak detectors on all pressurized piping), spill and
overfill devices, and conosion protection. The Utah Certified Tank Installer must siem pase 5 of the form
2. New T or Systems Only: Complete the PST Application (yellow) and Previous Pollution Incidents
forms from the enclosed PST Fund application packet. You must indicate on the PST Application
the type of financial assurance you will use for your share of eligible cleanup costs for each release
covered by the Fund.
3. . Conduct a tank and line tighfiress test and send a complete copy of the results to the DERR. The tightness
test must be conducted by a Utatr certified UST Tester for any new tank, line or system installed.. A list of
certified UST Testers is included in the PST Fund application packet. All portions of the tank and piping
system which could contain product must be tested. must-e..r'd DEBR fer autherizatiolr of e oftE:ffiiiE iIEEiE ] 16 lEsnng ur?oss for ncw USTs: eorltf,enhe
nFRR .rfic' at [phone]; 24 hours ir advarce; rc zEimEE for mi autho izatiorr: ,/F
?4. , New ]rrlks or Systems Only: Pay UST registration fees and PST Fund fees for all new tanks installed. These
il^y{:"gistration fee- $135 per tank; PST Fund fee- $250 per tank. These fees must be paid before a
't lffertifrcate of Compliance can be issued.
v \-,
L6lt0r0 q'ar .uf,nuopces ry?I etercrs punortEPuo
az1%"
asno,,qmdaruf aqlaroJeq,ffi :lX"f fffJJi',f;slfiTi"tlg:]ffi '#*:]Hs.';T,y,"rff:1
'uuv epoc qs6) 1cV 4rej ,aarors pun;;Erepun wn eq,L 's1uq rno{ ;o esn eID Jo ssol plo^u no,(-d1eq ptn
,."rori .W rfrfiprf Ui^ tlo"**rtnhu ra,1to PtlB sIIuoJ paPaau eqlJo uopelduroc {1eurr1 'elqucgdde ueqn
ecuugdtuo3Jo elucglua3 ? ens$ 111n\ UUSC arp'pe^Foal sI uopuuoJtrl frsseJau eql ueq/Ufssarpps a^oqB
eW 1u UUSC aql ol queu,(ud aa; fua puu 's11nsan Nq'suuoJ eI$ Pues 'paplduroc aIB srusll eloq? eql ueWU[
MRUERIK COUNTRY STORE
.--'
TEL : 80 t-292- 1 406 Jan t7 97 14:2? N0.007 P.01
lilaueil[GounW
Sbrcs,lnG.
trlavcrl[ (lrunt ry .ltoros, lnc.
880 w- (bn(er Strcct
Not'th Salt IaIe, UT
SIOFA
Phona: 801/206666? Dx. 88{
l'axr 8ol/roh,lo€
E.mAII: PAULWBMAVERII(.(X )M
lb: BillMooreFrom: PaulR-Weissenborncc: FllesDate: Friday,January 17, 1997
SubJect: Impressed CurrentSrslems
Thts memorandum is to tnform you that installatlon of lmpresscd current
systems is scheduled for the followlng stores:
tlao 1.
tTKo 2.
,nL g.
dL 4.
dr s.
tqell 6.
I tf1 7.
l'1 fo 8.
lctT I 9.
rq(t 10.
t1.sl tt.
g4.l't1t L2'
Cedar CitY #244
Price +249 /--
Sprittgvilld #258
Bouutiful (!g9 ,
Riverton6yF)
West Jordan #159
North ogden *153
Cedar Clty ,+245
Vernal #142
Provldence #ltl
Ogden #163
carland@
FID#
6000189
5000169
1000374
3000024
4000134
400013?
1200017
6000188
9000018
0100030
1200018
0100034
- ,Yec4l>c,< *<' P ' *q{>
q. r( c< lt 'l
\ivr'td-
-z'l1;-
' ' ^tL\ lq.'tj
,',^..1 --q3l
7vc<d Pec .C c' F. +tt{'
.1cq{'l
erkrt'
qqt,'
\ .t '1 't - l^"t+ Lq,.- aeJ
7'ttat-ltll
l,\.d Vftqs
It ls our understandillg that permtts will be requtrcd on all of these locations
except 258, 130, 140, and 144. Please let us know lfyour flles lead you to a dllferent
urderstanding.
Thank you for your conttnuod assistance'
Paul...
| /dttat&
Michael O. Leavift
Govcmor
Dianne R. Nielson, Ph.D.
Exrcuivc DiEtc
_ Kent P. Gray
Direttr
State cf tltah
DEPARTMENT OF E}WIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West lst Floor
Salt trke City, Utah 84116
) 5364100
(E0l) 359-E853 Fax
(Eol) 536"4414 T.D.D.
IO AUGUST 1995
TO: MAVERIK COUNTRY STORE,
490 W. MAIN
VERNAL, UTAH 84078
RE: Non-compliance of underground storage tanks at MAVERIK STORE
Facility I.D. # 9m0018
The Utah Underground Storage Tank (UST) Act provides that the Executive Secretary (UST)
may revoke a Certificate of Compliance if it is determined that a facility is not in substantial
compliance with all state and federal UST statutes, rules and regulations.
At the request of the Executive Secretary (UST), the Division of Environmental Response and
Remediation (DERR) performed a compliance review for the underground storage tanks at the
above facility. The compliance review, performed on 0![$-, indicates you have not satisfied
the requirements of the Act and are out of compliance. To achieve compliance you must do the
following:
l. Documenting that drop tubes extending to within one foot of the tank bottom have
been installed in UST(s) #1.2.3 .
Please return a copy of this speed memo with the above items to speed processing. The above
information must be submitted to this office by 10 OCTOBER 1995. If it is not received by the
date specified, we will commence the revocation process of your Certificate of Compliance. If
you have questions concerning this matter or need any assistance, please contact Gary llarris at
(801) s36412r.
Prinled on recycled pap€r
ARr 60t-
c'vAflcnt
*"o"3oJ tg L s rb /
Contact Person At UST Location Phone #
Facility Name
Street Address /1,1a t
tcz*/-t Ll 44.A o L,J,,\-
I have inspected the above-named facility on
K.1
Signature of Owner or Owne/s Representative Present During
x
$\
,r.
r$.
I\
t
Distribution: White-DERR,
$\
Distribution: White-DERR, Yellow-lnspector,
\
*,' ..,j
Tenlr I laalr )Tank 3 Tanlr tr
The UST system is filled by transfers of no more than 25 gallons at one
time. lf yes, spill and overlill prevention is not required.
Yes p Yes p Yes @ Yes No
ls there a spill containment bucket or another device that will prevent
release of product lnto the environment?
Yes @ Yes r@ Yes @ Yes No
An overfill prevention device is installed on the tank. lf yes, indicate
the type ol device in the space below.
Yes ,@ Yes lo Yes @ Yes No
Ball float valve (in veni line)
Arrtomalic Shrilolf valva lin fill ninal
Ovarlill Alarm
Othar Svslam lcnaaifu hrnal
For overfill alarm only: ls the alarm located where it can be easily
seen and heard by the delivery driver?
Yes No Yes No Yes No Yes No
For overfill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?
Yes No Yes No Yes No Yes No
Tnnk I lank 2 Tnnk 3 Tnnk I
Tanks and/or lines are made of a noncorrodible material (such as
fiberqlass) or aro made ol steel clad with a noncorrodible material. It
Tr*
Yes dG)v"" @ ,r"'* @
Td
Yes No
yes, cathodlc protectlon ls not requlred.
i
Llra
Yes @),""'- 6 Yes (fi'\Llm
Yes No
Tanks and/or lines are made ol unprotected bare steel and were
installed prior to May 7, 1985. ll yea, cathodic proiection lg requlred
Tr*
/Tx.s'\ No 6.ts No
Tar*
/@$, No
Trt*
Yes No
on or by December 22, 1998.ttr
(@, No @* *o
LIE
@No
tJ.E
Yes No
lndicate type of cathodic protection: lmpressed Current (lC) or --Sacrificial Anode (SA)
The results of the last two cathodic protsction tests are available.
(fests are required within six months of installation and every three _
years thereafter).
YeS No Yes No Yes No Yes No
Results (in volts) of most recent cathodic protection test,
Name of person who performed
Test
Ts*
volts
Tl*
volts
Td
volts
Td*
volts
LJrE
volts
tlm
volts
ttE
volts
UE
volts
For impressed currenl system: The results of the last three
equipment operation checks are available. (Equip. check required every
Yes No Yes No Yes No Yes No
lnspector's
Signature of Owner or Owne/s Representative Present During lnspection:
tJ--
Distribution: WhiteDERR,
This method ol leak detection requires both monthly inventory control reconciliation and tank tighhess testing. lf th6 UST has not been upgraded
(upgraded means that the tank and piping aro protectsd lrom conosion and that spill and overfill prevention devices have been installed) the tank needs
to be tighhess tested annually. lf the UST is upgraded the tank needs to be tested every live years. lnventory records must be kept for each operating
day.
Record of last Tank Tightness Test available on-site
Date ol last Tank Tightness Test
Result of last Tank Tightness Test. lf fail, specify in comments section what
actions have been taken to correct the problem. Has DERR been notified?
Tank Tighhess Testing method:u sfa4l s/
Name and company of tank tghrress t€ster: US Tn ( A ,\/Utah Tester Certification Number: UT ?
Documentation of perlormance claims for the Tank Tightness Test method is available and shows the ability to detect leaks of 0.1 gph
with 95% or greater probability of detection and 5olo or less probability of false alarm (3rd party certiflcatlon)
lnv€ntory volume moasuromenls lor regulated substance inputs, withdrawals,
and the amount still remaining in the tank are recorded each operating day
lnventory is reconciled monthly (sum of daily overages and shortages lor each
month is less han 'l% of tank's frow through volume + 130 gallons)
ll no, which months were not? (specify month and year)
lnventory Control records are maintained and available for the past 12 months
for each tank
Records include monthly water monitoring to ihs nearest 1/B'
Monthly water readings are used to adjust monthly inventory balances
Appropriate calibration chart is used lor converting product level measurement
gallons and is available for review
Dispenser pump has a current calibration sticker or appropriato
The drop tube in the fill pipe extends to within one foot of tank bottom
Owner/operator can explain inventory control methods and figures recorded
Books appear used and evidence of recent entries is apparont
Owner can demonstrate acceptable gauging techniques f #- Zou.t I i,,
The gauge stick is long enough to roach the bottom of the tank
The ends ol the gauge stick are flat and not wom down
The gauge stick is marked legibly and the product level can be detsrmined to the nearest 1/8 of an ith over the full
range of the tank's intemal height
"o ^"nr.
y'(Ay€rzr K /: t Foun>)nq 7; y'r" l,(/t-t€^/ STtcKrJ
Signature ol Owner or Orne/s Representative present During lnspection:
Distribulion: White.DERR,
\'|-+'; "* .Lr,-{
(:, ,ytk
Leak Detection lnspection ecklist
Ottnyftlry (Corporedon, lndlvldurl, Publlc Agory, or dror liltyf:
La*rh* q /*-r,vt*i, -/rL,u..uq:r.il.
4s1 (s rl,-
Contrct Pcnon At UST LocrUon PhonoI
St !.'.1g7/D
Frc[fi w, 4oz:z2o I K '
p urno r Socdq! l, chcck h.!. _ )irttttylllgrc,ComplryStr!d orOttorltir
,--{- (Q oa b'
thb pagp td compleb thc intornelin forrll addilionsl tenk$ '",,i:,,, '
It rpt, datg lasr lJsecl
lf 6mptled, verify I' or less of procrrrct ln tar{<
Month arld Year Tar* lnslall€c, (E-6lrnate a K-knotwt)
Mabrial of Cons;ruciim (E-esrlrnate a K-lapvyn)
of Tank (in gallons) (E-€stirnate a K-krown)
lV. A. Felease Detection ForTanks ch€d(ficnblrdluc{ionrmthdtOri{,oroatt r.-nlrrn-"r"o,rrr"a
ManualTank @uging (only for tanks undor 1,000
Marual Tank @uging anct Tard< Trgffiress Tdirp
(mly br tanks uncler 2,(}m gal.)
Tank Tigtrtness T€Sting and lnvenrory Oorltrol
Olrer approved rn€thocl (write in narne d nrdrod)
lV.B.ReleaseDetectionForPipingGre*lhcrrbasodgtEctim'ndEd(st''.dbPlrir'g.j
Ched< OrcType o, Pifing foroech T.nI
Automatic Une L.eak Detecto6, and
(check one of the ficllowinol
lV. C. Corrosion and Spitt/Overfill Protection , _ nri.u t\rr_,t{-,. ,,1!
Conosion protection installed (indicate ciate)
Spill/Overfill pot€ction instarl€d (indicsfe crats)
V. Site lnformation
Generdsiteobsorvationsandcornments(vioinrlyobservdions.grorndurabrletel.dJ ElV.Fih,:,,r.,,, .,..i
. tlFQtrC,hi:-,'' i ii;
lnspecior's Signaturo :
I haw inspectd the above n med hcility on 7Z-({'7.3
std,5e-t
nventory Control and Tank Tightness Testing
FacititytDf '*072O/
Mstrod crtank tghEts bstng:
Name and addr€ss ol tank tghh€ss t€sbr
-'a(-o/-
rr:,.Please,,c*omplete,ra!l,inf
ormatjonfor,each,tank
,1:,,, , ,., lf lhE facili-$ has rnoru lhan 4 bnl€, pteasa pnoUcopy lhis page ard
conrph6 the intumaiion lbr all addiliond tenks. , ,,
Date of last tiank tighh€ss tesl
Did tank pass tesn lndicale yes or no. lf no, specify in
comm€nts section below the status of the lank or what
actions have been taken (e.9., has state b€en ncrtifi€d?)
of deliverle arrd sales balance wlth
claily of liquid volume in tank arc
maiirtiained and avai lable.
Overaga or shortag€s are les than 1% + 130 gals of
tank's llow thro.gh volume.
lf no, whictl months rvere notrl
can explain invenbry control ancl flgur6 usod and tecorded.
Books appear us6d and evidence of r€csnt enties is apparent.
Books are reconciled monhly.
Appropriate callbralim chart ls tsed for calculatlrp volurne.
Disperser pump6 have q.rnent calibratiott- stickerB.-€;2-Th€ drop tube in tn lill pipe extgnds to within one bol ot tanti bottom.
Owner can dernonsfate corslsterrcy in dipGticking lschniquG.
Monthly water readings ar€ us€d in calqJlating montrly inrrentory balancs.
The dipstick is lorq errcugh to raach the botbm of th€ tank.
Tfre ends of the gar.rge stlck are flat and nc,t wtrn down.
The dipslick is marked legibly and th€ product level can be determined to u€ nearqit on+eiffi
of an inch.
The tank has been tested within the year arxC has passed the tighfr€ss t6t (if nscsssary).
A third-party certification of the tank tightn€ss test method is available.
Tank test€r complied with all certification r€quirements.
Moniloring and tesling are maintained and available for ths past 12 rnonths.
fr.lrr,l C;
./*.rork Oa"L
Facility lDf /npnr; t {
A rn€illrod must be sd€ctd tom each sa. Wlrqp apdlcaUte irdbsb d& of I8t bst tt lhb bcllity has nrore llrn 4
Set 1 Tank 1 Tank 2 Tank 3 Tank {
Aulomatic Flor Resridor
Automatic ShrJt-off Device L/'t---z (ul ./
Continr.rcus Alarm Srrstem
and
Set 2
Annual Une Tightness Testing lr''t/u*'/
Vapor Monitoring
tf Vapor Moniloring, docurnentation cf rnonhly
rnonitoring is available
lnterstitial Mmitorirlg
f lnterstitial Moniioring, docurnentation of nnnthly
monitoring is available
Grouncl-Wat€r Monitorlng
f Grounc,-Water Monitoring, documentation d rnnhly
rnoriiroring is avallable
Ofier Approvecl MEtlocl (specify ln commenE s€cllm)
Une Tightness Testirp (required every 3 )rears.) /
Vapor Mmitoring /
Secondary Cornainrnent with lntsrstitial Mmitorlng/
Ground-Water Monitorino /
Other Approv€c, Method (specfy ln commends€ction)
No Leak Detectlon Requlred ,/(must answer yes to all of the followlqf quesllom)
Operates at l€ss than atrnGpheric pri6sur€
Has only one check valve, wlrich i/located directly
urder pi.rmp /
Slope of piping allows product td drain back into tank
when suciion released
All above information on suclion piping is verifiable
On the back of this sheet, pleas€ sketch the site, nolhg all plping runs, tanks (lrrcluding size & substances slored)
and|ocalionofwellsandtheirdistanc6fTomtanksand=pipiiu;._'.'...,,.,..'...,.
4ry',,-,o i)*u,/r-" c r lzta/z"r') *" *.*r/*Z&L;
certily that I have lnspectsd lhe abore named lacility an /Z-/s--7-7
mo,ilr\ &y, r.r, ffr
o*: 17 -r5--7=
Sloo5g-5
\n-.-
t,
PST CHECKLIST
Uru, Q I
Non-Marketer Di scount
Previous Pollut.ion Inc.idence
- LUST F.it e y /&)
- Form Included On
$4ITT1qFE' y:'lru,rlr{r,..,
- Documentation ok?
- Rate ok?
Fund Paid
- FY 91?
Compl j ance
- Fees Paid
- FY 88?
- FY 89?
- FY 90?
- FY 9I?
Y/N
Y/N
Y/N
--/
!
a
-/
/"a fl &"-*u o#-,' tdh / 91.
Y /6P 1-/ ,/,/vru-@/x>t
An-{
Y/N
Y/N
- Compl iance 0utstanding?
- Leak Det. Required & in use?
- Notificatjon up to date & complete?
FACTLTT/ rD. 70O&)K
Not
Unacceptabi e Acceptabl e Appl j cabl e
2_25-r?/
SHIJ\SUPPORT\C0LLEEN. E\checkl i st. pst
/r-
i
FACILXTY L D. #
Norman H. Bangerter
Govemor
Suzanne Dandoy, M.D., M.P.H.
Extruuve Director
Kenneth L. Alkema
Dir4tor
- , i-**.*
DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
Bureau of Envrronmenta Resoonse and Remedtation
288 North 1460 West P O Box 16690
Salt Lake Crty. Utah 841i6,0690
(801 ) 538-6338
'1 ,1
TO:
DATE
FROM:
Your application for coverage under the PETROLEUM STORAGE TANK FUND is
incomplete. The following additional information is required before your application can
be processed.
[ ] The results of your Tank / Line Tightness Test and a copy of the field report need to
be submitted to this office.
[ "J A Notification Form, registering or upgrading your tanks, needs to be. filled out and
submitted (use Form 7530 (Revised 9-89). '
, . .,,
,
.' , t
[ ] Annual Tank Fee Assessments remain unpaid. Please submit a check for
$-.Thiswillcoverthefiscalyear(S)'88'89'90'9].(circletheapplicable).
[ ]You have not completed the form declaring "PREVIOUS POLLUTION INCIDENTS".
Please complete the enclosed form.
[ ] Annual Fees for the PETROLEUM
submit a check for $
amount for the current
[ ] Your "APPLICATION
following reasons:
quarter only would be $
FOR NON-MARKETER DISCOUNT" is defective for the
STORAGE TANK FUND remain unpaid. Please
. This would cover the fiscal vear '91. The
[ ] The release #
schedule to the satisfaction
Executive Secretary (UST).
[ ] Other (below):
been characterized or maintained its cleanup
, ]our project manager, and the
has not
of
Please note.that you will not be covered under the PETRoLEUM SToRAGE TANK FUND until the
above mentioned items }ra coPpleted.-If your are curently a LUST sitg and your F\nd application hasbeen approve$ qoYlrttter releases will be covered Uy tne nrna. ttyou trave any questioiri concerningthiq please ealt the Bureau of Environmental Responie and Remediition at 538{338.
DEPARTMENT OF HEALTH
DMSION OF ENVIRONMENTAL HEALTH
Bureau ot Solrd & Hazaroous Wasle
288 Nonh 1 460 Wesr. p O Box I 6G9O
Salt Lake C,lv. Ulah 841 I 6-0690
{801 ) 538,61 70
^1
PAcrLrrYLD.# 4 tiCC)i(
Norman H. Bangerter
Gowrnor
Suzanne Dandoy. M.D.. M.p.H.
Exmuuk l)trector
Kennerh L.{.lkema
Diretor
4t tLt z.
€.,,,L z f nlQ' t
amount for
[ ] Your ,,APPLICATION
following rquons:
FOR NON.MARKETER DISCOUNT'is defective for the
Dffi I_Li_Cil
FROM: 1,,, I /'Lc-<
Your application for coverage under the PETROLEUM STORAGE TANK FUND is
;:T['.,t'r:0.*t following addiTional information is i"quireo before your application can
ffIme results of yoyl Tank / r-rne Tightness test and a copy of the field repoft need tobe submitted to this office . /, n-." :f ", i'-r(.,::-.: g _,. ,c li / *,t
_ _ , ..b ,n , tlr., S t l; i;:;-' '
t ] A Notificatiot lotttl registering or. upgrading your tanks, needs to be filled out andsubmitted (use Form ZSSO tn."jsed 9-g9).
] Annual rank Fee Assessments remain.unpaid. prease submit a check for$ ' This *ili;;; ti. irr."r v.""<Jj 'ig ts ,s0 ,gt (circle the appricable).rli.Ll"::ff
i..,!Tfl :'::1,'* j'Hecraring'?REvrouspoLLUrroNrNcrDENrs..
' ffi ff:*i:1'r*rRolEuM rr*g:TINK FU. ND remain unpaid. preasethecurre@ril;J;. T! would cover the fiscat yr.r;q'r. The
[ ] The release #
:lT:1" to treGiiEffin o'i3f no, been characterized or maintained its cleanuExecutive Secretary (UST).your project manager,and
rP
the
[ ] Other (betow):
IJ:t';lt*ur:Yl aot n" eovc
ff1pp.*. *ffi#tF",iHlH,r* ffi:?y,**yg qrK .. ND unt, thehffim;rffiffiHffimrth\niise;ilffi ;ffiTrm"r"rffiffi'"ffi
Ot rg/;.t T|k($ r'(1"Data Ghart lor Tank System Tightness Tcst
'
tt rJt; ( i i{. C..t il,tf,.gldres 4* nr;a_fi'",{ !""\. ,""? ilo id
Rapctmlativt Ltapio.taHF
l. owirEn
2. OPERAIOR
3. BEASOI{ FOR
IESI
lErplrin fdDl
.. WHO BEOUESTED
IESI AiIIt WHEI{
5. TAilK I|Vo|VED
tL.ddlbnd lh.
5, nl.lral,old.d lmlr
8. TNSTATIAI|0il
OAIA
UI{OERGROUI.ID
WAIER
FITL.UP
ARRAiIOEl,lfIIIS
Frpr!!6lalr[l.L9,rona
LLglEoa
tr(lt {,iJ U*e
E. p_. A. Requlations__
'L|-tUt--l-(l
' ! Vcr ril,t,
F5 ir'11 'L;/ t/.1 7()7F
rilb Cmp.ny d Ailfi1ba O.ta
Prrrprtk
la6
9rdfrii. ertrota.Ll.Ilm
7.
8.
Ocpihtothcwstertabte {
Irnt! to ba liilod --.e-- hr. " -"-- O"t" Arr.nood by
Erlra p.odwt to 'lop otf and,un iol iBtr. ltor and rho to trovadr? Cm$d., NO Lcrd.
Ir lha rda, ovar tha tf*?
Dr. frr"
ld.pnara
PLEASE PRTNT
Sfors
ldmlity by 9rrQc!roo
,<,{[aLT .Brand/Suprli.t
e
Et\Fo
l{orlh tosrda dnveway
Ror, ol staron. etc
Covr
Cadece f,
Comllr. Elad foD.
Ernh. dc
4"
Sira. Tilalill mato. Orop
tubca. Rrmote Frlt3
flrmrntl o, othar contacl
lor notE! d inquary
-tal.gnon
COI{IRAGIOR.
MCCHANICS.
an, othar cootrGto,
SYolY.d
t0.OIHER
l1{F0RMAlroit
OR REMAEKS
J$rf
II. IEST RESUI.TS
r;b wrrr mrdl on lh. rboyr |rnk ryrlsmr ln lccorduc. wlth l!.l proccdurta prcrcdbod lor!r dctalld on dllchad trll chrl! wlth r6utt3 ar lo0orr:
fren Lesrrge-Jrd'i.1fuEertT-l{,ae{
13. nfr f tPJ.ttry or! lln br* 3Fl.rnt w... L.l.d oo lho drto(r) dtoilr Tb.. hdcrtrd er -ndd: ln..t ot Gil.f...|rDfhd b, !r.il.Uand Fh hobctton A..odrdoo p.mphh &!f
?acltiiialtril
,. qteve Lvona
cf,irrb.iton r 3 24QU3 52-
e .Tohn M. , Lynns -
c.,1sc.1m, 324OL4O52
12.sEitson
P.O.Box 391 Collbran Co.81624
PTEASE PRINT
I. OWNER
2. OPERAIOR
3. REASON FOR
IEST
lE$lrin fullyl
1. WHO REOUESIED
IEST AND WHEN
Froo.dy l)f
l-araf F
5, IANX INVOTVED
tac tddllbn.l $nc.
br m.nltold.d l.nh
'l)Jl1T?'*""'c.g&lly
-/IZ,gL 0rand:Su@hc,
7 /1/ L
Aporor All.
?
ltlxl/tlbf,lrtra
S-hc/
6. INSIALTAIION
DATA
L6rlion
."ilt I 1
rvont,,n"'a",iri,"*"y
Rear ot lltlrcn ?lc
CovG,
(4'te' tft
Concrrtc Blact loD
Errlh llc
Fills
t4"
Siar filf;ftll nete. OroDlub6 Famot? Fitl3
v6lB
.L"
sirG. M!nrloldcd
S.Dho6
pa
lrriich lmtt?
Plr?.
f*ralPR,,
grclbr. narua.ItLLlltm
7. UNOERGROUNO
WAIER
8. Fru.-uP
ARRANGEMENIS
9. CONIRACIOR.
MECHANICS.
any olhar coalrtclo,
lnvolvad
IO. OIHER
INFORMAIIOiI
OR REMARKS
II. IESI RESUTIS
t2. SENSoR
CERIIFICAIION
/lt'i ' 't'*.*r*"rffii:#e-,':
2,(2. _S.,lrl t{o ol niJad
oeprh lo the mler tabh '/-n'- pG
xmcrc
Etlrr Drodwl lO 1og Otf' rnd run lrnl trst? How a^d tho tO fxdrdar CS!r&, NO L.rd
Nm! rdahoia
' ilfr;;;.' ;o^i;;; ; ;; ,i;;;;;;-aiii;c,;; ;; ;'h;'; 6 b; il,*d *ho iil-e;; tAE
f.tlt weTr m.d. on lh. rboy. llnt lytlGmr h lccor&ncc wlth lGtt procadrrra DGcdbrd tor
't det.llcd on ritrch.d L.l ch.rtr wllh raulb I lollowr:
-__\.Irehi L!rt.g. tnd'cllca-Il'Ii: l-_,pn_Z-----l= _--
13. nrr f lPJ.tU thtl-Oilr.. ltr* trtonr. re.. lil.d o.r Or d.l.(t) drwn. lh.. hdcrlrd r ,ltghl, n!..1 [I nll,a& .tl-lhh.d t' Gall.0ood Flrr holoctfon lr.odrllon Prmphh ellrchnrcirn' Intermountain Manufacturl.ng Ine. dba, sEavc_ I{yo-nq lhtcfFount!$4..I,etq pptEaul;n
c.'n0c.,ion,3-24ol-!322-- D r-t Erav "JIt'1?H111-^l' T;.
I l;trv I tl(t
N- f '{z aata Ghart lor Tqnk SysP.m Tightness Test
P.O.Box 391 Cotlbran Co. Ot624
2 .TOhn M. Ly^nS
c.rnncdi', 324Ot4052
Addrra
c .t
I
- fenap r'{L Data Ghart lor Tank System Tightness Test
,) ', r
h'li,
r. owrtn *r*E
,-anrF 'laD.6.lrlrirYa :t"t)Cf4P}tt:r
nmrcralatm l.Loarom
2. OPERAIOR
3. BEASON FOR
IEST
lErpl.ln Fully,
{. WHO REOUESTEO
IESI ANO WHEN
5. IANK ITIVOLVEO
tL.ddhbn l[a..
fr. m.rrrold.d i.nlr
6. titsTAt-tAlroN
DAIA
UNOERGBOU}ID
WAIER
FIt[.UP
AREAiIGEMEt{IS
4! e,.:' (:_9t { :y-5 M F_ y'Z)
",1,
, 1
fd.Dl!o.t.
- E. P. -A. RegulaLions
Cmrrny d Altillt€ir
t.
E.
oGpth to rh. w.rd r.brr --e.-
ranr3 ro ba riflGd
-
h,
- -.- orr. Ar]anesd by
Erlra prodsl lo'1o, otf'rnd run lant tlailr ll,ow and iho to groyrd!, Consr(tr NO Laad.
E lha rilar ofl lh! lanl?
[r- ilib
t a.Oima
$.alr?lDf,eaaa rbo(
PumCt
,?'elalg1:
TdC
grcrbr. n ilola,
fd.glro,ra
PTEASE FRINT
ldanlily by Orlclion
Pl:;l v Br.nd Suppl€r
a1tln(
l{orlh rnsrda d,rvaway.
tlGar ot ltrtron, llc
qn
Slr T'tGftll male Orop
lub6. Remola ftllr
fErminal or olh€. co.lrct
lor notrco o. anquiry
l'Loqr.
9. CONIRACTOR,
MECHAI{rCS,
aay olhar conlr.Glot
hrclv.d
I(,. OIHEB
INFORMATION
OR REMARKS
,')€'
Addilonal nto,malaon on tny rlaoa rboyr ortroala o, olh!6 to bG aoyrgd ,ho ta3tho rr n pfogtaS3 o, coopldad vitnoB oi ob|.ma pro- aIingtrd. rr
forb wrrc mada on lho rbovc lank rytl.mt h accordmct wllh lGal proccdrnr pocdbrd lor.t daldl.d on lttrcrr.d lctl .rrrrlr r[h ]6ulb r. lollorr:
lanl ldanlrtrBtrcn
II. IEST RESULTS
12. SENSoR
CERIIFICAIIOIIt2/?#-
zc{7
!.dat rrb. ol tn md
San-a
Iight L.rt.qe todEAld)_ffPjLvw_--E*?-
13. nfr f t9J.ttry lh.! !r" trr* tr.ldttt r.r,. h.l.d on lh. drl.(.) rlrorn. ttE . hdcd.d - Tehf n .f !t crildr oAlfhrd Dy frlldood ft Plohclo.r Arodr0on Prmphlel &!3,
fmlnlci.il
,. Steve Lvons
cf,rncdbnr 32!9113-5a-
z .Tohn M- Lyons
cxtric.rio, 324014052
o. Compmy. !y:
Intermountain Manufacturlng Inc. dba
P.O.Box 391 Collbran Co.8L624
*jt
e,Eqe
/a((2'l.,
E*ri(dd(dn
lt;"t,lxi4ir $
qle1futln,,,,t t/pr ,t,t i' df €(,),:'F'
r temrm,.d"Jili,4
. .rAroi ,or nn fii f'
tl roattlrt
aacr rntra tttrta
/sA
v/r
NL
tt nralrutrall
,' ,.t: l;r.,i
/.,7.t," llrt i 7
COrCtUIOLl, larlaa xC Crorlaart
'VlE r.r I ;7.' .t , ,1
'i'r r.. 'i,'t i,1tI tttt ra0uatttO tt, tt"'t'' '
= , ,
",a lncur nllilrcnott,
F'uIlflY lJ)'
'
PETHOLEUIvI StohaGe taNx FUND APPLIcATIoN
FACILITY INFORMATION:LOCATION OF TANKS:
Ownef Name: Maverik Countrv Stores.Inc.
Street Address
Phone: [phone] Phone:Contactffinf Joe shaw Contacl
Facility Name:
Street Address: 490 west MainCity: vernat
County: uintah
State:
Contact
TYPE OF OWNER:
fi Marketer, or non-marketer with annual monthly throughput greater than 10,000 gallons.
[ ] Non-marketer with annual monthly throughput less than 10,0(X) gallons (Must verify).
DESCRIPTION OF UNDERGROUND STORAGE TANKS:
Tank #
Age
z3
lt //
Qapa.city R,6 tzc,e,o n O6Substance tua rr--rr- n TAn^
TANK TIGHTNESS TEST
Tank #
Pass/Fail
.Lz37*o E?<s F.<
CERTIFICATE OF REGISTRATION
IXI All Underground Storage Tanks (UST) at this facility have been registered.
t{l All registration TANK Fees have been paid.
COMPLIANCE WITH UST REGULATIONS:
ls the applicant currently in compliance with all Federal, State, and Local UST regulations
l(l VdS [ ] No ---lf "No'please describe item(s) of non-compliance:
PREVTOUS POLLUTION INCIDENT(S)
Have you ever had a pollution incident a! yotll facility?
t I Yes -- lf "Yeso plebse provide LUST (Leaking Underground Storage Tank) lnformation:
Xl No - lf 'No'please attacl.r a letter stating that under customary business inve.ntory. , .praitice standards you are not aware of any release from any tank(s) at this facility.
PST FUND FEES
I I Full payment for every tank at this facility is included with.this application.
bd Ouaheity payment(s) for every tank at this facility are included with this application.
I certlty under penalty of law that the abore representatlons made by me are true and correct.
Applicant's signature: J3. . ', Date signed: b'tl-Qo
M All Underground Storage Tanks (USTs) have been registered - Form 7530 (Revised 9-89).
[d Registration Tank Fees have been paid - 1988/1989 : $2sltank/yr, 1990/1991 : $4S/tank/yr
2. COMPLIANCE WITH UST REGULATIONS:
,,,',,:,,
: :,, pglH0tEthil StOnAGEr,taruK FUND Cl{MKLlSt'
1. CERTIFICATE OF REGISTRATION:
P I am in compliance with release detection requirements.
I I Tanks lnstalled belore 1965 or unknown: release detectlon by Dec. 1989.
I t Tanks lngtalled 196$1988: release detectlon to be completed by my compllance date.
I I Belease detectlon completed upon lnstallatlon.
(l am in compliance with all other Federal, State, and Local UST regulations.
3. PST FUND FEES .. ANNUAL FACILIW MONTHLY THROUGHPUT:
l#;|"{B,Bfii:i,:",1i:t l am a non-marketer with annualfacility monthly throushput sreater
I I $zSO paymenVtank: Flgcal year (July 1, 1990 - June 30, t99t).
ld Quarterly paymentr @ $62.50/tank (Due the lst day ol Jut, Oct, Jan, and Apr).
[] ! pm a non-marketer with annualfacility monthly throughput less than 10,0O0 gallons.
[ ] I have completed the APPLICATION FOR NON-MARKETERS DISCOUNT form.
I I ttZS payment/tank: Flscal year (July l, 1990 - June 30, t991).
I I Quarterly payments @ $f .2snenk (Due the lst day ol Jul, Oct, Jan, and Apr).
All systems pass the tank and line tightness tests.
! am submitting the results of the tank tightness test and a copy of the field report.
t I Alltanks do not meet the requirements set by rule regarding tank tightness testing.
[ ] I have contacted the State UST office and will submit evidence of a plan for review.
5. PREVIOUS POLLUTION INCIDENTS:
ld I have completed the PREVIOUS POLLUTION INCIDENTS form which states whether
under customary business inventory practice standards, I am aware of any release from the
tank.
6. INDEPENDENT FINANCIAL ASSURANCE (Keep records at vour facilitv):
( I have obtained financial responsibility requirements for the first $25,0oo/release:
ftsett lnsurance I I Guarantee [ | Commerclal lnsurance I I Surety Bond
[ | Blsk retentlon group I I Letter ot CreOtt I I Other:
[ ] I have obtained independent third-party linancial assurance by my compliance date.
[ ] I will obtain independent third-party financial assurance by my compliance date.
'See exflanatlons under "Holfl do I get started?,,
4. TANK & LINE TIGHTNESS TEST -- ACTIONS REQUIRED AFTER TEST:
PMUIT IIL
'
PREVIOUS POLLUTION INCIDENTS
To: Mr. Dennis Downs
Executive Secretary
Utah Solid & Hazardous Wastes Committee
Dear Mr. Downs:
As required by paragraph 26-14e4O4 of the Underground Storage Tank Act, I have
performed a tank and line tightness test on each underground storage tank at my facility,
and based on this test, there has not been a release of petroleum. Additionally, based
on "customary business inventory practices standards", I am not aware of any release of
petroleum from my tanls.
aR,
I have had the following releases of petroleum (detailed below; also mention any action
you took to clean up the release).
signature of owner/operator
*J
.
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fJl'
DBA INTERMOUNTAIN LEAK DETECTION
Maver i k CountryJoe ShawP. O. Box 26tloods Cross
Stores Inc -
440a7
Dear Sir:
The follouing is a summary of the product containmentsystem tishtness testing done at stores *g4, *143 , *L6z ,*7r, *14o , *L27 , *t42, *159, *Laz, *174, *L7L, *13o, f168,*145, *163, f153, *L79, *L7o, *184, *L44, *165, *44, *180,*160, *4L, in Utah during LggO-
j-('L't-'15 at Maverik country store * 34 in Moab ,the middle tankIine tested 'TIGHT' e +-ooo1 gph,the south tank line tested'TIGHT'O --OOO5 gph, the north tank Iine tested "TIGHT" e-OOS5 gph -
t((t"'a'lt. At Maverik country store *L43 in Roosevelt ,the easttank rine tested 'TTGHT' e --oo4o gph,the middre tank rinetested 'TIGHT. O -.OO5O gph, the uest tank line tested'TIGHT' e --OO3O gph.
i:Cl('rl'l AL l{averik Country store f L67 in orem ,the north tankIine tested 'TTGHT' e -.oo4o gph,the middle tank Iine tested"TIGHT'O --oOaO gph, the south tank line tested.TIGHT'o+.OO5O sph.
'iit l;'-{ At Flaverik country Store * 14o in Riverton ,the middletank Iine tested ,TIGHT" e +.OOOO gph,the west tank linetested 'TTGHT' e -.oo1o gph, the east tank rine tested"TIGHT" e +-OO1O Sph.
ll(('t'-lt: At ltaverik country store s Lz7 in Heber ,the north tankIine tested 'TIGHT. O +.OO10 gph,the souLh tank line tested'TIGHT'e +.OOOO gph, the west tank line tested.TIGHT. e
- OO6O s,ph -
l(ccil8 At Maverik country store * L4? in vernal ,the west tankIine tested 'TIGHT. O +.OO1O gph,the east tank line tested"TIGHT'o +.oo3o gph, the middle tank Iine tested.TIGHT. e+.OO2O sph -
tt('(Cl'),-l At Haverik Country Store * 159 in Hesttank Iine tested .TIGHT. e +-OO1O gph,thetested 'TIGHT. e --OO7O gph-
P.O. Box 391
Collbran, CO 81624 Toll Free 1-800-824-2853
ln Colorado 487-gS5ZPAGE 7
4OCdl33 At Maverik Country Store * Laz in Hurray ,the east tankIine tested 'TIGHT' O +-OO1O gph,the west tank line tested'TfGHT' e -.OO2O gph-
-ICOO l'7b At Maverik Country Store * L74 in SL ,the south tankIine tested 'TIGHT" e +-oooo gph,the middle tank Iine tested'TIGHT'e +-oooo gph, the north tank Iine tested'TIGHT'e+.OOOO sph.
.CCCliS At I'laverik Country Store * L7t in SL ,the south tankIine tested 'TIGHT' e +-oooo gph,the middle tank Iine tested'TfGHT'e +.oo2o gph, the north tank Iine tested "TIGHT" e+ . OOOO s,ph -
I
)CCCCZTt At Haverik Countrytank Iine tested'TfGHTtested 'TIGHT. e +-OoOO'TIGHT' e +-OOOO sph-
Store * 13O in Bountiful ,the north' O +.OOOO gph,the middle tank Iinegph, the south tank Iine tested
ICCIO'CZ1 - A_t Haverik Country Store * L6a in Bountiful ,the easttank Iine tested'TIGHT, e +-OoOO gph,the west tank linetested 'TfGHT' e --OO95 glph-
lCC.C.C26. A!, l'laverik Country Store * 145 in Centerville ,the southtank line tested "TIGHT' e +.oO35 gph,the north tank linetested 'TIGHT" e -.OO1S gph.
lzcCe'\6 At Haverik Country Store * L63 in ogden ,the north tankline tested "TIGHT. e +-OOOO gph,the south tank Iine tested'TIGHT' e --OO4O glph-
iZccc'lf At Flaverik country store * 153 in ogden ,the south tankline tested 'TTGHT' e --oo7o gph,the noith tank Iine tested'TIGHT. O +-OOOO gPh-
3Cf'.'<:Ct.2tl . o!. l'laverik Country Store * L79 in CIearf ield ,the wesLtank Iine tested 'TIGHT. e -.OO7O gph,the east tank Iinetested 'TIGHT' e -.OO1O Sph-
]tccc'?-:l At i'laverik Country Store * L7o in Layton ,the south tankline tested 'TIGHT' e +-oooo gph,the north tank line tested'TIGHT" e -.OO1O gph, the east tank Iine tested "TfGHT" e+ -OOOO sph -
7C,CL\ JO At Haverik Country Store * LA4 in Layton ,the east tankILne tested 'TIGHT, O +-OOOO gph,the west tank Iine tested'TIGHT" e +.oooo -
PAGE 2
-r16'6-lC1il at Maverik country store * t44 in Garland ,the southtank line tested'TIGHT'e +-oooo gph,the middle tank Iinetested 'TTGHT' e +.oooo gph, the north tank rine tested"TIGHT' e --OO3O Sph.
)|COO3C At Haverik Country Store * 181 in Losan ,the west tankIine tested "TIGHT' e +.oooo gph,the east tank Iine tested'TfGHT' e --OO1O Srph-
^\
LCCLS 3 At Haver i k cou nrr ytank Iine tested -TIGHT
tested "TIGHT. e +-OO1O"TIGHT' O -.OO1O srph.
Store * 44 in Smithfield ,the north' e -.OO4O gph,the middle tank Iine9ph, the south tank Iine tested
ICOL)TL At Haverik Country Store * 18o in Richmond ,the southLank rine tested "TrGHT" e +.oooo gph,the north tank rinetested 'TIGHT' e +-oooo sph-
)tAoObl At Maverik country store * 160 in Randolph,the northtank rine tested 'TTGHT' e -.oo15 gph,the south tank rinetested 'TIGHT' e -.OO5O Sph.
/LC.CO >( At Maver i k Cou nrr ytank Iine tested "TIGHTIine tested "TIGHT. e +'TIGHT" e +,OO1S Srph.
Store * 41 in Richfield ,the south' e -.OO35 gph,the south west tank
-OOO5 gph, the north tank Iine tested
Thank you for having rntermountain Leak Detectionperform your precision Eishtness testing-
Si ncerely
John M Lyo ns
PAGE 3