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Home My WebLink AboutDERR-2024-006154rr"[FA Phone Number (lnctude Area Cod€ (208) 429_8466 P lgt- zsgcl (Rcv.9.eB 1 Ere"rron," "nd pape["o,oi. ".i"-0,"0,"Prevrous edttrons may be use6 whtle srpp,,"" r"ii - Notification for Underground Storage Tanks Agencv Name and Adctress.STATE USE ONLY DATE ENTEHED tr.ITO CoMPUTE^, <lq, E n. r.rew FAcrLrw lEilr. our*o=o l.lr|-.w/ Number ot tantG I Number ol continuaton sheets alEched at tacility I - WAS COT.JTACTED TO CI-ARIF/ RESPONSES. COi,MENTS Pleass vpe!I@!]q]&. Atso, be $rre you have stgnatrres in ink tor secUonsVlll.ancl Xl. Complgte a nolificalron lorm ror each tocaton containing WhltTanl€ Ar! ErcluctGd FrEm Notiricltion ?. lanks rcmoad lrom th€ grourd betore May E, 19g6:' Farm or r€sidenliar tant<s of t , t oo gallons or tess caoacity sonng moror fuer tornoncommerc-ral purposes;. ]anks slonng heatng ol lor use on the premEes ufiere srored:. Septc tanks:. llp!!,l" Fqhtes (indudrng gEthenng tines) regutated unoerthe Nalural Gasrrp€rne !*r?ev Act ot 1969. orthe Hazardous Uqurd prpehne Satery Ac1 ol1979, or ufiicti rs an infrastate ptpettne faoflyregiiateo uncter Sule hws:. surlace tmpoundments, ptts, ponds, or hgoonsl". Storm waler or waste tvater collecbon slaiems:. Flow.lhrough prDcess Enks:' Lquid traps or sssociatecl gathenng lines directty rerated to oil or gBs produclon and gaflenng op€,alpns;. Tanks on or ebqre th€ ioor o, undorground arsas, srJch as b8s€rnenE ortunnels;. TanlG with a capacrty ot 110 gEllons or l€ss. Whgt Substanc.s Arc Cov?td ?Ths notifcaton requaram€nE appty to USTScontaining petrol€um or cerEin hr?rrdous substances. Femgum iriau'oes - - gBsoline' us€d oil, deser fuer. crucre oir or any ffiaction thereot ufii{rr s riqud arstandad conditons of temperature and presiure (60 deg*es ranrenneii anJil.zpryJt ?:l TT'B riBt_absdut3). Frazanbr.rs suUSancis are hos6 tounct rn Tqq9n. ]-ol (14) or the CortgEh€fls rr€ Envronmenbl Regonse, Cornpensaf1nT! lflil'try Act ot 19BO (CERCLA), with the exceptiJn ofirrose suOsafrcei-''reguated as hazarUous waile unclsr Sublite C o, HCRA. Whcre To Nodfy ?Ssnd compteted bms b: whcn To Noffiy ? 1. o,vners ot usrs in use or that have be€n reken out otoperation arter January 1 . 1 T,4, bur sriil in- rhe ground. must nomy uv ruay a. r gae. ?; 9-go l,to ry89 USTs irp .gse aler rvray "a. t9#, ;,rsr ,orry within 30 da!6ot bnngng th€ usr into us€. 3. rt the state r6qrnes n-oriicaton of anyamenctrflenE b hcilrty, send inrormaton to ua*te agpncy n rnedary: Pl*ltbs : Arry ou,n€r who lsultrrgfy ts ls b notty or srrbmiB hlse inbmamn lflE1y!31p i,lwr penany mr-rb erceeo iii,mo ri. esr Enk br u,hirrnolificatbn b not gi\ren orbrwiriat tabe lrrtorminci., S ien. unclergIound storErge tantG. It more lhan 5 tanks are ownecl at this t-ocaton, you may photoclpy pages 3 hrough 5 and us€ tlem br adclitonal tanks. The pnmary purpose of thrs notificaton prograrn rs to local€ and a/aluateundergrounc, srorage t,ank systems (usrs) thar store or have stored pelroreum or hazaroous substances. The intormaton you prwicle will be basecl onreasonabty avalable recods, or in th€ aDsence of sucfr recorcls, your knowlec,ge or recollecton. !.1{erat law rcguires UST owners to uae ttris notlfication lorm lor all YIT-" sqUg regulared substenc.s-that are broughi fnto uge aftciMaY A, 119!lgr USTs in the ground es o, May E, tgSG rhai ha,r storcd isgutirEdsubslances at any time since Janua4i 1,1914. Thc intonn*ion - requestcd is rgguircd by scction go&l otalo hcsoutre conrcwetion andRecovcry Aci ffiCRA), .s anrenctsd. wio Musi Notify ?section 9002 or RCRA, as amencrecr. reguires onn.rs of Y.:,T^. 11n,] ^rl?:_regutared subsrances luntess exem!rcof to nirry oesio"ieosrare or rocar agencEs ot the €rstence of their USTs. grne/ ii oenn60 as: ' rn the case or an usr in use on ^lo/emb€r E, 19g4, or bought into use atterthal clate, any person u,ho owns an UST r.rsed lor storage, use, or dispensingot regulated subslances: or . ln the case ol an UST in use before November g, 1g&4, but no long'r in useon that date, any person who offtert the UST immediatev b€6re G -- disconbnuation. Arso, it the state_so requires, any facilily that has made any changes to taciritymlorm?tgl or UST sysrem statJs. muit submit a notincafiirn fomiionry -- -, amended inrormaton needs to be ndud€d). What USTS Are lncluded ?An UST system is clefined as any one orcomDrnation ot tanks that (1) E usect to iontain an amrmulaton ofiJlufafeOsubsrances, and (2) whose votume_(inctuding connested unoergounjlilrn!1 is10o,6 or more beneah the gound. negutateO-USTs Sori pefUe,r, ol.hazardous substances (see the lollowrng Vnat SuOsances Are Covere<f). Owner Name (Corporatton, tndavtdual. pr6g1g Agrncl, or Otrer enflfyy 7-Eleven, lnc.Streel Address Gasoline Acctg. P. O. BoxZ11 Dallas, TX 25221_0211 Coun& ItgOu'JeOp Stare, gue lhe g€ographrc kDceron ot USTs by degrccs, mnuros, andseconds. Examfle: Lanud€ 42 i 36. t 2. tt, uong,r,Jde al7 ic, tl. wlrfrrb_ t.orEiuE Facalfy Name or Company Sit€ ldenthor, as appltcabte - eL,u"*rdd/t ,<;. C ll addr€Ss ts lhe same as m Secton l, ch€ck thc box anc, pn ce.d to socton lll._ lf a(EtBss ts dill€rent. enter address D€low:Straef Address SoBZ r^J \da,o}..^{.}z*: Page I ol5 9EPA L-, Unled Slaros Environmental Protestion Agency _ Washrngron, DC 20460 FOtm OMB No.205O-OO68 Notification for Underground Storage Tanks I l -l USTs are localed on hnd within an lndian Reserualion or on Irusit hncls outsiJe rsssnatbn boun@ies. USTs are omec! by a lJative Amencan naton or mbe. Tdb€ or Naton s'her€ USTS are located: Federal Gov€mmenl State Go/emment I LocatGwemm€nt X Gas Staton Peloleum Dslibutor Air Taxi (Aiiline) Aircratt Omer Auto Dealership I n"nro"o tr r"o"o,- Mn-Miliiary E r"o"o,- Military E tno*ri"t E c,or**, I rrucxinyrransport E u,i"o", [] n"o*nti"' tr r"* RI r-r, t, I tr Job Tite: Environmental Manager Aclclrass: 7-Eleven, lnc' 10220 SW Greeburg Rd #470 Portland, OR97223 Phone Number (lndude Area Code): (208) 42e-8466 Check All that Apply -l Self lnsurance Aq/--[. Commercnl rnsurance :j Risk Retention Group :. Local Go\remment Financial Tesl i ll have met the financial responsibility reguirements (in accordanca wih 40 CFR Subparl H) by u$ng lhe lollouring m€chenisns: E o*-,,* D suretyeond tr lenerotcreoit D ao"d Rating Test I srar runos E trustruno [] Oner uenoo (descdbe her€) I certity undsr penany ot law that I hrye pssondy €xernin€d 8nd em with the irilorm8lbn $bmmed in S€clbns llhtulgh Xl olthis nottcaton bm and dl attached doct menb. and thal bes€d ql rry inqriry orthe is lrue. accurale, and complete. r€sponsiu€ br oEtaining the inbmalim, I boliove lhat lhe subrnftted lnbmalion b|ftoo" Name ancl officral tite of owner or ownefs auflonzed represenlative (Print) Bob DeNinno Environmental Manager notrficaron torm mav be used whrle suppll€s last. EPA Form 75:10.1 (R.v. 9€6) Eieclronrc and paper ve'srons acceplable Prevrous ed[rons may be used whale suppl€s last. Pago 2 ol 5 _ uniled Sbrcs1 Environmental Protestion Agency, Washngron. OC 20460 Forn Aooroveo OMB rro.205e0068 Notification for Underground Storage Tanks ranim. llr-xno. e> lr",,ffirankiro. 1. St8tus olTank (ctred(ontyon€) Cunenty ln Use Temporadty Ctosed Pemanenty Closed E tr :r z Dfr ol lnstellaoon (rnonryyear)tl?% I t 3. Es0rnatld Total Clpactty (gEltons) 4. Material ot Constucuon (check a[ that apply) Asphalt coated or Barc steel Cahodacally Protected Steel Coated and Cahod'catv protected Steet Composte (Stsel Chd wih Fibsehes) Fiberglass Beintorcecl plastic Ltned lnterior E.rca\/aton Liner Double Wailed Pdy€try{€ne Tank Jad(et Concrcte Unloown It Other, pleas€ sp€crfy here Check box it tank has a/er b€€n .Bpaired r,, { D tr T tr tr tr D tr tr tr,/ { n tr tr DI tr T tr tr tr, { D tr D tr D D n T tr = -l -l -l ,l Jrr _J I trr 5. Piping Mareriat (ch.ck all that apply) Bare Sleet Gar\€nized Steel Fibergtass Reintrorced plastic Copper Caflodicaily prot€cied DouU€ Wa[€d SonOary Conbirrnent tr tr { tr tr tr tr tr Da7V tr tr trr tr ntr,/ { tr tr tr tr tr D Drr trx D T T D D Tr tr tr u 6. Piping Type (Check ail that appty) "Safe' Suctirn (no r/ahre al Enk) "tJ.S.' Suction (Elve at tank) pressure Grar/ity Feed Check box rf piprng has €ver b€en IepatrEd tr trd D tr r D,, w tr tr D nr/n tr tr D tr D tr tr T tr T Dx EPA Form 75ilG1 (Rcv. $9gl Eteoronrc and paper verslons acceptabtePrevious ectitons may be usaj ntrte .rpO,"irairl-' '-"Page 3 ol5 3l 9EPA \- Unnsd States -\- Environmental Protestion Agency_ Warihrngron, DC 20460 Form eioru(o OMB l{o.205GOO5S Notification for Underground Storage Tanks Tank ldenlilicaion Number Tank l.lo. I I ranr ruo.Z I rant r,r -L i ; * rank rlo 7. Subst ncc Cunendy Storcd (or lt3t Gasoline storad in tre casc ol cbgcd tsnks) Desel ( Ched( all thal appty) Gasohd KerDsone Heatng ot Used Oit lf Oher, deas€ sp€city h€re * trr D tr tr Ktr tr tr tr tr B-LrIr .-1' l-.1I .-i I ,l -l:J HazaElous SubsEnce CERCI.A name andor CAS number E t I Mixture ol Substarres Please specity here E tl b)t -I Belsssc Dctrtion (check all trEt apply) luanual tank gaLEmg Tank tigfrhess t€sting lnvsntory Controt Aulomatc tank gauging Vapor monilonng Grounch^rater monitoring lnterstilial rnoniloring Aulomalic line l€ak (bt€c.tors Llne tighhess testing No robase deteclion reqlnd (sudt as sflr€ tlDss of sucton F,iprng, emergBncy gsneraDrtE I(s orf€ld constllcl€d tanl(s) Other methocl allorysd by irnpaefneniing agEncy ($rch as SIB) Ptease sp€dfy o(h€r mdrod here TANK n tr ild . tr tr I w PIPE tr T tr D {il ! rANK I PIPEDltrltrl{1 tr IITtrlnDlnlvIttrln Iwl TANK tr tr D { u tr D tr { PIPE D tr D tr Wd l TANK D tr D T tr T D tr tr PIPE tr tr T tr tr D tr TANK tr tr tr n tr tr tr tr T PIPE tr tr tr D tr tr tr LD tE(o6{ CS LOW 9- Spill and Owrllll Probctlon Ovedll device instat€d Sprill dwice rnstailled "/g'dd P/V tr f tr D EPA Form 7530.1 (Rcv. $9E) Electonrc ancl paper ve'spns acceptable. Prevrous edfions may be us€d u,hil€ supt{ies last. Page 4 ol 5 Notification for Underground Storage Tanks STATEUSEONLY I a. NewFAcrLnY _ No.ot tanks a iacility _ No. ol coninuation she€ts attactred Data EnEy Oefi hitials Ornar Was Contadod to Clarity Bespcrsas. CommenB Please \me or orinr h ink all tterns .Eapt '*?n8!.re'ln roctiro V. This lorm rrr,rst be comdeted lor eedr lc8tilr ataining undergrund tDngo trttls. l, nu€ lhal frve (5) tanlrs ere owned d 6is lcrtion. photocopy the bllowirg sheets, and stapl€ contiruation sheas b tie tcrrlt. r. oWNEBSHTP OFiA.NK(S) [. LOCATION OFTANK(S) OE-6-srLErEln E IZL T4rtenrlZ . Xotmaost b iqsl!.| b, fu.ca lr fE, dl uia-lrura flll. l'la han b..n urdL ad,tfufr.aaulr.E..lEJ.Ert t. lt?{.llld E 16 th. gBrld - d t5 f , traar d tl5 ri Eu{rl Lro cr -rr I., l'ttaa Tlr hiqrrubG f,qu-.a brE*ra ts-fr-r tGldl'r.HrGru Conr.tdroa.na etc..rf ea. mCefl.. rE .d. The oanrrry q,rlrr ot lli nalhEr O,etrr!! 3 D t Ea an<, Gisara un(bE[!!fro Enlsi llrt aE a o. lte 3Ea< 0nEEa6 o? rt:lrrErsagE3rrE-. !:6 ate€ro [trt rrra rnlqrrrEr FJ qtDlt. H r r- on r-sorry sEdada na<EIG. c n !B ara-E olrl.Ei rtsG. tq, rJEr.-ga, bLal. Oa ?EU*EG lYh€{lrr Xorlv S-tdr W o, RCRA csnid. ,Erir na. ud- ataagal. orn-.t ot urE .ltqJllt Elfls tLl t8ra rtrJaDa t B:]E- rnrEl r€lt Asgrtr- SE[a orlcr. e-oGol !r sErE C !t I,rE o|ilt MI'E- a) h lh. as. ot an srdrlreud 3E!a E* h 6. qr llarrrrE !. 198a. or trqJgil aE rra arr, !- ctt. fly paEr riE -r rr u6.!rqrr, GEnrf, Ert E d br !r. E Ia. ts, d dilr.r.T ol rFra|C s.OEarr3, .rts b) h !h. -sorErud-gruJr!Erg. Errnl.r. &. l,brif t, 19&a. bJt,E loTl G raa r| tr.tOaf.. rrrt prr rE eri aJan l,* naedaEt b.lar 'r. dalcgrtlirrEr ol ir rr €) it tu SEa .FB.r so ltariri rrr7 tiry aa ra unrlgcnr rn7 dEro a o holry hbm.tslt ar E* al3a.n EEa (qrty affi-r rar abdaE r,r-E Er b nctlE d)- Wlrrt Tralr n hCgard? u.*E[q,rd sE T. rnl 3 6.fr!d E .Et crr. c cqroru.an ol E E A< (1) a rE- E Gsrrl,l D l€,nr{ar oa .lrg+-rai SsEEIr.' .rd (a rir. rol,n (na.dif gs..ra rrd-gtqr! frg, i, to'a cr ,!oa billr tr. gio{rt Sanrr qnrO:r,t rti-?qrE tralS Errg: 1. G.Dh.. u-.aol.Cdca lrt md 2. i!rs!Erlcr fd-rh.rticib d lt lgcrrs. Ilul Trntr rlrr EtduAd? Trr*r runar tgn !r gran{ n nq 3sqa1 o noafarrt Orrlnts card iorn rEftlmarr: 1. Ern cr-lmrd EEolt.tEga.brd Ecrf4tqca barp nar lul br nsroarnrtd EJ!!TT3: 2. t rts u.d b crtre lfEt <i be srrnmr l... an !r F!rl-riErt aDrxt: Fona Approvcd. OtlB No. 2050{06E. Approvrl crplnr 1/:llr!5 t -rars:a. !i'raa. fc&b truldrg grn-q l.i.-l rTuLad urxf l,t. N.urd G6 Piptn Sefrq Aa d r St. or lr ltrtr€.- Lbrd Pirdar S.bry As o, r 97!. c. rtidr a !t .rE-!rE ccir hcity rqufE ulr Str ft : 3. er.b BE €rrta. fir. Erc. a b.pdt: c rril ErrrGl. ;E (tEr alrEirc 7.ltrfiq.Eng€csrn s: a. lirr6 ErE s a-€rrE gsEi.n O lre drGly reED<t D od 6 grs lr€/clgr rB<l cattamg BailEGs: t. E(!a tnts al!-t- n an ur!-lrq,rrxl rr- lSdt as r oc-rai! crts,. ma-.EE!" grll Bra& c, lrrrd) il tra 3D,ea rrl E rruD sFQ d tEra lta 3'l.oolErlbt Wtrt &rh.rc lr Co-id? Thr rrricrnn ,crirtr-ttBaEy D uE enrrEr.Ta E Es tr.t crrnl'r r.!rutt- 3.€rr. This Ldn* gV 3.EJE alrn C3 i.!!trE B n 3EEl 1 ql (1 al o, tE C.ncltlJt3r &visrr-r- eerr. CsnruEr rE llE y Aa ol rEo (CEHCLA ra !I Gc.Er ct ttE ajrr,r rrfrL- - lr:D3rrr.3 E ut Sdrnb C C RCRA I rlo rrLd: g:mbri..-9- cnro oao?.ry, iar lr..driirt 3 S..il rr anarl (E rdlir.r oa lirtrrtjr .,td trEro tgO Ogrt- Fdrul- Gn ta.7 tE ra r.slI.s. rGi aEaJa)r wln To llaff Sroottgrr5 tm o: DEP^XTME}iT OF EWIN,ONMENTAL QUAUTY DMSION OF ATVIRONME}ITAL RESPONSE 168 NORTH 1950 9/EST IST FLOOR S^LT I..AKE CITY. UTAI{ t4I 16 Etra To t{aff f . O--r oa ut!-I,ruiti rEtF rr,rts h l.. dlral iLi! b- ar.r o/r o{ o,rf@r rlDrJrfl.fr l. 1r7a. bqr acll h tha Itult!. nillrEgty t y.I !. rass 2- O;rr rro frrp sra.3rurd roage *r ho cr rfr \( 19!e rltrs,t,sfy rrdrn ! AF o, lrit€ttf tr rrrls trD ur.. t I tt Sar. rtq,r lElbrixr ol ray rnrrnac E btty s.rn hbnnan b Srr. rgrrcy illlr,ful- Arrdrlrr: &r, qrto llutlry rrh 5 oollr, c l|tr* t- llora*t dul b rild 5 . Gtltl F.rGt lE lo .!Ed tlC'E lc.d trrt lcIhEr rdbtEr b El tlFa t lcrfrEi Lb. Llarrabi b rtrf.a. E '/)EPA Form 753G1 (8.Y. 2-92) @ ernea on Rr,yded PaPer TSLTI?EOFG!'ICF M.INDIAN II}IOS tr Fe&lcovtarrrl tr Conrrrgat tr SteirGornr:rt tr Pttta. tr LocCGo;atrrot Tedr8 ltc l€E qr letd witil rn ldrr Rrrgvatsrr a cn otfrrttsl ler6. Tar*s sr ofi.d bY nrlitll &lEi:rrl nnbo,Eib.. sir6fitnl Tr&orl'EtirutrI Itr V.T\TPEOFFAC!.ITY S# $. epoedar FeaAyDssFtn -Gas$nbl _Reeoad _fruclirg/frzcport -h:rnElstr -Fdrd-ttcr-*fy -lrllr -AtTrd(Atit l . -Alcreilfrn-. -AbOardlP _Ffr-tfir, 3td.rttsl _CcrrrEr Hdruid Frnr _Othr(Erpt=) vL @NTACT PEHSCTN lN CMFGE OFTArtll(S Nanr JOTXh AdE Ptsr lfrntr (Ef Ar..Cd) VIL FIiIANCIAL RESPONSAIuTY I lBUr rrat fi fnzriC nsecaiEy r*piomrnr h..-,triF rth ao cFR stGprt H ;;;;- -r--- -r--- t-l conrr-tidhsr.E I f-] st sryBqd I [-]rnrrata f-] Fu*Rlrearir.rcrqp I l-] Ltlrotc.dr I l-'lo,.rltstrodAtodspd,tt VllL CE TIIFICAI|ON (t.- rd dgn itr cocfld; d 16:r) I clfrf t * prtrtty ol b firt I lrrr grrarlly E rh.d rd rrn trnilr Sr !r ffiurrnn gbailld h t dr rd .Ldld Arart,rf lra-Edqrraf frqfycf traHrffrblnrrdrtrlyrupnlJcbrotgiirf lhe ffimdo, lbdilthrllr e.EriUknr&rbtt rE l1rdcgrd.L. tlrl|rrdGtfrdasao;r-t rffi trpraAr FfAl Strcrr DeStgttd P4rrrrt Brducilon llallcr EPA o:ilrnarc puOtc rrptrg hntr tstlil rfin to rr.rrg. 30 rlrrrL. pr ruponso ircedng trrr b rrviorirg hdtt dslr gGr.rhgrrd fic-dnr rrd- td conpbfng ;n rario rirrg drr tari Sert corrurrrtr t gerEtrg fiS^-bttd.o .dmrf b thrtl tniirrndm F.oi--B;r, ptfzz: uienitiiniiarr da;a;:rss,cv: {oi M-sm.r. wrqtlpr 6-c- zorso, nrgtrd 'Atrtfom D.J( OrlicD?i,, EPA'Thb ttm enrnds thr Fn ious;€flicdci fonir'as prima h & CFR *n zao, epcndr L Prrvirs rdlqrr d thb nodfcrdoo bm mry br urd wtdlr srlpp0s last. i': -I .tE' _l EPA ForE 75:lO-1 (8.f. 2's2,4z 1 t l I' i I X- OESCa|PTION OF UNOERGHOUND STORAGETANKS (Coraflar for .dr tenk Gtris tocdsL) Teds klndfcdon Nuntcr T.d<r*.. / T.r{.r{o. 2 Tad(r.lo.] Tar*No._ Tad<No. l. Sters of Trnl( (rn d(qfyoa.) Curremtyh Usr . Tofipor.rity orrt of Usr .- l-.a__tl Prrrnanonfy Out ol Usr . l-tar-lt Ameodrrt ol lnfonnadon Z-Od.. ol hsteldon (na.r)aer) 3. Esdmd.d Tsr.l C.pdy Gatb'!s) .3. lt/tAanel sl Constr,rdon (f,hrt Cl tt:[.ppy) Asphalt Coded or Bare Ste€l 4/os / e acoodcaf Prstcaed Staer Epqy Co:red Steel Conpos*U (So.l sitrr Fbergass) Fberglo* Reinlorcad ptastic Uned lrnenor Double Walled Polyetfiy'ene Tank Jac*a Cqtcrete Ercavaim Uner Ur*norr Gpr, Please specily Has rank been repaired? x x r-r_ s. Pipang (lr.ierid) ofark aI 6a.pply) BarE Stsel Galvanizd Steel Fiberglass Beiolorcrd Ptastic Cogpar 9dtodcetty Prsrued . Oo6leWdld Sccoodary Gontahment Otrr, Hease spe<ify e-nptopfiypc) (Md(rf tiarpptyf &Eioa:no y&e sttank'TH Gr.vity Fled Has prpl1, boen repaired? EPA Fclltl 753er Gcv. 2€2)ht3 \- : :r I v t5-- I ft'* No- - l Tttdt No. - | T'rd( r'lo' -7.srbs:re*t@ Itncre.rEou.ndtrbyvdrrt I I __--H l=l= casdo. ll-t I f- I Kerosene ll.-l I t-l Hedineoit lf-l-l Usedo! ll lll I odrer. PreasesP.ciry l--l i l--ll- l- l - ----- Hazardo.sSubstare li- | I i-lt-I-CEFICI-Anarrnetmq. l- | - cASn,mber l - I I r-l----- -----ll------- I -l - I Ptxnneolsubstattces ll lll -lrrt-I Pleasespecify l___.-l-ll- l-,,-ril 7, Srbg:ra C.rl"e.rdyorl,tScrcl I I."**E=il*-l=i= Gasdror ll--l I f--J Kerosene ll-l I t-l Hedinsoit lt-l I l--J Usedo! ll lll I odrer. PreasssP.ciry I --l i l--l | -l - Hazardo.s substare I I-l I l-l CEFICI-Anarrnetmq. l- | - cASn,mber l - I r I l-l----- ----r-----l t-l- I I I I :_ t-.l X.TANIG OUT OF USE. OR C}IANGE IN SERVICE l. qasir€ o{ Tanl( A Enimated@elastused $rr.Jdaffezrl --.-l_t In:lr-r I l--]|_t -l _lr-r I B- Eslimate date tank dosed (noJdrytyearl C. Tard< was renued from gra.nd D. Tank ura:t d6ed in grqrnd a Tankfill€d wifi hit ndarid D6crib€ F. Chzrgrhsrvbr 2 Ste AssenulCqnfid-_l Bilncasl rleekdadrd P.et.aEPA Fotar ?33Di (B.r: 2'92) t XI. CEHTIFICATUII OF COMPT.I.ANCE (COMPIETE FOR AL NA" AI{O UPGFADED TAI{KS ATTT{IS LOCATION} T3nk ld.ntificarod Nunt<Tellr,tr.. /T"r{.tb-A ranrtxo. 3 Tank t\b-Talcctrlo._ l.lnstdldio.t A- lnstaltcr cart fed byErl( and pipingmennea.rrc 6. tnstaller ceaified or 0censcd by the imlemenring agenc, C. lnsallaln inspecnrd by a r€stsrelorEin r D. lnstalairrr h+eclerl anrl , apFrov€d by irrybcalinE aE€ncy E- l&nulaarefs instel&n greciliss haw begl comgleted F. Ancdrer method atlorod by Slate sg6rcy. Please speily. 2 Fleleasa O€reaior (Mart all tha appty) A. ManuallanXgauginE B- Tank tjghtness teding C. lnventory coruols O. Altomadctenkg+dog E Vaprnrniuit'rg F. Grqrndrraer nrnitoring G. lntestitial rnoitoring double walled lar:Upiing H. lntersttia! nrcnitaing/secondary corrtainnEnt t. Ar.rtomaictino leak d€tEErs J. Une tigtmess testirrg K. Ctfier rrrthod alLcqd by lrnfl emeraing Agency. Please speily. TANK Ei_lEtlEEE E E = PIPING TflI E E []E I IPIPINGTAI{K EiEiEl r-JtEIEEIEDIEr:lnnlntr:EIE TAAIK EEEE t_lEE f_l t_l tl PIPING EflE EEE T TANKtr t_ltlEtlTt-r E E tI PIPING t_lIE i:l EEfI TAT.IK EtltlETEE E E E PIPINC tltlE []rlEt_l 3. Spill and Overf! hedion A. Ovrfillds{binndl€d B. Spil devha installd OATH: I canity the infonrairr corami:ng iniallation tra is pcwkted h sdon Xl,ls tnre to tfie besl sl betel ardlqtor{€dge. lndslec zf, Consrt EPA Fcrm 753{Ll lRtr. 2€f2l P.gr 5 a 7-Eleven Stores #24190 CATHODIC PROTECTION SURVEY DATA 3087 Washington Ogden, Utah 8440i (f' RECTIFIER MFR: coodal Etecfic MODEL NO: JsAYsL.Io.I2 SERIAL NO: 96UT1276 TYPE: Air Cooted A.C. VOLTS: A.C. AMPS: PHASE: D.C. VOLTS: D.C. AMPS: 120 5 1 40 12 TANKS (North) FILL (North) TURBINE (Middle) FILL (Middle) TURBINE (South) FILL (South) TURBINE ( ) FILL ( ) TURBTNE ( ) FILL ( ) ruRBtNE ( I F]LL ( ) ruRBtNE Fiberglasr N'A N'A N'A N'A N/A N'A N'A Fiberglass N/A N'A N'A N'A N/A N'A N/A UTIUTIES AC. CONDUITS WATER LINE(s) AIR N'A N/A N'A 1996 CORRPRO COMPANIES, INC. 1 lc z ll f > I 6 NO I S N I H T , V / A IIIIIIIIIIIIIII i : H- $: l {- ? sE -Y \ il l rq A . ! r a \, /' ,f r r ' -a X (" )x ; /l ' 8 b , A , + S{ :; {\ " 1 r \, , [ \ ll F I'| r r' l *= . i ll H l ' er d ll F r$ li l f l EE El l 8 ; I H r_ ll c c \ E I U I- -7 il o\. n l - F | { llrl $ 2?r ' O E5 $ 66 $ a 3 Ui ru h d *6 xZ - is x r i E zz - x f i [; i 8 E '5 d Es * tt36aoaz', iH r l EEotol( lr loFEoIr,orJs Ea6,, ". S I5 r ta I h 5 P' 3 ;= g d- * d0) ol l li 6AA E E. ; E6 . E TYPE OF NOTIFICATION I e" ruew FAclLrry B. AMENDEO g--n..oii*-r.;r""tity _ No. ol contruaoon shegts anached Form App?ov.d. OtlE No. 2050{0Gt. Approvrl rrplrrr t/!145 !.3acErrE: a. trD.arr. lcliti- trrdrd,tg g.n rll tr-l r.Cd.ad m- rh. llulrl GGPinarlSr,ayAad i$a. or tr. }tI16..t-gJdpl9.a.r. S.LOAdC rgri, o.rlidr-rr ntr.e Ec&. hJrrr?l,||iau!,Stra Ir.t Lb.nE Ettma.E ErC.rIeEr:t aa.n xr c r:r E cCEr alE rr; 7. tlolllrr{n 9.E . ar*r: t. lqrd lnr c.Eat- eatan tg liE &.c!y i.t !.d D oa c gairElclgr am eaoramg orrtE(r: t. -,Qa arEglrLorr an urxta,lrqrr!arr (jJdr asa bG.rl..r, cat,.mnarrG ort alrat d llttd) i na aDrlo ail. 3l!..a rrF.r d E o.srllc.oll,r h.. Norfk Oqi b .lqula }, F.adrl lr lq dl.{rd..$ur{ l.rL il.th.y. !..ll s..d lo .tot rrgnLtaa aultaaE. aLE .Lilr-, t. tt a, lhn !!-1" th. !!o.t(l r C Lr a, rtfa rilra !r..q|9ta h. rr. n &, a.1t!6. Th. lrlcil-bo rqi...a b rtalr.t ty Crala fC a Orr AroiriCoa...rllr rE n orrt fd. (nca^f r rila.a. Th. o.lnaryBrlEaC ararEdior o,lerrrn 3 D boEt a,tdGtat. un(br9rorrn6 ar*t lrat aE,a o, hava 3Etd IlDlJm o? tEu,l,6t- aUtsIE-.li 6 arodao ttxu t ra tnrqila!.rr !q, tratrr n oa !!ta, on ,-rolEy Evr{.Daa racotf, d n OI lI-Ea ol slEt r.cs!r. fq, rr!iloea, Ebl, o,recollGElt Who L.r.t tlotlly? Srcrot Gte ol RG8A B rrExad. ,rrrr- O.! ud-cr.mgtrt. *nat ol urtsa,lrqrr! lr,ua hat aEa ,rgtxa6 gJBrror ilrrrtrE0ty (bae ,rr- Strr or tcrt tiroe ol nr rrlru d !i., rrE olrrr'MI'I- .) ir rll (rr. ol .,t i,rfe.u,td 3E!r Et h lI. ar ilatiltr a, f g0a. sEq.g|r! nE rla.rta. arr (la. ant g.Er rl! dr tr u*$un! Erearnf lt- br G. -.Il.. tr. r dqtf,rr! cl rtgltd efla. lf bl h ,r. crra c arv rrr.,rgrun! Etea int n lI mra Nd.,no, a.I98a. UrtrElolr a U.ao,t Aal(lta, anyFltolrltoolllrrardr t rtrmmodrily brlcr lra daamlnaEn C aa lla. , cl it G..srt .e.lE' O rOrr. ft; tilty tld h- orlllqt .rv Grsre- ro lohv irbittatotr a El aFa.tr aEr (atlr rn ur llrr io.rrrlEn flc ro b. ndl^{dl. ttlrd Tralr lln hcf,drd? uoa,lrlurd iDe. rrt a.Llh.d c .n, dr.6 dr!,laIlrolE5 nd(r, alJ.- Dor[,r!r.Eulritatarol tacuaElsJB]r.']i (a r{E uolrn (narft slrorturtaa,qxlcgrt ilot 6 mo.r brr!| na erur!,soi. r.nic- a,t urclt!.rn Drrr-mg: 1. e--lr.. st ., d, adra lrl. frd a int.er mfE5rh.ruoCatrnolta. ttlr Tealr &r ErCrdrd? TIE cru tulr ar Cru,ra ft ,rd rrtir ro locicrrt Oorr anra argrril tlri aoohlEr rn: l. l,ttr a rrarrad t,E ol t.r@ C.tb.rs E.rfot tI- bct !moDa lLaa ba naroilnala !r.rf-iZ rnE u.- b aErt3 lrll ca bro.trnrva.r or ar Fltrrrrhara aDnts: ffia &tierE Ar. CoU..td? Thr mtfcrrn rootritt.r- o.f, D uro.e.q,ill.D.t. ttt tl.l G..ut r.gul5 3Elrr Ihb an frd- ft.sE E OtS ar lr..]rtlr rt aEr tot (ta, o, n Co.ttp,rlr.-r-Enigrtnf Recr Ccngrur oa tlllrt Ad of r fO GEEtAl. rrrrfr rafroliEarEr,rJlegd- lrt]u.E srf &.lbC RCRA t & ocrrb F!!trn. Getr ono Cclry tan ttrldJ5t ifqi'.rarx5 qrdixrd Ettt rut fr., ltEro GO (.e|I Frrn arfrd ta.7 F'r(l F.aqrra rE! aIotJaI WIr-r fc Idlrr? S.ra GstrC.E blr D: DEPAR.TMENT OF EWIRONMENTAL QUAUTY DMSION OF E}MR,ONMEN?AL RESFONSE I6t NORTH I95O WEST IST FI.crc)R SALT I.AI(E CITY, UTAH t4I 16 Itn Tc lhly? f . Orrrr of urErgoun firrgr l,rts h lI. r arat lr.vtrb.r aL,r oJt dor.Er a,]IrIJJ, t. re7a. h,t tlll h !I e.urilL mt-tElt ry y.y a. tIA Z Or:t rrE t ttg ut grun5.Drre. lrs rrD rrr rll lry t. t9ll mrllodrrtrr $tFC lrll! !r lrE io rr. 1, n Slr,rpII tfrD.t C rl'.narcttrta E httya.,td hbint D.r D Sta.etEiilr.Ar. FmlUr: lry crr rh. frEf.rCt tdb b idLy - ..rt t ,-.ldffir dll !. raf.d b..tr{ t nd, rE fo.E a tl0.Ct,odlLit lariEr iCnatEt 5.E Caii r5.rlrblr Ll. adqilab bri.r5.( *!.,y Notification for Underground Storage Tanks STATE USE ONLY IoNUMaEB l2-oo L3 Oate Entered lnto Conpurer Oaa Enfy Clerk lnitials oiner was contected to Clanty Responses. Comments Please tyoe or rrnr h ink sI ltarti.rotpt.ra{rnaIr.. ln .Gtirn V. This form rrurst be comCeted lof .dt locltin oaining undergund rbfq. ttil(t. I nrcre t lan live (5) tank! 8re orned d fi3 lston. phot@py the Hfcwing shs€ls. and st'Fle contnua0on shcrit to he bfm. r. owNERsHtP oF TAr.lK(s) E#A?rfirFrfif:fli:.]ffi ' u- t cor'!'m' r' n frr x.rr (c-E.t!t Lait.L AlEAerq. r olr: €n.V, OE-t-ra.mrrr [ ) FdtL-rcEi.-5-.-E+-aLEW! aroe 2,4t30 !E--=rrEE- R,g-P1 fro^AiN tta-tnN Wt\eN uJ 6_ 2"4 EPA Form 753G1 (R.v. 2.92) Pnntd on R6ydd Peoet Trdrr r,ttocruxlmtrlnritin m 16] RotrvaEr s sr oUre trust trr6. Tadrr n om.d bY nrriw Anri:en ndbo.Et .o(hdrr$r.l- tr tr tr FetrGonn,r:l {"rrrr-"rt tr selrGornn:rl El Ptirao tr ld Gorrnrrtt _ffirrntlttar -ffi-ttm.llIrY -tllla VT @NTACTPERSOiI Iil CHARGE OFTAT{I(S Plsrr tlmlr (lncit Artr Cabl et-t I-lr"o -tto-Sq<, v[. F|i{ANCI LRESFONSIBIUTY I v I srthera f-f FItrR.rrinnGrqtr I lryr rlrr lr firadrt nlpar&Ay rrfirtrfltr h strprlhaOCFR &nP$H l-l Ou., Mdto.l Alordsg.cr, VllL CEFttlCAltC{ (F.d raarr dlrorfldtg i rdrl .ubnil.d lfittlrEr b lll.errr rd oldrlr t c.rlty111.f piu6toiltrnd !hrnprurlyrrutrrdrturluflruilrlhr Hann&rrnaillrlhtlill rdrlrfdtd &*nr.,r. rn11nD.,dcr111yfi1rydrsrtdragrnrrslrrrr+cra*tcolLii.rg Jro hErnrtlqr. I bclirurthritlr OtrSlEn- ,/lz1 qi- Stgrrn ffr-; NdlrrndEJtlrdarcorn-t rffittFcrrd[eth, Az.rn S*e>q€.^^l tuvrz Prporrort Roductlon Act }{otb EPA rrtknaoFrtlcr.eil&ghrrfttq,tLbflnb llfiqo3O 4tl-f- rcrponllrdrdng ttr bf rli.Ii'E l.ltfi'(!dr'8:"ffiffi' .A[.nton o.c( oficir to? EpA. THr tmn rltr16 rh. tr viq! norficaxn rir"i' ". p** ln ]o crn ifi zeo. AP"tdr L Pttt'E'3 cdlorr ct thlt ndicdirr Enr rrrf br u!.d sld. gnpab lU' EPA Fotrl 7l!O't (R.r. 2't:ll lX. OESCRIffiON OF UNOERGROUNO STORAGE TANKS (@.rE€tc tor edl tank d thi3 locaton.) Tank ldent lication Nunber Tad( 10. I Tar* No. Z Tantr rc. 3 Tank No. - Tanlr No. -1. Stat s ot Tank (mait ordy one; Cunendy in Use Terporadly otJt ot Use (t-aI-El,l Pennanendy Otrt ol Use (t-atr-ll ArEndrrdlt ol lnlormauon ru rcl 2. Date ot lnstathtion (nplyesr) 3. Estirrted Totd Caprity (gdlons) 4. Malenel ot Constnraion (trjlart all thd epply) Asphalt Coafed o. Bare Steel Cahodicdly Protecied Sleel Epqy Coated Steel Conpo3rte (Slc.l $t,l Fibe@ass) Fiberglass Reantorcsd Plastc Lined lntonor Double Walled Polyothy'lsre Tank Jaclet Cgtcrete Ercavaliqr Uner Unknom Otrer. Pleesc sp€qry Has tenk been repaired? t_-r 5. Piping (Metenal) (Mart eI that apply) Barc Steel Galvenized Sleel Fiberglass Rinlorced Hasic Copper Catndcdly Piot*ied - OoubleWdld Secondary @ntahment UrJspwr O$e. Please rpdly l-t tNJt*rrEP Nfl t-t t-t L-t r-r t-lt-l t-t 1l'1tailra) AOvtrlf|cil{9- 6 W--PtE4-_ IN'TNl;b?NADlP{Ztt?CQ q\ BacffiD t7124 t-t 6. Piping fiype1 (Mart 8l thei apply) Suakrn: no vCve .t tank Suairn: vdve Et tarll Prcsun Grryrty Feed Has pipirg be.tr r€p.rred? t-l t-lt-t EPA Form 753Gi (R.Y. 2-92)P.t3 Tari( No. - | Tank t{o. - t-l t-lr:L]r-l rlt- ---l Tafl ldentfi€atrcn Nurtr 7. Subshnc. cl.rnenlY or L.i Sorad h Great6i OuanttY bY Volura Gasolho Diesel Gasohd Kerosene Heaing Oil Us€d Oil Otter, Pleasc sP€qly Hazardous Substars CERCIJnam sfilot, CASnumber l- l- rlil-lrt:I' 'l- | _r - ttr- r- rlri-lril i- ,-l- ll tt tvlixture ol Substances Please sPeotY lf-rlt-ll_ t-l r--l l=t- IT--ln I l_ I X. TANKS OUT OF USE OR CHANGE IN SERVICE r-l = Il|.-l ril,il r-l I l--l ll-l 1. Cbsng ol Tank A. Estmaeddetelstused lflE.JdEylYeorl C. Tank was rermved lrom grannd O. Tar{r was dced in grannd E. Tank filled witl lnrl mdDtid Describe r-l lr-l Evi,rrpot aledrdst ct d t_Ir=- Il--i XI. CEFITIFICATION OF COMPLIANCE (COMPLETE FOR ALL NETq/ ANO UPGRAOED TANKS ATTHIS LOCATIONI fank ldenufrcatoo Nuntor Tank No. t Tant< tto. Z TantNo.3 Taril< No.Tank No. _ 1. lnstalla0on A. lnstaller cortifi€d by tank and prpng manl,acurrs B. lnstaller certtfied or licensed by the impaem€rltrng ag€ncry C. lnstallatiqr inspected by a regstered erqinee D. lnsallatirrr anspecled and alproved by amplerEntirig agency E. Mandacnrers inslallalirn dteddists havr beqt corplotsd F. Another method allorved by Stato agslcy. Please spaty. 2.Release Oet€gl'm (Mark all thar apply) A. Manual tank gauging B. Tank tightness testing C. tnv€ntory conuols O. A.l6matbtankgauging E. Vapor nrnilaing F. G(oJnd$rder monitoring G. lnterstrtial rncriloring double walled tarwpitrng H. lntersttial rnonitding/s€condary cotnannEnt l. Al,lDmAic fine lealr detAors J. Line tightness t$ting K. C\her rEthod allound by I mdemeriling Agency. Please speofy. TANK IEf-liItlEE E E E PIPING EEE F EZfl TAT.IK EtlEEEE t_l t_l G tl PIPING EEE E EBE TANKtrEEEEEE L] @ E PIPING EEE -EgE I TANK IPIPING iEEEEEEE E EEE il E E EEE rANK EtIEE t_ltlE E E E PIPING EflE tl EEE 3. Spill and Overfi! Protection A. Ovslill d€vice hstalled B. Spil devbe installcd OATH: I certfy thc inlormstirn conceming instelleton that is p(otnd€d to the bestol ,ny bdd 8nd l<rrcr{odg.. lnddlcc /t/) Corprny EPA Fonn 753&1 (Frv. 2€2)Prgr5 #( SErncH* Palro Tech, lnc. 13974 Soulh 2700 West Blutfdale, Utah 84065 Phone (801) 253-4511 Fu (801) 253-4509 CM.TIFICATION OF PRESST'RIZED Paeastox Tnr & Tesnxa PRODUCT LrNE/LEAK DETECTOR PRODUCT LINE TEST RESI]LTS PETRO TECH, INC., certifies that the pressurized product line(s)at the above location have been tested using the Acurite LineTester, which meets all requirements set forth by NFPA 329-87 and USEPA 40 CFR Part 280 and has received third party certification. The pressurized piping was isolated and tested at l- 7/2 times the normal operating pressure for 30 minutes. The following results indicate a pass or a fail: Product Pump Manufacturer Results Test Date: Test Number: Test Operator: Utah Cert. No.: Location: Unleaded Super Unleaded Mid Grade Unleaded Super Unleaded Mid Grade October 27, 1995 9501_027A John Labrum uTo148 7-L1, #At'o 3087 Washington B1vd. Ogden, Utah Jacket Jacket Jacket Red Jacket Red Jacket Red Jacket Red Red Red 1l_6-036 1,L6-Ot7 115-O3 6 Pass Pass Pass Functional Functional Functional ATITIOI,TATIC LINE LEAK DETECTORS Automatic line leak detectors rirere tested in accordance with 40 CFR 280.44(a). Product I,LD ltlanufacturer l{ode1 # Perfomance Dated: Novemher L, 7995 PETRO TECH, INC. lz00zj3 Notification for Underground Sto,nge T.otB STATE USE ONLY SrE ASEsrttcdAlfut Divirim of Erndronerral ResponEe and Remediation 150 Norflh 1950 Wesc Salr l-ate city, ut h E4ll6 ID NUMBER lza0z37 TYPE OF NOTIFICATION DATE RECEIVED zl*lot A. NEW FACILXTY X B. AMENDED ,C. CI.oST'RE 3 No. of tanks at facility 0 No. of contimution sheets atrched A. Date Eilcred imo Corryuta 1|[1I B. Data F,ntry Clert Initiale E C. Ovacr was Contlcted to Clariry Responees. Comrnenrs INSIN,UCTIONS Plearc tvoe or otint in ink all ircms except 'Eigraturc' in sectioo V. This form mrst be corylaed fq each location conaining undcrground xorage trnlrr. If monc than five (5) tenLr are owned rt this locrtioNr, photocqy the following shects, ard uaple comimratioa sheets to the form. 3. qabtrr.; 4. dF&E ncrlidcl (iElodir3 !f.ri!S lb) rEtrbd lEdlf rte Nord(b bdiE S!fuy A.r of 196t, a ttc H.atdil Uqrdd ptF.hc Sey Aca d 1979, c rffi i rn irc fidire tuInt rErhd r& $n h,s; 5. rrho.irya|.dEd,pb,I[6,ct8G; 6. frrE*l!.atE!ffi cdlcdin3y@ Z. fh*tughrsuts; E. liquidETsc|lrcbdtdEi{tiDdtEdyrrledbdfatE f,otte rC ldcriryqaio:f. imSr flb dlrrbrl ia lr rndrrgrd ra (rri rr I bcnct, cr[r, cbcrath& ttrt, ad, c ---g if rb rallc Et i irfrd l4m a So?ctte rfiocdtlcf,r. Wtt Strbccs Ar€ Csvscd? Tte ditrc{ic rESi!@ qdyb orfu Sroodt$E -.*rtbcdli! rlSlhdrtdcc'. 1B bc;hbuy docc dcfrort utra{ol h rdo 101 (la) d tb Cqctardvc EeitEdl nc{lo-, Coq*n rd U$ify Aci d 19t0 (GRqA), rrtt 6c csccf,io d Oc rb.[[ccl rqEhd B t adqa u/ltlt urd.. $tillc C d n(IA, n &o i!cb.t3 pclolcrr, c.8. crr& dl a E, ftdin ttsld r,ficf h [qBit r rdrd codlb sf Erpcrurc ud pcrrrc (fl! dcgecr Ftffit lod 1a,7 pqrt p6 qoG ilcte). Wbt b Ildfr? Scld ooqlaod frob: DEPARTMENT A ENVIRq{UENTAL QUALITT DMSIOI{ G EilVIIS{MBI{TAL TESDq{SB t6t N*Tt{ 19t0WB!!T lSTFIIXX SALT LAf,A C[TT, UTAH 84116 Trha To t{ciff1. Orn.t.du&3mdt4stotrbr*clif brcbccr*Eddqslio.ftr.lElq l, 1924, hllilhtt.Srq!4 [rruri&b, rrlly 8, 19t6.2. OnGsxrtohtl8uoAgwldialgr&idols&Mryg, 1996.qr ldit rfr 30 dUr of briqig 6 -*. ;6 oa.3. If tellercqlircsrdlcdoduyrudoOficildy$od tutuolir o tu rgrcy hEcddy. FE li.r: Ary o*E r^o houhgly fribb !@ a ffi hbc tufuci:{dl bc r$jac ro . dvil D.!a[y lot b c&cGd 310,ffi fc acf, r* tu nticf,ldrc.b bdtiEaturtict ilc ifrdbidrilE( l{dtcdo b rrgiod ty &dcd f:? fu dt uda3urd c*r 51 66 g4q uDd b tEr ngobd rtOo de laq I, 194, 6r & h rL ;und rs d rtlt, t, 19t6, a tti re tnolh iao rn & Mry t, 19C6. Tic i&ario Eqo.-d btr{dldt, Sdin 9m2 dlL RilroG OGrraia d fsrr]t A.r, (R(xA), nrsdod. Ttc piory |Irpc of ttb nfficakr Forno b b fo@ |!d sadl,e *;td * tr tE c bxc rrld p.td.tro c hdor lboccr t ir crp..tdltnOc idbEdo yo gwib vill bc toodo rm$ly nrffb rcoct, c in tb *acc dld rcot, yr trnlotc, tff, c rccdcain. Wb ffri N@? S.ctirgqp dRGA, slrcrdlq rlFiE lh udca ocryEd orrcu d oa4rywod * 6I fiE rqtbd dos mr ro@&dfcd !reabcdrg*irdti.c*ibocof llci'.. Orrrqe- r) iattec-dnodlr;uodrrpdbosGlrlolrcd(rt, l9O{, c tlogl in o* rfts lc &, uy pcro rh omr ra oodcgruld tE|!c 6t fId fu rtc regr, r, c #!F.i"g dqlbd fuca, ud b) htE cc duyudslrWad ttS.d i! c b.fur lrlovcdcr t, I9&4, bu r h3cr ir ur o ttl &, .!t peru 16o onrd rrct dirrcddy bcfqsttc&ociqrin db u-, c) ilttr S grocy n roquirc, uy ndlilyttc tre udr4c ry "t-.!.r b ffiy idanb a d rrrlo er (Gty.q&d d ifroii! Dotibbc iicheo. tj'ta lbb Are lrcfo&d? thd!.gqrrd irl8r d b dcfi.cd a uy @ a od'rb d* rb (1) i rDdn ooti! u Ioulrin d.trftbd ilbfiocX' |!d (2) rtc vofure (incb&E urrcild orej:uudpipiq) t 109f cur bccd th gad. Sre +-!l 1s urrtrywde rring: l. grdic, r;ddl, a(bdfrd, ud2. i!fttalldeld,pGrdci&s,Hioihrrftaigril. Wh Ilfu Atl Erch&d? Tre oaovcd Aroo tte glold rE !d d{cd bDfficah. Ot.. ' crchdcdtoodiclillp: l. hc]l:ilrhlt&dl,lm6tr.nafc.Wilrordfcrig ffifoct famoccrhlFrpc; 2. &rldfuthgr.iigdltumqiEor6rtcftnb *tacCort; r. owNEnsHIPOFTANK(S)tr. IOCATION OF TANK(S) EPA Form 753G1 @ev.2-92) Itr. TYPE OF OWNER IV. INDIAN I,-ANDS - Federal Government -f, Commercial _ State Govemment _ Private _ L,ocal Goverment Tanks are located on land within an Indian Reservation or on other tnrst lands, Tanks are owned by native American nation, tribe, or individual. Tribe or Narntion: V. TYPE OF FACILITY Select the fupropriate Facility Description X Gae Station _ Petroleum Distributor - Air Taxi (Airline) _ Aircrafl Ourner _ Auto Dealerdrip - Railroad _ Federal - Non-Military _ Federal - Military - Industrial _ Contractor _ Tnrckfurg/Transport _ utilities - Residential _ Farm _ Other @xplain) VI. CONTACT PERSON IN CHARGE OF TANKS Name Bud Good Job Title Environemtnal Mgr. Address Phone Number 7167 So. Alton Way, Englewood, CO Q03)74G9333 Vtr. FINANCIAL RESPONSIBILITY I have met the financial reryonsibility requirements in accordance with 40 CFR Subpart H YES Check All that Apply X Selflnsurance Comrnercial Insurance Risk Retention Group Guarantee Surety Bond X (ruer of Credit State Funds Trust Fund Other Method Allowed Speciff VItr. CERTIFICATION @ead and sign after corryleting all sections) I certiff under penalty of law that I have pertonally examined and am familiar with the information submiued in this and all anached documents, aod that based on my inqurry of thoee individuals irnmediEtely responsible for obtaining the information, I believe that the submiEed inforrration is tnre, accurate, and corrylete. Narne and official title of owner or owners authorized representative (Print) Shelly A. McMurtrey Signature .,D.J0- tJ[-il,,i^,, Date Signed zl-lq+ Paperwork Reduction Lt h"tl"" \ \ EPA estirnates public reporting burden for this form to average 30 mirurtes per rcsponse including time for reviewing instruction, gatheing and mainraining the data needed and completing and reviewing the form. Send comments regarding this burden estimate to Chief, Information Policy Branch PM-223, U.S. Environmental Prorcction Agency, 401 M street, Washingron D.C. 2O460, marked "Auentioo Desk Officer for EPA." Thie form amends the previous notification form as printed in ,10 CFR Part 280, Appendix I. Previous editions of this notification form may be used while supplies last. D(. DESCRIPTION OF UNDERGROUND STORAGE TANKS (Conplete for each tank at this location.) Tank Identification Number Tank No.-!-Tank No.-l Tank No.-l Tank No.-Tank No._ l. Stahrs ofTank (mark only one) Currently in Use Terryorarily Out of Use G,ceEb€tbfillolttdh x) Permanently Out of Use (ReMbcr!o fllqnD.rir X) Amendment of Information x x x 2. Date of lnstallation (mo./year)19E3 1983 1983 3. E*irnated Total Capacity Gallons)12.000 12.000 12.000 4. Material of Constilctioo (Mark all that apply) Asphalt Coated or Barc Steel Cathodically thotected Ste€l Epoxy Coated Steel Corqosite (Sterl with Fiberglass) Fiberglass Reinforcod Plastic Uned laterior Double Walled Polyethylene Tank Jacket Concrete Excavaton Liner Unkown Other, Pleaee sPeccifY Has tank been rePaired? x x x NO NO NO 5. Piping Material (Mart all that apply) Bare Steel Galvanized Steel Fiberglass Reinforced Plastic Copper CathodicallY Plotected Double Walled Secondary Containment Undnovn Other, Pleaee SPeciS xxx 6. Piping Type (Mark all thet apply) Suction: no valve at tank Suction: valve at tank Pressure Gravity Feed Has piprng been re.paired? x NO x NO x NO Tank Identification Number Tank No.-!_Taat No._!_Tank No._!Tank No.Tank No. 7. Substance Curently or Laet Stored h Gr€are$ Quamity by Volunre Gasoline Diesel Gaeohol Kerosene Heating Oil Used Oil Other, Please Specifr x x x Hazardous Subsance CERCLA name and/or, CAS mrmber Mixurc of Substances Pteare Speci$ X. TANKS OUT OF USE, OR CHANGE IN SERVICE l. Closing of Taak A. Estimated date last urcd (mo./day/year) B. Egimarc date tank closed (mo./day/year) C. Tank was removed ft,om glouad D. Tant was closed in ground E. Tant filled with inert material f,)escribe: F. Change in service 2. Site Aeseesmeot Completed Evidence of a leak detected XI. CERTFrcAT'ON "F COMP l. Instalttion A. Installer certified by tal& and pipi4g manufactures B. Installer Certified or licensed by the inplemeuing agencyC. Insrallation inspected by a regi*ercd engineer D. Installation inspected and approved by irplememiry agercy E. Marufacnrrcr's installation checklists have been corpleted F. Another method allowed by State ag€ncy. please specifo. YES YES YES YES YES YES YES YES YES 2. Release Detection (Mark all &at aPplv) A. Manual tank gauging B. Tank tightness testiug C. Inventory Co,lltrol D. Automatic tank gauging E. Vapor monitoring F. Groundwarer monitoring G. Interstital monitoring double walled tanl/piping H. tnteraital monitoring/secondary containment I. Automatic line leak detectors f. Line tightoess resting K. Other method allowed by Irflementing Agency. Pleaee epeci$. TANX x x x x x x = x x TANK x x x x x x -J- - PIH}rc x x TANX x x x x x xx_ = x x 3. Spilt and Overfill protection A. Overfill device insrtalled B. Spill device insalled. OATH: I cerri$ the inforuution concerning Installer: - Name ided in rcction XI is true to the best of my belief and troowtedge.z-)nq Date Position P.E.S.t. 2440 South3270 West Salt Lake City, Utah 8(119 EPA Form 753G1 @ev. 2-92) any UST Installation/Upgrade Notification The Utah Underground Storage Tank (UST) nrles (Utah Admini*rative Code R311-203-3) re4uire that UsT tncallers notifr the Execurive Secretary, Utth Solid ad Hazardoue Wage Control Borrd, 30 days before insaliDg o,r upgrading aay regulated UST system. This form has been prep.red to aseist you in providing this information. Before inmalling or upgrading an UST sy*em, please colplete thie form and reirrn it to the Division of Envirornrental Responre and Remediation at the address below. If aay tanks or lines are removed or replaced, a Clozurp Plan for those tanks or lines must be submitted and approved, and a site assessment mult be perforured at closrre. Facility IDf (f not a new facility) 1200233 Date wort will commeme N/A I I New Installation I X ]Upgrade Ttnt Otrn t The Soolhland Comoratioo Phone #(303) 74G9333 Addrcss 7167 soulh Alton way cig-Esgleu@__ srEre_Uf,_ zip &ll2 Coot""t person &rd cood phone #€00)-Z4t*M__ Frcility Name_7-Elwen Address l(b7 \vaehinston Blvd. city_gsden _ state__U[_ zry_E44ol _ Contact Peno, hd fu phooe #(303) Zi0-9333 Certified Tant Insthller Name Cert. #TL___ E:<p. date_ Company Phone #( ) Stat€_ Z;ip-- Inrtellation/upgrade Information Tank # InstalWpgrrde Capacity (gallons) Type (FRP, Steel, etc.) Submance to be stored Piprag Type (Press., Suction, Gravity) Tant t ak Detection rnethod Une leat detection method Form of Corroeioa hotection Spill device to be installed (Y/N) Overfill device to be inxalled (Y/N) Uograde 12.000 STI-P3 Fuel Press. AGTS #2 Uosrade 12.000 STI-P3 Fuel hess. ATGS #3 Uqrade 12.000 STI-P3 Fuel Press. ATGS PLD PLD PLD sla nla n/a YY YYY Unusurl or extenutting circumsttnces expected: NONE xt 2L{(*? , SWra ZD /^od> oFcoupL .rce ponffiEffiAilD upcnl. -:o rAr{tci ATTHts LocATtcrN} Tarik ldenfficairm Number Ter* No.T.nkllo. ]-Tar*l,b.5:Tank llo.Tard( ttb. t. hdelaibn A lnctallgr ortfi.d by tank ard ;f,lhg manufdun! B. hslaller ertlflcd or lbcm.d bf $. tnplementfup lgpncy C. hstallalon lnspccted by a rcglatercd engincer D. lnstellstion lnsp.cted lnd apprwed by Lnplementing agencil E. lranulaciure/g lnsialhbn cfredr- lids han been ompleted F. Anofter method alowed by Stac agency. Please specify. ,ROCEqSE'BY ^DD J, b"I rl- r E{'' Ta\ rH.EffiY u.f{n.y,;{ir;r1r- lp 2 Rclease Detectbn (Mark all$af +dy) A ManualtankgauglrB 8. Tank tightness tssting C. lnvenory @ntrob D. Auomaictankgauging E Vapormonitoring F. Groundwder monitoring G. lnterstitial monhoring.double walled tankfiiping H. lnletslithl monitodnglsecondary containment L Afrmatic linc leakdctecbrc J. Unc tphtness terting K oiher method dbwed by lmplementing Agency. Please spedry. TATTIK w6EEEEE E E r TAIIK wwEEflEr E E tl TAilKKwEEEEtI t_l E E PFIt{G t_lflE E wBtl TATTIK EEtlEflE t_l E t_l fl PPII{G E t_lE E EEE TAI{K flEEEtlEE E E tl PIPING Etlt:] tl tl t_lE rlrlN(i EtlE E wwr rF,UT(i EtlE E KBE 3. Spfl and OvedillProtectbn A Overllll device imtalled B. Spill devbc lnstalled OATH: I certity the-informdion concemirp hgtalhbn tha0 b gwUed in s.cdon Xl b ftr b lhc bcct o, my belld end knowledgc. lrafre P.gn 5 )oa frrrl|LAfirlOriacdEnrionrrtrll5rPOb6lLarL-CilrttiCata6&APR 2 8 1986 The SouEhland Corporatlon StrcctAddr.$ 7 L67 S. Alton Way County Ar ap aho e Citv StrD ZIPCprlr' Englewood C0 80 I 12 Ame Co<to Pltor Numbor303 7 40- 9333 TypcotOrnor (firrlfrnryfr[t @ crrrrr,r E socr.ocroon E ffiI ro-". E ffinSff'o.,.. tr ffi, Nrrn! ancl oflioal tith of orirr or ouna/J tutltorirad rt9.G. - ,rttiva Ted Ovlatt Divlslon Gasollnc Mgr +- ttadltt.rh brlfrd ly Frdrrrlhrlcrl *gud rtrthtby. l-rId to lan njuhd dlE th J.rry l. tit( tht rrl b tL gud r d iley 1 lA c tt trt Lorli rro rr rnr Mr7 t lX. Tfr drroo rq:d r nqun! [ So ili o(tL Isrr Ccrtb rd nror.rt A&tlClAr errrrndd. Thc prinar) purporc of rhir norifrcttion prolnm L to locrta rri cv.h.tc undG?- ground unlr rhaa rrort or hlc rtortd FtroLum c barrdour rubuts. lt ir erpccrcd rlut thc rnfonnruon you pror'rdc *rll bc blrd on rcrrorbly rulleUr Rcord\. or. rn thc rbrrrn of rtrh rccordr yorr Lnorled;c. bclif. or rccollccrco. wto Mrrt Nodr? Scctron ftr2 of RCI,A. .r.trcnd.d. rcqurm rhrt. unlu ercmpred. orncfs ot undc[roura unl] rhar $ott rctuhtail subrursr nurr norfy d?srtn rd Sterc or lot r;rn of rlE GrltaGilr of rhar unls. Orr:r rncrr-(r) rn rlr crr of tn utdcryound rorrlt trrl ra uB on Normbcr t. 1Il. c broutnr rnro ura rfrr rhrt drt:. rny ,arr6 rlrc orlu ra u[d:t]outld tton; olll u$d for rhc $orr;. us. ordbF ttat5 of rt3drcd lubrtrtr.r. rrd r ur rn rhc or of rny urlc[round rtoltgr unt rn ur bcfoG ltosnbcr t. lCa. bur no lon jar rn ul or rlut drn. rny pcr:an iho orrrd rrh trnl imntdirdy bcfoc thc drrconnnuttron of ilr tr. rYbt Tailr Ar lnff? Urlcrgound ston; tral ir dcfrncd .t.ny o.: or combrnrrion of t.af. rh.t ( 1) r urad to cqr||n rn rccunubtioa o('rfulrcd srb rl|r!ct3.'.nd (2) rh6c roluttr ( rrrludin! col|lrsrcd undcrjround ppanl, ll lG,[ o? morc bfi.rrh rhrosllal. SdtrGumrlcrrr undcrfoud trrllr rrmnG t. rroailr. ur.d orl. or dlclcllct. rrrd tr rr{utriel rcltnu. fsrrdcr tr'ticilcl or fumr1ril, wb llilr Ar Erfl! Trntr rmrvcd frmr tlr routd.rt not rulFcr lo norrfrcrrron. ollrt ttnlt Grcludcd fiut aqfnrroo rrc: t. frnn or mrdcnrrl nnlrof I.lOpllonrc Irrcrpcrty urcd forrtonqmorocfrrl for noroarnrrcll arrocr: t. unlr urcd ror soiindtnrlnlol forcunutiFir lr on tlr punurr rlrre rtocd: t. rFE rrnlr: !. FFlatlt llaltrr lrrrlrdiq 'rfunar h,:r, 'trubtcd urJcr rtr rteru6t (ie. Piplit: Srfay Act of 1961. or rE Hrzriou. Liqui pirtrlr Srlcrl Acr ol 1979. ()r*hri-il ln riltacrr pplir frrliry qd rGd undc Sdr b... t. rutra33 tmpounaltlrilr. r1r. rond\. or lrlmor:] ttofln rat3r or wc nrr colhcrrca tyrtanE,.0oo.rllrorllrD.Grltrnts L lirlud tnpr orescr.r.d rlh.rint li,Bdircrly rtrcd to<il orp grodwrron end ,rtEnn!oFnuolta:l. rton;; trnlr rrtuetcd rn an undartrdrrd rct lrc{t rr I ba€rrril. crlbr.mrrwrrhng. drrlt. rhrft. or tunrrl) tl thc \toaata tanl tr {tuttd upoa or ebote rherurfrl of thc flor. *L !15 Art Caid! Thr norrfsrion cr{uirnrnrs rpplr- ro undcr- 3round non; unlr thrt corurrn re;ulrlcd \ubrur6. Thrr rrrludcr inr \ubrt.,rcB dclitld rl hrrdo.r rn rctton Ol (lrt) of rha Comrrth.lrrrrc Enrrronmcnrll Rcrgoru. Conpcnsrba rrd Lbhliry Acr of l![ I CE RCLA l. srt h rhc crccpr ron ofllra rotiarm quLtc rr lurdol urtc uldcr Suhnb C of RCRA. lr etsoitrtd6 Ftto&um. c.t . cndc otl o, rny firctroo rhcrto( rhrch rr hrlurd t sr.nd.rd conditiom of tcmfntuc tra prcrsurti0 dcttra Fahrnlrtr and il.7 pounds pcr {urttuEhrbolut f. 9Lt Tc Ndf CorrtdctC rldfExio.r fonnr should bc *rr ro rtr lddrc.. grar rt tlr top of thir p;. *fr to l{o.fy? l. otrr:n of undclrond rron; [alr in urc or rhrr hrr c bccnlrLt qrt of oFrrtpo eftcr January l. 197a. but rrrll rn rt: trouad. mu$ norrt\ 5\ Mry t. tI6. t. Orrn rho bana uadaryoud troo; un5. rnro u:r efrcr Mr1 d. 116. mwr rurfy rrthra !0 drn oI tonaif rtr onb riro rr. HE 4., c t lr frlr ll b lt c fl hI Ucrdon -r b r*.1 5. fl Fr, d ..rd tl.I b ra d h da.iffb-jrcbrHtUl*bfld. l.o. rrr1r tttll UIOfa' hlEE kdicrc numbfiof continurdoo shdsrnrdd (lt afrt r Sctoa t. mart Dor lUt Frflily ]ttt oi Comerny Siib ld.ntlfi.r, r saaola 7-ELEVEN lEGL| - A,ll3O a/, Pher rypc or prinr in inl ell itmn crccpr t3lrrrur' in SaLn V. Tb hr r 19 oghd b crci lodfu coiitrf uad.rttud ,arjr-trdr lf morc rhrn 5 anlr ert ouncd u thu l6rron. photcopy thc rwcfse sfc. rtd-nrph condnrlrtion shcar lo fiit form. Surt Aotlr: or h Roa6. r aD9.crb.--- -3o "7 { -irt.ili,,q{*..t County ., , ,lilcbc- Nuna (1, larnc .t Srtiqr l, fltart bor hJt Ted 0viaE E Job Tit Dlvlslon Gasoline ArrCO PltonrNumbar Manager 303 7 40-9333 E] M.rt bor lxft qrly it itb b fl ffi c rrbruml rdirEaiqr rd 0tat loclbn. I certify undar panrlty o, llw thrt I htv! parsmlly cHminrd Jld .,n hmilirrwith tha inrotfittion tubmittad in thb eml rll sttlchcd clocumant!, rnd thrt brrd on my inquary ol tha incllvitlrJrb iflt n dirbty rapontibS raooLining i! htomrtion. I b.licvc thlt the submrttcd inlormltron is trua, aocunE. 8r€ conrpLE. Oe$gi.dLl- /6- g6 Mlt bor lrn i, Enf(rlr,t locatad on l]l(l within rn lndirn nrflrtion or on olhar lndtan trua hndt W.rorbF-tsL-- a-- ,rF llr t(rtiltsrtoa ilq (ag ffE-tZll. ct*ft, Aqrd t qrol.t t{untr tro, r,2.,!_) fL*ilo, I rirlh. )tqtto Itilo.lLrI l{o. l.$rr.ollt(r,jaJrr?,{ro cunrltyhth llneondlvOldt.r hrnrmtyOutorut Brortght lrilo Lb. rthr 5Al! rr?1l-t tt t-l r,vll-l tt retl-l II ttl-l IIr-] tl 2. EtnmcAr0bfOt 3. Ednrbd TotI Cnrdty (Odoall /2aao /2 aDD 40oorrl tt tt s7/ P3 (Irtdddccutnctba sbd(kfr,,o) co,rcn.Fibrgbn anlbr€dptdc Unknown Oth.?,Pt rsetdty Sr lpz r=rl-t =II r:l II s}t 03 S.lnlauho|.cnbt - l.rilcrior Llning (a.g..cpory nino) ttqr Urtrrwrt O'Or.r, pf....S9dfy =T/ P3 r=1l-l lt l--ll-1 t_J II ST/ oe -sI -l LI tt III-rl-l l-l alrfadhfia(n)-J.t-ryi1,t - .Crou'lchoraurnrror..g..rre, Fibcrgtrrr R.intbrecd pt dE CotE t{qr Unknown o0!r,PtcSgdfy rTr tt lt ltI-] a, r,vll-lttl-1I-I -J rI?1l-t ltl-] ,?n"r^, l-l tt ttl-] II II T.Plphettiuitsa;gryg, l"srdGdvaniadSht Fibcrgless Rcinrorcd pt stic Ce$odicutyftoEE Unknown Ofier, Ptorspcity l-r-l I-l r.-l I-I e SqcrrCrrrurDctlstrr tn GrrH Or-ilt, D, yorrrr(,.rtto.,qttat Grldkt. (indrdng rtcottot btm(ll U!.doit Otrcr. Ptcspccify c lSrh.ftfn Plc.!. lndicetc Nrrrc ot princiget CERCIJ Subrencc crxnric.t Ab.tnct s.rvtco tCest?fo.Mart box O it trnk ltort! r martur! ol sJbrtmccr d. Ul*m;r r Bqly L hfulrn Oactl(rrm l-1rFl E'- E l-]f-rr'-rl l-] rx-l r-l - l-l - t. fdd0ood lnloartoo (for tr*r grmrara!;trl.noulol..rllca) .. Ertimrt d ct.tn h.t u!.d (mo/yr) b. Estimetod qutntity or subrtlncc rcmaanang (gat.) c. Mart bor tr il trnt wrs lillccl with incrt mltffirl (c.9.. slnd. concrctc) I /// EPA Form 75iD.t (lt-C) fua-turrnreorh tE{}rI ftC.2 UTAH UST PHOGRAM Permanent Closure lnspection Facititu tD: tgad aq q Ownership of Tank(s)Location of Tank(s) '/- gb' ownerName "/-tl Urr4-Location Name O-r/ Address ^ Pn &ov 7ll Address -?n g 7 0t r*st+ 8i, d city lJa t/a ( state TX zio )S zz t city A* ^-l stare ur ziofqYl)/ contact ?no,, o P>rh ^rkpnon" Land use df surrounding area: Residentiat tndustriat a-C;-r"A' Orher Tanlrc,Closed TankNo.'/TankNo. 3 fanr*o. -3 TankNo; 3apacity (gallons)/2L t2 k /2k Type (Steel, FRP, Composite)-{rTg-t--!Ec; r StEt t- Substance Stored fuaJ)t,E fate last used /J- /1. . n4 ))-/L -o4 /2 -/t,- o3 fate Closed /-Ja- o/t-),n-oY /'20 "t Ll low closed (Rmvd, in place, CIS)Et ,r-t {t,.d zr"r.r.r- 3 Original# of tanks J - Ctosed tanks + New tanks 0 = # ot tanks remaining fan k Cleaning and- Reqnglal : GW & Soir Samprer: ' td / n-* S'ruo.-/ d-_Ced. #: GS Expiration Date: R- 1Cr' UST Remover:k:- nn NLd) ) tw',a Lu A-v cetl. #'.rR D3fl Expiration Date: 7-c7 Cwner/Operator has an approved closure ptan:@ N Copy of closure plan is on Site: f?->N Product removed: Y N By: 7*?nm X €ArZn Disposed at: 7?€f,rt * t E/,t, th< Sludge removed: Y N By: I t t Disposed at:,l , Tanks cleaned: Y N By: t(/r Rinsate disposed at: t I t t \on-explosive atmosphere inside tank obtained by: --[Purging - lnerting. LEL or % Oxygen obtained: )roduct lines were: - Cleaned, secured in place, and capped _[€"ror"d, disposal site: I-ank disposal site: -Dhr 6 "*O Soil disposalsite: N/* Site Assessment: )lD or FID meter readings (indicate location on the site plat.): vleter Type: Gain or span: Callbration specs: Soil contamination is evident: Y (9 Depth of contamination: 0 - 3 feet Greater than 3 feet y'Vater contamination ls evident: Y (ry) Depth to water table:Slope direction of surface topography: \umber of samples collected CW: f, Soit: USC: 1 Cerlified Lab: 4r*r- k)ez* {nalysis Methods ' rpn f6-rxfu-f6B OaC TRpH HOC Other: nspector observed .oll""tion of trrpl"t, d2 location and depth of samples on the site plat. lnspector collected duplicate samples and submitted them to the State Lab for analysis: y & Sontaminated soil was overexcavated: Y * @ lf yes, confirmation samples were collected: y N Pana 1,o,f,z Distribution: White-DE RR, Yellow-lnspector, Pink-Facility/Owner Closurepl rev0201 .wpd Facility Site Plat NORTH ,4, ^' uV ^4'x l' )#,+,,)t .b, N $i Show locations of all buildings, streets, tanks, piping and dispenser islands. lndicate location and depth of all samples collected by Also indicate the location of anv reoorted PID or FID rcadinos sampler and the inspector *; t-,tI+fll , i,il l!$!i:!F*,s-XF,L,t ef rlE .S,rtl .urpcrion tre nearest: Residences L A ,l Commercial Buildings ,/ Or,Propefty Line 56 Active Water Well SudaceWater 7t<Sewer Line Water Line Natural Gas Line Telephone Line I Electrical Line Storm Drain Other: Comments: t (n"r") /A+f-4}d<,r( rT2 ."r.ty tn"t r in.p".t"a,r," "oorg-named facitity on (date): , m Inspector's signature: I 6U ' n* ZZ , cert# /: )2 rev0201.wrwpd -? RECEIVED FEB 2I M4 ,?..r,rrrrrr, re?5$e a Remeoraion DOCUUE]ITATIOTI OF UXDERGROU]ID STORAGE TAI'IK CLOSURE 7-ELEVEN, trNG, Forrner Store No. 24{3O 3O87 South YUashington Blvd' Ogden, tltah February 24r 2OA4 By SECOR lnternational lncorporated flt8 East t[500 South, Suite 100 Huniay, t tah 841073957 Gornelis Van Diik Assoclate Geologist GertiFled UST Consultant #CC0180SDk David K. Babcock, P.E., P.G., M.B-4. Senior Engineer Gertified UST Consultant #CC0134 a - TABLE OF CONTENTS EXECUTIVE SUMMARY INTRODUCTION UST REMOVAL ACTTVITIES AND OBSERVATIONS ....,.....................2-1 Excavation Activities..... ....'.'.....2-1 UST RemovalActivities. ..'........2-2 SAMPLE COLLEGTION AND ANALYTIGAL RESULTS ......................3-1 SoilCollection and Ana1ysis............... ...'."...3-1 Soil Sample Results ..'..............3-1 4.0 CONCLUSIONSANDREGOMMENDATIONS....-................. 4-1 5.0 STAN DARD LIMITATIONS.... 1.0 2.0 2.1 2.2 3.0 3.'l 3.2 Table'1 Table 2 APPENDIX A APPENDIX B APPENDIX C 1-1 TABLES (followtext) Underground Storage Tank Removal, Underground Storage Tank Summary Underground Storage Tank Removal, Soil Analytical Results APPENDICES UTAH UST CLOSURE NOTICE NON-HAZARDOUS WASTE MAN I FESTS TANK RECEIPTS 24130 UST Closure Report Feb 2004.doc SECOR INTERNATIONAL INCORPORATED EXECUTIVE SUMMARY This report presents the results of an underground storage tank (UST) closure by removal conducted by SECOR lnternational lncorporated (SECOR) at the former 7-Eleven Store No. 24130,located at 3087 South Washington Blvd. in Ogden, Utah. The Utah Department of Environmental Quality, Division of Environmental Responie and Remediation (DERR) refers to this site as Facility lD 1200233. The UST closure by removal was conducted in accordance with DERR regulations. ln January 2004, three 12,00O-gallon USTs formerly containing unleaded gasoline product and associated product dispensing equipment were closed by removal. A total of seven closure samples were collected during UST closure activities. Closure sampling included: five soil samples collected from the UST excavation and two soil samples collected adjacent to the former dispenser island. Product piping closure samples were not collected because the former dispenser islands were located adjacent to the USTs with the product piping located directly above the USTs. Soil analytical results confirm slight concentrations of petroleum hydrocarbons in soil located at the southwestern corner of the UST excavation [soil sample SS-1 at 17 feet below ground surface (bgs)]. However, petroleum hydrocarbon concentrationswere all reported below DERR Risk-Based Corrective Action Tier 1 Screening Leveis. Allsoil samples were classified according to the unified soil classification system by a professional geologist. The closure samples were collected as per the site-specific UST closure plan approved by the DERR. The native soils encountered during UST removal activities consisted primarily oJ meOium-griined gravelly sands (SP) and fine-grained clayey silts with slight plasticity (ML) to approximately 17 feet bgs (maximum depth excavated). 24130 UST Closure Report Feb 2004.doc SECOR INTERNATIONAL INCORPORATED 1.0 INTRODUCTION SECOR lnternational lncorporated (SECOR) was retained by 7-Eleven lnc. (7-Eleven), to provide documentation of underground storage tank (UST) removal at former 7-Eleven Store No. 24130. The site is located at 3087 South Washington Blvd. in Ogden, Utah. The Utah Department of Environmental Quality, Division of Environmental Response and Remediation (DERR) refers to this site as Facility lD 1200233. According to the United States Geological Survey map of the Ogden, Utah quadrangle, the site is located in the SouthweslTnot Section 32, Townihip 6 North, Range 1 West of the Salt Lake Base and Meridian. The work was conducted from January 19 through January 22,2004 in accordance with the Utah Administrative Code R311-204 and R311-205, pertaining to UST closure and site assessments. UST closure activities included: . Preparation of a site-specific health and safety plan; . Visual inspection of exposed product piping and USTs; . Qualitative determination of organic vapor concentrations in soils and backfill materials surrounding the USTs; . Examination for the possible presence of free product in soil; and . Sampling and laboratory analysis of site soils in general accordance with the applicable State of Utah DERR regulations. This report presents a description of the UST closure activities by documenting the decommissioning and removal of the three tanks, two product dispenser islands, and associated piping. SECOR prepared and submitted a UST Closure Plan to the DERR. The plan was approved on January 12, 2004 by the Weber-Morgan Health Department. A copy of the DERR Closure Notice is provided in Appendix A. lncluded in the site Ci-osure Notice is a site plan whiih shows the location of site structures, the former UST excavation dimensions, soil sample locations, historical borehole and monitoring well locations, and underground and aboveground utilities. 24130 UST Closure Report Feb 2004.doc 1-1 SECOR INTERNATIONAL INCORPORATED 2.0 UST REMOVAL ACTIVITIES AND OBSERVATIONS The former UST system was located in the southeastern quarter of the site with the tanks oriented northwest to southeast. The USTs consisted of three, single-wall steel 12,000-gallon USTs, used to store unleaded gasoline. A summary of UST data is included in Table 1. The dispenser islands were located directly east of the tanks and oriented northeast to southwest. The former product dispensers were supplied by single-wall steel piping. On January 20 to 21,2004, three site USTs, two product dispenser islands, and associated product piping were closed by removal. E.T. Technolgies, lnc. (ET) of Salt Lake City, Utah, using a trackhoe, removed asphalt and concrete paving covering the USTs. Mr. Kim Hemingway was the certified tank remover (Utah Certified Tank Remover No. TR-0351). The Tank Closure Notice is provided in Appendix A. Three to four feet of overburden material was encountered above the tanks. During the tank and dispenser island excavation and removal activities, observations of environmental affects were recorded. These included the following items: r The area was inspected for the possible presence of hydrocarbon product in the soil; . The physical conditions of the tanks were inspected for corrosion, pitting, and/or holes; and . All activities were continuously monitored for fire and safety hazards. 7-Eleven removed the pumps and turbines from the site prior to the UST closure activities. 2.1 ExcavationActivities Native soils and backfill material removed from the UST and dispenser island excavation were screened for organic vapors with a MiniRae, lnc., Organic Vapor Meter, equipped with a photoionization detector (PlD). Si!nificant'plD readings and hydrocarbon odors were not observed in the backfill and native soils associated with the tank, dispenser islands, or product piping excavations. Approximately 150 tons of overburden, and backfill material consisting of fill sand.was excavated and temporarily s[ockpiled along the perimeter of the tank excavation before the tanks and product piping were exoosed. 'After the USTs were iemoved, the tank excavation measured approximately 45 feet by 50 feet 1Z,ZSO square feet (ft2)1. The excavation bottom beneath the former tanks was approximately 14 feet below ground surface (bgs). After UST system removal activities were completed, the excavations were backfilled with clean imported pit run and fillsoils. 24130 UST Closure Report Feb 2004.doc 2-1 SECOR INTERNATIONAL INCORPORATED 2.2 USTRemovalActivities On January 19, 2004, a minimum of 't5 pounds of dry ice per 1,000 gallons of capacity was added to each UST. A few hours after the dry ice was added to the tanks, the explosive vapor levels within the USTs were determined to be below 10 percent of the lower explosive limit, and the oxygen levels were determined to be less than 7 percent. ETrs subcontractor, Thermol Fluids, lnc. (TFl) rinsed and cleaned the tanks. TFI transported approximately 79 gallons of residual liquid and rinsate for off-site product recovery at their facility in Las Vegis, Nevada. Copies of the non-hazardous residual and rinsate waste manifests are provided in Appendix B. Visual inspection indicated that the product delivery piping was in average condition. Upon removal and visual inspection, the three UST's appeared to be in overall moderate condition with moderate pitting and scaling, however, no apparent fiailures were observed. The tanks were labeled per the DERR regulations, loaded onto flatbed kailers and transported for disposal at Durbano Metals, located in Ogden, Utah. Copies of the tank receipts are provided in Appendix C. ^ 24130 UST Closure Report Feb 2004.doc 2-2 SECOR INTERNATI ONAL I NCORPORATED 3.0 SAMPLE COLLECTION AND ANALYTICAL RESULTS 3.1 Soil Collection and Analysis A total of seven closure-soil samples were collected in accordance with the revised State of Utah Adrninistrative Code R311-205 for site assessments and UST closures. Closure sampling included: five soil samples collected from the UST excavation and two soil samples collected adjacent to the former dispenser islands. Piping closure samples were not collected because the former dispenser island was located directly west of the USTs with the product piping located directly above the USTs. All soil samples were classified according to the unified soil classification (USC) system by a professional geologist. All closure samples were collected as per the site-specific, UST Closure Plan approved by the Weber-Morgan Health Department on January 12,2004. Sample locations are illustrated on the site plan included in the UST Closure Notice, presented in Appendix A. Soil samples were placed into an ice-filled cooler and submitted to Utah-certified American West Analytical Laboratories and analyzed for gasoline-range total petroleum hydrocarbons (TPH-GRO) and methyltertiary butyl ether (MTBE), benzene, toluene, ethyl benzene, total xylenes, and naphthalene (MBTEXN) by EPA Method 82608. Chain-of-custody protocol was followed throughout the investigation. Soil samples were collected from the trackhoe bucket using a clean stainless steel trowel bucket and compacted in laboratory-supplied, 8-ounce glass jars with Teflon-lined lids. Soil samples were labeled, sealed, and logged in a field notebook and onto chain-of-custody document. Before collection of each sample, the stainless steel trowel was cleaned in a soapy solution, rinsed in tap water, then rinsed a second time with distilled water. This procedure of cleaning the sampling equipment was performed to minimize cross-contamination during sampling. 3.2 Soil Sample Results All of the closure samples were classified according to the USC system. The native soils encountered during UST removal activities consisted primarily of medium-grained gravelly sands (SP) and fine-grained clayey silts with slight plasticity (ML) to approximately 17 feet bgs (maximum depth excavated). Petroleum hydrocarbon constituents were not reported above the project laboratory method detection limits (MDLs) in soil samples SS-5, 55-6, and SS-8. Trace concentrations of TPH-GRO, total xylenes, and naphthalene were reported in soil samples SS-2 to SS4. TPH-GRO, totalxylenes, and naphthalene were reported at concentrations below their respective Risk-Based Corrective Action (RBCA) Tier 1 Screening Levels in soil sample SS-1. Soil analytical results for this investigation are summarized in Table 2. Laboratory analytical reports and chain-of-custody documents are included in the UST Closure Notice, presented in Appendix A. 24130 UST Closure Report Feb 2014.doc 3-1 SECOR INTERNATIONAL INCORPORATED 4.0 GONCLUSIONS AND REGOMMENDATIONS During this investigation, a total of seven closure samples were collected. The native soils encountered during UST removal activities consisted primarily of medium-grained gravelly sands (SP) and fin+grained clayey silts with slight plasticity (ML) to approximately 17 feet bgs (maximum depth excavated). Shallow groundwaterwas not encountered during soil excavation. Analytical laboratory results of closure soil samples collected following UST removal activities confirm that petroleum hydrocarbon constituents were not reported above the project laboratory MDLs in soil samples SS-5, 5S-6, and SS-8. Trace concentrations of TPH-GRO, total xylenes, and naphthalene were reported in soil samples SS-2 to SS4. TPH-GRO, total xylenes, and naphthalene were reported at concentrations below their respective RBCA Tier 1 Screening Levels in soil sample SS-1. ^ 24130 UST Closure Report Feb 20M.doc 4-1 SECOR INTERNATIONAL INCORPORATED 5.0 STANDARDLIMITATIONS The findings and conclusions documented in this report have been prepared for the specific application to this project and have been developed in a manner consistent with that level of care and skill normally exercised by members of the environmental science profession currently practicing under similar conditions in the area. No warranty, expressed or implied, is made. This report is for the exclusive use of 7-Eleven and their representatives. A potential always remains for the presence of unknown, unidentified, or unforeseen subsurface contamination. Further evidence against such potential site contamination would require additional subsurFace exploration and testing. lf new information is developed in future site activities (which may include excavations, borings, or other studies), SECOR should be requested to reevaluate the conclusions of this report, and to provide arnendments as required. 24130 UST Closure Report Feb 2004.doc 5-1 SECOR I NTERNATIONAL INCORPORATED aa TABLE { Underground Storage Tank Removal Underground Storage Tank Summary Former 7-Eleven Store No. 24130 3087 South Washington Blvd. Ogden, Utah 1 12.000 8X32 ,t ne 2 12.000 8X32 lnleaded Gasollne 3 12.000 8X32 ne Former 7-Eleven Store No. 24130 SECOR Projed No. 26EL.2413O.04 SECOR lnternational lncorporated 24130 USTTable Jun 2003.x1s Table 1 UST t ogoo - (7 ' {-N<.Nei zuo( o bN69 c-e6 6. E tr c *o - -d90 tr o 6t u lL a E' O o, = (E a E SE 80 ) CN =o 6=3E poE: ;FOc (J = ul -@9 .c(6FFU) fo(?tN (L IJ JE=OE E. = EEE E E' t s o ;E E -o : ' j ; - o ?f ; * E= - e 8E b 9E : . - E' ( E ( l ) Fs + E E$ e E E I rp x I E + Ee = E s €E Er T E E d; -g t e F i 6' = Ee s ;E ; EH eB E E E a$ E3 g€ ; ae p P Ee il = ii rr rL rr rr 9t o EE o53 Es ' 5 8 RE ;- E ES E' 6 ' @ :> , EE x F -' J E E 9g E 3 E= im E 't s iI bP F EC ) NX . E EE b6 5 8_ g oo E o E _> o p tr 6 55 t + ut c . F- oB E E gE ,E I f Et r F HS EE * aE ' - F E: E H: =E E t + Ea g| E E f i E E H $ [ E: EI 9g E *g f l E g EE 9I EE E E E E ; E EH El ', u u u rr rr E tt rn E -t=t z El gg e E E E '7 id EI O: A A E E E ' uJ l E .B E 8 = ro oc{ oC! N @ o o^ tr q r oX iE t tr g oor (ooqo Gl q(r ) oloqo oroqo olr )qo oorO c, ,YE" trotoCLEoozxutF@= otroE.CctGz C\ l ct ) ol. c )qo (f )qo (f )Nqo olooqo olooqo orooqo o o TP66 F> x d loloqo lr )$qo o, (oqO olr )oqo olooqo olr )oqo rOcoN o >r O gN rr J 6o NC; orOoqo o)$oqo olf ,oco orooqo olooqo orooqo aaN otro6F oci orr )oqo CD.toqo otooqo orooqo olr ,oqo orooqo (o otroNtroo orJ )qo lf ) (\ toqo lf )Noqo roNoqo lr )Noqo roNoqo roNoqo o,o tumF= oo orooqo o,$oqo olr )oqo orr )oqo otooqo olOoqo i' i l i o.Eo sooNo \tooNro $or$lo soo(\ Io \toC\ to rtoNo $ooNo IooJ oE o- E c!N(f , qo e. i q@ oci d qo oU' f ILa TLU) TLa o-a J o-U) o .C ED E- o P6 Ll o I qf. * q(o qro qrO ero orO q(or E.Etr(,ooa = *. E ot r i ! 'E - q IU)a C\ l taa (r ) Iaa $Iaa lr ) Iaa (o IaU) oIU)U) o) troot .EO (i l t E -t l fl o { f r Ea 2 t .( E o dr X- c il -H , E s. ; s E; E g = E Ei 4 E O BE t d e( / , g E EL ^ L9 E 8- l a,1 APPENDIX A UTAH UST CLOSURE NOTICE Documentation of Underground Storage Tank Closure 7-Eleven Store No. 24130 3087 South Washington Blvd. Ogden, Utah SECOR Project No.: 26EL.2413044 February 24,2004 UNDERGROUND STORAGE TANK PERMANENT CLOSURE NOTICE (REVISEd O1/01/97) Facility lD #rlooa3T Closure Notice prepared at the request of the owner/operator (identified below) Oy Ca-t tiS Varaa. DljY- of (company name)SgC.oe -f-r.+o-,ntficn^e,l a,ra. phone#f&l r2lb - ?ton(rfr'\ Address 700 v *sf 4-soo So, r\,Soib to} cuy 9,tt* L+tQ cit state (AT zp1qto+ FACILITY INFORMATION T"nk O*ner ? - €t*A)<-- , ?^/. Phone * tL* I \L1 -BqV lt [ ]sole proprietorship [ ] partnership ffi corporation Roore." ?'4 BpX ?ll citv ?* tl r.s-- stateflg- zip@l Facility Name 1- e tr,,.;eaa- S*are f.lo. ZttlSD noor""" 3o9? Sr,r,t^ Wrtr\,€{r-. B\vL citv-fud:*--state ttt zip-dljg!- contact person V r*i! 7 *b rlc v Phone * t %l l14o-+<ooLts*\ Number of regulated tanks at the facility before closure: 3 Number of regulated tanks at the facility after closure: O TANKS CLOSED Tank #A B c Date lnstalled rqs)rrg)11 D? capacity (C*l)l7,ooo ll,o99 l&r0o D Substance stored tllL /^^ <^l'.f^L,:^-*tL 6,'l6rtl.a t Date last operated .,(tr,lr,,ot rlf rLlrq,)oltuluol Date closed rlzrlrooq izt lzwt rlzr llcy How closed (Removed/ln place)Ae,rha/rt E^ror.,&8e*nar"I * lndicate the specific substance stored in each tank to be closed (regular, unleaded, diesel, waste oil, etc.) TANKREMOVERName Prn ttcr,rnittg wltsY Cert.#TR03Sl Exp.dateS?A'2c|l) corp"ny E,a. T&\oi.9 , T^z . Phone * r Oot t 91+- o?31 noor"." 3u O \r/aek ft16r.i* foa. citv 5xl.* Ve \ stalg ttt zip gtlo{ in LUST File # . CLOSURE TNFORMATION ffi Fuel was emptied [2{ Sludge was removed [rd Tank was cleaned. Tankwas: [ ]Purged ffi lnerted. Method UseO: Dr"1 ?cZ Location of Closure Records 5ao0,aa*.?.nr . 3t ? fnrl tr qo'D cuutu, S^i L ten ,5L4, ufu\ 6tt to? For ln-Ptace Closure: tanks filled with p & For Change-ln-Service: Substance to be stored hlt DISPOSAL SITES USED: Location Name Contact Name Phone #Date Amount Tank(s)Drvlanao *ce)tutVqAOat*bl.6u-5?l tfzrlog Tank# 3 Product From Tank(s)ltrarro flqiff Tnc.%bo-+ -../a-rrr h.a.n )ot-z1c+lU Yrtlo\+g gal Contaminated Water From Tank Cleaning 1 (I (gal Sludge {,1,.1,J,gal Contaminated Water From Excavation UA ^ gal Contaminated Soil de vd3 er-excavZ-i6d still on-site? - Yes - No x Not applicable Was Free product encountered during closure activities? rJ 0 tt yes, please indicate thickness, -lnchesSITE ASSESSMENT complete the Facility Site plat (closure Notice) and sample lnformation Table (closure Notice) on pages 3 and 4 to show the locations, depthl, and other information on all soil/groundwater samples taken for closure. The samples must be consistently identified by sample lD # on the site plat, table, and lab analysis report' [(] Completed Facility Site Plat (Closure Notice) is attached. Thefollowingmustbeinduded(enterthedistance,anddirection(N,s,E,w) fromtheareaof contaminationor,whereapplicable, bry##;Hfiff;ffiJil:8ffi,*);,Gas rilp stormDrain eL-rerephonep{-Eb 61;6a1[[eropertvLinecr'u Buirdings [;<] cornpleted sample lnformation Table (closure Notice) is attached. ixj CertineO lab analytical environmental sample results are aftached. [xi UnltieO Soil Classification (USC)sample results are attached. [x] Chain of Custody form is attached. samples were properly: [x] collected Ix] Labeled [;] Packaged t xl Transported [X] Samples were in sighiof the person in custody at all times or in a secured locked place. lcertify underpenalty of lawthatthe closuresite assessmentatthisfacilitywas conducted in accordancewith R311' 202 (parts 21d.s2 aiazaolzl and R311-205 U.A.c., and that any additional samples required by R311'202 parts 280.62 and 280.72 and R31 1-205-2(aX1) were proPerly eollecte{. Signature of Certified Groundwater/Soil Sampl", \ FunnameorcertiriedSamprer Bqbrtn, Nr"rhh fr "ldr t D"" 4240q lf contamination at the facility is confirmed, any person providing remedial assistance for a fee must be a Certified UST Consultant. The Certified UST Consultant providing assistance is: CERTIFIED UST CONSULTANT Name Cert.#-CC-- Exp. date Company.Phone # ( ) Address City State_ Zip FACILITY SITE PLAT (CLOSURE NOTICEI The site plat must be drawn to an appropriate identified scale. lt must show actual sampling locations, substances stored in tanks, and other relevant information. Tank and sample identification numbers must be consistent with the information given on p. 1 and 4 of the closure notice Facility rD # lloof)3 o,r*n ay (^a,rnr,t,'l Vr{.r,\DljK o"t"-2!-0-l-La4 1t NORTH Scale: 1" = 3D Feet 2 Z:r CI > LEGEND vES-l+ ABANDoNED vApoR Elct'RAcIoN WELL Mw-l+ ABANDoNED GRoUNDwATER MoNlroBlNG wELL _s -s _s _s _s _ USTA-PREMIUMUNLEADED UST B - MID-GRADE UNLEADED UST C - REGUI.AH UNLEADED 31OO SOUTH STREET I **''o*'fl[=* | I OVEN}{^NG t c.o. --\ I r-t---t \ I .,o-.o E--[I-- ----Q: --r=il'o-1 EI 5 *(9 I )E I Mw-z + : a, CT I I Irh al6 7-11 STOHE NO.24130 I =ea --\ i\i ffi,i**^i\,'f' tA1,\ *r** ! )-Mw-3 | \/re-,re{g I\\srr - ',. {5-3aj ;]i.-) *;!.\i e>.se \",'ff'r /l.-i{w^ . [, _l d FaIU t! I I I I I fi$H-i-l -l--_+ - t" -' ,a-rh{ trgc-trr7 \ r,lw-sf -9c 59 Erll-r L\4 {0-w- w-u,- r, -.w-w_w_w X = Sample locations (SS+, WS+, USC+) = Monitoring Wells (MW+,) O = Soil boring (SB*), or Geoprobe Boring (GP#) O = Water Wolls (domestic, livestogE\etc.) Slope of Surface Topography: (N, E}y w, SW, S, SE, E, NE) Land Use At Site: _Residential )!Commercial _ lndustrial Surrounding Land: -Residentiai-!Commercia- lndustrial Site Plat Must lndicate Actual Locations Of: / Cunent & former tanks, piping & dispensers / Excavations, GW monitoring wells & soil stockpiles / Location & depth of all samples taken r/ Buildings, fences, & properly boundaries / Utility conduits (sewers, gas, water, storm drains, electrical etc.) / Depth to groundwater (if encountered) FEB-Lg-2AA4 15:59 E\11 C0RP OFFICE 253 ?96 7t2A P.A2/42 sf upLE INFORIJIATIoN TAELE (CJoS!e. Egll"gll he hbte must be conslstentwith Complete table for all eamplee that wer-e takel fot ".lT.'l1f lTlI-,- rarar* the aanpte tD numuerriil"ionlt " site plat and ln the lab analysis report. i sorrtssl otountluatcr (GW), or unltled SollClasslllcation,(UsC)' z nneiueiir, $n feet) bolor grade awhlctr samplE8 wll! tsksn' i b';;rfiffiti qt p"'tat"t .nalvzed Gr ecn iample (rPtl, BTE(N' o&Gr 3t9l'- - 4 Appmprtateanaltslsrnrthir&i&corramnartdpo,nifiiift-JachgntPir(adr5noO"gOZ0"t13'1'stc)' SEte CertifiEd tsboratory usea: Annc^rics.a w€At lrr*tY H# :: AddresE cUitlt ststeJaLzipJB-!!S- Gontaaperson 6t.**.- {ro e*{ rrrc-J -- Phone# ( 8Df 1 abl - Bftgt [' please erplain any unusual or artenuatlng ciralmstancas Bn@untsred during the slte assassment or oloSura: 1 I certily undor penalty of law that I am lnfiormatlon onthls form and that It were followed dudng rank Signatura of UST Owner Full name of Ownar ianf(") depcribed above and that I am familiar wlth the riedt6 anO further, thatthe proceduree deecrlbed hersln Retum comptetad qosure i,lotice 6rm, /raoility Slte Plat.and sampte Inbrmation Table, soil/Groundwater sample lab anatysiaresirtts, USC i"mpte resutts. and Chaiir sf Cusudy form within 90 days of UST Closure to: State of Utah Dept. of EnvlDnmenhl Quallty 6ili1i; oft;tf5;r#ntaiRCPonse ana R6madlatlon UST Section P.O. Box 144840 168 North 1950 West Salt Lake Clty, Utah 84.11ffi40 Analysla method(s)' ORGANIC ANALYSIS REPORT Client SECOR Collected: January 20, 2004 AMERTCAN Received: January 22,2004 WEST Contact: David Babcock Analyzed: January 25,2004 ANALYTICAL LABORATORIES 463 West 3600 South Salt Lake City, Utah 84115 Analysis Requested: SW8260B/5030A Lab Sample ID: L58639-0lA Field Sample ID: SS-1 @ 17' Site ID: 7-Eleven #24130 Analytical Results 8260-S-MBTEXN/GRO (80 I ) 263-8686 Toll Free (888) 263-8686 Fax (801) 263-8687 mail : awal@awal-Labs.com Kyle F' Gross Laboratory Director Peggy McNicol QA Officer Units = mgikg-dry Final Dilution Factor: 50 Compound Surr: 1,2-Dichloroethane-d4 Surr: 4-Bromofl uorobenzene Surr: Dibromofl uoromethane Surr: Toluene-d8 Methyl tert-butyl ether Benzene Toluene Ethylbenzene Xylenes, Total Naphthalene TPH C6 to ClO (GRO) Report Date:January 29,2004 7o Moisture: 15 Anatytical Result 102 0h 96.6 Vo l0l Vo 102 Vo < 0.10 < 0.050 < 0.10 0.12 6.1 Page I of 7 Reporting Umit 7r-136 7Gt25 8r-122 85-123 0.10 0.050 0.10 0.10 0.10 0.10 1.0 @@ The sample required a methanol extraction. The reporting limits were raised 50x due to sample matrix interference. Rereasedbv, 442+,--- Laboratory Supervisor Client: SECOR Collected: January 20, 2004 AMERICAN Received: January 22,2004 WEST ORGAMC ANALYSN REPORT Contact: David Babcock Analyzed: January 23,2004 ANALYTICAL LABORATORIES 463 West 3600 South Salt Lake City, Utah 84115 Analysis Requested: SW8260B/5030A Lab Sample ID: L58639-02A Field Sample ID: SS-2 @ 16' Site ID: 7-Eleven #24130 Analytical Results 8260.S-MBTEXN/GRO (80 r ) 263-8686 Ioll Free (888) 263-8686 Fax (801) 263-8687 mail: awal@awal-Labs.com Kyle F. Gross Laboratory Director Peggy McNicol QA Officer Units: mglkg-dry Final Dilution Factor: 2.51 Compound Surr: 1,2-Dichloroethane-d4 Surr: 4-Bromofl uorobenzene Surr: Dibromofl uoromethane Surr: Toluene-d8 Methyl tert-butyl ether Benzene I oluene Ethylbenzene Xylenes, Total Naphthalene TPH C6 to C10 (GRO) Reporting Limit 7t-136 7G125 8t-122 85-123 0.0050 0.0025 0.0050 0.0050 0.0050 0.0050 0.050 7o Moisture: 20 Analyhcal Resrlt 108 % 107 0 102 0h 102 0A < 0.0050 < 0.0025 < 0.0050 < 0.0050 0.055 0.0s0 0.86 Released by: Z)Z-= =)r-- Laboratory Supervisor ReportDate: January Z\,2OO4 Pas.e 2 of 7 ^n ^^nta^t Thic ^^mh2nv a..Antt ^^ rFeh^neihilit ey.nnl for the dr re nerformanm of insmcrion and/or analvsis in oood faith and accordino to the rles of the tfade and Of SCienCe. Client SECOR Collected: January 21, 2004 Received: January 22, 2004 Analysis Requested: SW8260B/5030A Lab Sample ID: L58639-03A Field Sample ID: SS-3 @ 15' Site ID: 7-Eleven #24130 Analytical Results ORGANIC ANALYSIS REPORT Contact: David Babcock Analyzed: January 23,2004 AMERICAN WEST ANALYTICAL LABORATORIES 463 West 3600 South Salt Lake City, Utah 841l5 8260.S-MBTEXN/GRO Units = m/kg-dry Final Dilution Factor: Compound 2.46 7o Moisture: 20 Analyical Result 108 % 102 0h 102 o/o 104 0 < 0.0049 < 0.0025 <0.0M9 < 0.0049 0.045 0.013 1.2 (80 I ) 263-8686 Toll Free (888) 263-8686 Fax (801) 263-8687 .mail: awal@awal-Labs.com Kyle F. Gross Laboratory Director Peggy McNicol QA Officer Surr: 1,2-Dichloroethane-d4 Surr: 4-Bromotluorobenzene Surr: Dibromofluoromethane Surr: Toluene-d8 Methyl tert-butyl ether Benzene Toluene Ethylbenzene Xylenes, Total Naphthalene TPH C6 to C10 (GRO) Released by: Reporting Limit 7t-136 7Gt25 8t-122 85-123 0.0049 0.0025 0.0M9 0.0049 0.0049 0.0049 0.049 Laboratory Supervisor Report Date: January 29,2004 Page 3 of 7 ORGAMC ANALYSIS REPORTA Clienr SECOR Collected: January 20, 2004 AMERICAN Received: January 22,2004 WEST Contact: David Babcock Analyzed: January 23, 2004 ANALYTICAL LABORATORIES 463 West 3600 South Salt Lake City, Utah 841l5 AnalysisRequested: SW8260B/5030A Lab Sample ID: L58639-04A Field Sample ID: SS-4 @ 15' Site ID: 7-Eleven #24130 Analytical Results 8260-S.MBTEXN/GRO (80 I ) 263-8686 Toll Free (888) 263-8686 Fax (801) 263'8687 'mail : awal@awal-Labs.com Kyle F. Gross Laboratory Director Peggy McNicol QA Officer Units: mg/kg-dry Final Dilution Factor: 2.5 Compound Surr: 1,2-Dichloroethane-d4 Surr: 4-Bromofl uorobenzene Surr: Dibromofl uoromethane Surr: Toluene-dS Methyl tert-buty I ether Benzene Toluene Ethylbenzene Xylenes, Total Naphthalene TPH C6 to ClO (GRO) Reporting Limit 7t-t36 76-125 8t-122 85-123 0.0050 0.0025 0.0050 0.0050 0.0050 0.0050 0.050 7o Moisture: 12 Analytical Result 109 o/o 98.3 Yo 102 0h 102 0h < 0.0050 < 0.0025 < 0.0050 < 0.0050 0.069 0.023 3.2 Released by: Laboratory Supervisor ReportDate: January 29,2004 Pase 4 of 7 /a ORGANIC ANALYSIS REPORT AMERICAN WEST ANALYTICAL LABORATORIES 463 West 3600 South Salt Lake City, Utah 841 l5 Ctent: SECOR Collected: January 21, 2004 Received: January 22, 2004 Analysis Requested: SW8260B/5030A Lab Sample ID: L58639-05A Field Sample ID: SS-5 @ 5' Site ID: 7-Eleven #24130 Analytical Results Contact: David Babcock Analyzed: January 24,2004 8260-S-MBTEXN/GRO (80 r ) 263-8686 Toll Free (888) 263-8686 Fax (801)263-8687 'mail: awal@awal-Labs.com Kyle F. Gross Laboratory Director Peggy McNicol QA Officer Units = mg/kg-dry Final Dilution Factor: 2.49 Compound Surr: 1,2-Dichloroethane-d4 Surr: 4-Bromofl uorobenzene Surr: Dibromofl uoromethane Surr: Toluene-d8 Methyl tert-butyl ether Benzene Toluene Ethylbenzene Xylenes, Total Naphthalene TPH C6 to ClO (GRO) Reporting Iimit 7t-136 7Gt25 81-122 85-123 0.0050 0.0025 0.0050 0.0050 0.0050 0.0050 0.050 7o Moisture: 18 Analytical Result 109 0 100 o/o l0l Vo t0l oh < 0.0050 < 0.0025 < 0.0050 < 0.0050 < 0.0050 < 0.0050 < 0.050 Released av _*7g>-, Laboratory Supervisor Report Date:January 29,2004 Page 5 of7 AMERICAN WEST ANALYTICAL LABORATORIES 463 West 3600 South Salt Lake City, Utah 841l5 Client SECOR Collected: January 21, 2004 Received: January 22, 2004 Analysis Requested: SW8260B/5030A Lab Sample ID: L58639-06A Field Sample ID: S5-6 @ 5' Site ID: 7-Eleven #24130 Analytical Results Contact: David Babcock Analyzed: January 23,2004 8260.S-MBTEXN/GRO Units = mdkg-dry Final Dilution Factor: 2.51 Compound Surr: 1,2-Dichloroethane-d4 Surr: 4-Bromofl uorobenzene Surr: Dibromofl uoromethane Surr: Toluene-d8 Methyl tert-butyl ether Benzene Toluene Ethylbenzene Xylenes, Total Naphthalene TPH C6 to ClO (GRO) Released by: %o Moisture: 18 Reporting Analy[cal Limit Resrlt (801) 263-8686 Toll Free (888) 263-8686 Fax (801) 263'8687 .mail: awal@awal-Labs.com Kyle F. Gross Laboratory Director Peggy McNicol QA Officer 7t-136 7Gt25 8t-122 85-123 0.0050 0.0025 0.0050 0.0050 0.0050 0.0050 0.050 ll2 Vo 102 o/o 103 0h 100 V" < 0.0050 < 0.0025 < 0.0050 < 0.0050 < 0.0050 < 0.0050 < 0.050 Report Date:January 29,2004 Page 6 of 7 aboratory Supervisor Client: SECOR Collected: January 20, 2004 Received: January 22, 2004 Analysis Requested: SW8260B/5030A Lab Sample ID: L58639-07A Field Sample ID: SS-8 @ 16' Site ID: 7-Eleven #24130 Analytical Results ORGANIC ANALYSIS REPORT Contact: David Babcock Analyzed: January 23,2004 AMERICAN WEST ANALYTICAL LABORATORIES 463 West 3600 South Salt Lake City, Utah 841 l5 8260-S-MBTEXN/GRO Units = mg/kg-dry Final Dilution Factor: Compound 2.48 7o Moisture: 10 Reporting Analytical Iimit Result (801 ) 263-8686 Toll Free (888) 263-8686 Fax (801) 263-8687 mail: awal@awal-Labs.com Kyle F. Gross Laboratory Director Peggy McNicol QA Officer Surr: 1,2-Dichloroethane-d4 Surr: 4-Bromofl uorobenzene Surr: Dibromofl uoromethane Surr: Toluene-dS Methyl tert-butyl ether Benzene Toluene Ethylbenzene Xylenes, Total Naphthalene TPHC6toClO(GRO) Released by: 7r-136 7G125 8t-r22 85-123 0.0050 0.0025 0.0050 0.0050 0.0050 0.0050 0.050 108 % 100 o/o t0l oA t0t oh < 0.0050 < 0.0025 < 0.0050 < 0.0050 < 0.0050 < 0.0050 < 0.050 Laboratory Supervisor Report Date: January 29,2004 Page 7 of 7 &b q 1 oa)o|oo. h6 6 A A 6 b A 6 6 q @ @ A oo o o o o o o o o o o o o EE E E E E E E E E E E E E o. o. o. a. o. o. o" o. a a a E o o. 0i c r o o C ) o o o o o o ( ) ( . ) i ) 6l l o0 ti l , ol r bo o0 bL b{ , o0 b0 b0 ho o0 00 LL L L L ! 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UJ=zF=d(! o5oov)>(oE{)ooo& [!=zFEL U)Fztu=oo el r Z € ) Nx r r - € u \ (1 e p ! si a u ; e l u o C ro rs q u n N pe p a l l o c au r l u a l B o o-9o-Eoa 0)Go oEi: oG oEi: efo.9U);lDDo,c.9:o.c6t It l=zF=t(t . eo.aoi@Eo.2@ooil ul=zFzno- oE(uzoq) 'a ' o_ 0)oo- 1a APPENDIX B NON.HAZARDOUS WASTE MANIFESTS Documentation of Underground Storage Tank Closure 7-Eleven Store No. 24130 3087 South Washington Blvd. Ogden, Utah SECOR Project No.: 26E1.2413004 February 24,2004 _ eb. a6 2aa4 a+ia?Pn P2 qf.} t r) R i) REMTTTo:t/r a' iL' L \' t- THEBttlo ttulDS:lND. . PIIIC BANK. P.0. Box 3100t-0723 PASADENA, CALIFOENIA 81 1 10.07 TER[18: ilEI 10 DAYE TECHNOLOGIES FRX NO. GUSTOilB PTCIruP NGXEI AGISIOWLEDGEIUI E}TTIREGH M EPAil (ll ADpllmDlo) =---- fi\t"cc IIIAiIIFEET# iaat977g74t rilYOlCE ''1': -'l ',., .:i.,#l Fad. 1;0:50i!!110[f"i SIATE t,W ZIP TNETHOD OF PAYIIEIITCITY i ,f,.EttLl)rG ADDRESS 0F DIFFEREIIT) .$lflppti{8 IIAME: R0, EI,|VIR0NMENT,[L|-Y ilAZABsOUS SUBSTANCES. Lloulll, N,0,s. (Elhylono Glycol}, g,uN3tt82, Polll 1tf vtrhhlo nroflt R0 Sn00 Lnt; 0r gruilter lur Elhylnne Glycoli 3 g,o' ,w HITOOEII TESIEO: Qonerelot't descdpllon ol warto and soltlco: (allach anrlyllcrl diit, ilSDS, ote. to Datll yqs- ilo- HALooEtl IESI RESULTS PPM r;:ii1 ''" Slgned 8elow, subloct to larmr and condlllone as specllled 0n rovott. rlda ol lerms lorm. RECElVII'IG FACILITY SI G}IATUBE RECEIUII{G FACITIW TIAME PHINTED (sEE REUERSE)BECEIVI}TO FACITITY COOE: ^a . APPENDIX G rANK REGEIPTS Documentation of Underground Storage Tank Closure 7-Eleven Store No. 24130 3087 South Washington Blvd. Ogden, Utah SECOR Project No.: 26EL.2413004 February 24,2004 DURBANO METALS 2904 PACIFIC AVE. . OGDEN UT 84401 (801) 621-5221 DATE I. CUSTOMER'S NAME 1'-- narrur lro/ ADDRESS ,;;;;;, cAHRTER I neuanrs ' LBS. GROSS LBS. TARE - DRIVER ON "/- OFF - LBS. NET @ - PER LB. PRICE - 53 42 su0 e20-s> 1.l,'l itt WE!GHEO ON A FAIRBANKS SCALE SHIPPER WElGHER frt,*,* DURBANO METALS 2904 PACIFIC AVE. - OGDEN UT 84401 .t i'i I nennnnrs CARRIER ,^* /- / l-n\ (801)621-s221 cusroMEB's NAME { { &lk q ADDRESS COMMODITY 52 7!q 42 fi1Q q,Tzc LBS. GROSS ,/ LBs. TARE - DRTvEH o* X-orr LBS. NET @ - PER LB. PRICE SHIPPER WEIGHEHWEIGHED ON A FAIRBANKS SCALE 1 DURBANO METALS 2904 PACIFIC AVE. - OGDEN UT 84401 (8ol) 621-5221 DATE LBS. GROSS LBS. TARE - DRIVER ON "//' oFF - LBS. NET @ - PER LB. PRICE -rt'tf WE;6HER f?r t r" $' cusroMER's NAME f,*t C ' / ADDRESS COMMODITY I neuenrs CARRIER 52 5+O 12 8U0ffi WEIGHED ON A FAINBANKS SCALE ^r 2570 Granrnvenue Ogden,t tah 84401 f80r1399€433 Fr0( 180t, 399€306 @{TTM. HOUSE M.PH. l-lealth OfrlcerrDtecmr DMdon Dlrccors KAY| RR6oN,Adminisrauon CI.AUTXA PRICE, NUrsirE JOE DEC^nA EruirormenEil Heatth rcUN IHOirPSOtl, Hedfi ftornoion COI.IEENJET{SON, WC January 12,2004 t-{rCuiv nt JAN l3 200rr J[Lt i:nvil.0rlrllentai Iltspilisc & H etrtediair"tt v'1 , ---.*-.*.'7-l1krc. Atfir: David Babcock PO Box 7ll Dallas, TX7522l RE: Closure Plan approval for Underground Storage tanks at: 3087 Washington Blvd, Ogden, UT Facility Identification No. L2N233 Dear Mr. Babcock: The Closure Plan for the above-referenced facility, received by the Weber-Morgan Health Departuent on January 12,2004 has been approved subject to the noted modifications, if any. Local health and fire departnents must be notified 72 hours before beginning closure activities. Our records indicate that your proposed tank remover certification expires within four months. Please ensure that your certified remover has a valid certificate dtring clostue activities. Any proposed change to an approved Closure Plan must be submitted in writing and approved by our office before implementation. If contamination is suspected or found during closure activities, you must report it to the Division of Environmental Response and Remediation (DERR) at (801) 536-4100 within 24 hours of discovery. Enciosed is a copy of the "Closrue Notice" fomr which must be compieted and submitted to the Executive Secretary (UST). The closed tank records will then be removed from the tank fee billing lists. Please submit the environmental and Unified Soil Classification (USC) sample analysis data an! Chain of Custody forrrs with the Closure Notice asi soon as possible, but no later than 90 days after tank closure. If you have any questions please contact Ray Bakker at (801) 399-8171. Victor Scherer, DER& PO Box 144840, Salt Lake City, UT 84114-4840 Corralis VanDirk, Secor International Inc., 308 E 4500 S, #100, Murray, UI 84107 HEALTII DERANTTEM L . Glosure Plan Review Summary Facility lD Non-Notifier: No Number of regulated tanks at this site not previously closed: Database: 3 Closure Plan: 0 Certificate of Compliance lssued: Yes TANKS TO BE CLOSED Tank# Type Date lnstalled Capacity Substance Last Used Hmvd/ln Place I Irnpressed Current Cathodic 4ll7ll983 l2m0 Gasoline lArcl03 RMVD 2 Impressed Current Cathodic 4/1711983 12000 Gasoline 12116103 RMVD 3 Impressed Current Cathodic 4ll7ll983 12000 Gasoline 12116103 RMVD TANK REMOVER Name: KIM R HEMINGWAY Cert. #: TR-IB:351_ Exp. Date: 911t2004 SOIUG ROUNDWATER SAMPLER Name: SCOTT O'NEILL Cert. #: GSGLL4(D_ Exp. Date: 5flt2004 lf different from database: Tank Owner: Address: Site Name: Address: Remarks: Phone: City: Phone: City: State: Zip: State: Zip: COVER LETTER TO FILE COPY TO AREA SCIENTIST Thursday, January 08, 2004 Page I of I oL/08/04 09:51 FAX E01 266 Z\r8 SECOR SLC +++.{ERR @ oorzooo sECon II.JTERNATI ONAL I ht CORFo*ATED 3O0 Esst {50OS6rJlh, Blrite loo Munty, trl 0,a107-3957 601-28tF7100 rEt / B0't '2E171 16 nrr UE CO \^/r /w..ge(or.ccrrrl SE R fax 19; attention: comFan)4 date/tinre: Vi-{zrD& no. of pages (including covar): Disclaimon.nnation transmitted herein is interrded onl5'pgrson or entity Lo vrhich jL is addressed and may z,ol.rain confidenual and)or prlvileged material. li you are nof lhe-,intended rudpienL of this mess.u9.: Yo1 ?t=.|,fl:?I notified that.any use, rwiett, rel.ransrnission, 4;ssgrnination, disLributi6n, reploduction or anY as1ic'n latl'.€n in relianoe upon this mesEeEe is prohibil"ed. ll you recieived ff,ii *rnrrnitrEti:,n-in eroi.please not'r! the senderimmedialelv and d^r-r^.t- ^-FiF-r E-/ Fil -rd-^ha'.^r-..^F ".",' alertrnnin l'ilri.q ol/08/04 09:51 FAX 801 268 ,{.s sEcoR slc ++y{f,f,f,@ooztooe Received I - ?: o4 1t?tl - Mailed toLHD l-8-o+ Received From LHD UNDERGROUND STORAGE TANK cLosuBE PLAN (rev. 10/04#19) FAdLmY D# te Ooe 33 LHD Approved- to State Closure Plan prepared at the request of the owner/operator (identified below) by.Z+,rlt-lis Var-, D; it< of (company name | +e lhtl -r*-lra^z-.. tr- a-rr,t Rna .Phone#(Gat ) t&b-rroo Grzr) Address ao_g A,O* 49ogoufi^. 6".1a IOO_City ttury \ Stare t^A-_Zp 6qro$ A Contractor may pr€pare this Closure Plan as the owner/operator's agent. ln preparing the Closure Plan, the Conhac{or must act with the owner/opeetorJs 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 R311-2U (u.A.c.) FACILITY TNEORMATTON Tank Owner ? - le+.rc,r,r. ,Tvtc,. Phone # (?eg l4L7' g.+bb [ ] sole proprietorship t I p"rtnership V(coqontion looress ?.9-- B0?< '? t I cO D +\h< stares5-zp@!__ Facitity xame ? - E[-*.rel^ 5b* No . 2413o -Addres, 30 B? 4ot.*r^ W^Fh;hS{oh BNJ- citv @g de- state trt ziptj4o!-*1t? Gontactnerson D*.-il R,r.lorrot- -- phone#(&t t&b-ilooff${) Total numbsr of regulated underground tanks at this site 3 Total number of regulated underground tanks at this site @be closed 3 TANKS TO BE CLOSED Tank #A ts c Type (Steel,FRP,etc.)Slcol *c-l *l<-z-.l Date lnstalled r 1s1 rq s3 \q s3 capadty (Sr$o.rl)12.ooo iZre m ta.0o D Substance stored'_wrtrsll.€lagolinr LarY&leo 6rsrl;rr.r- t r\\c€.at6a.rrtltt/- Date last operated pltvbqt 14tbftlrl,^z{tvllrrt Removed/ln Place/ Chanqe in Service?Pcrnov.l eurweL &t rarJ ' lndit-ta thE Gp€cifc subsienc€ shred ln eacfi lank to be dosed (regular, uoleaded. dlesel, waste oll, eto) For waste oil tanks: Have degreasing or other tlpes of solvents been stored or mixed with the waste oil? Yes (identify if known)No_ Notknown UA Analysis for lead orothercontaminants may be required priorto disposatof contaminated soilorothermaterial. (Checkwith your disposal facility-) ot/08/04 09:52 FAX 801 266 ,3119 sEcoR sl,c ++,=\ERR @ oogzooo TANK REmovER Name Y-ttA tle}^t^f a vJt Y Cert. #TRolEl exp. oate-3E!r33 Company,toai a*L.Phone#(3ol ) q??-oa3l Address SttO WeSt (*t.4ovn'"a An/e.cru 5+t+rrrla cihr state-9T zip-%1J-93- soruqRouNDwATER SAMPLER Name 31dt ZNai I Cert. # GS 14o9, Exp. datelt . gpl, Company <6 fatl'l-*.lorwt fi .t.'J a^.^t .phone #(Aor I Lbb-+\oO Address--. 3oS trll{ 44oa^urfhi-:k too city N\rvf^J statelI--apjlllCL- Beforo tlre closure plan is submltted for approvel, the local health and flre departments where the facility is located must be contacted. lf the hclllty ls in Beaver, Cettr/n, Emery, Gafield, Gand, lrcn. l6ne, Salt Leke, San Juan, Wasatoh, or WBg,hington county oonF,otDERR(USl)et (iI1)SSH|OOins6dofthetoal heatthdistid. Ywsdll mustctrlt!€olthaloalflrcdeoailmentinthesecE/.unt/6,s. DISPOSAL INFORMATION Tank(s) will be disposed at: Facility T- trrrbru.O l,lro* xl$ Address ?1oul ?xci {4 c lryy.erl-lu./.ciy WstatelL zrp9!!l-eJ- Contact percon 5c*{. horr.#- Phone # ( Sal ) 6}l - 52}f Product lines wlll either be: -X- removed or - cleaned, secured in place, and capped, Vent llnes will eitrer be: - X- rcmoved or - cleaned and secured open- Piping will be disposed at: Facility D .rr brhr.o !A^G-+ud S cW e3&+^ state-L[ zip g{tl oI- Contact person Ae.Ao-Vnttao -Phone #L%rlLZ! - 524 Tank(s)willbeemptiedby: company -7hc.z...ot €Lrri&. Phone*(Gor I fAb-6at! Tank(s) will be cleaned by: company 'Tncar*.4 [ Ttwi{g, Phone # Contaminated water ln the tanldrinsate will be disposed at Facility T1ne"'*'ot F\W\A.! Phone#(Bol r Zt|l:-6All purged or L rendened inert bythe fullowing method: DFI Afz- Residuat aludgas will be disposed at the following facitity: Th e'rno I f\u id,< aaaress t=ltu Wrft }IeOo 5ou#u. Crty-teJ-9gg-GfEi- Statel,tl- zip-ML- Gontact percon Phone *tfrit )rtb:6tll Contact percon Tank(s) willbe: FOR CLoSURE IN.PI-ACE ONLY [ ] Approvalfor in-ptace dosure has been granted by the Loca! Fire Depadment. Fire Dept.Phone#contact- Date- I I Approval for ln-place closure has been granted by the Local Health Departrnent, Health District-Phone#.Contact Date 0L/08/04 09:52 FAX 801 ,U6 r\18 ' The following SECOR SLC ++4ERR @ooq,tooa CONTAMINATED MATERhLS MUST BE DISPOSED ATAN ACCEPTABLE FACILITY: All materials generated from UST closures must be managed and dispos6d in a manner that does not place those materials in direA contact with the environment. On-site stockpiling of contraminated soils may be rcquired prior to any soil management activities. Any parcon providing remadialassrctance for afea, including aeration and over-exavation (of more nan 50 yd), rnust be a Certified IJST Consurcnt. Conl,aminated soils generated ag pad of tank removalare to be disposed at the following facility: Addrees Ao3o \)eat taoo Sowt. citvs+t*tattr-4tY state-ll:LzpjIlgS-contac'tperson Deh Dcx, . Phone#{ Brt } qE.--?rtB SITE ASSESSMENT A site assessment must b6 perfornred for all UST closures and changein-service. Site agsessmenis must be performed aa outllned ln 4lt CFR 280.72 and R311.205 (U.A,G.), lf contamination ie f,usoectqd. additional eamoles must be colleE-ted at the location where contamination ie most llkely to be prosent. lf oroundwaEr ie encoUntered. a so,ll sample must bo collected. in the unsatur?ted zone. in additton to each qroundut tter sarlPle. Soil and gtroundwater samples must be analfzed for the compounds shown in the followlng table, using appropriate lab methods. Subslrncc or Produc't TlDe Contrminrnt Compoundr to be Anrtyzcd AITIALYTICAL METHODS Soilo Groundwater or Surfrce lVeter Grsollne Total Peuoleum Hydroca,rtous CI?H); 39{ Bmzc,ne, Toluene' Erhyl benzene, Xyleuos, Naphthalene, (BTEXN) and MTBE EPA 80158 t snd EPA 80218 t or 82608 Diesel Total Pctsolerrm Hydrocarbons (TP[I); aod Eenzeue, Tolueno, Ethyl benzene, Xylcneq and Naph&alene (BTEXN) EPA 80lsB 44g! EP/q' 80218 or 82608 Ueed Oil Oil and Grease (O&G) orTotal Rscovcrable Peboleum Hydrocarbons CfRPH); and for Bsnzeng Toluene, Ethyl' beuzene, Xyteues, Nophlhalene (ETHO{) & MTBE: and Heloqenated Volatilc Omnnic Conrpouuds (VOC's) EPA 1554 or 5520' CIC EPA 80218 or 82608 New Oil Oil and Grcese (O&G) or Total Recovcrgble Petroleum Hy&ocarbous (TRPII) EPA 1664or5520 Other or UDklrown Total Peholsun Hydrocartons (TPH); and Boaze,ne, Tolueng E6yl benzeue, Xylcncs, eud Naphthaleue @TE)O.I); g{ Heloecnated Volatile OrEanic Comow& (VOC's) EPA E0l5B aud EPA 80218 or 82608 to theso ccrtifiod melhods are cousidercd asogptoble by the Exaoutivc St rretrry (USQ: A. Ducl cohrrm confiranadm rnayuotbe rcquircd forTPH & BTDO.IMTBE aoalpis. B, A micrrsxtrsstion or scaledoum tccbnique may be used for aqucous semplcs. C. Hexano may bc urcd Eq an extraction solvcnt NOTE: The samplc proparation method and any modificarion(s) to a certifiad method must be reported by the laboratrory on the fi nal analytical rcport. t Merlods or t€st proc€durer allov/ed for Oil and Grcasc (O&G) or Toral Recovcrablc Pcholeilm Hydrocarbous (TRPH) arc 5520(b) or 5520(f) rcspeorively. Complete the Facilfi Slte Ptat and Sample information. CONTAMINATION INFORMATION tnformation Table on pages 4 and 5 to provide Eito assessment lf contamination at the faeility is ggspestesl or confirmed, the information must be reported to the Executive Secretary (UST) at (801) 536-4100 within 24 hours. The Division of Water Quality must be notified at (801) 538€146 if Free Produst is encountered or if sufface water has been impacted. lf contamination is confitmed, any person ascisting in the remediation pro@ss for a fee must be a Ceffied UST Conslltant- 0L/08/04 09:53 FAX 801 266,,aUS sEcoR slc ++^sERR @ ooszooe FACTLITY SnE PrsT (CLOSURE PLAN) The site plat must be drawn to an appropriate identified scale. h must show planned sampling locations, substances stored in tanks, and otlrer relevant information. Tank and sample identification numbers must be consistent with the information given on p, 1 and 5 of the Closure Plan. Facility lD #-ll!l-ooa33 Drawn ey c?Y*tt3 VM Di \K . or,. PATTERSON AVENUE l I l l l l I h- E$. F lD It J'. aks UJ oo =sEo =6 s J P$tr. FAW 4LEY SIOO SOUTH STREET PARKTNG Lor *utr!ff PUUP Nw-slf ;; E.s,8H ^qzE5 =EEH: sEEtEe oH $EEE uw- USTA - PnttttW UtttAoeO UST E - MID.GRADE UNLEADED U,TC.REGUURUNLEADED BARBER SHOP ,r-*ffi:k il4^:S lu*ufr II STORE # I* .t{rE le= !H =H* EH= HEt t{ HH- E e=e;E JJJJIllt E Heill{f JI{I s d E(!uld a=IJ Ea IJ'rt U I I **+s Ei* 1I NORTH 5o;";1'=ft1[Feet X = Sample locrtions (SS+, WS+, USC#) o =MouitorinE Wells (MW#,) O - Soil borins (SBr#), or GeoDrobe Boring (GP+) lD = Warer'Wells (domcstic, livcrtock, i:lc-) Slope of Surftcc Topography (NN!il.W,SW,S,S4E NE) Land Use At Sitc: -Rcdideodelliconmerciet _Indusuiel Surmuading Land: -Rcsidcntiall(Coromercial -Indrurial Site Pht Must Indicete Approrimetc Locrtions Of:y' Canefi & former tolks, piping & dispcnsos y' Location ofall sauples to Be tateay' Euildingl fetces, & propertybouodariee / Urilify conduits (scrncrs, gas, water, storm drains. "1""61CqI, etc,) 4 0L/08/04 09:53 FAXJi.lFFErr-eEltrdt Llrd..)801 266^(18 SECoR SLCr uulv tf,raE *-1.ltlR-.@ ooezooo S. LIUPLE tUrOnUlX QN TABLE Complete table ll9r all sarqples to b€ tal€n for dosure. Sample*Substmoe ltor.d ln tank Smrplr tyPet Detsltt Compourdd Analysls rrcthodpf 99-r trlt,&w$rs 56 tl.s Ift{+RID 3llrfrill'BP4 rrctrcp 9l4ob *-Z {9'l:..<I / *r-,h 5q rl.$I 5-q e9 lr-S \ 53 -S 99 3'D *-L 9q 3.? 59-1 93 3.o ,y \y tl6C- l 1164 tx.s uk f-^l.*o*ara61ir.rfi'51,1 lJrC,*2 r29L 3'o .Ir9L / w9c-3 u VF|.3.o u9(.u 1 So[ (SS). G]unrdur.Ef (GW), arUnnca SolChGelt!.tofi(USe). Z eppir. Oeplh h h.l bebtr, grodc . Itrc Eq&Ed nrlnltnunr ile ocesaarrf emghr ntrC be tdren at 0.Z fd b€low GE bEdf,/nsive loll hf #ece. s conbmh8il GofiEomds to D€ au[@ frr udr enpte (fiur trbL DIr D. +4 ApproFrlel rnihElr lllEurod! ,.r cotbn[url onpurd(e) ri eE}r unplr (idh tabL ql P. g). Approdrnate depth to grcundprter ln the virinity of ttre icnlc: . > I 5, lbet. Regiional goundwater fl ow direcflon: -.--ilI oftfulr6* Stste Cefiirlad Laboratory U Ue rsea, aoar"" 4b3 -lCeeLl6oD Sa.ldd^ w4*+t+rl.t C\ state-fi-zp-&{Us.- Eontactpenson Elr*.-a H*.f . .-rif, Rtrone*L$at t ol,63 i €ta 8{o ., Plaase explah any unusual or efrilreling drcurnsEnces spestid Egardlng the site gsaassment or closure: I cerUry underpenaltyof luthetlem tfia lnformatton on thb furm arC herein wlll ba folbrcd during Slgnatrre of tenk ownsr tanl(s) refrmnced above and that I an famlliarwith Full Neme sf tank owlpr and furtfiar, tEtthe pfocedurcs dascrlbad \ UNDERGROUND STORAGE TANK CLOSURE PLAN (rev. 10/04/99)FAclLtwtD# lloof33 LHD Approved- mailed to Closure Plan prepared at the request of the owner/operator (identified below) by.Corr*\iE Vaan D:it( of (company name \ q€ b>/L 7'^+'"/ ^" h- at^'l *..la 'Phone#(3ot ) LbO-rtoo (xrzg) Mailed to LHD Address 3oB {tat 4sao 9ou{t^. rSvi Lz lotl Gity jtrt \rrr hr State-t^-T zip 6t{ t o} A Contractor may prepare this Closure Plan as the owner/operato/s agent. ln preparing the Closure Plan, the Contractor must act with the owner/operator'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 Owner phone # (2a6 \47-el- $Llleb [ ] sole proprietorship t I p"rtn"rrnip l(corporation ooor"r. ?.0 . Bo)< -? t I citv D r\h+ statef:L zpl923l- Facility Rooress 3O $? 6o*gth \)o.sl^ih5+o\,. B\vJ- citv 09 de'. State-lrt zip-U!!Ol5l17 Contactp"oon P.t,it Brrloro]L phonegfgrr reUO-+roo(x${) Total number of regulated underground tanks at this site 3 Total number of regulated underground tanks at this site !q@ closed TANKS TO BE CLOSED Tank #A R c Type (Steel,FRP,etc.)6l.ol Acnl '*cel Date lnstalled r 103 tq 83 \183 Capacity (5rlto$)t2.o00 12,ogo la.0o 0 Substance stored' urrvc&il aasolirrr t-1,!V,aded 6oqrl.'nr- t \\4qrr. 6acoti.\a Date last operated iltvtaor,t vltvftat e,ltvltcrl Removed/ln Place/ Chanoe in Service?Pa"ronr.t er;nt "f,SrunalrJ . lndicate the specific substance stored in each tank to be closed (regular, unleaded, diesel, waste oil, etc.) For waste oil tanks: Have degreasing or other types of solvents been stored or mixed with the waste oil? Yes (identify if known)No_ Notknown Analysis for lead or other contaminants may be required prior to disposal of contamil$*:Eg your disposal facility.) JAN 0 I Z00rt .-,tL .,i I v I i t.r, l, : i r, r tta ! Fi i1 1: r1, ,,,,,r, & il t: nt i;, 51urc- rJo. L4rto UT TANKREMovERName Et* tlel^t^t6 vJ,tY cert.#TRo35l exp.oate-3El-1911 lo a*O.Phone #(Aol ) 6l?1-g?3f a66r"rr 3 t to Wagt (tl i{ovn, a lwa citv 5n+q{rg Ciiv state_!!'T zip9 3)o1 SOIUGROUNDWATER SAMPLER Name *co*t grPeitl Cert. # GS l4oq Exp. dateiFr. &14,1 Company 56 h(L A*{e/.^.t ti ,rJ a-^L.phone #(got 1 Lbb-?toO Address- 3oS a6{ 4Eooeourfhtfu:lr loo citv hwr*.l statehT-zpjgl-git- Before the closure plan is submitted for approval, the local health and fire departments where the facility is located mUSt be COntaCted. ll the facility is in Beaver, Carbon, Emery, Garfield, Gnnd, lron, Kane, Salt Lake, San Juan, Wasatch, orWashington county contact DERR (UST) at (801)5364100 instead of the local health district. You still must contact the local lire depattment in these counties. Contact Pe.l B+ Klr-gf Tifle *^-gP€c +a/ Phone * 6Or- 3i9-C3Dl CoNTACTLOCALFIREDEPT. Nameof Oept. ,glea^ firc hl*v?tna,[ oate-u€.1-?aO-4 conraer lA*+t 6c-Lrn:n-,.V mte fi'ra t{WrsWal phone *ibt-6fi-'gxtcontact W*++ 6d^v.Jce", lA GoNTACT LOCAL HEALTH DISTRICT Name of Oist. wc.bcrz - }^oe gar/t +{<u,ttt \il. oate-!s)bo/ Tank(s) will be Address 2 Phone *llot-6P.-007O DISPOSAL INFORMATION disposed at: Facility T\ u,rbrr.o ltloi Xl5 l otl ?xci 4t c t, ' v* ciry Ogie. state UT zp-3!!l-e)- Contact person .q(A. harr-3r-Phone#(gol )6al-5221 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' Piping will be disposed at: Facility D.rrbtrro 14--frr{S a66pgs5 }'f o t{ P+a; Fi c. An/€,,^ rrr- ciy @}La State-.fi zipJ4tl o.l- Contact person 6C*Se-VqUce- Phone #(%t I b>l - 52U Tank(s) will be emptied by: company -Th c^2.-'rt tl}riJ'Phone#(Bor ) )ab-66tt Tank(s) wifi be cteaned by: company -Thayu o t TIWid< Phone # (&t ) ]ctlr- 66tt Contaminated water in the tanUrinsate will be disposed at Facility -T-lnev*.ot F\wi&( Contact person phone#(gol ) Z{lr-6btl Tank(s) will be: purged or X rendered inert by the following method: DrY ?(u-' Residual sludges wiil be disposed at the foilowing facility: Th s' ltro I F[u i&( nooress t?to wrlt 2&oo 50u#,a city w-oo&J6fo5(-statelll zip-ollog+- Contact person Phone *tea 'Plb-bbll FOR CLOSURE IN-PLACE ONLY [ ] Approval for in-place closure has been granted by the Local Fire Department. Fire Dept.Phone#- Contact Date [ ] Approval for in-place closure has been granted by the Local Health Department. Health District-Phone#- Contact-Date coNrairNareo MarenhLs Mult ee orsposeo arlN accepraele rr.uu-rw: All materials generated from UST closures must be managed and disposed in a manner that 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 UST Consultant. Contaminated soils generated as part of tank removal are to be disposed at the following facility: E.'(.Icch^o tosl,g , 1.".c. aooress (o o 30 Neat tSoo Sowtr,r city6+t* t+lU Aity State l)T ziD gtl lOtl contact Derson D ew Derr) Phone # - ( Brt ) q.+r_-b&6; 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 R31t-205 (U.A.C.). lf contamination is suspected. additional samples must be collected at the location where contamination is most likelv to be oresent. lf qroundwater is encountered. a soil sample must be collected. in the unsaturated zone. in addition to each qroundwater samole. Soil and groundwater samples must be analyzed for the compounds shown in the following table, using appropriate lab methods. Substance or Product Type Contaminant Compounds to be Analyzed ANALYTICAL METHODS SoiI, Groundwater or Surface Water Gasoline Total Petroleum Hydrocarbons (TPH); and Benzene, Toluene, Ethyl benzene, Xylenes, Naphthalene, (BTE)O\| and MTBE EPA 80158 t and EPA 8021B I or 82608 Diesel Total Petroleum Hydrocarbons (TPH); and Benzene, Toluene, Ethyl benzene, Xylenes, and Naphthalene @TEXN) EPA 80158 and EPA 8021B or 82608 Used Oil Oil and Grease (O&G) or Total Recoverable Petroleum Hydrocarbons (TRPH); and for Benzene, Toluene, Ethyl- benzene, Xylenes, Naphthalene (BTEXI{) & MTBE; and Halosenated Volatile Orsanic Compounds (VOC's) EPA 1664 or 55202 and EPA 80218 or 8260B New Oil Oil and Grease (O&G) or Total Recoverable Petroleum Hydrocarbons (TRPH) EPA 1664 or5520 Other or Unknown Total Petroleum Hydrocarbons (TPH); and Benzene, Toluene, Ethyl benzene, Xylenes, and Naphthalene @TE)O.{); and Halosenated Volatile Orsanic Compounds (VOC's) EPA 80158 and EPA 8021B or 82608 t The following modifications to these certified methods are considered acceptable by the Executive Secretary (UST): A. B. C. NOTE: Dual column confirmation may not be required for TPH & BTE)O.IA,ITBE analysis. A micro-extraction or scale-down technique may be used for aqueous samples. Hexane may be used as an extraction solvent. The sample preparation method and any modification(s) to a certified method must be reported by the laboratory on the final analytical report. 2 Methods or test procedures allowed for Oil and Grease (O&G) or Total Recoverable Petroleum Hydrocarbons (TRPH) are 5520(b) or 5520(f) respectively. Complete the Facility Site Plat and Sample lnformation Table on pages 4 and 5 to provide site assessment information. CONTAMINATION INFORMATION lf contamination at the facility is suspected or confirmed, the information must be reported to the Executive Secretary (UST) at(801)536-4100within24hours. TheDivisionofWaterQualitymustbenotifiedat(801)538-6l46ifFreeProductis 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. \ ' FACTLITY SITE PLAT (CLOSURE PLAN) The site plat must be drawn to an appropriate identified scale. lt must show planned sampling locations, substances stored in tanks, and other relevant information. Tank and sample identification numbers must be consistent with the information given on p. 1 and 5 of the Closure Plan. Facility lD # le-Ooa33 Drawn ey fu"*{is Vm DSK o"t"tzlrs lzoog Scale: 1"=h0 Feet1I NORTH EXIST. PAVED ALLEY PATTERSON AVENUE PARKTNG LOr 'wlT EXTRACNON PUMP MW-* LT. * Il l I J Ij Iolkt<lEi -Jtc\ b-6H bS*r6hZl+E{gUstsr hrf- ,t'-T t1i,-3 =\l =o Nilf,q =S={l esi= HtE p. tr Lrj Lu gldilF= =oo-'t.9fifi b=85 ss =s iE tjJlJlillll I' p.poc)---r.7ra*'2 s-{(5sJ==R=xo ==>F< -, =H ^HS*- ^:=s_iio =(4s6 ss $s =HE==;r$$$ **+s $i* USTA _ PRTMIUM UNLADED U,T B - MID_GRADE UNLEADED USTC _REGUURUNLEADED , 4_5 FT. DEEP s-5_S_5_s 31OO SOUTH STREET BARBER SHOP --]J,eq# X = Sample locations (SS-#, WS-#, USC-#) e : Monitoring Wells (MW-#,) O = Soil boring (SB#), or Geoprobe Boring (GP#) O = Water Wells (domestic, livestock, etc.) Slope of Surface Topography: (N,NW,W,SW,S,SE,E,NE) Land Use At Site: _Residential f,Commercial _Industrial Surrounding Land: _Residentialf,Commercial Industrial Site Plat Must Indicate Approximate Locations Of:y' Current & former tanks, piping & dispensers y' Location ofall samples to be taken y' Buildings, fences, & property boundaries / Utility conduits (sewers, gas, water, storm drains, electrical, etc.) JAN-47-2e/e,4 11:43 1-r, coRP oFFIcE 253 796 ?tzq P.A3/43 SAI{ PLE INFORMATION TABLE Cornplete table fqr all samples to bc taken for dosure. Sanple*Substancc *orEd ln tank Semplc typet Depttf Compoundd Analysls method(s)' 59-l uluGurtinr,35 tl.s lF{.6Ro 3nBf?xN'EPA rrgt'e B%Ob *'2 t 9'11.<I / t'7 h c(ta.(I %-q E9 a.s \ s9-s 99 3.o 39-b 99 3.o 59-+9<3.0 v v u6C- I u5c te.s ugc (*ltl..-^* DecaArrh-na tl;qt-2 \rAC 3.o 'trgL / V'L-3 v U;9t-3.o l/.qC 5, Soll (SS). Gurndwebr (GW), or Unlird 8oI CElllcdoa (USC). Appor. dcplh ln frst below grrdc. The ruqdrd mlnlhum cltr e$caanent:amplc muC be laken at SZ fe€t below tre baddfll/ngtlve eoll htstfsce. ConEmh!il comFundr b Do $aLtzEd forcadr sanpb (0un trbL on p. 3I Apppprlete analyaF mE$odr lc cootB.nhant Eonrpound(e) h esch cnpl€ (fiun |tbte on P.3). Appoxirnate depth to groundweter in the vicinity of ttre trnksl l!5-feet. Regiionalgroundwaterflowdkedionr tlofthW?r* Strate Certified Laboratoryto Ua usea:-/unz^riaar rd cA* ttrrrr.{ fi atl aaa'"." 463 \leat 36oD ga*tlr cltv*kutrgqy statal21_ zip3!ille Contacl peneon Ef n*a H*y , r.-rl Phone *if'rt t )b3 - Sto th Please explain any unusual or ertenuating circurrstances expected regardlng the site assesement or closure: I 2 3I I certlff undar penalty of lrwthet I am the lnformatloD on thh form end herein will ba followed during SlgnaEre of tank owner Full Name of tank ownsr tan(s) reftrancedabovcand tfrat I am familiarwlth and furflrer, thatthe procedurea dgscrlbad \ Closure Plan Review Summary Facility lD mox3 -l Non'Notifier: No Number of regulated tanks at this site not previously closed: Database: 3 Closure Plan: 0 Certificate of Compliance lssued: Yes TANKS TO BE GLOSED Tank# Type Date lnstalled Capacity Substance Last Used Rmvd/ln Place I Impressed Current Cathodic 4ll7ll983 12000 Gasoline 12116103 RMVD 2 Impressed Current Cathodic 4ll7ll983 12000 Gasoline 12116103 RMVD 3 Impressed Current Cathodic 4ll7ll983 12000 Gasoline 12116103 RMVD TANK REMOVER Name: KIM R HEMINGWAY Cert. #: TR-TR-3SI Exp. Date: 9nt2004 SOIUGROUNDWATER SAMPLER Name: SCOTT O'NEILL Cert. #: GSGLI409__ Exp. Date: 5fit2004 lf different from database: Tank Owner: Address: Site Name: Address: Remarks: Phone: City: Phone: City: State: Zip: State: Zip: COVER LETTER TO FILE COPY TO AREA SCIENTIST Thursday, Januara 08, 2004 Page I of I Utah UST Program Release Detection lnspection Checklist ID Ownership of Tanks Location of Tanks vr^ owner Name t-\tu -r"7/' Z - ,r/ (/-,-,Location Name )- l/ Address 2 2// )-/r4(kct t Address .'7f f "7 /1t)?< 4 /?t, i citv /)*, ,r{ state 77 zio 7\h:'Y cirv 1-.-,, ,"/ , stare uT zio u /yzt/ contact {:*rt /2 ,, ,) rct Phone t/1 Location Contact l/rt-x Phone Complete for each tank. lf facility has more than 4 tanks, eomplete informatlon lor additional tanks on separate form. Number of tanks at facility:Gip ffi)(Frc)Tank 4 Tank lnstallation Date /Qd,4 /4f1 t Cae Capacity of tank (in gallons)/2./z ,r2tt /21/ Substance stored ;^/- t t / (/,, ,-/i), Tank is in use (Y) or, if not in use, give date last used Y u/ lf not in use, depth ol product in tank (in inches) Answer the following for all tanks. Note any exceptions ln the last column. Current year tank tags are in place Material ol construction ol tanks 3rz ?Z Material of construction of piping ,-z P Piping type (' Type of Spill Prevention Device. Note if tank is filled by transfers of less than 25 oallons. lf so. no soill orevention is reouired..2 S'.2-.( Type of Overfill Prevention Device. Note if tank is filled by transrers of less than 25 qallons. lf so, no ovedill prevention is required.^s/ilr*lf an overfill alarm is the primary overfill device: Alarm ls located wnere it can be seen and heard, and alarm is clearly marked (@ fio Corrosion Protection. Answer the following for all tanks. Note any exceptions in the last column. Method used on tanks sn Method used on piping L-d1,,/' Method used on flex connectors A- Enclosed containment sumps at tanks (subpump) and dispensers Yes @ lndicate dates of upgrades- lining, tank or piping cathodic protection. Cathodic Protection Testing. Show test results tor each tank, line, or tlex connector. The results of the last two cathodic protection tests are available (within 6 months of installation and every 3 years thereafier).Yes No Tank Tester -. Date volts volts volts voltr piDino rester G"(i^l ).L*: ,Date L: - fr ^r // votts-2.-r I -ri n#./ . ,i?, vorts voll! Flex connectors /Sub pump Tester Date DisDenser volts volts volts voltr volts D volts volts volt! For impressed current system: The results of the last three equipment operation checks are available. (required every 60 days.)(Yq No Comments Pase I ol ?- r(name) I. AV ^ti *Vh/Jf? cerrifvthailinsoecredtheabove-namedfaciritvon(date) / Z - t 1- "" tnsDector's sionature /1a .r* z^/,Date -12 -/ 6, - 1,7 Siqnature of owner or owner's ("rr"."n,"*" present durino inspectio " Q.#o,o*z -.S-: ) Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner Ldcheck.wpd rev0302 s) used for oioino: 7-) .VF T/S <.<3'd oartv cert. available Ye-d: ruo Clrcle and ldentlfv bv tank anv exceotlons to the answer ln the first column. Records on site document that the system is properly installed, calibrated, and maintained (svstem and tank setup reports, maintenance Device documentation is available on-site (owner's Equipment used to acquire data, take readings, perform test is adequate, accessible and ol valid testing or monitoring is available tor the last 12 monlhs. Show Tilt Factors: #1 f2 f3 #4probe is located at the center of the tank, or, if not in the center, show the tilt {actor tank was filled to at least the minimum level required by the manufacturer's protocol to ensure a valid leak test, and the tank size is within the allowed Secondary banier is properly placed and conslructed, designed for groundwaler considerations, has an acceptable permeation rate, is compatible with the substance is non-corrodible. and is not in the 25-vr flood plain (per site lnventory readings for product inputs and withdrawals are properly obtained and Records include the proper number of water readings, and water readings are used to iust inventorv balances as necessary. An appropriate tank calibration chart is used and is available for review. and extend to within one foot of the tank bottom, ts of monitorinq for each tank for the last 12 months.No Results. lnvalid (ATG) or lnconclusive Tank and Line Tightness Testlng, Llne Leak Detector Testing: Date ol last tiqhtness test for tanks: Date of last tiqhtness test for piping: certification number of tester:r /-7 A /+ ril/, MES t?J s'Xt V Automatic Line Leak Detectors. lndicate type and model number for each leak detector. resr: 1 -'q - i 'L rest resurts Saie Suction piping: Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, Tank and Piping Leak Detection Yellow-lnspector, Pink-Facility/Owner Ldall.wpd rev0302 ^ i,b CATHODIC PROTECTION COMPLIANCE SURVEY UST SYSTEM FOR:7-ELEVEN, INC. 10220 S.W. GREENBURG ROAD SUITE 470 PORTLAND OR 97223 Contact: BOB DENINNO 7-ELEVEN #24130 MARKET #1851 3087 S WASHINGTON OGDEN UT 84401 SITE: BY: TANKNOLOGY/u/r## Gilbert W. Schutza Date: 06/08/01 Corrosion Engineer Manager (NACE Cathodic Protection Specialist #4108) Work order: 2216279 8900 Shoal Creek Blvd., Building 200 - Austin, Texas 78757 - P.O. Box 9429 - Austin, Texas 78766-9429 - (5121451-6334 - FAx (512)459-1459 COMPLIANCE SURVEY 06/08/01 COMPLIANCE SURVEY IMPRESSED CURRENT CP SYSTEM 7.ELEVEN, INC. 7-ELEVEN #24130 MARKET #1851, 3087 S WASHINGTON OGDEN, UT 84401 I. SCOPE: A cathodic protection survey was conducted on 06/05/01, on the cathodic protection system at 7-ELEVEN #24130, MARKET #1851 , 3087 S WASHINGTON, OGDEN, UT. The purpose of this survey was to meet regulatory requirements for periodic testing, and, more importantly, to determine if the cathodic protection system at this facility meets NACE criteria for cathodic protection. NACE criteria indicates if the system is functionally controlling corrosion (see Appendix). The cathodic protection system for the underground tanks consists of unknown number of EZ-SS anodes energized by one 4O.OO volt-12.00 amp rectifier. The UST facility consists of three 12,000 gallon steeltanks and associated fiberglass piping' II. RESULTS & ANALYSIS: The structure-to-soil potential measurements are tabulated on Table l, and the rectifier and anode current outputs are tabulated on the Rectifier Maintenance sheet, attached. The rectifier was adjusted and set at a total constant current output of .200 Amps +l- 5o/o. The potential measurements, with the cathodic protection system de-energized, ranged from -1087 millivolts to -1312 millivolts. III, CONCLUSIONS: The results of the survey indicate that the structure-to-soil potential measurements meet the -850 millivolts instant off criterion for cathodic protection as established by NACE. IV. RECOMMENDATIONS: It is recommended that the rectifier output be observed monthly. lt is also recommended that a structure-to-soil potential survey be conducted annually by a qualified corrosion engineer. The cathodic protection system should operate with minimal maintenance and it is not recommended that any spare parts be kept on hand. V. REGULATORY REQUIREMENTS: Federal and State regulations require cathodic protection systems to be checked periodically. (Reference: 40 CFR, Part 280.31, "Operation and Maintenance of Corrosion COMPLIANCE SURVEY A 06/08/01 Protection".) - All cathodic protection systems must* be surveyed (tested) every three (3) years. - The cathodic protection system must be inspected and tested within six (6) months after any repairs to the UST system. (Reference: 40 CFR, Part 280.33, "Repairs Allowed".) - All impressed current systems must be inspected every 60 days to see that they are functioning properly. lnspections must be logged (documented). - Within six (6) months after initial turn-on of an impressed current system, it is required that a General Survey be conducted and any necessary adjustments made. " To meet minimum regulatory requirements. lt is good practice to conduct such surveys annually. (See Appendix.) APPENDIX:TESTPROCEI ES 06/08/01 APPENDIX: TEST PROCEDURES ln order to determine the effectiveness of the cathodic protection system, structure{o-soil potential measurements were performed at representative locations throughout the subject area. These measurements were collected after the cathodic protection system was energized. These measurements are then evaluated to determine if an adequate level of cathodic protection has been achieved. The two (2) most common criteria for cathodic protection as established by the NACE standard RP-02-85 "Recommended Practice - Control of External Corrosion on Metallic Buried, Partially Buried, or Submerged Liquid Storage Systems" are as follows: 1. A negative (cathodic) voltage of at least 0.85 volts as measured between the structure surface and a saturated coppericopper sulfate reference electrode containing the electrolyte. Determination of this voltage is to be made with the protective current applied. 2. A minimum negative (cathodic) polarization voltage shift of 100 millivolts measured between the structure surface and a stable reference electrode contacting the electrolyte. This polarization voltage shift is to be determined by interrupting the protective current and measuring the polarization decay. When the current is initially interrupted, an immediate voltage shift will occur. The voltage reading after the immediate shift shall be used as the base reading from which to measure polarization decay. These potential measurements were obtained, utilizing a copper/copper sulfate reference electrode and a Fluke, ModelST Digital Multimeter. Wo r k Or d e r : 22 L 5 2 7 9 6 u 7, a9u Lo-FsqI 5zT at:-* t .},}c It :E j_---(t \r T\ \ \ \.I I I a Ja ,t {!oao vl Io fl =l El =l H[ { i { lr "$d Ta n k n o l o g y - N D E 89 0 0 Sh o a l Cr e e k , Bu i l d i n g 20 0 Au s t i n ' Te x a s 78 7 5 7 Work Order: 22L627 9 u,UAol /V1 r.'. : Itr-.. ; .,?:1-1iI ii.,r. I.r. :iR1 i:ii:.::pt.: : i zLt6z?7 CA'I'HODIC PROTF.C T1 OI.i R EC TIFIER MA INTENANC E Crstofler [.ocation: ?-Elevcn flZ{130 10fi7 Si WashingrorL Ct_Edcn, linh Locelior oI Rectifter l:uit: Stitte rtrttft frrrnt left T-r'pe oI lteclifier linit: rr-umbcr of Anodes: D'pt of Anotlc: Unknrrun Typt of Crtrund Bedl Distrihutcd Srrrf:rcc L,metioo: TanI Perirnctcr Rcctificr }t*nufactured bY: (itrrrtl'.tll llodcl: ISAYSL Serisl f: 96rttl276 Rcctificr A(. Iapulr 120 \i Phasc I 6(t Hz Rcctilicr DC Output: .10 V l2 A Shunt; Inrtelhtion Dete; tlnliJtrrwn Commcots: CP rectifier opcrrting: Yes Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas78757 - // Address SQB S 5, / 91q, Contact Phone ( )Location Contact Phone ( Complete lor each tank. lf facility has more than 4 tanks, complete intormation for additlonal tanks on separate form. New lnstallation or Upgrade Tank is New or Used (must be recertified if it is used) Material of Construction (FRP, Steel, Composite, etc.) Single walled or double walled (indicate if dry or liquid{illed if DW) Date pre-installation Air Test passed Pressure for pre-installation air tesl Leak Detection Method to be used Type of Overlill Prevention Device installed (shutotf, ball float, etc.) Type ol Spill Prevention Device installed (spill bucket, sump, etc.) lntornation Type (Pressurized, Suction, safe suction, gravity, etc.) Leak Detection Method(s) to be Used Date pre-installation Air Test passed Pressure for pre-installation air test lnstallationspecifica . hespond to the followins questlons. Explain any'no Equipment used to lift and lower tank is of adequate size Visual inspection ol tanks reveals no damage. Any damaged components have been repaired. Tank and piping excavations are free of debris Estimated depth to Groundwater : Tanks are placed at sufficient depth for traffic requirements, groundwater donditions and adequate piping slope. Depth of backfill bedding for tanks (must be at least one foot): Backfill has been adequately compacted for full support along tank length at 5 and 7 o'clock Anchoring method is adequate for groundwater considerations. Note method here: Hold down straps are in place according to manufacturer's specifications. Distance from tank(s) to nearest property line (must be at least 5feet) : Distance from tank(s) to nearest structure (must be at least 5 feet plus 45 degrees from surlace to tank) : Spacing between tanks is at least 18 inches (stable wall conditions) Spacing between tanks is at least 7z times the diameter of the tanks (unstable wall conditions) Anodes have been checked to determine that the plastic wrapper has been removed. Tank and/or piping cathodic protection system has been checked to see if it is working properly. Amount of tank deflection meets specifications. Readings: lnitial:After backfillng: Final: 4ql- zzaa UTnn UST PROGRAM lnstallation/ U ZaoZ Distribution: While-Y ellow-lnspector,lnstallp l rev0201 .wpd Utah UST Program Release Detection lnspection Checklist ID t?ioLw Location ol Tanks Gomplete tor each tank. lf facility has more than 4 tanks, complete lnformation for addltlonel tanks on Sparate lorm. Number ol tanks at facility: Tank lnstallation Date Capacity of tank (in gallons) Tank is in use (Y) or, il not in use, give date last used lf not in use, depth of product in tank (in inches) Answer the following for all t8nks. Note any exceptions in the laet eElumn, Current year tank tags are in place Material of construction of tanks (steel, FRP, composite, etc.) Material of construction of piping (steel, FRP, flex plastic, etc.) Piping type (pressure, safe/Us suction, gravity, etc.) filled bv translers of less than 25 qallons. lf so, no if filled bv transters of less than 25 Corrosion Protection. Answer the lollowing lor all tanks. Note any erceptions ln ths last column. Method used on tanks (NM, CS, lL, lC, SA, NP) Method used on piping (NM, CS, lC, SA, NP) Method used on flex connectors (8, CS, NC, CP, NM, NP, NiA) Enclosed containment sumps at tanks (subpump) and dispensers lndicate dates of upgrades- lining, tank or piping cathodic protection. Cathodlc Protection Testing Complete lor each tank. 6 months of installation and every 3 Flex Tester Date Page I of ol Owner or Owner's Representative Distribution: White-DERR, Yellow-lnspector. Pink-Facility/Owner Ldchecklist rev0201.wpd Utah UST Program Tank and Piping Leak Delection ID Methodusedfortanks: 4{f / S'1rc )Method used for pipinq: Tts-C z Manufacturer, name and model number of system: Tf PZ L Svstem 3'd oartv cert. available Yes No Circle Yee or No tor each question, ln the last column, explain and identify by tank any Ex@rtions to the anewer ln ths first column. Ail lecords on site document that the system is properly installed, calibrated, and naintained (svstem and tank setuD reDorts. maintenance records).Yes No ATG IM )evice documentation is available on-site (owner's manual, etc.).Yes No Ail lquipment used to acquire data, take readings, perform test is adequate, accessible and 'unctional. lncl. ATG console. dipstick. etc.Yes No Ail )ocumentation of valid testing or monitoring is available for the last 12 months. Show '6ciih^ ^r mnnitnrinn racr rlic in nrid halnrrr Yes No ATG fhe probe is located at the center ol the tank. lf not, the tilt correction factor for each :ank is shown on the tank setuo reoort. Yes No ATG [he tank was lilled to at least the minimum level required by the manufacturer's )quipment protocol to ensure a valid leak test and the tank size is within the allowed rpper and lower size limits. Yes No IM Secondary barrier is properly placed and constructed, designed for gw considerations, 1as an acceptable permeation rate, is compatible with the substance stored, is non- :onodible. and is not in the 25-vr floodolain (per site assessment). Yes No IC MTG srR lnventory readings for product inputs and withdrawals are properly obtained and recorded. Readinos are orooerlv reconciled.Yes No -.[^ c IC SIR lecords include the proper number of water readings, and water readings are used to rdiust inventorv balances as necessarv.Yes No 7 IC MTG SIR \n appropriate tank calibration chart is used and is available for review.Yes No IC SIR )ispensers have current calibration stickers or proper calibration documentation.Yes No IC SIR )rop tubes are Dresent and extend to within one foot of the tank bottom.Yes Nd Show results of monitoring lor each tank for the last 12 months. lndicate pass, fail, no results, or inconclusive. Mol/r .-or\7 -oi.t P -nn 4i:rt /i- ott / / -rto t2'ot /-D/2 -t;/4 -nt 4. ot --o I #NZ ME ^/{teft uK-N/_NL P NP r P f #N,,(NK NF N(M(pft N/t P ilR P P P #NR NtL NT lU rL NP Nra /u /?r rvP p P P # Tank and Line Tightnese Tesiing, Line Leak lletector Testing:Tank 1 Tank 2 Tank 3 Tank il Date of last tiqhtness test for tanks:Test results: Name and certification number of tester:Test Method: Date ol last tiqhtness test for pipinq:9'z B - o o D \u*,,".,,,.,P tr r) Nameand certirication number ortester: &/-t a Lf Er*trJ'-1"?*"rnoo, 7-t o * t ,v Dateoflastleakdetectorperformancetest: 8- L f - AO Testresults: /'7r F P Safe Suction piping: Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, has onlv one check valve (under pump). has oroper slope of pipinq. Yes No Comments Paae /- at (- Yellow-l nspector, Pink-Facility/Owner rev0201.wpd ooztlt F-zo Ir 'a-t-F lr , o (D c,a!mz CNm7 {o3a (, !(D 3 E 3 {o *(, !(D 3. ) {D5-(r f !e 3.3 {D 7 (r t !d 3.E 3 {o -o, 'o (D =.3 {o 7 ot !(D =.E 3 {o3t N czoo CLoo. -{D 7 N C itoo. (Do. {o =7 N c doq,o CL {o 7 N C =oq,coo. -{o =7 N C it 0t CLo CL -{o =x N C it o,CL (Do. -{o)7 =o. (c t ts CLo {o =7 =o. (o ts CL (D {qt J7 =o. (c I ts CLo o r =o. GI ts CLo o, J7 =o. (c I ts CLo o Jx =o. (c I ts CLo o ao c o lol{lvlclol{tc lalr l- { lo ll n lo lrloloI{ lmlzl- { t>tr lol< t6loIt r lc } IElalo l5 l= o =o (D = 0t !,o v(Doo o Q zx a ! l {o (D = 0t t,o vooo o a? {zx a-{ ! I {o o = qt Eo 7ooo o Q zx a ! I o roo!,o z 0,='o roog o co c elo lno oa (,5 ooo o o oo5 oq,N oN5 o(r )o o @ oNo o tr ,o o (, IoN (,oo or (, o (, rq, (o I o (, r (, loo Ioo c, t, ro(, CD5 ar t (o o (, roc, (r r (oN (oo (, (o(, (oo5 (, t G' (. , z 0r o vo o o xo CL o tro tr o ooo o*o tr ,o D FI 5 c,5 (r l STATE USE ONLY IEENTERED TNTOCO{PUTEF (a ILi n. r.rew FActLtrY lI e. rueNoeo oATAENTRYCLEFK|NTIAIS; h/> Numb€r ot taril(s I _ Number ol conlinua0on stt€€B atached OWNER WAS CO^TTACTED TO CIARIFY RESPONSES. COi,MENTS: Pl€as€ vD€ or Dnnl m ink . AEo, be suro ),ou have ggnaurcs n ,nk lor secboosVlll and Xl. Compaete a noltftcaton brm breach tocitirn conAnnng underground $oragB tant€. l, rnors then S tent(s ar€ ou,n€d al has 6caton, !,o,rmay phorocopy pages 3 hrough S and us€ them lor aclctitional tant(s. The pnmary pupose of this nolificalion pograrn ts to locat€ ancl gvaluate unclergrounc! sto,age lanr( s)6lems (USTs) lhal store or have s10r€d petrol€um or hazardous subslances. The inlormation l,ou prwide wifl be basecl bnreasonauy avalable re@rc,s, or in th€ aDsence ol srch recolds, your knowledgo or recollecton. F-cclcral law rcquircs usr owncrc b ur rhb notrficction rorm ior ail 99T^" "tqgg ,.gutsrcd sub3rrnc.s ttrt rre brougtrt hto'urc'jftcr lleY e, ]9!!'. or USTs in the ground as ol May E, t9E6 tri hrvc rrorcd rcguteiadsubstenc.s at lny tintc dncc Janurry 1, 1924. Thc lntoinrtion rcgucstcd b rcquired by Srcton gO(E of trc hooutro Cont.rudon endR.covcry Ac? (RCRA), tl !'ttcnclc(L w]ro Murt Nott y ?S€ction 9002 ot RCRA, as amended. ,Equar€s ouners ot uSTs thar store reguratsd subslarEes (unl€ss oxemprod) to nitity dsegnated Stale or local agencies ol the exstence ol their USTs. qrnef ii OenniO as: ' In the case ol an usr rn use on rrrorember g. r9&4, or b'ol{ht into use arter trr9l dale, any person who owns en UST us€d br sbragE, use. or OCpensng ot regulat€d substianc€s: or . tn tte case ot an UST in use belore l.,lovember g, 1964. but no longsr,n use on that dale. any person who ovl,n€d lhe UST imm€dalety bebre G dtscontnuatton. Also, it the Stale so requires, any tacility that has mad€ any chang€s to hcilfiy Intormaton or UST system status, must submit a notificat6n tomi lonlyamended intormaton needs to be ndud€d). What USTs Are lncludcd ?An UST sl,stem ts defin€d as any one or comDrnation ot tanks that (1) E usec, lo clntain an ammuhton ot rsgulated substances, and (2) whose volume_(including cgnnect€d underground piprng) is 1oouo or more ben€ath th€ gound. R€guhl€d-USTs slrcre pefoEum or hF'arclous substances (see lhe tollo,ung 1^/hat Substan€s ArB Correr€d). Whlt Tanlq Art Erclu.t d F Drlt Notlticdbn ?. Tail<s rmorett fioot the grotlrlcl b€ild€ tvlay g, 1986:. Fa,m or r€sir€nliat tenks;t r.f Oo gffonJ-& res.-cao".tty sonng mobr fuet lornoncomm€rcla| purposes;. lanks stonng heatng oil for use on lhe premEes where stored:. Septc tanks:. lp€llne Fq[t€s 0ndudng gEthenng tanes) reguhred uncterths Narurat GasPtpeffl€ satev Act of 196E. orthe HazaEEvJS Ltqutc ppetme satery Act ol1979, or ufiid ts an tnfastate ptp€ttn€ aofltyregilAreO unoer State hws;. SudacE impounctments, ptE, ponds, or hgoons:-. llom waler or wase water coll€cDon sysiems:. Flow.hrough process Enks;' uq'fld lraps or asscralod gElh€nng Lnes drectfy rerared to oil or gEs producton and gathenn g oporatons;. TSnks on or Sbor€ th€ ioor of un*lground eGas, sudr es Es€rn€nts ortunnds:. Tar{<s wilh a capecity d tlO gdlons or less. lYhat Subotrnccc Arr Corrcrld ?The nofifcaton reguaro neots appty b USTsconErntng petroleum or cerEin hazedous substances. petolsum rnautbs gBsoline. us€d dl, crssel lu€|. cru6e cil or arry lraction thoreot u,h($ ls lrquid at standard concllions ol lemperatrre ano pressure (60 degiees Fahrenhert anc, 14.7pourEs p3rs$lare i S€dfrn 101 (14) and Liet llty Act rBgulsled as WhcrpTo lryhcn To Nodty operation alter 2. Offn€rswho of bnngng the ol 8.1986. 30da),s any ameftrnents b hdltty, s€nd inlqfiEton to State agEncy rlm€ey PcnaltLa : Any fln€r si|o loowngly hils to ndfy or stsnlts tEe lnlornairnsna be sublect b a cMl pendty rct b o@a€d tl i,mo tor €t E I( b, whichnoltficalim as not gr/€n ortoluiltich hbe inlonnation is Sriy€n. f . Ornes ol USTS in use orthal have b€€n teken 1974, but soll in rle grounc,, must notlry by Owner Name (Corporaton, tndivrlual, prblls Agsrg, or othcr Enmy) 7-Eleven, lnc. Street Actdress Gasoline Acctg. P. O. Box711 Dallas, TX 75221-0711 It r€qurrad!ry state, glvo the goographtc tocatDn ol usTs by dagrlG, ,llnuros, rnds€conos. ErampE: l3mu(b a2 . 36' 12. N, L,ongItljd€ 95. 24' 17. W Lrins- bngi!!. Faotny Name or Compeny Silo ld.otftcr, as apphcaDlef-er EvLN+?Hra c ll a(trass ts lho sarne as rn secton l. ctrGck th€ Dor and p.ocacd ro sacton lll. st"ctA'kr'lss 3DB1 5. r,,xl ns\\\NQTDN Phone Numb€r (lnclucre Area Code)-Y1l--??r PA untted st,ares - Environ n-^.lF! !-!9S!on Agency wasnrngon. DC 2(x60 Notification for Underground Storage Tanks Form ADorcvec OMB t.ro 2050{OGB EPA Form 753&1 (Bov. 9{8 ) Etecrronrc and pap€, ysr$ons accapBbter'lrevtous ectttons may be used whttr suDotlgs ulst.Paoo l cl 5 Notification for Underground Storage Tanks i- ! ,t_: USTs ae located on hnd withr'r an lmlafl Resen alion or on lrust lands outsiJe res€nation boun@nes. USTs areomed bya t{alive AmerEan natoo or iribe. Tdbe orNation nrtren USTs are lcated: Federal Govemmeal Stebcoremm€nt I Local Gor/emment N xLl r-lti Ir Gas Station Petroleum Disfibutor Air Taxi (Air'lins) Aircratl O,vner Auto D€elership tr n"lro"o ! r"o"o,-Mn-Milliary ! r"o"ra,- Military D rnousrril E con**, I rr"*,nyrransporl tr urm", I n"g*n,i", I r"- Job Tite: Environmental Manager Acklress: 7-Eleven, lnc' 10220 SW Greeburg Rd #470 Phon€ Numb€r (lnduds &ea Code): Phone: (503)9TT-1713 Fax: (503) 24+3438 il s"n Insu'mce Xaornrn"*al tnsurance ] n,r* Retenton Group ' Local Gwemmenl Financial Tesi i ll have met the finanoal responsbility reqJit€rn€nts (in accodance with 40 CFR Subparl H) by uing th6 bllouing meclranisns: Check All that Appty tr o*-rr* D sureyaono f] 'uettorotcreoit I eord RalingTost D so," rr.o" I trusruno I OnerUemoO (describeher€) I c€ffy under pendly ot hw thet I h8v€ pilronafy amhd and ern brl&lr uf fre inlomstin EDrnnsd h Seclixs I tl]u,Eh Xl o, this notfcaton brm and all rs true. acq.rrale, 8nd oompl€te. Name and otfioal fre of owner or owna/s authonzecl representalNe (Prinl) Bob DeNinno Environmental Manager and tev'ewng lhe form. S€nd comments rcAatdrng thls butoon ostmate to Drreaor. OP. Rcgutarory lnlomaUon Dvsron (2t371, U.S.tnvrronmenel Frotea'on Agcncr, 4Of U Sfr*I noldrcatron torm may De used whtle suDgtEs lasf. ,/r/^ .9EPA EPA Form 7silol (R.y. 0€t) Eledronrc and pep6r v€rsrofls accepraOte Pr6vrous edtttons may b6 us6d whale supplEs lasl. \/ Unlted States Environmental Protection Agency , Washrngflon. OC 2(x60 rorm Approveci oMB No.205GOO68 Pagc 2 ol 5 Un[ad Sbrcs tnvironmentat Protection Agency- Washngron. OC 20a60 Notification lor Underground Storage Tanks Tarr No. J-- | r"nr rc. o2 | r,,,r no.-Z- | ,"* *. - r"nr r,ro 1. Surtu!olTank (ch€d(mlyme) Curentyh Use Tempoaity Ctosed PennarEnty Oos€d g- tr tr H- D tr )* tr D Z DGd lndillttm (r?lontrl/y€ar)r/t?9b^/?93 I r//?93 I 3. EltmlEct Totll C.plcliy (gailons)/4,ooO /2.o00 4. Materill ot Conrtucuon (check all that appv) Asphalt Coated or Bare Steel Cafrodtcaly Protected Sleel Coated and Cathodcafiy ploted€d Steet Composte (Sts€l Ctad $rm FbeEEss) Fib€rglass Reintorca<t Plaslic Lin€cl lntenor Ercavaton Liner Double Wail€d Pgffrylene Taril< Jadet Concnte Unloourn It Oher, pl€ase sp€cify here Ch€ck box i, tank has arer b€€n t€pair€d { n tr tr tr tr D tr tr tr i--'l =/ll tr tr tr tr tr tr tr tr u =,.w tr tr tr D n tr tr tr D =J J r-l _J i-']J ! tr IJ i- J i-.i r-lrJ r-1! D ! LJ 5. Piping MatGriel (chGck all thst lppty) Bere Sloet Gan amz€d Stsel Fiberg[ass Reinrorcod Pleslic Copper CafEdca[y Protoc€d Dodrle WaX.d SsrCryContaiment Unloown Otr€r, ptoase sp€dfy IY trr nI tr tr? n tr tr D tr trY tr D tr tr tr T D tr D tr ! D n I D DIr tr D T 6. Plping Typc (check a[ na +pu) "Sate" Suclin (no lahr€ at Erk) lJ.S." grctlon (\atye at bnk) pressure Gravity Fe€d Check box it ppng hes sver be€n reparcd trV tr tr tr "r/ D tr tr "-/ tr D D ! D D tr D tr tr tr D EPA Forrr-7silG'l (Rcv. $98) El€ctrmtc and paper \r€Isbns acceptabte.Provious gonons may be us€cl u,hil€ s,r.gpltBs last.Page 3 ol 5 EPA Form 7530.,1 (Rcv, $39) Etectronrc and paper verstons acceptabte.Previous editions rnay be used wnib sr,rppl[es hit.' G9EPA\, Unil€d Stales \/ Environmental Protestion Agency_ Washrn$on. rc 20450 Form Aooroveo. OMB NJo.205GO068 Notllication lor Underground Storage Tanks Tank ldentilicabon Number Gasoline Desel Crasohol Kerosene Heatng Ot Used Oil :l*::i:"**::: Hazanbus Substance CERC|A,rarne andor CAS number Mixture of Substances Please specily here 7. Substlncr Currcn0y Storcd (or lesl ltorrd an lha cltc ot cblcd tlnks) ( Chock aI that apply) Ktr! Tr tr i-Jt-_J -.]I -l .l 8. Rclala Dstcction (check aI that apply) Manuat tank gBug[r.tg Tank tighhess testing tnventory conrol Auiomatc tank gBugmg Vaoor monrtonng Grounclu/ater monitonng tnterstitial monrtonng Automatic line l€ek delsclors Lrne tightrless lesting No rel€ase doteclbn r€quir€d (sudl as sdn€ types o, suction pping, em€rgency gener&r tanks'or fiCc, conshrctod tanl(s) Ofpr method altovr€d by rmpasnorning agpncy (srrcfi as SIR) phass specify olh€r m€hod h€re TANK I P|PErltrl -''t Iurl dl -l;l;Dlnrltrldl-t(ilr Idl!l TANK I HPE Iul IrJl DIvldtlntrlntr1.lrvld)trlnlel rarx I HPEtrltrlrlrlntrlnDIDtrlnIiltlilttrlnl {t ,i- | P|PE !ltrl IItrlnrlnrlnDirlnlnDln tr TANK I P|PETItrl ILJIDlntrlntrlntrlo Ilrlrtrln > /r<-C t,4--<*.--a< 9. Splll and Owrllll P?obctlon Overltll dwice instalt€d Spill devic€ rnsliallecl {V-dV {/ D D I tr Page 4 ol 5 Unned Sbt€s-Environrnental Protec-tion Agency Washngron. DC 20460 Notification for Underground Storage Tanks TankM. iTankNo. lrankr.lo. - lrrn** ]Tank,{o. l. Clolur! or Chrngc ln Scrvice Estmabd date the UST was hst us€d tor stonng r€gJlaEd substancss ( montr/day/year) Check box if this is a change in s€ryice itttr-r- 2. Tank Closure Eslirnatecl cbte lank dos€d (monwdayreao (ch6d( all that appty b€hv) Tank $/as remwecl lom gound Tank was dosed in ground Tank fill€d wilh inen materiat Describe the ineil fill matenal here l .l _J -];-J Sats Alsr3lmcnt Check box irthe Ste assGsnent was compl€ted Check box it €vidence ota laak was detec.ted lnstalter certilied by tank and prping manulecturers lnslaller ceniliod or hcensed by the tmplomenttng agency lnstallatDn inspectod by a rog,stor€d ongincer lnstallaton inspecred and appoved by mpl€rnontrng agtcngy Manufacture/s installahon cr,iecklists lrave besn complctod ! I T tr n tr I D trr I tr tr D tr tr tr I tr tr T tr D D T I T tr T trAnother method dbittd W Slate aoen6, tl so. riea6e epccfitrer6 Signarure ot UST lnstalter Certilyng Roper tn*allaton ol UST Sygem EPA Form 753&1 (Rcv. $98) Ebdronic anct pap€r versions acceptabte Preuous editions may b€ us€d wt$ls supgates lasl Paga 5 d5 54 3 97 ? ?? L 1 P. A 2 / A 2 1, 4 . 3 2 \ sc i u r s l R N D co R P NL r Dr u . t,2r*B:t ot,{IEaI,I ozlU=Eo z3i(,uio3J(,2oozrI-UJG3JILIlr I!=oll , lr TO T R L P. A 2 0c T - 2 ? - 1 9 9 8 oFJ=oUIEtr-U'oo,cl FcII Jtr=II JFouloao]UGoF.azul II JJUJaN (DoFt\ l c, 0cT-2?-199e L4232 SiJI.JTHLFND CORP NI,I DIU.- 503 9?? ??LL P.AL/Az \-, ^.= ':7 i Th e S outhland Corporution Env ir o n m ent ol S ent ic es \Ui2OS.W. Crqburg M., Suitc 4ZO Podla!4 OR 97223 FAX COVER SHEET o*, l6'?148 TO: Eoaition on Cdt COMPAI{YIOCATION: Stete of Utrh/DERR FAX NO: firr) SB.sstts PHOI{E NO. (E0D s364100: FROM: FAXNO. (s0312.393t PIIONE NO. (9t31977-77t3 Nunbcr o,fpegcs ircludirs rhis cotq rhg" 4 t.8-aee)EcJfa #g9,E{ 9: 6! E. E sE $* fi E gE is E I i; r s i; E P dl A A EE ! ll s 5 9€ s ge . E '- 9! t EF E E; H vtoo-aorEo)oo5Egr :EoECLa5 5? 3 97 ? 77 L L P. A 2 / 2 3 S0 U T H L A N D C0 R P Nt ^ i DI U . 5aBOvEgE odsFFe Fi 9 sr = dJ o 63Eqr o €e cL c sO €oar o ONE?g68; .E E Nst$E6C!.)o-sG gIcp YI4lC' ' 0deo!oIoaE5a!,c,sEgDoE. a.a:q5o!,o!EEooFa(9t0(t0Iio ooz6=tr2IoFoUJ= etEo!.8c, Et*Itra, z19Jls, rl izU' JJozouGjr Il!aJart ItI !-J3o Ft \ H Bor t8! \9uriIf$ NO U - 1 ? - 1 9 9 8 rnt-foUJE1oCOOrC, tu, lEEuJFo. lr JoIqtl Jd.oazIUUJJll J I coot rl l r.lo(J-17-1998 47.49 --i 9?? ??tt \-,sourulnND coRP NtJ DIU. The S outhland Coworation Enoironmental Sroices 10220 S.W. Greenbwg Ril. #470 Pttlstd, OR 9nZ3 FAX COVER SHEET Pbese r,,tc our aa o &not ad phoae nd fu *l,ttbenrlr Dab: "'. ' -.q g -.. TO: Ppsition on Call COMPA\ry/ IOCA:nON: Stac oJ .V.rah/ DERB FA)( No (8fi)qse{853 &ot- {Ar'4401 pHo1r15 No: 6g.l)$6-a1gQ FROM: Bob DeNiFno. Environule.,Etal Map3ser FAX NCI (so3) qn-nB PHONE No: (503) 24$343E Number of pages including thig cover sheet .- ? .. COMMENTS: Sou$tlend C-ofpora6on utilizec Slatiaticat -. InventorJ ir,En*t oJ "ffiri"n* b...g* of ths nu-bg" of riF th.t it.op"r.Eo. frg purpose of &iF fax is tg inform the agenc), as- to the rcsulb of investeatons 5A3 977 77LL .P;@7/93 anC precis-ion tank bsting (wherg FquilgdL I Zoo233 THE SOUTHLAND CORPORATION October l, L996 Mr. Bryan D. Whitaker Underground Storage Tank Branch Manager State of Utah Department of Bnvironmental euality Division of Environmental Response and Remediation 168 North 1950 West, lst Floor Salt Lake City, Utah g4116 Re:change of Release Detection For AII 7-Eleven Gasoline stores in utah Dear Mr. Whitaker: During the past few months, this office has received a number of non-compliance letters on the underground storage tanks at many of The Southland Corporation's ("Sorithland,s,,) operating 7-Eleven gasoline stores. Most of the non-compliance issues involve the run time of the tests being conducted by theAutomatic Tank Gauge ("ATG"), and also question the percent of invintory being used.Another related issue was the failure of the ATG to rucc"ssfully conduct the required monthly leak test. It has become evident to this office that circumstances at some stores do prevent the ATG fromtesting monthly. Also, although it is believed that the third party cirtification allows fortesting at v.aried levels and run times, until these issues can be resolved, effective immediatelyit has been decided to change the method of release detection from the ATG to annual tank testing plus inventory reconciliation for all 7-Eleven gasoline stores in Utah. Southland will continue working with Utah to correct these perceived problems, and as soon asthey are resolved, it is Southland's intention to switch the gasoline stores in Utah back to theATG method of release detection. The ATGs will remain in the stores and will continue to be monitored as part of ourcompliance program. They will, however, be marked so as to alert your inspeclor that they are not currenfly the method of release detection. This letter should also be considered the response for any non-compliance letters receivedinvolving ATG issues, including the letters listed below from Mr. William Moore. (iitvpl:tcc Cctrtcr Erst / lTll N.rrh H.rskcll Avc[tr" r,r,,,,il IIJ_II,,*irr,,,,o Mrrlrrtll Arklrcss: [Jos 7l L/ I):rll:rs. .l-X 75]ll-r r-li v \-, October l, t996 Mr. Bryan Whitaker Page two 7-Eleven Store Facility ID 125534, Salt Lake City, UT #4001040 #20137 , Riverton, UT #400lW2 #22567, Riverton, UT #4001005 #22933, Draper, UT #4001009 {23387, Murray, UT #4001037 #23850, Murray, UT #4001038 f25948, Midvale, UT #400L020 #22232, Murray, UT #400L033 f25760, Salt Lake City, UT #400t043 #L8345, West Jordan, UT #4001001 #22965, Taylorsville, UT #4001010 #2384r', West Jordan, UT #4000987 {23848, West Jordan, I.l'I #400t014 #22967 , Salt Lake City, UT #4001011 #23746, Salt Lake City, UT #4001013 tr25946, Sandy, UT #4@10L9 {25791, Salt Lake Ciry, UT #4001018 #16345, Sandy, UT #4001419 #27028, Murray, UT #4001050 #25117 , Salt [ake City, UT #4001039 #23901, West Valley City, UT #4001015 #26357, West Valley City, UT #400L021 #26690, West Valley City, UT #4000985 #295t2, West Valley City, UT #4001442 Non-Compliance Inspect Date rnspector ktter Date 8116196 William Moore 8lt9l96 8120196 William Moore 8121196 8120196 William Moore 8122196 8120196 William Moore 8128196 8121196 William Moore 8128196 8l2tl96 William Moore 8128196 8l2tl96 Wiltiam Moore 8128196 8122196 William Moore 8128196 8122196 William Moore 8128196 8123196 William Moore 8129196 8123196 William Moore 8129196 8123196 William Moore 8129196 8123196 William Moore 8129196 8127196 William Moore 8130196 8127196 William Moore 8130196 8127196 William Moore 8130196 8129196 William Moore 8130196 8129196 William Moore 913196 8129196 William Moore 913196 8130196 William Moore 914196 914196 William Moore 9112196 914196 William Moore 9112196 915196 William Moore 9l11196 915196 William Moore 9112196 Should you have any questions, please don't hesitate to call me at (2L4)84L-6592. Sincerely, The Hilliard Environmental Manager South/Central Region KH:cg cc: Judy Woodley, Southland, 0148 I-aura Picht, Southland, 0147 William Moore, LJDERR Bob DeNinno, Southland,- ,€Sds'_Ron Radle, Southland, 188 'r'4 UTAH UST PROGRAM Release Detection on Checklist l. OwnershlpofTank(s)ll. Location ol Tank(s) At USlLocation- Phone # Facility Name i 7-// 9,9911Unn Iiaclll$,haa mo'othan { tsqtts.SompEtp ttlgl$lqtn foraddltlon*ltanto.on gppgrrlqjcftt! Number of tanks at facility: ll not in use, date lasl used lf not in use, depth of producl in tank Material ol construction of tank (steel, FRP, etc.) Material of conslruction of piping (steel, FRP, etc. '- lV. Release Detection For Tanks hdlcats mettrod(s) used lq each tantc Compbb tE approprtats chectdtst for oach mctpd tt3.d. Other approved method (indicate name of method) V. Retesc lletection For PiPing conptete plplng checkllst and rypropriato rank checktist(s) tor each rufiod u0ttss4 certify that I inspected the above-named facitity on 3 -Z Z '? f Date: 5-^ zz - 7 ? Distribution: Whits.DERR, Yellow-lnspsclor,Revisad 0U0&97 UTAH UST PROGRAM Automatic Tank Gauoino Facillty lD No. Manufacturer, name and model number ol Please circle Yes or No for each question for each tank ff lacility has more than 4 tanks, complete inlormation tor additional tanks on separate form. @ &6.ffi Tank 4 Device documentation is available on-site (e.o.. owner's manual).652r.ro @no feE)No Yes No Records on site document that the system was properly installed and calibrated (system and tank setuD report).@*o r.t@ ruo @*o Yes No System is maintained in accordance with manufacturer's instructions(records are available on site).3s2u"@No t-@o Yes No Theprobeislocatedatthecenterofthetank.lfno,indicatetiltcorrectionfactor'rom< the tank setuD reDort. @ro Titr: @no Titr: €eP no Titr: Yes No Titr: Device can measure the height of the product to the nearest 1/8 o, an inch :ffio 7D No G--*.Yes No tqqvice monitors the in-tank liquid levels over the rull ranqe of the tank's internal heioht &o ,:/ff) Ho 4-es;a 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 ol oaoer lor resulls documentationl aQro @*o 9no Yes No Documentation is available demonstrating that the Automatic Tank Gauge performed a valid leak test at least once a month lor the last 12 months ves (6 ,"" @ Yes No Yes No lf no, for which months was a valid test not performed? (speciry months and year, use space below it necessary) ro\f, ,t F T,6 The tank was filled to at least the minimum level required by the manulacturer's equipment Drotocol 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 manuracturer's equipment protocol to ensure a valid leak test Buo @Ho @to Yes No Have any of the leak test reports indicated a lailed test? l, yes, specify in the space below the month, year, and what follow-up actions have been taken. Yes @ ves <<6-ves@ Yes No Documentation of perlormance claims for the automatic leak test leature is available and shows the ability to detect leaks ol 0.2 gph with 95o/o or greater probability of detection and 5% or less probability of false alarm (3rd party certification). @*o @No Yes No lndicate month(s) ot invalid or missing test: lndicate month(s) of any lailed test: tVA g (_- Q 4 r--*> ,^ ,/n No ft.sr zW*qE'M /<s* 3 Signature of Owner or Owner's Representative present During lnspection: -L2- ' Distribution: White-DEBR, yeilow-tnspector, pink-Faaility/Owner Bevised 12\95 Automatic Flow Restrictor (if yes, indicate model in commenta section) Autometic Shut-off Device (if yes, indicate model in commonts sectionl I Continuous Alarm System (if yes, indicate model in commonts section) Recorde of last Line Leak Detector performance test aro available on-site Date of last Line Leak Detector Result of last Line Leak Detector psrformence test Records of last Line Tightne6s Tost are available on-site Dato of last Line Tishtness Test Reault of last Line Tightness Test Utah Tester Certificetion Number: UT Groundwater Monitoring (if yes, use Groundwater Mgnitoring checklistl lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklistl Statistical lnventory Reconciliation ISIRI (if ye8, us6 SIR checklist) Other approved mothod (if yes, use other mothod checklistl Records of last Line Ti Date of last Lina Ti Result of last Line Tiohtness Test Vapor Monitorins (if yes, use V Groundwater Monitoring (if yes, use Groundwator Monitorinq checklistl lntarstitial Monitoring (if yes, use lntorstitial Monitoring checklist) StatiEtical lnvontory Reconciliation tslRl (if yes, u6o SIR Other approved method (if ves, use bth€r mothod Slope of piping will allow ALL to drain into tank when suction is All above inloyr(ation on suction piping is VERIFIABLE, use comments s€ction belowlo document how it is verifiable. Signature of Owner or Owner's Representative present During Distribution: White-DERR, Y€llow-lnspoctor, /6/8080 p€s!^eulopedsul-aoileA'uu3o-sl!r.lM :uo[nqulsro 'sluauaJrnbgJ epeiodn 866t slo;ur# (s)IuEl l.ll!/t^ 'cossB xag6urdrd Jol uo[calo.rd uolsoxoC tr * (s)luel rol uo;lca1ord uolso.rJoC tr#(s)Iuel rol uolluanard llua^O tr *(s)>luel rol uolluanatd lpdg g:slueutarrnbal aper6dn 866 t or.ll laaul ol rspro ut 966 ! rZZ requecaq {q pelelduroc eq }snur suel! pglJEuJ 6u;rnrolgo1 eq1 leql puelsiapun 1886L-?rd rolNOllVCtCtrON 'pelaldu:oc sel luoJlsr oql alEp oql eleclpul '(pelcelo:d Aggecrpoqgec ro pau;1) l[o]lar uaaq seq luel oql ll Og tua^o parlnboJ lcoqc 'd!nb3) 'alqelle^e are slcaqc uollBJado luaudlnba eaJql lsel eql lo sllnsar oql :urals^s luaJrnc pessardrul roJ xalJ 6udta IUEI :rolsal lo ourPN 7\- clporllBc luocoJ lsoru or,ll lo sllnseu '(JeuPaJaql sJEeA e rua^a puB uollBllBlsu! lo sr.lluoru 9 ulqlpn) 'elqBlp^E are slsal uo;palord clpoqleo o^ l lsBl aql ,o sllnsor eql 'uollces slql lo Jepuleurer eq1 alelduroc lou op :g661 'ZZ 'ce6 lllun perlnber lou sl uollcelo,rd uo;sol,roc 'seA I ageo I '/ ABllI eroleq pallBlsu! DuldldAuel oql se,u 'palcelord lou sl ISn oql ll oNr,@ polcolord loN pue (yIN) cllletau-uoN '(dC) pelcelord ^leclpoqteC '(CN) Jelpir^ Jo llos qll,r lcpluoc ur loN '(c1) luau/urPluoc lPlol '(g) peloog :slurol 6u;mg ropue sJolceuuoc xoll uo uolcagord uorsoroc lo adA atll alecrpul '(dN) pelcelord gop ro '(yg) epouv lelcllycEs'(Cl) pernC pesse.rdurl '(11) 6u;u;1 teurelut '(99) pels allsoduroC '(yIN) qlptour-uoN :uotcolord uorso.uoc lo edl(1 aq1 aleclpul espunos uuele eql uaqi luBauJ s! leqil^ slpclpu! ol psyeur Ipeelc urele aq1 s; :I1ng urrBlB lMa^o roJ uees {rsee oq uec }! araqi palecol ulJBle sql s; :Aluo urJElE lllya^o roJ luan ul) leou fleg:ecr^op lo ad{ eqt l[jJa^o ue oJsrll sl elEc!pu!uo pallelsur ecrnep uouuaaatd elueuruo.lllua aql olur lcnpord lo aseeleJ luenerd llll lEtll ocllsp Jor1loue ro lalcnq lusurureluoc ltds e e.rerll sl gglds 'seI ll 'ssal ro suolle6 9Z lo srorsuerl ,(q pettg s; uelsi(s ISn aq1 lmlugnoflltHs r ,.tL. 'HVTTI Area Code Phone Number l,nt/) ' -''oa Cont5a Person At UST Location Phonc # Facilitv Name' \-//sutt-z- P't- - )ttt)o St e€t Addross-,---"'-i'i,L- u/, ir/* zrry' City - , 6tate Zip Codc' Prrlou , r.i _'Fiqal County / Certificate of Compliance od sitd?ife-d l.lo ExDiration date: FFCEI'./! certify that I have inspectod the abovo-named facility on Signature of Owner or Distribution: Whito-DERR, Yellow-lnsp€ctor, h' tr UTAH UST PHOGRAM Automatic Tank Gauoino FacllltylDN/o. t2OO)it Manufacturer, name and model number ol Please circle Yes or No for each question lor each tank I facllity has morc than 4 tanks, complete lnlormation tor addltional tanks on separate lorm. Tank 1 Tank 2 Tank 3 Tank 4 Device documentation is available on.site (e.o.. owner's manual)-G., No Adeg No ffi, No Yes No Records on site document that the system was properly installed and calibrated (system and tank setuD reDort).@No @No @No Yes No System is maintained in accordance with manufacturer's instructions(records are available on site).@) no @No @No Yes No The probe is located at the center of the tank. lf no, indicate tilt correction factor from the tank setup reDort. @No Titt: GNo Titt: @No Titt: Yes No Tilr: Device can measure the heiqht ot the product to the nearest 1/8 of an inch ,4f, No -{EBi- No @No Yes No Device monitors the in-tank liquid levels over the full ranqe of the tank's internal heioht @ruo ,YA No 4Gt 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 ol paper lor results documentation)@, No @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 months @ffi V", @ Yes &Yes No lf no, lor which months was a valid test not performed? (specify months and year, use, space below if necessary) fU-o.k )t fu)r o,f, hc , lo*,'r4 The tank was filled to at least the minimum level required by the manufacturer,s equipment protocol to ensure a valid leak test r @no @No @to Yes No The tank capacity is within the upper and lower size limits required by the manufacturer's equiDment Drotocol to ensure a valid leak tesi @No @No GNo Yes No Have any ol the leak test reports indicated a lailed test? !f yes, specily in the space below the month, year, and what follow-up actions have been taken. ves @ Yes @ ves @ Yes No Documentation of performance claims lor 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 5olo or less probability of ,alse alarm (3rd Dartv certirication). -\Cg) No @No @No Yes No lndicate month(s) of invalid or missing test: lndicate month(s) o, any failed test lnspector's Signature:Date: q-9-9/ Representative Present During tnspec rron, CLr*n 7,u-t {r*-Signature of Owner or Oistribution : White-DERR, Yellow-tnspeitor, pink-Facility/Owner Revised 12\95 Automatic Flow Rostrictor (if yes, indicate model in comm6nt8 sactionl Automatic Shut-off Device (if yos, indicato modol in commonts soction) ) Continuoue Alarm System (if yes, indicate model in commonts ssctionl Records of last Line Leak Detector performance tost aro available on-site Date of last Lino Leak Detector performance test Resuh of last Line Leak Detector performance test Records of last Line Tightness Tost are available on-site Dato of last Line Tiohtness Test Rerult of last Line Tishtness Teet Name and comDanv of certified tester:Utah Toster Certification Number: UT 6r lnterstitial Monitoring (if yes, use lnt€rstitial Monitoring checklist) Statistical lnv€ntory Reconciliation ISIRI (if yos, use SIR checkliotl Other approved method (if yes, use other method checklistl Records of last Line Tishtness Test are available on-site Date of last Line Ti Result of last Line Ti Statistical lnventory Reconciliation tslRl (if yss, us€ Other approved method (if yes, uso bthor Operates at less than Slope of piping will allow product to drain into tank when suction is on suction piping is VERIFIABLE, use comments below to documsnt how it is verifiable. tnspector's Sisnature: /ri4 - 5'", Signature of Owner or Owner's Representative prossnt During lnspection: Distribution: White-DERR, Efrili iiiititiiii::ifi liiiiii Eiii$ii,.ii ii.l',.,'.:.:.iIiiii.j,,,l# ilr ffiii# rEr+v.4ii's#t#ffi Tank I Taak ?Tank I fank A The UST system is filled by transfers of 25 gallons or less. lf yes, spill and overfill prevention is not required. Yes @ Yes @ Yes @'Yes No ls there a spill containment bucket or anoth€r device that will prevent release of product into the environment? @No €") No @ No Yes No ls there an overfill prevention device installed on the tank? lf yo". -indicate th6 type of device: Ellgg4-Alarm, or Other (specity) da No fE No @'No Yes No For overlill alarm only: ls the alarm located where it can be easily seen and heard by the delivery driver? Yes No Yes No Yes No Yes No For overfill alarm only: ls the alarm clearly marked to indicate what is meant when the alarm sounds? Yes No Yes No Yes No Yes No i+11.....1:f,;ig11ri 1l#i:ii ++ill.rllriiriixi.r":r,lrrrl Tank 1 fank )Tank 3 Tenk d lndicate the type of corrosion protection: Noncorrodible material (FRP), Composite steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacriflcial Anode (SA), or Not protected (NP). lf FRP or CS do not complete the remainder ol this section. Tar* ,-L Tar* \'/7. Tar* c'ia Td lJm /: /. t, Um :4/LlrE t:/t / h lf the UST is not protected, was the tanMine installed belore May 7, 1985? ll yes, corrosion protection is not required until Dec. 22, 1998; do not complete the remainder of thie section. No €s: No @, No Yes No The results of lhe last two cathodic protection tests are available. (within 6 months of installation and every 3 years thereafter). Yes 1$,,Yes @ Yes d)Yes No Results of the most recent cathodic protoction test. Name of tester: ( /i ,-l //o/,ro- Test Date: f -t? -Q s- -, s i) uou, -.F/;* €a-7 volts Tank . volts Tank volts /:4 / volts Um /--4 f volls Llm i'A / volts Llm 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. I tnspectors sionature, /,/1i- -?q ,t Date: '/ -, - 2t uPcnAOe,mO*rri ionr (pdil lMe) understand that the lollowing marked items must be completed by December 22, 1998 in order to meet the 1998 upgrade requirements: E Spill prev€ntion for tank(s)# ! Overfill prevenlion for tank(s)# /Corrosion protection for tank(s) # ! Conosion protoction for piping assoc. with tank(s) #! Facility meets 1998 upgrade requirements. Signature of owner or Owne/s Representative Present During lnspect ion' (-,r.n^-TZ-*' Q n- Distribution: White-DERR,Pink-Facility/Owner 1 State of Utah Dept. of Environmental Response and Remediation 168 North 1950 West. lst Floor Salt Lake Ciry, Utah 84116 Attn: Mr. Bill Moore RE: Southland Corporation CP upgrades and installation Permitting Corrpro Companies, Inc. "A Commitment to Excellence" 505 North 24th Street Billings, Montana 59101 Tel 406-248-7770 c 800-448-7770 Fax 406-248-7304 Mr. Moore, In response to our recent phone conversation regarding the 5 (fir'e) sites in Utah s'hich are scheduled to receive impressed current cathodic protection upg:ades, I am pleased to offer the following: l. I.D. #1000282 -Southland Store #19326 Please find the appropriate Permit Application rvith payment 2. 1.D..#1200233 -Southland Store #24130 Potentials appear to indicate that cathodic protection probably existed on the tanks at one time in the last 10 (ten) years. 3. I.D. #4000997 -Southland Store #16072 Potentials appear to indicate that cathodic protection probably existed on the center tank at one time in the last 10 (ten) years. 4. I.D. #1000295 -Southland Store #25621 potentials appear to indicate that cathodic protection probably existed on the all ofthe tanks at one time in the last 10 (ten) years. 5. I.D. #4001018 -Southland Store #25791 Potentials appear to indicate that cathodic protection probabty existed on the tanks at one time in the past 10 (ten) years. I trust you n'ill find the enclosed information to be satisfactory. Hou'et,er, if you have any questions or require more data, etc., please do not hesitate to call me at 1-(800) 448-7170. Cordially, Corrpro Companies, Inc. g/r/-,d- John H. Forslund Billings Region UST Representative Encl: Permit Application for site I.D. #1000282 Corrpro Check # /32 z U ST I nstal latior/Upgrade Notifrr,ation The Utah Underground Storage Tank (UST) rules (Utah Administrativr Coclo R311.203.3) require that UST lnstallers nority the Executive Secletary, Utah Solid and Hazardous Waste Control Board. 30 days belore installing or upgrading any regulated UST system. This lorm has been prepared to asabt you in providing this information. Brfiorc inetalling or.u,. upgrading an UST system, pleasc cortrpleta this lorm end retum it to the Divlsion ol Environmental Response and Remediation at lhe address bclow. lf any tanks or lines are remov€d or rcplaced, a Closurc Plan lor those tanks or tinas must b€ submitted and appFved, and a silc asscgsment musi be peilormcd et elosure. Faclllty lD# (lf not a new racility) / ZOQ 233 oate work willcomrnen"e f,Pr;kot??6 - I I New lnstallation [b(l Upgrade Tenk Ownrr SourH LAND CoPPqBA TtoM add,"st 37// ll"arH /fis<EtL Ava CiV DnzcA S Srar ZX zip_Y'p,!& Contact Person in charge ol tant<s Ke^t r4rcttnAD Phonc * e/( \ €il- 4S?Z Facility Nrme 7- €r-ru t,v SroZE $aqt 3o Addregs SOSa h/astttMGTo^/City.9aorru Strte_U7- ae_€/{ol__ Phone *(etL/ I 8//-65?ZContaot person k er.f ,4ttua4D Certified ?anlt lnst lle? Name J;h^ //. *t/*^J Cert. f TL Erp. date_ Company bAP PAo ConPAN/ES /rrtc ,Phonc*(/06 12/8 r17O Addreos 5OS A/, e//A Srzecr City./LL/..y'65 Stat Zp,5?/o/e-L. lnrtrallatiory'tJ pgrade lnformrtlon Tank * lnstdUupgradc Capacity (gallons) Typc (FRP, Stccl. ctc.) Substance to be stored Piping Typ.e (Press., Suction, Gravity) Tank Leak Detection mcthod Linc leak detection melhod Form ol Conosion Protection Spill device to be installed (YlTtl) Overlilldevice to be installed (Y/N) ? \*ant r v5' ? 5, ,.1(5 ir1( ) l/t ( 5 /z-3 dp UP UP /0K /o K- ;rt Pe 6r/ps /0K SN PS G,+ s Ppess ,t<.q C.E-'A.r'J'* 'f c',. L(. {:-i;e:): f:;,,.sGns Pee"? - GA3W DL Exsr &.t 3r x Ex,;r futsl- t, ErtS T €zsr r- /s 6Unuaual or artcnueting clrcumstancei Gxpocna, PtP^,R /rtsfzz-4lfua.t/ Cr Y< l,^plEssED - agLe,,t r C, /, 5lr" rrt-, Mril completed form to: Utah Depailmcnt of Erwironmentat Ouatity Division ol Environmcntal Response and Remedlatlon '168 North 1950 We$, rst Floor Salt'Lake Clty, Utah 84116 State U6e Only: Date Flco'd _ Hcc'd By Notico Sent To O/O h',|,nh', lutun t I Ner Pcral'E Ir,atsl1eE,1oB CoDpaEy Addr6!a 05 N,3 r2 PhoE6* ( (06 t 2{8- 7/70 Dar,e worK wifl commence APA; 3O l??1! Facillty iD* (if noE a T8ak 0116.r Address ConEacr per E.N PsclLlty N!.ao Address conEaci oerson Kgn t-crA2O U.c\ Ins EaI Iat, ion/Upgrade Pp,\nit t I PorEiE Hodillcatlon RAPP,O P.ral't No: c*y BtLL/ilGS sel.Ec /7,7- zte 5?/0/ cerc. * Cerc. # Cerc. * t &<p. date E:<p. dace TL E:.p. dat,e- I New Inscallacj,on (XL upgrade €t) cir,y # 2q/ cLr;u OGDEr! scace UT zip ?hone * l2t'1 1 scace 7)( zip7520{- 2?O6 - Phone * r2t{ y 8%- 6,5?Z t Tas)ca Irvolvsd 1a IBatallaEloa Irpgrad€ Tank ;I 2 3 Inscal! /Upgrade UP UP UP Capac!Ey (ga].lons)/OL /oA /o K- Dpe (FRP, SE,eel, erc. )ft*(5rac.Srect SubsEance Eo be SEored Gas G,aS Gas Piping ry?e (Press. Sucilon, GraviEy)/or,r.P*,,Przuts ?1Ac of Itr! EaIIaElos/Upgradc DcacrlpcJ.oa llurbcr )-,.1o// ca/LJ;o pzotte/to -,irin:iiiiixirr*iffi ii ixiixiiiiiixiiitiii( /.^p ?f ss 2 d a-u.rrn'l ffi i*ii:iii::iiii:iii:xliliiii:ii :ffi :ifiii:ffi rii.ffi /,.rLstqnti[ [3" ! 4o=zDzo G.ffiffiiiiii.,iffi ::::,: :.:.i::8::::ii:::::::::i::::::::i::::::::::::il ii:r:iiir:,i::iitiiili:+f ir:liiiiiiiiiiiiiIiiiiiiiffi mffi i+tirliiffi t T I I I I I InstaLl clacu.EaE crlr€cEed: !4a11 coBpl€r,ad folE Eor uEah Deparcmenc of Environmet.lEal euarj.Ey Di,vj.sion of Envi,ronmencal. Response and Remediacion 158 NorEh 1950 wesE, 1sE, Floor SaIE Lake Cl-.y, UEah B{I15 SE,aEe Use OnIy: DaEe .EPproved App. By Dac.e permiE Mailed , .'.JGALVANIC CATHODI^PROTECTION. INSPECT]ON REPORT ,OCATION ft /0RESS: 4U/70 crY, srAlE {f f,s"ffifir,=. d-- 2 Commr*neni to €xcClenc-" 610 Brendylrinc Pkuy- r lYest Grcsisa Ps. 19380 Tet ila/3*7OOL Fg, ilA/3*7A92 -/o'1d ' Zo4'cr z/' ' tl Neq' ccrtat .i .' rr d i-e"nf s.t It..l.._..{..1- $.L*.'.kfrp. . .:.-.: -.,.'.j_-*; l':-"\+i'#"i,1 il""tl E f l-i '*!*i:iza*y") i]=oial ' E f ,i i Gros g Tonk EieCro Potentiols (m Tonk d 77 I .{fZ_tt./eq / l<q /. -rTt- R -t -,nJL f-aota I - L/ /.r73l eor1 EasT fr fta ,604 a : /,*/ ,"rty' t:t CenTe-a 4 f c'{ u'F lal^ ,7 C..r, 1 O*4O>t 7 t'...q.q.1tilliuis-ne&i<id 6rr: 7 t,- T l/a /;r"Notq /-,4ro{ 7q4'n certl e-a 4-rutn' --Fdt iuis-ne&iaed 6y: r) T" A4d''7 -ft k1: ^o t Dqtc: ;it*j"if; il;k ro.'Br-1o ond srl-Pi L"frc'h "^ kt'p tqnk+ the tedrnieien is te 15g s woad or oict'Je golc with #t Z wire csnnegt=ti to *s bott Ust mqk* 'quoiity' scntesi wiiJr the tqnk bottom. D Plcs:e eomplcte tils rcPo* in e ncst- lcEiaie mcnncr. Pot=nUals Rcviewed Voltmeter Moke/vlodel f: W 0cte: tF Af\ry TANK pOTENTiAL lS LESS TI-lAI.l -850mv, PROCE=9 wlTH ELECTRICAL coNTlNUrTy TEsi, CURRF',NT REQUtREtur=NT TESI', AND SCIL RESIST]VITY TES:i', oN _"BS/=RSa -,s!q.E- _ . ...' .4.-.,.a'.., March 8, 1996 THE SOUTHLAND CORPORATION Mr. Kent P. Gray, Director Utah Department of Environmental Quality Division of Environmental Response and Remediation 168 North 1950 West, 1st Floor Salt Lake City, Utah 84116 Re:Cathodic Protection at 7-Eleven Stores in Utah Dear Mr. Gray: Compliance inspections have revealed the below listed sites have cathodic protection (CP) systems that fail to meet industry standards. The repair of these systems are being scheduled and a plan will be sent as soon as it is finalized. Market 1851 Aotxtq E1 -- 7-Eleven #12932,1157 California Avenue, Salt Lake City 8csoocs36 - 7-Eleven #L9587,341 N. Main, Tooele 4c.to t o a 5 - 7-Elev en #23099 , 2L02 S. State Street, Salt Lake City l zctrczTZ-7-Eleven #23842, 4t6 8.2604 North, Ogden t2-ooL73 -:I-Eleven#24L30, 3087 S. Washington, Ogden ol ool86 Jt-Eleven #25472,405 N. Main, Logan 4oo 1078 -7-Elever#25587,1690 S. 900 West, Salt Lake City o I oo 187 -7-Eleven #26577,1395 N. Main, Logan LlOotoLtT -7-Elevet#26836,510 E. 1300 South, Salt Lake City t l o() t cs17 -7-Eleven #26999, 175 El 800 South, Salt Lake City t-loo 1338 -7-Eleven #27L26, 114 W. 1300 South, Salt Lake City 40 oo188 J-Eleven #27330, 1285 N. Redwood Rd, Salt Lake City tl oct r Ll zT -7-Eleven #27875, 780 S. 900 West, Salt Lake City 4ctrsrq4z -7-Eleven n9512,3634 W. 3500 South, Wesr Valley City 4oot LluH {-Eleven #29514,309 E. 400 South, Salt Lake City Market 1852 4ooo\qn -7-Eleven #16072, 6990 S. Redwood Rd, West fordan 4 oo t q ln -7-Eleven #16345, 10600 S. 700 East, Sandy I ooo28z- 7-Eleven#t9326,210 N. Main, Springville 1 o o o 1 77 - 7-Eleven {23844, 4800 W. 6200 South, Taylorsville 16 soZa5 - 7-Eleven f2562L,419 S. Srate, Orem l oo t o 113 - 7-Eleven f25760,895 E. 4500 South, Salt Lake City looto lO -7-Eleven#25791,4110 S. Redwood Rd, Taylorsville l oo01g'l - 7-Eleven #26332,9800 S. 700 East, Sandy 1 oo t o 2 l - 7-Eleven {26357 ,4700 S. 4000 West, West Valley Ciry 4 ooole s -7-Eleven#26690, 4100 S. 6400 West, West Valley Clty L{ oo ( ti H 3 - 7 -Eleven #2951t, 7820 S. 700 East, Sandy Ciryplace Center East / 271 1 Nonh Haskell Avenue , ""^;:r[Irl]rrti;2906 . Mailing Address: tsox 7 1 1 / Dallas. TX 75221-0711 v \-/ March 8, 1996 Mr. Kent Gray Page two Once the systems have been repaired, a certification test will be conducted and the results placed in the "red" in-store compliance binder. Please advise this office if there is anything else that is required. Sincerely, The $outhland CorporationZt/,*-./ KenHilliard/ rfnvirorunental Manager South/Central Region KII:cg cc: Ed Fusco, Southland, 0148 Ron Radle, Southland, 1899 Rich Foote, Southland, 1889 April2, 1996 THE SOUTHLAND CORPORATION ,/soo233 Mr. Kent P. Gray, Director Utah Department of Environmental Quality Division of Environmental Response and Remediation 168 North 1950 West, lst Floor Salt Lake City, Utah 84116 Re: Cathodic Protection of Underground Storage Tanks at 7-Eleven Gasoline Facilities in Utah Dear Mr. Gray, As reported to you in my letter of February 20, 1996, and again in my letter of March 8, 1996, a number of 7- Eleven gasoline facilitics (21) have Cathodic Protection (CP) systems that fail to meet industry standards, and a plan to repair these systems was being scheduled and would be provided to your office when finalized. Accordingly, please find this plan as outlined by Corrpro Companies, Inc. (Corrpro), who will be performing the necessary repairs to bring the systems into compliance. Additionally, Corrpro will be adding impressed systems to five (5) stores that require CP. For locations needing anode upgrades, Corrpro will replace all anodes even those which are currently operable. Corrpro will do the work as mentioned and is targeting completion by May 15, 1996 (see attached letter). Corrpro will be responsible for obtaining necessary permits and completing Amended Tank Registration Forms (EPA 7530-1) on the five (5) sites being upgraded. Corrpro will recertify systems, and copies of the recertification tests will be placed in their respective in-store compliance manuals. Corrpro Field Supervisor, Mr. John Forsland (800/448-7170), will be in contact with the appropriate individual(s) in your departrnent to ensure all necessary procedures are satisfactory. It is hoped that this plan and schedule developed by Southland and Corrpro shows your Deparunent that Southland is committed to being in full compliance with Utah requirements. If additional information is needed or you have questions, please contact me at (214)841-6592. South/Central Region Attachments Ed Fusco, Southland, 0148 (w/o aftch.) Mike Pitcher, Southland,2988 (w/o attch.) Jim Nelson, Southland, 2988 (w/o attch.) Ron Radle, Southland, 1899 (w/o auch.) Rich Foote, Southland, 1889 (w/o attch.) Mike Ryan, Southland, 1899 (w/o attch.) Bob Lunder, Corrpro (wio attch.) Cirplace Center East / 271 I North Haskell Avcnuc / Dall;rs. TX 7520-l-2906 . Mailing Addrcss: IJox 71 1 / Dallas, TX 75221-0711 I1+-U28-7(lI 1 Sincerely, DEAR i\,'sD a/tr^c '?C -S E March 8, 1996 Southland Corporation 7167 South Alton Way Englewood Colorado [Ot tZ Re: Preliminary Schedule of Completion for the C athodic piotectioo nep ;;;;f;"{.i- Attention Mr. Mike Ryan Gentlemen, Preliminary Corrp ro Compariics. lnc. .4 (ontnitntent to Excellence., 505 North 24th Street Billings, Montana 59101 Tel 406-24V777 0 . 8ffi _448_7 120Fax 40G248-7301 March l8th April8th April l5th Receive confirmation to proceed from Southlandorder materials' rwiewiroj;i6G;: prr" sequ€ncc of complerion,and obtain permits. Roceive materials for sacrificial anode installations,Mobilize Crew #1. Begrn installation ( complete at anteof 2 stores every three days) Receive materials for Impressed currcnt tnstattationsMobili.e Crew#2- Begro installation ( complete at a rate of I store wcry three days) ;H.lil:H begin to installation of sacrificial anode rystems as soon as the impressed c,nent qystems A realistic target date for completion is May l5th ass,ming that we receive.notice to proceed as spheduled. we will provide a detailed schedule for completion sequence prior to beginning actual constnrction- Please note that there may be an additional $200.00 per-tank fee reqriired by the state of utah prior tobeginningarv tank wot ilr" rfr;;.*s of confirndng this at the preseot time. L%If: you informed' AIso if you would like to include me in your nelr sharery meeting I would be glad Sincerely, RC. Lunder N.W. District Manager ffu79,.2,- ^ Fozoou,o :eooooE! cq<& t\(o a€@ oIN N@ @@oa €^iN NoNo ooo aN oo oot (o ofaoo> !-oc @Nd c? 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I ISi s: ooc- A- sE*s (, E=5 odtr l?t -< l EgEI xlEI oooo oooc. { octoot ol. )o ooorr , ctoi oo@(o oo$ot c,o@L! €q t sa Gt = F (\ l t \ ,\ cr l f\G' 9F G I O aq 6 aD F l 6 o( D 6 1 6 .o o c{ c i -bo=g8 o oc3C , ur o o- ctoc ) cz rs s l; E s E,oo c@ - , ct oo o to oz Es g @-CE rD o oz -5 52 e t s, f f (, g€0oi tco o=5ooGF ot ot tlc(!o cJo t,cot) G!l(,E! lorBoooc, fo(r )oCON E5oD IEloat )oowooUIooo ool,55 aoBoo@rl tE:o.DooNt' I o to rt i :l o f, lc ! fl e (r 1 6=l e f I= 3 to o lu ) >l o )t o -l -r lr t l@uloo,\EIo<t )oot (D c3o(oooro lr fou, roolo toouJooa\a,5o<t ,ooaoo oo@ .( t t\oN(l CY loCDN =u, o)o{ TG' (o !trto(? ,N ro (v , (oot IOl@(o(\ I roo) (\ l I@t\roN NF) (! ) t,N (, !o= (,@ ro@ r/ ,@ oa io6 rtp oo 6€ oD oo t( t ao -t '1-: '1 t .3'5 ! ^ ,^ t ), I tcEoo8to(,caaaoGoa GI 'oG' t E35 o5/3L/95 14:05 FA.I t01 359 8t53 DIv EhT RESp BEX +++ IiESTECEra A/ UST lnstaltationAlpgrade Notii ticin The Utah Underground Storage Tank (UST) rules (Utah Administrarive Code Fl3:1-ZO+31 reqirtra thar UST lr:sralters rrstify the Executive Sec.retary, Utlh Solid and l{rz:616s3 Wastc Control Borrd, 30 drp belora innetllng or upgrading rny' regulated UST systcm. This lorm has baen prepared to assist you ln providing this lrdonnatlo[ BetorD lrstalllng or . r. upgrading an USf syatem. please complete thlr torm and rBtum h lo the DMslon ol Ervironmentd Fe+onsa rrd\' r Femediation at thc address bclow. ll eny tanks or lincs ara ramovtd or replaced, t Ctosurr Plan lor ttprc tenks or llnes must be submitted end approrred, and a siic asessnrnt must bc pcdormed at closurc. \zoo>33 Fadllty lDf (ll not g new fadlity) 24130 Date wort wlll commencr July, 1995 J. Tank Ownar Tlre Southland Corpg:4rt.i-on Phons*( 303) 740-9333 addr"sr C[y Enslewood Sbtc-.,1Q[Zp--99!12-- Contact'Prrson in charge ol Frcility Nama,7-11 Store I I Naw Inslellrtlon FUEL EOU ld ooz I x I Upgndc ...: Addrcss CrtV Oeden SEte UT ZiP-IAAOL ' trontasl plr:oq Phone*L80f ) 39-4413l Not known at this tine.'To'be notif ied 4 Certificd Tank lnatallar Nameas soon as qontractor is selected C€il | TL ExP- date; Company Phone * ( I Stete_Zrp- - UJerade . UPgrade UPgrade 10.000 10,000 10,000 Gasoline Dracc.ag ATG Press. ATG ' '?ress. . ATG€ Gasoline GaSoli -EltfiINVIR0NMENTA!,jESEQXSE-& REir'l[ I I - -A A YYY - Over{ill deviee to bc installed (Y/}.J) y Y _I_ Unusrnt or c.tcnulttng circuragtanees Grpceted'. To install f lt* e at ".MPD I s 'and' S. T. P. I s Address Cttyi ln*allaUorW pgrade lnlormation Tank n lnstaltlupgrade Capacity (gallons) Type (FRP. Steel, eta) Substanee to be storect .Piplng Typ.e (Pnss., Suction. Gravity) Tank Leak DetEciion mcthod Linc leak deEaion mathod Form of Conosion Protaclron Spill device to be ln-stalled (YN) Mall completed torm ts:lJta]r Deparrmcnt of Environmcntal Ouality Division of Erwironrnental Flesponac end Remadhtion 168 North 1950 Wrst. lst Flor Salttako CIty, Ut h 84118 Naticc SrntTo O/O 'HT' trIE May 15, 1995 THE SOUTHLAND CORPORATION Mr. William Moore State of Utah Department of Environmental Quality Division of Environmental Response and Remediation 168 North 1950 West, lst Floor Salt Lake City, Utah 84116 Re: Change of Contact Dear Mr. Moore, This will confirm my phone conversation with you in which you were notified that I am the contact for The Southland Corporation (Soutiland) for all environmental issues in the State of Utah. J'v6$ Effective immediately, please address all correspondence to the following: Mr. Ken Hilliard Environmental Manager The Southland Corporation 2711 North Haskell Avenue Dallas, Texas 75204 Phone # (214)84r-6592 Fax # (214)84r-6727 As an additional item, if possible, could a copy of all correspondence be addressed to Southland's environmental consultant at the following address: Mr. John Wainwright Phone # (801)266-7100 Senior Project Manager Fax # (801)266-7118 SECOR International, Inc. 4001 South 700 East, Suite 250 Salt Lake Ciry, Utah 84107-2178 Please disseminate to all appropriate DERR personnel. Your assistance is greatly appreciated. cc: Gary Davies, Southland Bud Good, Southland t trr 1't.t.r I ( iri.r [:.i\i Z ]- I I \.rrrlr Fl.itkcll Bob Vasquez, Southland John Wainwright, SECOR 1r i rrrrr' / I).rll.r'. I\ -ilrr-l-l',|() . \l.rtltrrr: \-:-: ll-{-sls--rtl i City ^ State Zip Code ,/*n'rtt , ,r',,,r/, cftt/ Area Code Phone Number Contact Person At UST Location Phone # Facility Name)- 5'/;.t^ rtc,r-/- Lt/tJe Street Address-"--"'7'i7 ) .r, ,c/,,,' i ,,: ' ., ll r ' /. City State t/ Zip Code certify that I have inspected the above-named facility on t/ vtt lnspecto/s Signature:. Signature ol Owner or Orne/s Representrative Present During t' lr.m) l) - )t - 1'y Distribution: Whit+DERR, Manufacturor, name and mod€l number of Device documentation is available on-sit€ (e.9., manuiacture/s brochures, owne/s manual) Records fn sitd document that the sllslem was installed, calibrated, aM maintained accoding'to tre manutacflrrer's instnrctions (if no explain below) , i: t ) A probe is present in the tank (checked by inspection) Device can moariure the height of the product to the nearost 1/8 ol an inch Device rnonitors the in-tank liquid levels over lhe full range ol the #A#"t A monitodng box is present and there is evidence that the device is working (i.e., the device is equipped with roll of paper for results documentation) Documentation is available demonstrating ihat the Automatic Tank Gauge was in leak test mode at least once a rnonth lor the last 12 months lf no, which months are missing? (specify months and year) The tank was filled lo at least the minimum level required by the manufacturE/s equipment protocol to ensure a valid leak test The tank capacity is within the upper and lower size limits required by he manufacture/s equipment protocol lo ensure a valid leak test Have any ol the leak test reportrs indicated a failed test. ll fail, specify in comments section what actions have been taken to correct the problem. Has DERR been notified? Documentation of performance claims for the automatic leak test leature is available and shows the ability to detect leaks ol 0.2 gph with 95o/o or greater probability of detection and 5% or less probability ol lalse alarm (3rd party certification) Signature ol Owner or Owhe/s Representative Present During Distribution: White-DERR,Pink-Facility/Owner Distribution: White-DERR, 1 @ Michael O. l.eavitt Govcmor Dianne R. Nielson, Ph.D. Exccutivc DirEta Kent P. Gray DiIetG RE: DEPARTMENT OF ENVIRONMENTAL QUALITYjDrvrsloN oF ENVTRONMENTAL RESPONSE AND REMEDTATION 168 Nonh l95O West lst Floor Salt lake City, Urah g4l 16 (Eol) 536-4100 (801) 359-8853 Fax (801) 536-4414 T.D.D. February 21,1995 TO:The Southland Corporation Attn: Bud Good, Environmental Manager 7167 S. Alton Way Englewood, CO 80112 Non-compliance of undglgrolrnd storage tanks at 7-Eleven #24130130g7 s. washington Blvd.,Ogden, Utah. Facility I.D. #1200233 The utah underground storage Tank (usr) Act provides that the Executive secretary (uST) mayrevoke a certificate of compliance if it is detennined that a facility is not in substantial compliance withall state and federal usr statutes, rules and regulations. At the request of the Executive secretary (usr), the Division of Environmental Response andRemediation (DERR) performed a compliance review for the underground storage tanks at the abovefacility' The compliance review, performed on Decemb er 20, tloi, inarcite, yo, r,ur" not satisfied therequirements of the Act and are out of compliance. To achieve complianca you-Inu., do the following: 1' submit documentation to show that you have had a qualified cathodic protectiontester test your cathodic protection system for usTs it, n and #3 within the last[nree years. 2' Submit evidence that proper Automatic Tank Gauging (ATG) is performed onUSTs #1, lf2 anil #3 by: a' Documenting that the ATG system performs and records a valid leak test atleast once a month and that a test record is available for each of thelast 12 months.b' Documenting that the ATG system is properly installed, calibrated andfunctioning. 3' submit a copy of a current precision tine tightness test for the product linesassociated with tanks #1, y2 and #3. 4' Submit a copy of a current annual test for proper operation of the automatic lineIeak detectors on the pressurized product lines associated wittr tant<s #1, y2and #3. Printed cn recycled paper vU Please return a copy of this speed memo with the above items to speed processing. The above information rngst bg'srnitted to this office by April 14, 1995. If it is not received by the date specified, we will corngrcnoe the revocation process of your Certificate of Compliance. If you have questions concerning this rnatter or need anyassistance, contact Janet Keller at (801) 5364121. a March 23,1995 Ms. Janet Keller Department of Environmental Quality 168 North 1950 West, lst Floor Salt Lake city, utah 84116 RE: Response to Notice of Non-Compliance of Underground Storage Tanks at 7-Eleven Store #24130,3087 South Washington Blvd., Ogden, Utatr. Facility ID #lacr]l233 Dear Ms. Keller: Attached you will find the documentation requested in your notice dated February 21,1995. Item # 1 is addressed on the cathodic protection test sheet that shows results of the cathodic test which was conducted by SECOR. ltemlli2a is addressed on the tank history reports for the years 1994 and 1995. February and March 1995 results are on the history tape. The copy of the history report lists results from January 1995 and February through December 1994. Item #2b is addressed on the Tidel installation and start-up check-list. Item #3 and lt4 are addressed in the USTest test report. If you have any questions or need more information please call me at (801) 266-7lOO. Sincerely, SECOR International Incorporated Wfu"HMM Field Technician ,t!**SM- Janet S. Roemmel, CPG Project Manager Attachments y7D5 ^\ lLoovTZ STCOR Itt te r t t ctt i o t t ct I I tt co t|x.t ratecl - 40ol .\ctuth 70o F.dst. Strite 2i0. Sult ltke Litt,. 17 87 1():2 l-s tB()l t)()6-'l(x) (t;()l)J66--l l,\ t:.1.\ HRR-A1-1995 LAt4t Michocl O. Leavitt Govcrnor Diunne R. Nielson, Ph.D. Exccuti"o Dirctrx lGot P. Gny Dirctc a sourHLRND coRP. ,\ra a4L G?2?P.AA2/OZ3 I $ s *rr **: ,tii-" t-i i*e i: l'oepann*,IENT oF ENvIRoNMENTAL QUALmY.$UVtSloN oF ENvIRONMENTAL RESPoNSE AND REMEDIATION 1 l,{ reg il"rrh I95o west lsr Floor i!satri,r." cirv. ur8hr.,,u'oo' R EC E lV E nt1gol).s3aaroo ENVIRONMENTAL SERVICE$ ttor) lsg-aesl nar( (801) 535.d,414 T.D.D. February 2L,1995 FEB 2 8t995 HE SOUTHLAi{D CORPORATI(]N DALLAS TF.XAS TO: The Southland Corporation Attn: Bud Good, Environmental Manager 7167 S. Alton Way Englewood, CO 80112 RE: Non-compliance of underground storage tanks at 7-Eleven *24130,30E7 S. Washington BIvd., Ogden, Utah. Facility I.D. #1200233 The Utatr Underground Storage Tauk (UST) Act provides that the Executive Secretary (UST) may revoke a Cenificate of Compliance if it is determined that a facility is not in substantial compliaoce with all state and federal Yff 1urcs, rules and reguluions. At the requesr of the bxecutire Secreury (UST), the Division of Environmental Response and Remediadon (DERR)iperformed a compliance review for the underground storage tanks at the above facility. The compliahce review, performed on December 20r 1994, indicates you havc not satisfied the requirements of the Act and are out of compliance. To achieve compliance you must do the following: 1. Subniit documentation to show that you have had a qualified cathodic protection tester test your cathodic protection system for USTs #1, YZ and #3 within the last three years. 2. Submit evidence that proper Automatic Tank Gauging (ATG) is performed on USTs #1,#2 and #3 by: Documenting that the ATG system performs and records a valid Ieak test at least once a month and that a test record is available for each of the Iast 12 months. Documenting that the ATG system is properly installed, calibrated and functioning. 3. Submit a copy of a current precision line tightness test for the product Iines associated with tanks #1, #2 and #3' :4. Submit a copy of a current annual test for proper operation of the automatic line leak iletectors on the pressurized product lincs associated with tanks #1, *2 and #3. I b. Pr'inred on racycled paper NAR-a1-1ges La24z 1 sourHLRND coRp. 1a e41 6?2? P.aa3/6a3 Please refirrn a Copy of rhis speed memo with the above ircms to speed processing. The above information musr be submitted to thi6 office by April 14 1995- If it is not received by the date specified, we will corRmence the revocation process of your Cenificate of Compliance. If you have questions conceming this matter or need any assistance, contact Janet Keller at (801) 536'4121 . 1 ^ Tank/SoilPotential Piping/SoilPotential STCOR I n te r n a t i o na I I n c o rpo ra, t e cl - March 22,1995 Southland Corporation P.O. Box 711 2711 North Haskell Dallas, TX7522l-0711 Re: 7-Eleven Store #24103, 3087 South Washington Blvd., Ogden, Utah Facility I.D. #120n/233 Dear Sirs: The following is our report of the Cathodic protection survey made on the subject tank system on March 16,1995. Product Regular MidGrade Premium -1.25 mv -1.25mv -1.09mv NA NA NA Pass/Fail Pass Pass Pass Tank/Soil Potential and Piping/Soil Potential must be -0.85 mv or a greater negative to be protected. Piping is fiberglass and is not tested. Sincerely, SECOR International Incorporated fu"r{6r"**4V Janet S. Roemmel, CPG Project Manager 4001 south 700 East. suite 250, salt LLtke cit.y. LtT 84107-2178 (801) 266-71()0 ftt7t ) 26(t-7118 IrAX :r;r,;ili,,:lUi.i;ri.ou**i+r*i,; 1.!.i::'ri:ii::: :' ' ,ii,._i:._*::...,. $. $ HrsToEr/ F.:EFi,i=:r j $i{ lri # 241r+ I I I *a:E;r::4'.r rir.r.- .,+l .'j= fi i, rgIIT 3 II : HISTOE't' HEPUE:Ti PE0FUCT r-iFjHtiE ;-'i-il I : THH[( '! PR0DUCT GEHIli i.i-,.. gUT0l'llJTiij T'iii.jt:' ::,,., :.r: LEHH: TEEI Hi;;:,1;";-- i:] It{FLl:tLl::: ;.i.j .: I ----Lf,5T f, TE:T:;r---- 1 Fl:t!i:E[:, ].,j:i: . :,:. I r_r LtrHrr.r, i.i :., I ?f,:,f::t:iI '-r?.,-:,-,.:-r-I EruD: niiif:ii ----LFr:rT f, TE:rT!1---- I ey r,,rF{sEfliol"iFio., 5TffRT: rrr,J.'Ri j: I !.{l.l_LE8li iiErEr::TE:.rii :{i :d= I ut*;InEiLr- T*ii[ '5TffRT : trl'J.'Ri j: I H!.l__LEHti Lit : et-:iE-iii:4i :4*i I ur*;InEiLr- T*ij[ ' EH0 : fft.rrlt."_+: I HIsToRv e$lr.r ID * 24118 a7:58 f 34 gz.fBi,',!1 IH_H6!lr IPIDI .:i___ ffUISltHII[ TsHl,t riftUr_iE LEHI{ TEET iilirirF:ir ----LffST I TEgTr:---- ITHRT : il!,,i_rJ.r'-+! EE:31;31END: B!./8I,,!:82:I4::R FEFtFrlEl,lEt, HT t_, :: IJHFHIiTIi l.ltj LERt{ FErEr::TE} -_? LEHF. TEII iE.r ii;liiE BEEH PERF'iEf''lEii :ii.j THIS Tffl.lH itl Fer t:I II.{FLilLJ! iJ.,J :;I FI]SSED l[rri ..r::B LEHfiS i:i . ii :i 5TffRT : B!.rE:..'.+5 2Et :;4 ;11El.{D: i:12..'ii: ,:ji EerrropNE2fi toti t =i.,,, CHPPIIT? ND LEHI{ I,ETEUTET HisTu,ii/. . EI : ri! :;rE F_ii.,!6..?I Fia: l Bf,:41 r4i PEEFUEI'1EIr i-jT il ," rlt.lFrlr: I TYflI LEf,ti l]!E:a,-rr_: THEFT t'11-ti:f fl i!:iii:; H0l'lE ..5ELF TEST LHST TES.IE-I.i: t,lEl,l0R!, TEIT STHRT: EHD: DUE TO THEET l,ttrllE li i i l:ii-,,, F{fiF{E ..SELF TEIT LFIST TESTET:: HEI'IOE? TE:]i gTgRT: 82./Er2../:15 El{ri : HE:gE ll= TEEET,EH*I:'ti,,i= ,, f,HPHr-'ITri l.lr_l 19911 [iETEr:TEij E 1.'Ela..''i4 14 tEiT :4:{ El l..rr:1E,.''_i4I E. i:_. r -{.-.I._rrli.+,:: THEF: tqq { nql {*${{dtjh'l PRItTR VTf., 5l-iiliiirFi't'10 PH55 i-ri-.tlF;ii.T.3n I 1 -Feb B ;lr \l'lar 1 ti \ffpr 2 ;li II'lal., ! :; IJtrn I iit I,Iul Ei Ii \ FH?o* lJuor,,'o /5ep 4 i;r I0ct I i.! Itl':r,, i:i I IDecI::l J :JHIJE THJ:1 F:EI]IJF;TrrrnuF F'E[il-iL!TijE ii HtiEHtl'/ lq? { FRIL'lFt YTli !i:!'1ri,-,ill0 PHSS ltlrlF;iiJen B ur-Feb E rJ\Flar A ril \Apr B lilI'ley [t tj.1 IJun 0 i4 I.Iul Et r,r Itius B r'i \ PRIOE \JEI-FI: \Sep B ErlOct I ElHov I rir tDec B trr I) 5I]UE THI,--; F:EF.ijljI frflHfi.$.ut,1;ii-iE, ,; PRI0E ?T[i lut'tf'tt]Ft,,rl,lu Ff,il:-{ ftLt{Ei1Jan 47 4-fiQ{Feb I 1\'l'lar 5 E )Hpr16 i II'lgr., E t: I.Iun F_r 1 IJUI I r-l [H?or'fro*l' \ tqq+5ep il t4 /0ctii 7 IHo'.r lE r tDec lE iJ nqr ,i,IilE IEI,il.EfE;HIT F.lFJ HEEf..ICt,] THEFT IIflI:E tirltiE HI:_iTr_:i:ii . "l.iii:tlt'--r:;:',: ll1 t,-.:11 . '':'-: l I i- H:.:. I I.H;[Erf [E:ti5_lr rr:; FROEE i P'Hgi FROBE ] PI]:;i ..,rflfirrrrl;r;L Fr:ir_Ii:: . ..sELF TEiT Lf,ST TESTED: l'lEl,l0E,/ TEST CUSTOMER: SOUTHLAND CORP (7-11) SITE lD: 24130 ADDRESS: 3{46 GOLD CAMP DRIVE ADDRESS: 2087 WASHINGTON CITY:RANCHO CORDOVA CITY: OGDEN STATE: CA ZIP:95670 STATE: UT ZlP. Testino Evaluation Report The USTest 2000 System declares a tank to be leaking when the measured leak rate exceeds the threshold of .05 gallons per hour and has a probability of false alarm of <1% and a probability of detection of >99%. TANK 1 TANK 2 TANK 3 SYSTEM INFORMATION VOLUME VOLUME VOLUME DIAMETER DIAMETER DIAMETER FUEL TYPE REG UNLD FUEL TYPE PLS UNLD FUEL TYPE SUP UNLD TANK TYPE TANK TYPE TANK TYPE FUEL LEVEL FUEL LEVEL FUEL LEVEL WATER IN WATER IN WATER IN WATER OUT WATER OUT WATER OUT SYSTEM RESULTS I-EVEI-LEVEL LEVEI- ULLAGE ULLAGE I ULLAGE :: tEAK DETECTOR PASS 21 091 -7099 LEAK DETECTOR PASS 41 1 93-8996 DETECTOR PASS:,Nfi,,. LINE PASS/.OOO LINE PASS/.001 LINE PAS5/;000 VAPOR II N/A VAPOR II N/A I "41.!..-r= TANK 4 TANK 5 TANK 6 SYSTEM INFORMATION VOLUME VOLUME VOLUME DIAMETER DIAMETER DIAMETER FUEL TYPE FUEL TYPE FUEL TYPE TANK ryPE TANK TYPE TANK TYPE FUEL LEVEL FUEL LEVEL FUEL LEVEL WATER IN WATER IN WATER IN WATER OUT WATER OUT WATER OUT SYSTEM RESULTS LEVEL LEVEL LEVEL ULLAGE ULLAGE ULLAGE I.EAK DETECTOR LEAK DETECTOR LEAK DETECTOR LINE LINE LINE VAPOR II VAPOR II VAPOR.II ATG functional: YES tr NO tr * Product line and mechanical line leak detector tests only. TECHNICIAN: DALE SIMMONS CERTIFICATION #: UST-666 DATE:SEPTEMBER 14. 1994 {)sr.'{)9.91 l3:03 6'rduo1 8I!E XNEPECTION CBECKLIST Southlsnd Address: Storc No.: Zo 87 E+rgo ox", 1>s/q/ City; - fl+der-, Stlte: c,T 1) k overfill protection in place? 2) k spill proteaion in place? 3) T-vpe & uodel of Leak Detecmr: (:r) Is site piped for Phase II Vapor Rccovery? @ 7) Will Phasc tr piping rvork wit! Gilbuco Vapor Vuc? 4) Tipe of swing joinrs or fle.x pipiog: stt*L Conditiou: O< 5) Type of product lines:S\WZ- Condition: oc @o N N 8) Are there obscrvatiou wells ln the talk pad? 9) What rype of cxing used in wells? Condition: Ccrndition: Condition: N Condition: A,< Ot<. O,z N o N Couditiuo: Or= @Ovi Coodition: oR 10) Sketch locatiou of oh.servation welis, tanh and dispensers in relstion ro store afld note north dirertion. r.U :::jii ivr, Commeots: v9 f'R f ENGINEERING,INC. TTDEL ENGINEERING, lNC. INSTALLATION AND START.UP CHECK.UST EMS-3500 \rfir/ArF]N[NG: THIS DaaUMENT MUST BE REcEtvED wlTH A IY,AruTENANCE REPORT AND WARRANTY REGISTRATION CARD BEFORE THE SYSTEM START'UP CREDITTS TSSUEI)- 9- t -9S / /'/n ,L TELEPHQNE# (tot) ?a</ A^?3 ctw &*; 71P ( F'sa ' TELEPHONE # ( 1.r-no SERIAL NUMBER ')-tr TECH. NAME De'..-'r Hqs 7 ooMPANY fs s E cERTlFlcATloN * /r3y' TELEPHONE# (F"n @ CITY t '-. *. //t //r) (.'r /) APF/r'ADDRESS 2'-,ld S.' '+ ) 2''' t^) ' STATE / '. l- 1. 2. 3. 4. All of the fottowing questions musf be answered' ls the console powered by a dedicated circuit? ls the console supplied with a secondary earth ground? ls the conduit routed through the AC raceway? Are any tanks manifolded? ll so, explain. @o YO) N N Are all conduit runs filled with an appropriate sealing compound? Are any probes mounted within three feet of the submersible pump? tf so, were they installed in drop tubes? Explain. 50016 REV.O 326/93 a ^ On this sheet of paper, please sketch out a diagram showing: buitding with console location, conduit runs (for internal and extemal probe cables), pump islands, power lines, tanks, location of probes (intemal and extemal), location of sub-pump and filt. THANKST n $o, *t -P v\\tr_ \) A =q -P ?^]L=\n s- 'tlr= -l tl S->*,\-. A l-lcg I t Y,. 9:I ul lo.-.(y' ^r Cl -gI B'G a.\ on lnspectlon st Oun!. Xrrn (CorF.enoq hdlvlC{ Ps561grrf. c dtr rrty[ Cor*rca Porrco Al UST Lcdoi Plur, lll. Tank lnformatlon hbnn&.r E rclr H( I t{. icllty lr! rnot firr { brl( tb oo md comoldb fir hlonnrllon E d dUond w*L ,nor. cble l8d tled f .rnpil€d. yilfy 1'q l.xi! dtrodJct h E f( llqrh ancl Yer Tar* lrsa,lcd G-dmaf q K{(rEtril Maedal c, Correhrctlon (E-drnate c K{sEwvrl d Tar* (h gallqtl fi-slmrr a K-lrfiru lV. A. Releage Detectlon ForTankg 'ch.d(fi.r..dEdtffiaN/Altur ilarrd TErI( Gsuehg (ctty trbrla tndu l,m gJ.l llanral TyI( GarglnA q4q TJI( nflnc Trd.€ Icrty 51tat{o urdor eOO rlJ re,t( Thhhsr Tdhg rx, rwuv cdld Othr egor<, rllthod nillb h nurr d w. B. Releasc Dotectloo For Plplng ch*tn rdrdrbcturn*iod(.)r..dt?r9he! . CE( On flo. c, Fhhe EdtTr* '(gP and SpilUoverrill Protectlon Conocbn p.obcdon lrlalod Fdcn(bl SprfOverfl erectott Mlcd (}rftO d0l V. Slte lnformatlon ' Gcncrrl rib o0qrnlql rnd onrrrt (Ytcdty ob.rvdor. gund we bld. 6.1 cdfyftiIhar}rrgecbdn tcl,lnemrdhcltyar I / -,lrril*,O- //-r/-9 3 _ Automatic Tank Gaugin 2cry L3Hty lO* Manuffinsr, narne and model number cf gtrs,brn:i;/1 s 3 iO-C 4 -, r I /- \ ,/ r c/a// ,2 ,/ l'zatzt' t-t-.2.9\ Ptease answoi yes or no for €ach question':u, oelce docunrentation ts available at site (e.9., rnanrlacure/s brochurs, otms's mantJal).116l no Device can measutB height of prodLtct to neatstt one+lghth d an incf'|.ysl "nol Ooo.rnrenbtfm shovvs tfiat water in bottom c,t tank is clrecked nronfrly to nearest\or6eignCI of an lncfi....i .,x*a y€s I ml Device will declare a leak on ths basis of inventory reconcillation if discreparrcy o<ceecb 1% of flow-thror.rgh, plus 130 gallons on a monthly basis- y66l /noI Documentatlon is available that th€ ATG was in tesit rnode a minimum of onca a rnonh.y€6 I ---nc, Checked for preserrce of gaug€ in tanks.y6l mt Ctr€cked tror presnca of rnoniloring box ar,d eviderrca that device is working (i.e., device i3 equipped with roll ol paper br results c,ocurn€ntatim). y6l .-noI Own€r/ooerator lns documentation on file verifying m€thod meets minimum p€rbrrnano8_^. standardb of .20 Sph wirh probability of deteciion of 95j! and_Erobabilitf of.fflse alalm d 596 Or automatic tanE'gar.rgirp (e.g., resulB sh€€ts under EPA's 'Stanchrd Tal Procedurs fq Evaluating Lsak Detection Methocb'). y€sl -noI Ch€cked documentation $1at system was installed, calibrated, and rnaintained according b manuf acturers instnrtions. y6[ml Maintenanca records are available upon r€qu6t.y€s I rloI Monitorirp and testing records are available for th€ past 12 months.*wl 1 nol 1f , g,;r;t oil "n *,& /,r|au fi)' t14i *f t?f 3. @rnrnents: lnsp€c{or's Slgnatrre: i { -(a, t o*: I l'V -? l slG+.4 E M lnventory Control and Tank Tightness Testing Frcllh, lD *ltrttt3S Mdrod ol trd< tghE 6 bcthg: ihr€ end sd(fEs! ciltenk tghtla bsbtl '7 fr,,u 7?ca7o - o tsy ( ,t t 'rro r/2,,/,( Please complete all information foreach tank i .. j: i.... . i:::. : . .: ..: . ... It lhE lhcuty ilas rnor€ tlgr 'l tanb. ptem pnouoopy lhb pegc and: onpHlheinfonnafonforllddi[mdtenkt ::: . Tank t Tank 2 Tank 3 Tank tl Date cf lasttanktQhrlesr H.7*/L-?/7-lt- qt 3 - /2 -?/ Did tank pass tssn hdicate )r€8 or no. ll no, specify in comrnents section belo,v th€ sl,atus d tle tank or wl'ut actlorB harre been taken (e.9.. has siate been noffi€dl)Y cl'74'/ t't- Doorrn€ntratlon cf ctellverls arld sal6 balanc6 wnh dally measurem€nE of llquid volume h tank ar€ rnaihtained artd available. Overage or shortragre are ls than 1% + 130 g6b d tank's llow ftrough tolurrp. lf no, wlrictt rnonths rvere not? @i lruenbry cortrol .netpcb and ltgue used and tgco.d€cl.yes t no Recoda lrElude monhly wat* trDnitdlng.y6t no Bool(s appear us€d and evktence cf r€cent enti6 b apparmt !,Bl m Books aro reconclled rnonhlY.v6l noI App,oprlate callbratlm chari ls us€d for calculatlng rclunr.y6 noI Olspenser pumpe ltar,e cunfi callbratlon stlckeG.y6 nol the dop iube ln the fill plpe extencb to wihln me lbd d taril( botbrn.y,gsl noI Ourns can clenronsfate coflslst€ncy ln dlpsthklrp t€cmlqu6.1,6 tt Montrly water toadlngp als r.sed ln alculatlng ntonhly lnventory bdancs.y61 nol The ctlpstld( ls lorp €not€h to r€acfi the bottom c, the tart(ye8 |nol The errb cil the oauge stlck are flat and not worn dofn.y6[rpl Tho dlpstl* ls maftod leglbly and ft€ product level can be cbtermlned to tho n€ar6t me'elghth d an inch. l/61 noI fne tar* has besr tsted wihln tre year arldl has pass€d tle tight,'€€s t6st (if n€cessail.yes I rl() A hirdfarty dtmcation d the tank tlghtrlcs t61 rndlod ls availab'le.y€s I m Tank toster compll€d with all certificatlm r€quirernents.y6l nol Mmitorlng arxj lesting are maintain€d and available brtt€ past 12montls.y6 nol lnspecbr's Slgnd.r": 'rl' -.,G,,o*: // -{-? 3 sr@3 Leak Detect or Piping / )cn: 2)3 ,, Pressurized Pipin g n ffiT.nffiHm *.ffiffi ffi,[* iedriv ?'E rq f94 I ) -ro '? z- lf Vapor Monitoring, c,oqJrn€ntalbn of nrcnthly rnonitorlrc is available tf lnterslhlal Monltorlng, documentatlm d rnonhly monfioring le avallable lf Grouncl'Water Mmitorlrp. clocurnentatlm of rnonhly rnonltorirlg le avalhbh O'tprApproved Mdtod (speclfy ln oomments sectlon) Une Tlghrles Tetlng (requlred every 3 yearc.) Otpr Apprwed Metrtoc, (sOeclty ln comments sectlm) No Leak Detec'tlon Requlred (mu!il answet yet to al! ol thc lollowlng qucstlons) operatsat l6lhan atmcphelc prsutE llas mly me cfieck valve, witictr l8 locat€cl dltrclly under purnp Slope of piping allotrs product b draln back into tank YUh€n suclim released on the back of t1is sheei, please g(etch the site, rrctlrB all plping rurls, tanks (lrrcluding size & substarrces stor€d) and location of wells and their distancs fiom tanks arld piping. : ; gornmont* /,, /, /L/?T,:- cx i1'- I 2 /, ot- 5+ o*.- "t *r,,^t,/ - - ,.,,'t. .4 4z >,a.y' /rt ( cerlrfyUtdlluwlnspec6dtreebo/erumedlrcility q //' L/ -9 ) mo.i\ d.r, rarr llla 1 ^ FACILITY TD. PST PROCESSING }IECKLIST Year q I lz c0233 Unacceptable NotAcceptable Applicable Non-Marketer Discount Previous LUST Form Pollution File fncluded Incidence Ylo otN TTT - Verify tank/linesvs registered - Documentation ok? - Rate ok? Y/N Y/N Y/N Z Fund Paid FY 91 Y/N Fees Paid FY 88? FY 89? FY 90? FY 9L? Y/N ,// Compliance Compliance Outstanding? - Leak detection required? Y@ dt* ,/ t/ -''/ - Notification up to date & complete? &)S _tlAppLication? Date Qualified Review completed and certificate issued SUPPORT \CE \CHECKLI ST . PST by APR 2 3 r99t L200233 PETROLEUM STORAGE TANK FUND APPLICATION FACILITY INFORMATION:LOCATION OF TANKS: Owner Name: 7-ELEVEN sALEs coRpoRATtoNStreetAddressffi StreetAddressffiFacilityName: 7-ELEVEN 24L30 treet Address:427 LAVINDALE DRIVE City:SALT LAKE CITY CiW: ogden Co[rn State: Phone'B-oED6a-G484 Contact County: State: Hnone: $01t262-6484..UONTAq PETSON: JOHN P. CHIRBY TYPE OF OWNER: I t! Marketer, or non-marketer with annual monthly throughput greater than 1O.0OO gallons.[ ] Non-marketer with annual monthly throughput iess thin '10,0:OO gallons (Mu'st veiity;. Tank # Age Capacity Substance REqU=LAR NO LEAD PREMIUM NO LEAD 1983 1983 1983lmod- -ifdd- -i4000'- TANK TIGHTNESS TEST Tank # Pass/Fail CERTIFICATE OF REGISTRATION $lR t DESCRIPTION OF UNDERGROUND STORAGE TANKS: [ *] All UndergLou@-qlglage Tanks (UST) at this facility have been registered. W Al registration TANK Fees have been'paid. COMPLIANCE WITH UST REGULATIONS: ls the.applicant currentlyin compliance with all Federal, State, and Local UST regulations I x ] Yes t I No -- lf "No" please describe item(s) of non-compliance: PREVTOUS POLLUTTON |NC|DENT(S) I?yq .you gvg.r had a pollution incident at your facility?[ ] Yes -- lf "Yes" please provide LUST (Leaking Unherground Storage Tank) lnformation: I x] No - lf "No" please attach a letter stating that under customary business inventory practice standards you are not aware of any release fiom any tank(s) at this facility. PST FUND FEES ] full payment for every tank at this facility is included with this application.xl Quarterly payment(s) for every tank at this facility are includeO witn this application. certify under penalty of law that the above representations made by me are true and correct. Applicant's signature:Date sisne d: 3 -/A -g ( vV PETROLEUM STORAGE TANK FUND CHECKLIST. 1. CERTIFICATE OF REGISTRATION: il-tl All Underground.Storage Tanks (USTs) have been registerecJ - Form 7530 (Revised 9-89).[! Re9istration Tank Fees have been paid - 1988/1989 = $esAanklyr,1990/1991 : $4S/tank/yr 2. COMPLIANCE WITH UST REGULATIONS: ffi I am in compliance with release detection requirements./l\ Tanks installed belore 1965 or unknown: release detection by Dec. 19gg. Tanks installed 196$1988: release detection to be completed by my compliance date. Release detection completed upon installation. [[ I am in compliance with all other Federal, State, and Local UST regulations. 3. PST FUND FEES .. ANNUAL FACTLITY MONTHLY THROUGHPUT: la[qmarketer,orlamanon-marketerwithannuattacrti n 10,000 gallons. I I $ZSO payment/tank: Fiscalyear (July 1, 1990 - June 30, 1991). I I Quarterly payments @ $62.50/tank (Due the tst day of Jul, Oct, Jan, and Apr). I am a non-marketer with_anluq!fq!.rl& monthly throughput less than 10,000 gallons. I have completed the APPLICATIONER NoN:MARKEiERS DISCOUTf torfi. I I $125 payment/tank: Fiscal year (July 1, t99O - June 30, 1991). I t Quarterty payments @ $31.25/tank (Due the 1st day ot Jut, Oct. Jan, and Apr). 4. TANK & LINE TIGHTNESS TEST -- ACTTONS REQUTRED AFTER TEST: tltl All systems pass the tank and line tightness tests. -l am submitting the results of the taik tightness test and a copy of the field report I ] Lll tanks do not Jl.eet-lle req-uirements set by rule regarding tank tightness testing. [ ] I have contacted the State UST office and will submit-eviden-ce of a"pran for revievi. 5. PREVIOUS POLLUTION INCIDENTS: 1ft_have completed the PREVIOUS POLLUTIOI'I llrtClDENTS form wnich states whether yn{er customary business inventory practice standards, I am aware of any release from the tank. INDEPENDENT FINANCIAL ASSURANCE (Keeo records at r facil I have obtained financial responsibility requirements tor tne first $ZSpOO/release: flfuerr tnsurance [ ] Risk retention group [! Guarantee [ ] Letter of Credil I I Commercial lnsurance I I Surety Bond I t CIher: Kl nqy".qbtained independentthird-party financial assurance by my compliance date. I fl will obtain independent third-party tinancial assurance by my compliarice date. 'See explanations under "How do I get started?' To:Mr. Deruris Downs Executive Secretary Utah Solid & Hazardous Wastes Committee Dear Mr. Downs: fu required by paragraph 26-l4e404 of the Underground Storage Tank Act, I have performed a tank and line tightness test on each underground storage tank at my facility, and based on this test, there has not been a release of petroleum. Additionally, based on "customary business inventory practices standards", I am not aware of any release of petroleum from my tanks. PREVIOUS POLLUTION INCIDENTS Rs,frENfrpOR' I D* v,iR 1 e I have had the following releases of peuoleum (detailed below; also inengjp5rI nave nao tne ro[owrng releases ot petroleum (detailed Delow; arso menE$rpdf you took to clean up the release). $lnii-Eij{iii: signature of owner/operator Failure to report previous releases could void your coverage under the Petroleum Storage Tank Fund. -9E, J.ler 16:-\2 sTIIJTHLAHD 14 l<TG^ CERTIEICATE OF FIhIANCIAI, FESPONSIBII.TTY The SouEhland Corporati.on hereby cerbiftes bhat tt is inco'nol ianee wt th bhe regu i remenbs of Subpa r t H af. 40 CFR pa r e zgq . The f inanc i.aI assurance mechanism useC to rjemonstrate f tnaneialresoonsi.bili.ty under subpart H of 40 eEp part 2g0 ls as followg: rrrevocabre standbv [,etter of cr:edit \o. 92s09, tssuarl byNCNB Texas Natlonal- gankr on January 24, 1939r rrr:rsuant to40 cFR 280.q9r to riemonstrate financiat responsihilitv foctal<i!q _ggrreetiue aehlon aad/or comoensaEinq thirrt parr-.i.esfor bodity injury and property darnaqe caused by aeei,rterltatreleases ln t,he amount of a'r '1.esst $i,000-,000.00 rr:,:oecurrenee and fi2r000,000.00 annual aqgreqat,e. THF: SOT'THI.A\ID EORPORATION 1v: rlame: Ti rlelnaEe: March 16, l9B9 9.TATE OP TEXAS COT'NTY OF NATLAS ltv Com,n t ii ton Expt res s :' BFSGR3l s s s IANKNOLOGY CORPORATION NTERNAIONAT5225Hollister,Houston,Texas77040-6294 phone:Ol3ioso-rAn( -- - Eax-:lzisj-eilr2ss CgftifiCaftg Of Tght.lg$S scrvice order * 182e 1 . rest dau 3l Lz / stthfirglurd sr{E ts* ryrEn$f tslb.t rd fud Emfa [3 ]Tank(s)&Piping,Ou!n-[ ] Tank(s) only, ouan-[ ] Piping only. ouan- Tank Owner/Address Somffi CNoWrN.'716 0 Tank sizes & producB EsEd TA}IK /I1 12K PdG. TAI{K #2 12K RI]N. TA}iK /I3 12K PI]N. Piping Tested LINES: LA. 2A. 3A. J0!; L rRruK lfou4u-Lzl3ol9Ltr llOO22 ;r.;.:r irir: Vditonlywih Cor?orabSalGrfl' -'onl e Eqi&rle Q trf txf.gtrdr3 9._.S-._P:!q!..^ !$n39, -Crnrdlm Prtcnt . I105693. 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H l ,E g E # l Ui d€ l #l td -t II i' c | ,. -s I ts Ir;{ lo lc . , ILF' - . - - - - lril n Yl n, _- t i r- l r '- $ i *e II cl o €' 1{ -+ Iii, t- . il!4:- - J -j fTIt -o J lr .* c - J .J -'. i b "I rll.r'tr , /,oql tt i - U"t- _ $ite# _J.!t_jir_ Locati t t1 frl ij-gt*r.n *.l.trjs Dcpth k.r{ i Prod.DetcEt Partr end I-*bor uscd CrCncrd -E_. rcgulationr -Coupletc the folloring:Reportcd to: _ a r-+ t-. Frirt: C*fiificd Tcr I Tcrtcs Sifrr'tslc Fonn - Teatatl.i Erer I /E I . .,1{ . :: 'il . -r-I-(-)l Drtc Tcrrrnl ConplAcd YfrrY.-ULuu,F Ii";q?i.".',.lJslJi[if *.,,_-,__klt|rnt trNE TE$T LoG S.O.# rttir Customer Date_3:/.?.'; , ,PipingMateriaI_JrTacto-^.-_l*-furI9guctful, Test Pressure -fo - psi calib.Murtiplier E tiS:}n;*mmr z;;ff"* :'iisl=]:T,-fl[--; ,t rffig'*s' ! .r ' a ll_____ii i,==J-**.-: --::r'*.4-*:=:=- xTank No. .-t_ __-"_** ' r 0,cf%_-:___*, FAII 1 PASS tlor ,5, i,, n: c n r ",, j':;1,:.? 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