DERR-2024-006249

Ownership of Tanks Location of Tanks
UTAH STATE FUEL NETWORK UDOT STA. 3433
4315 S 2700 W 3652 N 37900 W
SALT LAKE CITY UT 84129 TABIONA UT 84072
Contact Name:#lEmail
SPCC Plan?: Yes No Last Fire Marshal lnsp:ATG lnfo
Complete for each tank,# I tar".q r '?-tuvb #E #L
Capacity of tank (gallons):6 ()d)-7o oD
Orientation of tank:
^) ovYkt 9a,,r-th
Bottom of tank in contact with (soil,
gravel, concrete, not touching):Cnncxe*o,-
-Substance stored:Drs"A W?-
Date last used/depth of product:
Type of spill prevention device:\r.rUr tanLs i tt x:P
Type of Piping (Pressure or Suction):
Does pressure piping have LLD:@ No NA D No NA Yes No NA Yes No NA Yes No NA Yes No NA
Spill bucket is clean, intact, etc.No {V ruo Yes No Yes No Yes No Yes No
Type of overfill Prevention device:AIAfiY\ -
Overfill alarm (audible or visible) is properly located so delivery driver can hear or see it, and is clearly identified:frA ruo NA
Pipe trans flex protection method
(Sump, CP, Isolated, Booted)Sarvp
--)
Containment sumps dry (9 No NA f/E No NA Yes No NA Yes No NA Yes No NA Yes No NA
Sump comments:
Stage 1 Vapor Recovery:2pt None 2pt pb9l{ ruone 2pt Coax None 2pt Coax None 2pt Coax None 2pt Coax None
Pressure Vent Valve is on vents:(rts No NA F) No NA Yes No NA Yes No NA Yes No NA Yes No NA
Secondary containment area
comments:Nlk
Gomplete for each dispenser # llLl #E ##
Flex protection method (UDC,
Cathodic Protection, lsolated, Booted):\^DC --
UDC sump dry:No NA rei No NA Yes No NA Yes No NA Yes No NA Yes No NA
Fire valve anchored, located below
grade, and without ball valve:
fp No NA ty' No NA Yes No NA Yes No NA Yes No NA Yes No NA
Comments:
Additional dispenser questions ######
Flex protection method (UDC,
Cathodic Protection, lsolated, Booted):
UDC sump dry:Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Fire valve anchored, located below
grade, and no ball valve:
Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA
Comments:
Page 1 of_Utah Department of Environmental Quality
APST Equipment Verification lnspection
9000145
Financial Responsibility (State Use Only)
FR Method Method OK?Yes No
Signatures
lnspected this facility on_.
Signature:TI
O/O Signature
Attach Tank lnfo Sheet to lnspection with any edits.
Additional Comments:
qwl'15
APST Facility Site Plat
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Show locations of all buildings, streets, tanks, piping, and
manways and identify each: submersible pump (S), tank fi
(specify).
dispenser islands. lndicate the product in each tank. show locations of tank
ll (F), ATG probe (A), interstitiat probe (t), vapor recovery (V), capped ptug (C), other
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