DERR-2024-006251

Page 1 ot
Additional Comments:
I Utah Department of Environmental euality
APST Equipment Verification lnspection
9ooooss
Ownership of Tanks Location of Tanks
Pilot Thomas Logistics 140 Roosevelt PTL
PO Box 2136 380 S 200 E
GRAPEVINE TX 76099 ROOSEVELT UT 84066
Contact Name #lEmail
SPCC Plan?: Yes No Last Fire Marshal lnsp:ATG lnfo:
Complete for each tank.
Capacity of tank (gallons):\,2V
Orientation of tank:t \10.6[,5q.^h
Bottom of tank in contact with (soil,
gravel, concrete, not touching)5o,o\d'\t
Substance stored:e-IKlT:\
Date last used/depth of product:
Type of spill prevention device:
Type of Piping (Pressure or Suction):
Does pressure piping have LLD:Yes No Yes No Yes No Yes No Yes No Yes No
Spill bucket is clean, intact, etc.No No No No No No
Type of overfill Prevention device:
ble)properly delivery rlyalarmOverfilliblerovtstts(aud solocaled driver hearcan seeor and cleats identifi ed:it,Yes No
Pipe trans flex protection method
(Sump, CP, lsolated, Booted)3"^r?
Containment sumps dry:No NA No NA No NA No NA oNA No NA
Stage 1 Vapor Recovery:2pt None 2pr None 2pt None 2pt None None 2pt None
Pressure Vent Valve is on vents:Yes No Yes No Yes No Yes No Yes No Yes No
Secondary containment area
comments:
Gomplete for each dispenser #
Cathodic Protection, lsolated, Booted)
protection method (UDC,upL
UDC sump dry No NA No NA No NA No NA No NA No NA
Fire valve anchored, located below
grade, and without ball valve:
No NA No NA No NA No NA No NA No NA
E<nComments:
Additional dispenser questions
Flex proteclion method (UDC,
Cathodic Protection, lsolated, Booted):r^Dc
UDC sump dry:No NA No NA Yes No NA Yes No NA Yes No NA Yes No NA
Fire valve anchored, located below
grade, and no ball valve:
No NA No NA Yes No NA Yes No NA Yes No NA Yes No NA
Comments:
mrl
Financial Responsibility (State Use Only)
FR Method:Method OK?Yes No
Signatures
I lnspected this facility on_.
Signature:TI
O/O Signature
Attach Tank lnfo Sheet to lnspection with any edits.
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APST Facility Site Plat
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Show locations of all buildings, streets, tanks, piping, and dispenser islands. lndicate the product in each tank. Show locations of tank
manways and identify each: submersible pump (S), tank fill (F), ATG probe (A), interstitial probe (l), vapor recovery (V), capped plug (C), other
(specifu).
Comments: