DERR-2024-006268

UNDERCROUND STORACE TANK PROCRAM
Adiustment Tracking Form
llil , * r{ollo-,5*,,e
lb,',,*^- dwe*
FACILITY NAN4E:
OWNER NAN4E:
FAc # /oCrbZA€
/WaiveREASON FOR:Adjustment Refund
'Z OiT t ,roa4t<cl rz lX
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F?qs ?file< * u u,.(ot tz oat 7/t /ctz- E-r c $ E:.,-J
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RE-BILL?Yes 6
sa1.7! o/6.-
APPROVED BY
BY *rt5rtZ
vo
UNDERGRoUND STORAGE TANK PERMANENT CLOSURE NOTICE (Revised 01/01/97)
State Use
Facility lD #6000286
Closure Notice prepared at the request of the owner/operator (identiiied below) by CIT{RAD IVIIII.iR
of (company name @NRAD IVIII,LR CAL Phone # ( 435)a2s -1626
Address P.O.BOX 116 C ity SALINA State-u[AH Zip 84654
mples to LUST Review_
3js
ample s in LUST File #
ate Mailed to LHD
UST Status
ate Processed
FACILTTY INFORMATION
Tank Owner DONNA OWEN Phone #( 43s) 33s -7 74C
Sl sole proprietorship [ ] partnership [ ] corporation
BOX 1449 City POIIT,I.P State-!ry .Zip 8471 6Address
Facility
Address
HILLS & HOLLOWS SERVICEName
840 WEST HWv 12 BOUL ER.StatQrAlLZip 84716
Contact person DONNA OWEN
Number of regulated tanks at the facility before closure:-?-
Number of regulated tanks al the Jacility 3[9g closure: 0
TANKS CLOSED
Phone #( 431 33s-7349
DERR
RONfuIENTAL RTSPOi
-l
' lndicate the Specihc substance slored in each tank to b€ closed (regular, Unlsaded, diesel, wasie oil, etc.)
TANK REMOVEB Name CCT{RAS'MILI,M
Compan ClTizuO IIIIJ.;R MEG'ANICAL
SALINA,
SOIUGROUNDW ATER SAMPLER Name @IiRAD T{I[;LR
Compa CDNRAD MILI,ER I,IECHCNICAL
Cerl. #TR 0061 Exp. dare 5/1 /99
Phone #( 435 ) 529-3626
Cert. #GS 0061 Exp. oate'l /1 /2ooo
Phone #[phone]
EN ITRED
1 2 ITank #
iiate lnstalled
i
I1 00Ogal20009a1Capacity
T'NLEADEDSubstance stored
IBYJI'LY 98JIJLY 98Date last operated
12/14 /e812/14/98
REMOVDHow closed
(Removed/ln place)
rIIIIII
State UIM Zi 84654
a.r.i'ac. P.O.BOX 116 Sratet TAll_ Zip_ i39!1_
Address P.o.Box 116 -_ city___ I4!IILL_
I
FEB?
UNLEADED
Date closed
RB4OVD
Location ol Closure Records 840 WEST HWY 12 BCXJLDER, [,TAH 84716
For Change-ln-Service: Substance to be stored
DISPOSAL SITES USED
ls any contaminated soil which was over-excavated still on-site?_ Yes _ No x Not applicable
xx Certitied lab analytical environmental sample results are attached
x Uni{red Sc:! Classification (USC) sample results are attached.
x Chain of Custody form is attached.
Was Free Product e;icountered ciuring closure activities? Iio l, yes, please indicate thickness, _lnches
SITE ASSESSMENT
lomplete the Facility Site Plat (Closure Notice) and Sa mple lnfonnation Table (Closure Notice) on pages 3 and 4 to show the)cations, cepths. and cther information on all soiUgroundwater samples taken ior closure. The samples must be consislently':sntified by sample lD # on trle site plat, lable, and lab analysis report.
dl Completed Facility Sile Plat (Ctosure Notice) is attached.
The rollowing must be included (enter the distance, and direction (N,S,E,W) lrom the area of contamination or, where applicable,use g.tl{or overhead, NP tor nol present):
_ -j.watei Line
-sar(er
une i. Natural Gas ---Z-storm Drain ,etephone __-=:Etectricat __< property Line __- BuitdingsCompleted lampte lnformation Table (Closure Notice) is attached
- - Samples vrere properly: IEb j Collected fdS I Labeted mF I packaged yESl Transported
[1] samples were in sight of the person in custody at aI times or in a secur6o loct<e-o itace. '
I certify under penatty o, lalv that the closure site assessment at this lacil ity was conducted iriaccordance with R311-ZI2 (parts 280.52 and 280.72) and R3I1-205 U.A.C., and rhat any additional samples required by R31t-202 parts 280.52and 280.72 and R311-20$2(aX1) were properly coltected.
Signature of Certified Groundwater/Soil Sampler 2/,2
Full name o, Certified Sampler @I{RAD }IILLB Date ,/ -(-r'?
lf contamination at the Jacility is conlirmed, any person providing remedial assistance {or a {ee must be a certified USTConsultant. Tne Certified UST Consultanl providing assistance is:
CERTIFIED UST CoNSULTANT Name Cert. # CC Exp. date_
Company
Address
Phone #
Location Name Contacl Name Phone #DEIE
Tar<(s)WESTMN MEIIAL ; RECYCT,ING KEN SWM{SON 798-3548 12/31 /91 Tank # 2
Product From Tank(s)NONE 0 gal
Contaminated Water From Tank Cleaning NATIONAL TANK @EG KE{L 280-3324 12/30/et 50 gat
Sludge gal0
Contaminaled Wate. From Excavation NONE 0 gat
I{ONE o yd'
r
II
CLOSURE INFORMATION
[X] Fuel was emptied t19t@l Sludge!-s removed llttg] Tank was cteaned. \-- \
Tank was: [ ] Purged 8l lnerted. Method Used: DRy fCE. I/K)f,Iflfftm WTITI OXYGII I@IER
For ln-Place Closure: tanks tilled with
I(
Amount
NONE -
Contaminaled Soil
city--- slate_ zip_
Tiie srie plat must be dra,,!n t3 an appropriate identitied scale- lt must show actual sampling locatio"s, s.bstances :i J.ed in tanks, arl
other relevant information. T3nk and sample identilicaticn numbers mus{ ba consistent with the inionnailon glven on p 1 and 4 of the
closure notice
FacrtrtyrO* 6000286 D.awn B-v ROBERT OWEN Date-l!,| 1 4 /98
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Sh. Hn Mui lndic.L Aciral Locadona Oi:
/ Curent & lom6r larks. prc.ng & :Epens€rs
/ E&avations, GW fircllnonng werrs & sod nodpios
/ Locatbn A Cottlfi ol all sanples taken
r, Burhilgs, lenc63. e orcpeiy bolndanca
/ Utlity clnduds {s6rrcG, gas, wat€., $onn
c,rarrB. elecLcal dc.)
, 0€9th lo groundwaEr (it.nco!ni6,!d)
X = SanEle locafona lSS+ WS-|, USC-r)
r. = Mon(onq, Wells (MW-*.)
O = Sol bomg (SH). or G6o9rob. &tug (GP{)
a : Vvatq, wella ((bm63E. liveslock, elc.)
Slope ol 6udac. Topograptry: (N, NW, w, Sw' S. SE. E, iiE)
Land Us. Al Stc:
-Re.ild]lr.i - Co merclal - Indusuial
Suiounding tatrd:
-Besilential - Co.rrnorciat - ItldusEEl
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L INFOHMATION IAB lo tic
ComPlete table fol all samples that were taken ior closure. Sample lD numbers on the table must be consistent with
the sample lO numbers given on the site plat and in the lab analysis report.
1 Soii (SS), Ground",vate. {GW), or Unified Soil Classifcaron (USC).
2 Final depfi (in te€t) below gradg al wnich samples tNer€ lalen.
3 Cociaminant compound(s) aflalyzed for Each sample fiPH, BTE)(N, O&c, etc).4 Appropriats analysis mehods to, cortaminant comFpund(s) in €acr! samptE (8O15 riod., 8020, 4.t3.1, etc).
Stals Certified Laboratory used:AMRTCAN !{EST AMLYTICAL IABORATORTES
, Sample #/Lab lD Substance
stored in
tank
Sample
typet
#1 /L35636-1 I]NI.EADED 55
#2 /L3s536-2 SS
T'NLEADD SS
#4 /L35636-4 I]NLEADD SS
Depth'?Compoundss Analysis method(s)'
r
ll
TPH, HTEX,8015 !0D. EPA 8020
8'
3r
8'
#5 /L3s536-5 T]NLEADM
#6 /L35636-6 USC o
i
#7 /L3s635-7 USC 3
Ir
Address 463 hEST 3600 SOUIH C src,StateL"I. Zip 84115
Contact person Elona Ha!&,ard Phone * 1801 1 263-8686
Please explain any unusual or extenuating circumstances encountered during the site assessment or closure:
IrcNIE
I certify under penalty of law that I am th6 Owner of the tank(s) described above and that I am lamiliar with the
information on this form and that it is true, accuftrte a$d complete and turther, that the procedures described herein
were tollowed during tank clo
/""/r,LSignature of UST
"-44Fult namc of Ownor 17)ourll .Tcaut P O t -t<tr^,--,oata /-ilS-11
Retum completed Closure Notice form, Facility Site Plat and Sample lnformation Table, Soit/Groundwater sample tab analysis
results, USC sample results, and Chain of Cuslody form within 90 days ol UST Closure to:
State ot Utah Oepl. of Environmental Quality
Oivision oi Environmental Response and Remedia:.on UST Section
P.O. Box l4rl84o
't 68 North 1950 West
salt Lak6 city, utah 84114-€40
4
tNi,EADm
#3 /L3s636-3
D2488-84, X4.2
-
ORGATVC ANAI.,YSIS REPORT
Client: Conrad Miller. Contact: Conrad Miller
A)' IEP.IcAN A..BlYgis Requested:
r^rrc-r Volatlle AromatlcsYVLJIM
ANAlyrrc;iTotal Purgeable Hydrocarbons
LABORATORIESIab Samole ID:
f$T3GTfeffiod Blank
Date Analyzed:December 22, 1998
lvtethod Ref.Numbcr:WA
(Purge & Trap GC/MS)
NIBTXN;,TPH-P
= ppm
463 lVest 36()0 South
Salt Lake I, ry, Utah
[phone]
Toll Free (888) 263-Sb86
Fax [phone]
Benzene
Toluene
Ethylbenzene
Total Xylene
Naphthalene
Total Purgeable Hydrocarbons
Amount
Detected:
0.002 <0.002
0.001 <0.001
0.002 <0.002
0.002 <0.002
0.002 < 0.002
0.004 < 0.004
0.020
Repgrtjng
Lrmrt:8+rr5 Compound:
Metltyl+-Butyl Ether
<0.020
Released By:
Report Date: December 24, 1998 1of1
A
Analytical Results
t
I
.,
ORGANIC ANALYSIS F.EPORT
ANLIERICAN
WEST
ANALYTICAL
LABORATORIES
Client: Conrad Miller
Contact: Conrad Miller
Analvsis Reouested:
Volatlle Aromatlcs
Total Purgeable Hydrocarbons
Lab Samole ID:
B5TT6:NIeihod Blank
Date Analyzed:December 23, 1998
Method Ref.Number:WOA
(Purge & Trap GC/MS)
463 West 3600 South
Results
Benzene
Total Xylene
Naphthalene
Total Purgeable Hydlodarbons
}IBTX}.JiTPH.P
Amount
Detected:
<0.002
<0.001
<0.002
<0.002
<0.002
<0.004
<0.020
Salt Lake Citv, Utah
841115 Compgund:
Metnyl-t-Butyl Ether
Repgrtrng
Ltmlt:
(801) 25$86uu
Toluene
Toll Free (888 ) 26T8686
Fax [phone]@7 EthYlberzene
0.002
0.001
0.002
0.002
0.002
0.004
0.020
Released By
Report Date: December 24, 1998 I of 1
.,
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Client: Conrad Miller
Date Sampled: December 14," Date Recdived: December 15,
AI,lERIC.\N
rnrrcrAnalvsis Reouested:
A NTA r v.fl. a r volatile Aromatlcs
."i"iiiiifrriTotal Purgeable Hydrocarbons
Field Sample ID:
ORGAMC ANALYSIS REPORT
,I SOUTH WEST CORNER TANKS EXCAV/8' BELOW GRADE
HILIJ & HOLLOWS SERVICBOWEN UST SITE ID #6000286
L:T'6TG1-
Contact: Conrad Miller
Date Analyzed: December 23, 1998
Method Ref.Number:WA
(Purge & Trap GC/MS)
Lab Saryple [D:
998
998
1
1
463 West 3600 South
Salt Lake City, Utah
84i15
Toll Free [phone]
Fax[phone]
Results
Conlpound:
Methyl-t-Butyl Ether
Benzene
Repgnjng
Lrmlt:
N,IBTXN/TPH.P
Amount
Detected:
<0.0052
< 0.0026
<0.0052
< 0.0052
<0.0052
<0.010
<0.052
[phone] Toluene
0.00s2
0.0026
0.0052
0.0052
0.00s2
0.010
0.052
Ethylbenzene
Total Xylene
Naphthalene
Total Purgeable Hydrocarbons
% Moisture 0.t%3.$Vo
I All compouuds are reponed on a dry weight basis.
Released By:
Report Date: December 24, 1998 lofl
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I
A
II
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1
ORGA\IC AIYALYSIS REPORT
Client: Conrad lvliller
Date Sampled: December 14, 1998
Date Rectiived: December 15, 1998
12 SOUTH EAST CORNER TANKS EXCAV/8' BELOW GRADE
HILLS & HOLLOWS SERVICE/OWEN UST STTE ID #6000286
Contact: Conrad Miller
Date Analyzed: December 23, 1998
Method Ref.Number:m.{
(Purge & Trap GC/MS)
I-ab Sample ID:
L35636-2
'\ \ IE RIC-{\ Analys is Requested :
,.*ll*S*iffirocarbonsLABOT{,ATORIES
Field Sample ID:
Results
Reporting
Lmlt:
NIBTX}i/TI'H.P
Amount
Detected
<0.0055
<0.0028
<0.0055
< 0.0055
<0.0055
<0.0i1
<0.055
463 West 3600 South
Salt Lake City, Utah
84115
Toll Free (888) 263-8ffi5
Fax (801) 26}.8687
Compound:
Mefryl-t-Butyl Ether
Benzene
[phone] Toluene
0.0055
0.0028
0.0055
0.0055
0.0055
0.011
0.0s5
Ethylberzene
Total Xrvlene
Naphthalene
Total Purgeable Hydrocarbors
% Moisture 0.r%4.AVo
* All compounds are reported on a dry weighr basis
Released By
;l
I
Client: Conrad Miller
Date Sampled: December 14, 1998
Date Recelived: December 15, 1998
A}.{ERICAN
',,r.rAnalysis Reouested:
ANA LYTIC_,\L v otatlle Aromatlcs
."uoiJi"[iuJTotal Purgeable Hydrocarbons
ORGAI{IC ANALYSIS REPORT
Fieid ID:
#3 NORTH EAST CORNER TA.I\iKS EXC.{,V/8' BELOW GRADE
H&LS & HOLLOWS SERVIC&OWEN UST SITE ID #6000286
L356363
Contact: Conrad Miller
Date Analyzed: December 23, 1998
Method Ref.Number:ffiA
(Purge & Trap GC/MS)
Lab Sample ID;
453 \4'est 3500 South
Salt Lake City, Utah
84115
Toll Free [phone]
Fax [phone]
Results
Conlpound:
Methyl-t-Buryl Ether
Benzene
Reporting
Lrmlt:
NIBT}Ni/TPH.P
Amount
Detected:
< 0.0058
<0.0029
<0.0058
<0.0058
0.0064
< 0.01i
<0.058
[phone] Toluene
0.0058
0.0029
0.0058
0.0058
0.0058
0.011
0.058
Ethylbenzene
Total Xylene
Naphthalene
Total Purgeable Hydrocarbons
% Moisture
* All compounds are reponed on a dry weight basis.
0.r%3.$Vo
lLReleased By:
,
s\
^{%.
I
a
ORGANIC ANALYSIS REPORT
-Date Sampled: December 14, 1998
Date Rectiived: December 15, 1998
a r t EIU, c;$
Aryt v.gis F.equested :
" LJr Volatlle AromatrcsANALYTIllLTotal Purgeable Hydrocarbons
LABORATORIES
Field Sample ID:
Client: Conrad lvliller
#4 NORTI{ WEST CORNER TANKS EXCAV/E' BELOW GRADE
HILLS & HOLLOWS SERVICBOWEN UST SITE ID flffi286
Contact: Conrad Miiler
Date Analyzed: December 23, 1998
Method Ref.Number:WA
(Purge & Trap GC/MS)
Lab Sample ID:t35Er6rr-
Results
Reportins
Limit:-
ilIi]TX}iiTPH.P
Amount
Detected
<0.0055
<0.0028
< 0.0055
< 0.0055
<0.0055
<0.011
< 0.055
.153l4lest 3600 South
Salt Lake City, Utah
84115
Benzene
(801) 26$.858e Toluene
Toll Free [phone]
Fax [phone] Ethylbenzene
Compound:
Metfiyl-t-Butyl Ether
Total Xylene
Naphthalene
Total Purgeable Hydrocarbons
0.0055
0.0028
0.0055
0.0055
0.0055
0.011
0.055
I
% Moisture 0.t%4.AVo
* All compounds are reported on a dry weight basis.
Released By:
Report Date: December 24, 1998 lofl
{l
Client: Conrad Miller
Date Sampled: December 14,
Date Rectiived: December 15,
AiVIEIiICAN
*o*lAnalygis Requested:.n*,.rrotTi@
."u"ii"iijfrrjTotat Purgeable Hydrocarbons
Field Sample ID:
ORGANIC ANALYSIS REPORT
,5 PUMP ISIIND/3' BELOW GRADE
HILLS & HOLLOWS SERVICEOWEN UST SITE ID #6000286
L35636-5
Contact: Conrad Miller
Date Analyzed: December 23, 1998
Method Ref.Number:WA
(Purge & Trap GC/MS)
L[ Sample ID:
998
998
1
I
Results
Reporting
Lrmrt:
NIBTX}i/TPH.P
Amount
Detecred:
<0.0053
< 0.0026
< 0.0053
<0.0053
< 0.0053
< 0.010
<0.053
1163 West 36CO South
Salt Lake City, Utah
84115
Toll Free (888) 253-8t85
Fax [phone]
Comoound:-----
Methyl-r-Butyl Ether
Benzene
[phone] Toluene
0.0053
0.0026
0.0053
0.0053
0.0053
0.010
0.053
Ethylbenzene
Total Xylene
Naphthalene
Total Purgeable Hydrocarbons
% Moisture 0.t%4.UVo
* All compounds are reponed on a dry weight basis.
Released By
Report Date: December 24, 1998 1of1
:l
Client: Conrad Miller
1\tvtEI{ICAN Date Sampled: December 14, 1998
IvEST Lab Sample ID: L35636
SOIL ANALYSIS REPORT
Method Ref. Number:
D2488-84, X4.2
Contact: Conrad Miller
Date Received: December i5, 1998
Received By: Rebekah Richanison
ANALYTICAL
LABORATORIES Analysis Requested:
Uniired S oil Ciassification
Analytical Results
453 West 3600 South
Salt Lake City, Utah
84115 Lab Sample ID.:
L356.36-6
(801) 253-85 ae L35636-7
Toil Free [phone]
Fax [phone]
Field Samole ID.:
Hills & Hollows Service
Owen UST Site ID #6000286
tt6 North West ComerTanks Excav
USC 8'Below Grade
Hills & Hollows Service
Owen UST Sire ID #6000286
#7 Pump Island USC/3' Below Grade
Classification:
Poorly Graded Sand (SP)
Pooi'ly Graded Sand (SP)
a
'f-/,>Released
tl Report Date l2ll7/98 lofl
Laboratory Supervisor
USC Master
I IJNT
)i rRltss
ILINI]/FAX
),.I^CT
i( !r/P.o-l
CONRAD MTLLER MECHANICAI,
201 EAST 300 I$ORTH P.O.BOX 116
.qar.rIJ,l trl,\,l lid6q
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 36fl) South
salr takc ci
CI.II\II,I Ui; UIJs i UDY
(80r) 263-8686
(435) s29-3626/ 529-3242
(
(
Ot^IE[r USI SITE ID# 6000286
I I HILIS & }IoIIOWS SmWe] 840 WESI HWy 12
BOUI.DB,84716 SrTE rD# 6000286
5'culwq
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dei o.
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TURN AROUND I1MES
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tr = Priorig Il
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COMMENTS
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rl Instructiora: I
SAMPLES TP BE KEPT AT Tf,XJR DEGRMS C.
ANALYSTS 10 BE AS PM L]ITAH STATE
STORAGE TANKS. SI111 ID II 6000286 TO BE OiV
PN.INT NAME
frrrr xeme
t/ /0
Rccclrcd ,or Lr Dr
E
tSAMPLE
DATF/TIMB
MATRIX
/ Z-,/1-, g
?, 2n A,r.Soil It7t1-q83D)ta -Soil t {
I z- / ?'?A
/o ; t5 *t',-Soi I I {
/ 2- /1-?a Soil
/ z-tY-rAto ; ?oAt\Soi /i {
t L- /1'/t,9il I E
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I ,
DitCI'lrr./Z-/f-?tIt,zl-)),zt
R.cdrd Br: S{'-.n
Con.r.l l)7,1btPRIT{T NAME
n.lhqulsh.d Br: Slir.r.n DraCTlrtl.
PRIITT NAME
Dracfnnr.Dlqrrtch.d Ilrr Si,ndn
PNINT NAME
KIIIIIIII
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TIIIII
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IIIIIItrtIIIIIIIIIITIlrlIIIIrI
ITIIIITIIItrIIIlrlIIIIIIIIIIITlrr
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IIIrIII
IIIII
T
IITrIII
$rI
II III
PRIMT NAME eK44 Ruu<X&!
,B
t4 55
cotutAD MIT.T,r.R
r I ,R'S SICNAruAE
SAMPLE ID
Fu(sor)263,8687 LAB # 35 lr3l"
Soi I
]N
lrll
[----T----I
It
,
LOGIN CIL\IN OP CUSTODY REPORT {1n01)
Dec 15 i999, 04:13 pm
':,
-L
ctLogrn NUElcer: L35635
Accoun'-: MIL447 Conrad Mi}Ler
SlEe : HILLS & HOLLOWS SERVICE/CWEN
,?
UST SITE ID *5000286
ConEactr: Canrad M!lLer
L35535 - r
SoIids
L35636-2.
So Iids
L3553 6 -3
Sol ids
L35636-4
Sol ids
*T SOUTH WEST CORNER ?ANKS EXCAV/8' BEI,o!* GRADE
S MBT)O\/TPI{-P Furge & Trap MB'rErN/TPH
;2 SOUTH EAST CCR.TIEE TA}IKS EXCAV/$' BELCW GR.ADE
S I,tsTXN/TPH-P Purge & Trap MBTE)N/TPH
#3 NORAH EA.ST CORNER TANICS EXCAV,/8' BELOI+ GRADE
s MBTXN,/TPH-P Purge & Trap i.4BTEXNITPH
#4 NORTH iTEST COFf{ER TANI6 EXCAV,/8.' BELOW GRADE
S t'CTl0\/TPt{-P Purge & Trap MBTE)N/TPH
S5 PUUP ISLAIID,/3' BSLOW GRADE
14-DEC-98 15-DEC-98 PA 24-i]3']-!i
Expj,res:26-DEC-98 purge 1 Concain
14-DEC-98 15-DEC-93 PA 24-DE:-99
Expires:28 -DEC- 93 purge
14-DEC-98 15-DEC-98 PA 2{ -DEa-38
gxplr€s:28-DEC-98 purge 1 ConEaln
14-DEC-98 15-DEC-98 PA 24-DSC-98
Expires:28-DEC-98 purge l:ancair
14-DEC-98 15-DEC-98 PA 2{-DEC-98
Expires:28-DEC-98 purge L ConEain
14-DEC-98 15-DEC-98 PA 24-DEC-tg
1 Concain
L35635-5
solids
L15535-5
so1 ids
L3s635-7
So l ids
S MBTXN/TPH-P -
s usc
S USC
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*6 NORfi{ '.rEST CORNSR TANKS EXCAV tSCi18' BELOW SRADE
Uniform soil classif icaE.ion
#7 PUMP ISI,AND USC/3' BEIPW GRADE
Uniform SoiI ClassificaEion
14-DEC-98 15-DEC-98 PA 2.1-DEC-98
hail L C'fn:ain
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DEPARTMENT OF E}WIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAL RESPONSE AND
168 North 1950 West
P.O. Box 1214840
Sdt Lake City, Utah 841144840
(801) s364100
[phone] Fax
(801) 5364414 T.D.D.
www.deq.state.ut.us Web
b(
*,J#,6,c0P y
Michael O. Leavitt
Govcmor
Dianne R. Nielson, Ph.D.
Exeaudve DirEtor
Kent P. Gray
Dircctor
ERRU-723-98
November 18, 1998
CERTIFIED MAIL
RETURN RECEIPT REQI]ESTED
Donna Owen
Hills and Hollows Service
PO Box 1400
Boulder, Utah 84716
RE:Lapsing of the Certificate of Compliance and coverage under the Petroleum Storage
Tank (PST) Fund for Underground Storage Tanks (USTs)
Located atHills and Hollows Service, 840 West Highway 12, Boulder, Utah
Facility ID #6000286
Dear Ms. Owen:
The Utah Underground Storage Tank Act ("the Act") requires that the UST owners and
operators pay yearly UST Registration Fees, PST Fund assessments, late penalties, and interest.
The Act states that if any of these assessments remain unpaid 60 days after the due date, the
Certificate of Compliance and coverage under the PST fund lapses.
Our records indicate you have not paid Registration Fees, PST Fund assessments, late
penalties, and interest , in the amount of $515.10, which are now more than 60 days past due.
Therefore, you are hereby notilied that your Certilicate of Compliance and coyerage
under the PST Fund for Facility ID #6000286, known as Hills and Hollows Service, has lapsed.
Without a Certificate of Compliance your tank(s) cannot receive product. Without coverage
under the PST Fund, you must demonstrate financial assurance using another allowable method and
costs of investigating and cleaning up releases becomes your responsibility.
To obtain a new Certificate of Compliance and renew your coverage under the PST Fund,
you must:
1. Document that you are in compliance with release detection requirements. Contact
our office for the specific leak detection records required for your facility.
2. Pay all past due Registration Fees, PST Fund assessments, penalties, and interest.
\
Facility ID #6000286
Page 2 .'
Pay a $ 150.00 Recertification Fee.
Submit a new application to the PST Fund.
Conduct a site assessment as explained in R-31 1-205-2c.
Please take care to monitor your own records to ensure compliance. If you have any
questions, please call William Moore at [phone].
Sincerely,
3
4.
5.
AA /[-'
Gary A. Harris, UST Environmental Scientist
GAH/Kf
r
Michael O. Leavin
Dianne R. Nielson, Ph.D.
GoYemor
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMED
168 North 1950 West
P.O. Box 1,14840
Salt lake City, Utah 841144840
(801) s364100
[phone] Fax
(801) 536{414 T.D.D.
www.deq.state.ut.us Web
Executivc Dircctor
Kent P. Gray
DiBtor
ERRU-723-98
November 18, 1998
CERTIFTED MAIL
RETURN RECEIPT REQTIESTED
Donna Owen
Hills and Hollows Service
PO Box 1400
Boulder, Utah 84716
RE:Lapsing of the Certificate of Compliance and coverage under the Petroleum Storage
Tank (PST) Fund for Underground Storage Tanks (USTs)
Located atHills and Hollows Service, 840 West Highway 12, Boulder, Utah
Facility ID #6000286
Dear Ms. Owen:
The Utah Underground Storage Tank Act ("the Act") requires that the UST owners and
operators pay yearly UST Registration Fees, PST Fund assessments, late penalties, and interest.
The Act states that if any of these assessments remain unpaid 60 days after the due date, the
Certificate of Compliance and coverage under the PST fund lapses.
Our records indicate you have not paid Registration Fees, PST Fund assessments, late
penalties, and interest, in the amount of $515.10, which are now more than 60 days past due.
Therefore, you are hereby notified that your Certificate of Compliance and coverage
under the PST Fund for Facility ID #6000286, known as Hills and Hollows Service, has lapsed.
Without a Certificate of Compliance your tank(s) cannot receive product. Without coverage
under the PST Fund, you must demonstrate financial assurance using another allowable method and
costs of investigating and cleaning up releases becomes your responsibility.
To obtain a new Certificate of Compliance and renew your coverage under the PST Fund,
you must:
Document that you are in compliance with release detection requirements. Contact
our office for the specific leak detection records required for your facility.
1
2. Pay all past due Registration Fees, PST Fund assessments, penalties, and interest.
\
Facility ID #6000286
Page 2
3. Pay a $150.00 Recertification Fee.
4. Submit a new application to the PST Fund.
5. Conduct a site assessment as explained in R-311-205-2c.
Please take care to monitor your own records to ensure compliance. If you have any
questions, please call William Moore at [phone].
Sincerely,
AA /[-'
Gary A. Harris, UST Environmental Scientist
GAH/Kf
Michael O. Leavitt
Governor
Dianne R. Nielson, Ph.D.
Executive Director
Kent P. Gray
Director
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box lzl4840
Salt Lake City, Utah 841l4-4840
[phone] Voice
[phone] Fax
[phone] T.D.D.6-286
ROBERT AND DONNA OWEN October 29,1998
P O BOX 1400
B4O W HIGHWAY T2
BOULDER UT 847 L6
Re: December 22,1998 upgrade deadline for Underground Storage Tanks
The Division of Environmental Response and Remediation (DERR) records show you have one or more underground storage
tanks (USTs) which have not met the Decembe r 22, 1998 UST upgrade requirements. These tanks are located at HILLS AND
HOLLOWS SERVICE, P O BOX I4OO
Under Federal regulations issued in 1988, UST owners and operators have until December 22, 1998 to upgrade, replace, or
permanently close USTs that do not meet the requirements for protection against spills, overfills, and corrosion.
This deadline will not be extended. If your tanks are not in compliance by the deadline, they will not be able to receive
deliveries of fuel.
Our information shows these requirements have not yet been met:
Tank ID Substance Tank Capacity Spill Protection Overfill Protection Corrosion Protection
I Gasoline 1041 No No No
2 Gasoline 2000 No No No
Any metal flex connectors connected to fiberglass reinforced plastic (FRP) piping at the submersible pump or dispenser must be
cathodically protected or taken out ofcontact with the soil.
USTs filled by transfers of less rhan25 gallons at a time (usually used oil tanks) are not required to meet the spill and overfill
prevention requirements as part of the upgrade requirement.
If you have questions about which requirements you still need to meet, or would like to have someone visit your site to help assess
your needs, please call Alan Jones at [phone].
?^
Michael O. Leavitt
Govemor
Dianne R. Nielson, Ph.D.
Executive Director
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box 144840
Salt Lake City, Utah 841144840
(801) 5364100
[phone] Fax
(801) 5364414 T.D.D.
www.deq.state.ut.us Web
rf L t c0PY
Kent P. Gray
Dircctor
ERRU-698-98
October 27,1998
Donna Owen
PO Box 1400
840 West Highway 12
Boulder, Utah 84716
RE: Closure Plan Approval for Underground Storage Tanks (USTs)
l,ocated at Hills and Hollows Service, 840 West Highway 12, Boulder, Utah
Facility ID #6000286
Dear Mr. Owen:
The Closure Plan for the above-referenced facility, received by the Division of
Environmental Response and Remediation (DERR) on October 22,1998, has been approved subject
to the noted modifications, if any. The DERR office and the local fire department must be notified
72 hours before beginning closure activities. Local agencies may have additional requirements for
closure or may charge inspection fees.
The Closure Plan approvai is effective for a period of one year from the date of approval.
If closure does not take place within one year, submittal of a new Closure Plan will be required,
unless otherwise approved by the Executive Secretary (UST).
Any change to the approved Closure Plan must be submitted, in writing, and approved by the
Executive Secretary (UST) before implementation. If contamination is suspected or found during
closure activities, you must report it to the DERR at [phone] within 24 hours of discovery.
Enclosed is a copy of the Closure Notice form, which must be completed and submitted to
the Executive Secretary (UST) after the closure is performed. Please submit the Closure Notice as
soon as possible, but no later than 90 days after tank closure.
If during upcoming closure activities, it appears that a confirmed petroleum release has
occurred, then the conditions, as explained in the attached notice, may apply to your site, provided
the facility complies with all of the applicable rules and regulations.
fl
G--
Kent P. Gray, Executive Secretary (UST)
Utah Solid and Hazardous Waste Control Board
Facility ID #6000286
PageZ
KPGAVEM/Kf
Enclosures
cc:
If you have any questions, please contact William Moore at [phone].
Sincerely,
e4,-/H*
Chief Ray Harshman, Boulder Fire Department
Conrad Miller, Conrad Miller Mechanical
60@x6UNDERGROUND STORAGE TANK CLOSURE PLAN (rev. 01101/97)FACILITY ID#
LHD USE ONLY
Date Received
Reviewer
Date LHD Approved
Date mailed to State
Ciosure Plan prepared at the request of the ownerloperator (identified below) by D.:l.;r.r r- e).rr. n
ol (comparry name)t-\; t\t i *,4 No.,r'Phone # ( )
Address T<oc,t-LO€r Statel$_Zip 94tr h
A Contractor may prepare this Closure Plan as the owner/operator's agent. ln preparing the Closure Plan, the Contractor must
act wilh the owner/operato/s knowledge and approval. The owner/operator must sign the Closure Plan.
This Closure Plan is subrritrtec in compliance with the requirements contained in R311-202 Subpart G and R31 1-204 (U.A.C.)
FAglLl rY _uEaB_r4 4 I"! o,!
Tank \rrrrr.J€r- Arr< O Phone * ( \lsg 33'r'' Zs q7
1{oreproprietorship [ ]partnership [ ]corporation
2ot) A 0,,state L zie- gq7/l
STATE USE ONLY .
"-d4,1
6
evi wer /Date Ap
Received
ate Mailed to LHD
Received From l-HD
. Beview/Date
Address
Facility
Address
s
Qrtc w' Au,,. ra-B
Contact perscn
Total number of regulated undei'ground tanks at this site t
Total number of regulated underground tanks at this site to be closedre
i2.*JAt state L,(L zip Qa1!.L-
Phone#( -i,,[l.,r.{ -
a
' lnclicate the specific substance stored in each tank to be (r€,lular, unieaded, diesel. wasle oii, etc.)
For waste oil tanks: Have degreasing or other types of solvents been stored or mixed with the waste oil?
Yes (identifu if known) No Not known
I I
tIj
1
Tank #2,t
Date !nstalled
Caoacity nL .aao l, OOO
t-rP t-eeaL
CAso(.i r-, e
(ANL(AD ?Lv!
Crost/ ^v<-
Substance stored'
l^^L q8 J-.L qEDate iast operated
'/-2
t
Analysis for lead or other contaminants may be required pnor to disposal of contaminated soil or other material. (Check with
your disposal facility.) i , I
I
I
t
E Hei'iD DELIvERED
--#
olrz:7194
)Llq t/
TANK AEMOVER Name corRi!'rr"r,u*
CONRAD },{ILLER MECHANICAL
cets* 119!!l- E*p 6a.g6/1/99
Phone * d35 \ 529-3626Comp
Address P.O.BOX 116 SALINA,Srate I4AllZip 84654
SOIUGROUNDW ATER SAMPLE R Name CONRAD MTLLER
Company
Address
CONRAD I.{lLLER Phone#(435 \ 529-3626
SALINA,Stare UgLHZip 84654
Before the closure plan is submiiled for approval, the local health and tirc departments where the facility is located
must be contacted. n ne tacitity, is in Beaver, Caboo, E n€ty, Gafield, Crand, kon, Kane, Salt Lake, San Juaa, Wasatch, ot washhgton caunty cnntact
DERB (USI) at (E1l)53641cp instead ot tte l@21heatth dbttct. You still mlst conlact the tc'cal tue deoanment in these countjes,
CONTACT LOCAL HEALTH DISTRICT Name ot Dist. ''-Donn-Date_
Contact Tifle Phone #gol s.c ,tt ob
CONTACT LOCAL FIRE DEPT. Name ot Dept.Date l,Nr., v
Contaci
DISPOSAL INFORMATION
Tank(s) will be disposed at Facility WESTERN METALS
Address 970 SOUTH MAIN City SlAxl€x_Io3x! Stateql_:_ Zip 84550
Contact pe ;56N KEN SWENSON prrone* ( 801) 798-3548
Product lines will either be: X removed or X cleaned, secured in place, and capped.
Vent lines will either be: X removed or X cleaned and secured open.
CONRAD MILLER MECHANTCAL
Piping will be disposed at: Facility
Address Ci State__ Zio_
Contact person Phone # ( i
Tank(s) wil! be emptied by: company
Tank(s) will be cleaned by: company NATIONAL TANK & MONITORTNG
Phone #
Phone #[phone]
ARE EMPTY
Contaminated water in the tanurinsale wtll be disposed at: Facitiry NATTONAL TANK & MONITORING
Contact person GREG KEHL on",?01 \ 280-3324
Residual sludges will be disposed at the following facility : E . T. TECHNOLOGY
Address P.O.BOX 535348 SLC StateQ!._ Zip_18,! 1 L3_
FOF CLOSUFE I',{-PLACE CNLY
[ ] -Facility Site Plat, Sample lnformation Table, sample results and Chain of Custod\,,forms are included.
I I . Approval for in-place closura has been granted by the Local Fire Department.
Fire Dept._Phone#
[ ] Approval for in-place closure has been granted by the Local Health Department
Health District Phone# Contact Date
Cert. # GS 0061 Exp.date_Ll)j!2900
,n(au,f.o:rA Z,r, !ire ".\)Title Tir r \r-r s[6-\- Phone #_
SAME AS TANKS
Tank(s) will be:
-
purged or X rendered inert by the following metho6; DRY ICE
Contact person CfNDY MORGAN Phone* (801 r_.973-2065
Contact oate
[ ] Substance to be used to filt tanks
i
dpilHi',tiI{ATED MATEH|ALS MUSl
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 aention and over-excivation (of more tnan iO yd),
must be a Certified UST Consuftant.
Contaminated soils generated as part of tank removal are to be disposed at the following facility: ':
EAST CARBON DEVELOPMENT eaOr"." EAST CARBON City PRICE,
ua.zi 84501 Contact I MCMULLTAN Phone #[phone]
SITE ASSESSMSNI
A site assessment must be performed for all UST closures and change-in-service. Site assessments must beperformed as outlined in R311-202,Parl.28O.72and R311-205 (U.A.C.). lf contamination is susoected. additional
samPles must be collected at the location where contamination is most likely to be present. li oroundwater is
encountered. a soil san?Pllmust be collected. in the unsaturated zone. in addition to each qroundwater sampll. Soil
and groun,iwater samples must be anatyxed for the compounds shown in the following table, using appropriate lab
methods.
SUBSTANCE CONTAMINANT COMPOUNDS TO BE ANALYTD
\
ANALYTICAL I"ETHODS'
soL GROUNDWATER
oTSURFACE WATER
Gtsoiine Total Peroleum Hy&ocubons (TPFI)
P-
q q4qeJol uqne. E g1
i benzer;e. Xy lenes ( BTEX), and IIITBE
8015 Modiired and
EPA 8020 or 8240
8015 Modified and
EPA 601 or 614
Dicsel Total Petroleum Hydrocarborrs (TPI{)
Benzene, Toluene, Ethyl benzeoe, Xvlenes, Naphthalene (BTEXN)
8015 I'Iodificd and
EPA 8020 or 8240
8015 modified and
EPA 602 or 624
U.ied Oil
I
Oil and Grease (O&G) or Totai Reccverable Hydrocarbons (TRHi '
Benzene, Toitrne, Erhyl benzene, Xyie;res, Naphthalene (BTEXN)
Halogenaed Voladle Organic Compounds (VOC's)
EPA413.1 or4lE.l;
and EPA 8020 or 82*0
and EPA 8010 or E2a0
EPA413.l or418.1
anci EPA 603 or 624
and EPA 60t or o24
New Oil _at!-e!g,Al94!e 1O4Q) o1 To1al Bgqqverable Hydrocarbons (TRFO EPA413.l or418.l EPA4li.: or4l8.1
Other or
Unknown
Total Petroleum Hydrocubons (TPH)
Benzene, Toluene, Ethyl benzene, Xylenes. Naphthalene (BTEXN)
Halogenared Voluile Organic Compounds (YOCs)
Or other EPA metlods as approved by the Executive Secrcury'
8015 Modified
and EPA 8020 or 82a0
and EPA 8010 or 3240
8015 rnodirred
ud EPA 601 or 624
and EP..L 60l or 624
Complete the Facility Site Plat and Sample lnformation Table on pages 4 and 5 to provide site assessmenr
information.
CONTAMINATION INFORMATTON
lf contamination at the facility is susoected or ccnfirmed, the information must be reported to the Executive Secretary (UST)
at (801) 536-4'100 within 24 hours. The Division of Water Quality must be notilied at [phone] if Free Product is
encountered cr 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.
lAltemative methods allowed for 413.1 are 1664 or 5E2O{bl, and 41g.1
method numbers can change or be replaced (e.g. 824O can be replaced by 8260).
sampler, or your analytical laboratory if you have questions.
3
may arso *. .rrf,,,.
check with * "l''
Note that analytical
your centfied
i
[E PLA T
pling locatrons, substances storedThe site plat musl be drawn to an app ropriate identiried scale. lt must sholv plann
in tanks,. and other relevant information. Tank and sample identification numbers must be consistent with the informalion given
on p. 1 and 5 of the Closure Plan.
Facitiry tD #Jiil0!&d2Drawn By Date
E]
b,l
N
ft
NORTH
Prop"rly l-rue
Scale: 1" =
c
iP"-
,s.- o.o-
oo
*
Feet
nccrzi-L€!5l.In
^-!>o}Lt.c--)
+-5.5
\n
1
T6
a(
A1
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\Jgxc+,
F,r I
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ll",
x
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3s
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9
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U\
ftr
l7iI
lr
{.
irIr';t^tt
g
o
+
n
qs'
$x'
o
a
\h
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l$
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n.+
n-!
oro-
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ulp.
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o
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E(\
€
=1.
$
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oro-
f'-tl^
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6
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a
:.$
fr
P#
i.!JCJ
E
-'
--+'
f
i2
)-
{
P
=o
:
I
X = Sample locations (SS+, WS+,
@ = Monitoring Wells (MW-#,)
O = Soil boring (SB-#), or Geoprobe Boring (cP-#)
O = Water Wells (domestic, livestock, etc.)
Slope of Surface Topography: (N,NW,W,SW
Site Plat Must lndicate Approrimate Locations Ot:y' Cunenl & former tanks, piping & dispensersy' Location of all samples to be taken/ Buildings, tences, & property boundaries/ Utility conduits (sewers, gas, waler, storm drains,
electrical, etc.)Land Use At Site: _Residential mmercialVco
Surrounding Land:_Residential_Commercial lndustrial
4
-so.
:T
c2
(.0
ri
I
. .. 1 sAIupLE miFoRtulATloN TABLE
Cdmplete table for all samples to be ,aken for closure.
1 Soii (SS), Grounowater (GWi, or Unifed Soil Classificatbn (USC).
2 Agptoy.. depfi in teet belcw grac,e. The reouired minirnum site assessment saRDlis rl;r-rsl be leken a, 0-2
3 Contarninant compounds to be anaryze€l lor each sample (from table on p. 3).
4 Appropnale analysis methods lor contaminant compound(s) in each sample (hom table on p. 3).
Aoproximate depth to groundwater in the vicinity of the tanks: 6ienter tur 6Bet.
Flegional groundwater flow direction
State Certified Laboratory to be AMERTCAN WEST ANALYTTCAL BORATORTES
Address 463 I{EST 3600 SOUTH C SALT LAKE CTTY stateuTAH zig 84115
Contact person ELONA HAYWARD Phone r 801 I 263-8685
Piease explain any unusual or extenuating circumstances expected regarding the site ment or closure
I certify under penalty of law that I am the of the tank(s) referenced and that I am familiar with
the information on this form a it is true,that the procedures described
herein will be followed dur
5elcry'.lrE backfili/natvs soii in!E,'lac€;.
Signature of tank olvner
Full Name of tank owner
5
Sample #Substance
stored in
tank
Sample
UPet
Depth2 ComooundsgTtr rt'1 f\BE
f<T< Y N
Analy sis method(s)'
g o)Dl-Es d AsoLtr.SoJ I 9',3 ")lrl s
2*ss CAgcLi.r e t-1r ll lt\r
J-s5 l^4 1 lt\r ltu
''l - ss II t,,t\1l al
s-ss lt t/,l tlIr ltlt
A-sg tt tt tt 4 lr rl l1
u5C CSS r)
I 1r 3f tlIr
uso- a (5)tl{1.\4/It1,I\
I
nkc re.
and complete, and further,
oate /?-t6-7f
a
s/e
ROBERT AND DONNA OWEN
P O BOX ]-400, HIGHWAY L2
BOULDER UT 847T6
//fr
fl a4
tt^S
Cb
Re: December 22,1998 upgrade deadline for Underground Storage Tanks
Division of Environmental Response and Remediation (DERR) records show you have one or
(USTs) which have not met the December 22, 1998 UST upgrade requirements. These tanks
HOLLOWS SERVICE, P O BOX 1400;; HIGHWAY 12, Boulder, facility ID# 6000286'
Under Federal regulations issued in 1988, UST owners and operators have until December 22, 1
permanently close USTs that do not meet the requirements for protection against spills,
This deadtine will not be extended. If your tanks are not in compliance by the deadline,
deliveries of fuel.
The DERR encourages owners and operators to meet the 1998 upgrade requirements as soon as
1998 deadline. It can take several months to upgrade, close or replace an UST system. Delays
may not be available if you wait. Start planning now!
Our information shows these requirements have not yet been met:
Tank ID Substance Tank Capacity Spill Protection Overfill Protection
I Gasoline l04l No No
2 Gasoline 2000 No No
Any metal flex connectors connected to fiberglass reinforced plastic (FRP) piping at the
cathodically protected or taken out of contact with the soil.
USTs filled by transfers of less than 25 gallons at a time (usually used oil tanks) are not required
prevention requirements as part of the upgrade requirement.
If you have questions about which requirements you still need to meet, or would like to have
your needs, please call Alan Jones at (801) 536-41 15.
No
No
March 17, 1998
underground storage tanks
At HILLS AND
8 to upgrade, replace, or
and corrosion
will not be able to receive
before the December 22,
not unusual, and contractors
Protection
pump or dispenser must be
meet the spill and overfill
visit your site to help assess
Dept. of water quality
Cedar City,Ut
Dear Mark Bertleson;
Hi. Here are the three months figures for you. Hope
order. I will be gone till after the new year, if you need to
great Holiday season.
Sincerely,
Donna Owen
6ooo Lrb
& Hollours
1M9
u1.84716
1 5,1 997
find them in
to me.Have a
J;t^
t)
#/u*ieag4y'
t/5
488
98.9
51.4
I
1 78.9 i 180i
82.6
-Aut /7?7Plob#
D rJu 73ry
c D F
19i6
6/
575
489
6/8 393
6/2day tota!
6/11 17
s96
529
6119 21e
753
65_7_
6/2 6 7
38.9 680
69.4
169.6 3s9
129.9 ?29
11 17
51 7
99.4
7
654
7
5_r 1
383 i
I
289i
?49....------.--.------t
?2.1/8
18.75
17.5
70 30.25
28.75
17.5
I.5
28
2
5
19.3/8
390
342
9
1 0.51
81 707
6.1/886
56/12
6_113
6/14
71e
678
709
2911
I
-1
A B E
:
G H
1 DATE strt stk gals. gals. delvrd tl. gals. pmpd stk.book invntry end r
2 6/1 162197/8?93 1131
3 6/2 161 6s.6703 798 33
4 793 726130.3/86/3 67.1 3
9?!s,
-5
in. endstk.
1
723
793
5
I
6s7 i r0
6
28
66.2 591 25.1/B
6/4
6/s
76.2 647723
657 -16575
7 489 1
I 39 3
9 3s9 17
r0
11
12
13
-4't76
-5
719,,IZ
81 i
t4 -3678 i
t5 609 ?5.7/8 -12s96
5571655625.5 1
529 121751723.s
3s9 *018
19 12..25 219 -10
20 809 -8
21 -4753 l
?2 6/21 657 3
23 600 36/??
529 18246/23
75 6/?4 2day total
26 /t
27
28 6/27 571 -3
-10
-1
571
493
29 383 *0
30 383 36/29
31 6/30 297
32
33
6/?8 493
2465.2t?4+130= 1
13.3/8 248
-9
-1
87
6/7
3s9
90.s
6/15 39.9
6/16 557 40.5
6/17
6/18 3s9
0.5 33.5/8
6/20 809
60
600 88.s
s29 304 94 739 30.5 726
144.6 581 25
8't -4 490 22.2s
110
93.6
47.8
water=no rx
uilL€a&L&l rtL &/":\q
Dc FABE G H
35
36
37
38
39
-4
4
6
7
-6
40 393 -4
41 -16238
42 147 1
43 32',Z
44
45 604 -22
46 557 4
47 457 -7
48 407 1
49 317 1
-9
50 238 30
51
52 68s -38
53 657 I
54 -7543 I
55
56 258 -10
57 213
58 69
l_9
-9
59 s86
60
61
62
DATE strt stk ls. delwd tl.end
248 80 1
7/Z 158 700 13s.6 30.s
7/3 i 7 21
7/4 712 169.4 542 7
7/5 5 6 38.9 397 18.75
7/22?1
7/7 146 2
7/8
7/9
117.6i7t19
7 /11
606 1
50.5 53 24.5
7 /12
7 /13
1 21
s0.9 406 19.25
7111
7 /15
81.1 3261 161
108.8 ?08 13
t)
7119;2-$Y !e!d i
7 /17 2_38
685
6s8 172.7 723 ?9
37 648 28
657 107.1 24
275 268 13.7
258 194 12
2't3 13 7
69 598 79.4 s88 25.5
586 126.4 460
457 72.2
I
385 l 1
53
64 ?31 1
7
7 /?9
7 /31
0
386
284
106.4
52.9
'14.75
65
66
67 water no ?7+13O=157no
-2
457 17
1
4284
23
-25
\
;tk. in. endstk. qals. dl
7/1 168 164
722 726
705 30 712
393 170.7
238 92.2
147 117.3 30
2dav total
138 626
604
557 464
457
407
317
7 /18
7 /19 550
7 /21 3dav total:
7 /?2 -543
7 /23 64
7 /24 5.5
7 /25
7 /26 2dav total
7 /27 21
7/24 386
280
13 7
238 102.9 135 8.75 136 1
FABE G H
69
70
71
72
497
267
end
22.4.
z
st
51
5l
25.?
z-2:7
delvrd tl
1 1 7
DATE
8/1
8/?
8/3 507
579
1
125.1 t3
strt stk
73
10.37557.5l 1 93748/5 251
76997.2751678/
76
k. in. endstk.
-34571
760 22
10
--16_
-26
77
1147'-t I78
-1I
383 l79
80
81
82
83
703 6?.4 1.75
698 238 460 ?1.5
471 384 18.5
8/11 total l
8/1 ??8 1?.7 /8
8/13 total
8/14 705 214.9 725 30
8/15 712 75.2 637 27
8/16 628 11 2.8 1 23.25
8/1 7 tota!
8/18 21 1 8 1 ,,8 r6
8/19 331 104.6 13
8/?O 238 72.2 35.5
/?1 857 46 811
8/2?806 111 5
8/23 total
8/?4 698 150.5 23.7s
8/25 s36 80.4 4 ?1
6 total
8/27 457 i .."..... ,'!.97-'6 2q9)
1
l8_81
I
6s5 i
15
/?8 291 102.6 't1
8/?9 1 54 5 .?8
23.s1?7.7 s29
84
-13
?3 7
5
7,1?
6?8t -9
s21i85
86
331 i -987
88
89
90
91
1?
-1?s36
5
238
857
B0q
6_98
92
93
4571 194
95
:
2911 796
97
98
99
.Z
0
*0
?
1 7 .5361158.4 i100
. -1\ItLD101
8/30 657
392_3.,! i ..
l^
8131 529
rufi.r 1*.u.
694 60s
507
3s6 392 36
251392
167
98 ?9
738a/7 98
8/8 ?
8/9
86.s8/10
154.8383
?3s
340
226
-6863698
33.s
-469529.s
548
188
55777.5
*s29
359
<t"t t l i(n
A B E G H.
I
?
3
4
5
5
7
DATE start stick ls m
1
2
1
. deliwd tl k.bookst den
'l ?.
128.5
41.1/8
1 206 36.s/8
25.1/8
30.5
6/2
6/6
6/3
6/5
6/4
?92
8s8
1 362
1187
156.2
2?2.6
98
964
734
943 i 845i28.3/8
8 6/7 731 142.1 s89 21.3/8
I 152.1 435 17.5
10
6/8 587
6/9
19
13
11
_8_5_8
731
587
1l
12 52
13 1 309
-2
-17
14 1201 I 7
15 1
8s8
-7
216
606:217
392 ?18
19
20
21
22
23
24
25
1 380
't7
248.7
1107
1
3
11
606
39?
,|
1
1
1326
10.5 1
604 21.7/8
1 106
42 2
1 5 11 ?
254.2
215.6
248
z8?.9
2?4
147
54
1 194
1 029
4
39.75
37
390
't44
16
8.2s
6/?5
6/24
6/23
6/?Z
21
140
79.2
3.4
873
427
245
6/16 )
6/'.t7
6/19
6/18
298.3
167.3
104.3
171.5
r 06.3
115.1
166
6/10
6111
6112
6113
6/14
6/15
1
1
?6
27
-1
1
0
-1
z1
7
6
873 *
427
151
1122
245
165
28
s96 -229
445 ?330
308 131
32
33
34
35
36
71
138.1
s082.1
50+1 30=rwater n
1 28
42?s96
127.9
6 1'122
174.4
27
1
6/30
24.7/8
?1.5/8
17
13
844
721
6/2-7
6/29
6/?9
37
38
41
39
40
41
,20
c
Bol llYl borrlpr, L* 9q7lb 'ff .r:r- B r?
+I oN
D
q-,
F
in. endstk. qals. dail
6/1 392 101.7 13 292 2
1362 -4
1 187
943
1
2
-21
445 10
445
158
5?
32.s
8s6 28.3/B1023
8s8
35
873 28.75??
445 17
8.75
35 112?-10
944 -7
-57?.1
s98
307445
180 no
FABE G H
4?
43
44
DATE start stick gals. deliwd tl. gals. pumpd stk.book invntry end stk.
1 238
'''''i - "'- " """'- """'1""" "" ""-""" " - i
159
7/?158
7/1 308 159.2
146.8 1 255: 37.375:
45
46
47
48
49
50
51
52
53
54
1 5
9.5
7 /10
160
1 ,4
1 048
27
1 7.2
7/3
7/4
7
7/
7/7
7/8
7 /11
7 /12
1 2081
1 063
7
268.7 794
33.s
26.5
?1
186
354
1
46
?48.2
2 33s
140
106
248.8
1 381
1 003
4
983 i
575
1
21.5
27
7/9
55 7 /13 591 170.1 421 16.7 /8
7 /14 42356
57 7 /15 230
I
7l 221
14
58 7 /16
59 7 /17 84 1 283 127.9 1239 37
60
61
62
63
64
65
66
67
68
69
70
138
8
6
tn.
1
8?4
84
883
I
3
7
?2
54
186
554
591
423
2
7
677
2
15
-5
z3_o_
60
903
71
72
73
74
75
76
77
126
78
79
80
8r
82
7 /18 't201 169.8 1 031 33
7/19,1063i 173.5 889
7
7 /21
7 /?2 BB3 489 394i 'l
7 /23 392 176.8 215 11
7 /24 230 155.4 75 4.3/8
7/2 1 227 896
7 /?6 903 219.2 684
677 144.8 532
7/! 5!,
7/?11 7 ?7
7 /30 276 206.1 70 4 .7 /8
5073.2
water no 50+!.301
8.5 158 -1
1?O8 -47
1 063 15
784
s90 591
-10
1
r9
80
-2
32 20
7
11
81 5.5
1 201 -38
1 063
29
3?
-6
392
60 29.5
?3.7s
20.s
554 402 16 392 -4
392 12.5 276 3
70 *0
180 no
*a
FABE G H
83
84
85
86
87
88
B9
90
328
1243
710 24.5918
1
2 1
8/1
8/9
8/?
8/8
8/3
8/7
8/6
4
8/5
579 ?1 .1/8
DATE start stick
99s ?93.7
224.4
154.8
107.6
r 50.2
181.3|
?7
606
308
463
70
745
5
15?1
371
stk.book
771
3s9
delivrd tl
91
92
27
1
5
706
648
9-
?6
-22
14
1093
94
263 -895
95
1236 -1897
9s3 -498
755 1099
100
67.8 638
12.?648 377.1
1 258
174 10.5
?3706
't
1
1172
8/15 t
8/16
2 7.2i
1
404.5
8/10
8/11
8/12
/13
8/14
8/17
8/18l
8/19
37 .7 /8
25.75
30.75957
745
755
324
1 259
857
10328/21
8/?5
8/??
8/?4
3
336 | 1 5.3/B
197
844
371
225.1
"t39.7
169.9
3_sq
162
278.9
207.8
101
102
r03
104
105
106
107
108
109 8/26
1r0
111
-26
-87
371
21
-?o
35
18
1 043
324
1172
186
50
-13
-25
10284
112
7451 14113
I t 4
I1 5
r16
-28
117
25.s
5487.7
54+1 30=
460
1997
1
4
184 nc,
?74
215
1?.75
17
/28
205.3
218.?
170.7445
?849129
_8_13_q
8/31
812_7
in. endstk. oals. dai
2s.-5 745 -76
s26
16 3s9 -12
606
455 463
308
1272 38.2s
208.3
270
263
1236
9s3
't4
249.5
36.25186
34 1 082
28 8441 082
508.4
445
33
312.11 043
water lin
Michael O. travitt
Govanor
Dianne R. Nielson, Ph.D.
Executive DiElor
Kent P. Gray
Diretor
DEPARTMENT OF ENVIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAL RESPONSE AND
88 E. Fiddlers Canyon Rd. Suite H
Cedar City, UT 84720
(801) s86-2437
[phone] Fax
(80r) 5364414 T.D.D.
DATE: 10116197TO:Donna Owen
P.O. Box 1400
Boulder, UT 84716
FROM:
RE: NON-COMPLIANCE OF UNDERGROT]ND STORAGE TANKS AT
SERVICE, BOULDER, UTAH; FACILITY ID# 6000286.
To continue to maintain a valid Certificate of Compliance, the facility
with Federal and State Rules and Regulations. An inspection of your
our records has shown that the following information is lacking:
tA] Submit a copy of a precision tank tightness test, performed
tanks 1. and 2 .
tBl Submit evidence that proper Inventory Control is performed
documenting that inventory records are reconciled monthly
overage or shortage for each UST, and the variance is compared
gallons plus one percent of the UST's monthly throughput.
The above information shouldt be submitted to this office by lll5l98.
concerning this matter or need any assistance, please contact Mark
2437.
AND HOLLOWS
be in compliance
and a review of
the last year, for
USTs 1. and 2- bv
determine the total
the allowable of 130
If you have questions
at (801)586-
"["
Zip Cod.
Phonc #
Nrmh.r 6l rrnk. .r h.ilirwl
0
Por
0
*c
City
\l
tff*-YWqAroa Cod6
Ownor
Add1688
OV
fiu5i locrtloi -Complilnca on sit.C6nifi crto ot
F.cility Nrms
Stao6t
City zip
No
.4
TehI lisied 6n Carrificrre ol Comolirn..dN^r;)Yes No
Tank or6s6ntlv in us6 ->lG -/ No
ll nor in u!e. det6 lrit used
lf n61 in uc6. d6olh of Droducl in trhk lin inchesl
Month rnd v.er tenk instrllad 7/n 7.,4
Cao.citv of trnk {in oellon8}7./r 'z-,/,
Su&ranc. srored €^) t 6-) r
Metedal of construction ot tenk Istael. FRP. erc.l /rZ--t i.L,z
Mrt.rirl of .on.t8 rction .f ninihd l.r..l FRP ar. I )z--/r2.-/
Emaaoencv Genorelor tenk ll6ek detection dslerredl
t:ltl ffit ffik.%,iiifltl'i{ffili
lnvantoru Control/Tank Tiohtn€ss Tostino v
Autometic Tenk Geuoino 7
Manual Tenk Gauoino
Vrooi Monito.ind
Groundwater Monitorino
lnrei itiel Monitorino
Sletisticel lnventorv Reconcilietion lSlRl
Autom.tic Line Leek Detsctor
iiiff ,iiiiiiiiiiittriHi.{ar:A
ii:n
gi ffi l:::.:..:: i:r :r : ..::r:.::r :iI
.Ujji::::J-i.-iii;Iff *,!t+Ii{iirj:tli
Lin6 Tiohtness T€stino j.-/
Valar Monitorinq
Groundwet€r Monitorino
lntorstitial Monitorino
Slelisticel lnventorv R6concilirtion lSlRl
Signaturo of Own6r oa Owngr's Roprosantativg Prosont During lnspection
certify
Com
olnap€ctor's Signaturs
I hsvo in6poct6d th6 .bovs-nsm6d fecility
Diltribution: Whit6-DEnR, Y p6ctor, Plnk-F.cility/Owncr
$
,.hr#tifit*l
i;J;
9i^i^^ rw^a l^i....r,a ."^ri^^ ^,rvitu -r-I icn/r-1
Oth., rn^,^vr.i m.rh^.i lih,ii^.ra ^.m- ^l h.rh^.lr
Other rnnrdva.l math6.l li^.1i..1. ..m. ^I maih^.lt
I
This method of leak detection requires bolh monthly inventory control reconciliation and tank tightness testing. It
(upgraded means that the tank and piping are protected from corrosion and that spill and overfill prevention
to be tightness tested annually. l, the UST is upgraded the tank neods to be tested every five years. lnventory
day.
' UST has not been upgraded
have been installed) the tank needs
must be kept for each operating
Record of last Tank Tightness Test available on-site No@ i6)\o Yes No Yes No
Date ol last Tank Tightness Test )-, )z /.q/l--//srt fl
Result ol last Tank Tightness Test. lf fail, specify in comments section what
actions have been taken to correct the problem. Has DERR been notified?(
Fail@ d :ail Pass Fail Pass Fail
Tank Tightness Testing m€thod
Namo and company of tank tightness tester:Utah Tester )ertification Number: Ut O/ (6
Documentation of performance claims for the Tank Tightness Test method is available and shows tho ability to
with 95% or greater probability of detection and 5ol" or less probability ol lalse alarm (3rd party certificatlon)
lnventory volume mgasurements for regulated substance inputs, withdrawals,
and the amount still remaining in the tank are recorded each operating day @ No-
leaks ol 0.1 gph
No Yes No
qD
Yes No
No
lnventory is reconciled monthly (sum of daily overages and shortages for each
month is less than 1% of tank's flow through volume + 130 gallons) 1t !' i.. ,'- 4
Yes {)Yes 'y/Yes No Yes No
ll no, which months were not? (specify month and year)o-x /y .71,./7 /74 ,r l),b
lnventory Control records are maintained and available for the past 12 months
for each tank
(/Yes Yes (@ Yes No Yes No
Records include monthly water monitoring to the nearest 1/8'No6s 6)No Yes No Yes No
Monthly water readings are used to adiust monthly inventory balances 6,2 *o @ No Yes No Yes No
Appropriate calibration chart is used for converting product level msasurement to
gallons and is available lor review
No @ \
Yes No Yes No
.NJDispenser pump has a current calibration sticker or appropriate documontation Yes Qr"(
Yes Yes No Yes No
Yes NoE;ffi,, -"\
,4'I
-+(,2"/
The drop tube in the fill pipe extends to within one foot of tank
Owner/operator can explain inventory control methods and figures recorded
Yes YesuottorJu a\
XJ
iiiiiili...::i:iiii
No
Yes No
Books appear used and evidence of recent entries is apparent G No
Owner can demonstrato acceptable gauging techniques 6S No
The gauge stick is long enough to reach the bottom of the tank 64 No
The ends of the gauge stick are flat and nol wom down re,\No
The gauge stick is marked legibly and the product level can be determined to the nearest 1/8 ol an inch over
range of the tank's intemal height
Signature of Owner or Owne/s Representative Present During
Comments:
lnspector's Signatu 1
tu[No
Distribution: White-DERR,Pink-Facility/Owner
ilank,
UTAI{ UST.:PBOGHAffi
1fe$ln$,.,An,fr
riff more lhan,f r::tank$r:
TAN K. T lGllTN ESS.f E€Tl NG Tanlc,tr Tanl( l Tank't Tent 4
INVENTORY CONTEOL Tanft::l Ttnt.,atil(i:$iiiiiliiili:rahkiil,
@
F-tease.CitCie,.Yes or No.tor eUCh questlon r/#J
o
Set I Tr* I Tllil 2 Tr.* 3 T.r* 4
Automatic Flow R6strictor lit yo!, indicrle modol in commonts s6ctionl
Automstic Shut-off D6vic6 {il y6s, indicato modrl in commoms soction) }
Continuou5 Ala,m Syst€m (if vo6, indicsto modrl in comm€nt8 3octionl
Yo8 NoRocodr o, hst Lino Lcak Dotoctor p€rformancs tast lro lvrilablo on-8itg Yes No Yo3 No Y6s No
Drt6 of last Line L6ak Ootoclor peatorm6nc6 t66t
Pels F.ilRgsuh of last Lina L6ak Dotootor psrformlnce to6t Praa :ail Pars Fail P.ss FEil
Set 2
Rocords of last Lino Tightn6s6 T6st are avail.blo on-8ito Yo6 No Y66 No Ycs No Ys8 No
Dato ot la6t LinE Tightnoss T66t
Rslutt of l66t Lin6 Ti0htno66 Tost Pa.s Fail Pasr :ail Psrs Flil P.s6 Fail
Nam6 and company ot cgrtifiod lo6l6ri tJtah T68t6r Conification Numbsi: UT
V.por Monitoring (if yo8, uso Vepor Monitoring ch6cklisl)
Groundwltor Monito.ing (if yos. uso Groundw.tor Monitoring chocklist)
lnlorstitial Monitoring {if yos, uso lnt6r6titi.l Monhoring chocklist)
Statistical lhvontory Rsconciliation [SlR] {it ye6, us6 SIR chocklist)
Othor rDprovod m6rhod (if y68, uso othsr mothod chocklistl
R6cord6 of last Lino Tightngas Tsst are availablo on-6ito G>No n)No Y6s No
Date of lasl Line Tightn66s T6st ?At/rl f/ar./,z$
Rosult of last Lino TightnoEs Tsst /6/),,,//'"e Fail Pass Fail Pas6 Fail
vEpor Moniroring (if yes, us6 Vapor Monitoring checklistl
Groundwater Monitoring (if y6s, use Groundwater Monitoring checklistl
lnterstitial Monitoring (il yos. us6 lntorGlitial Monitoring ch6cklist)
Stalistical lnventory Reconciliation ISIRI {if ye6, uso SIR checklistl
Oihor .pp,ovod mothod (if yos, uso othor mothod chocklist)
Oporat66 at lo6s than atmo6ph6dc pr666ure
aldiliiai: !, :',::.: ..::.. : .,
Y6s No Yoa No Y66 NoY6s
i.ffi!!r:F
iiil,iirii.i:a,i:l.,:iii [ffi
No
Slop6 o, piping will allow ALL product to dr.in into tank whon auqtion ia
roloaEod
Y66 No Y€s No Y68 No Y6s No
HaB only Ot{E chock v6lv6, locatod dir€ctly undor pump Yes No Y€B No Yos No
All abov6 information on suction piping is VERIFIABLE, use commonts
section below to document how it is v6rifisble.
Yo6 No Yes No Yo6 No Yes No
Signaturo oI Ownor or Ownoa's Raprsssntativ€ Prssent During lnsp6ction
Comments
lnsp6ctor's Signalure
IIII
l.tJrri
Oistribuiion: Whits-DERR, Y , Pink-Fscility/Own€.
Y66 No
Tank 1 Tan!l Tank 3 Tank 4
The UST system is lilled by transfers ol 25 gallons or less. lf yes, splll
and overfill prevention is not required.Yes rq ves (tgt Yes No Yes No
ls there a spill containment bucket or another device that wlll provent
release of producl into ths environment?Yes 4A Yes Yes No Yes No
ls there an overfill prevention device installed on lhe tank? ll yes, indicate
the type ol device: Ball lloat (in vent llne), Aulomatic shutoff (ln flll plpe),
Alarm, or Other (specify)
Yes Yes Y Yes No Yes No
For overllll 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 overllll alarm 6nly: ls the alarm cleady marked to indicate what is
meant when the alarm sounds?Yes No Yes No Yes No Yes No
Tank't fank2 Tank 3 Tank 4
/rP r4r Tek Tsk
/3"iryl Piphg Pphg
ffin ;rtr Sub-PurrT Sub.Putrplndicate the type of corrosion protection on Flex connectors and/or Swing
ioints: Booted (B), Total containment (TC), Not in conlact with soil or water
(NC), Cathodically protected (CP), Non-metalllc (NM) and Not Protected
(NP)ffi',WI Dkpser Ol!ps&r
Ygs r"nk No Yes r"nk No Yes r'nk No
Yes P'pne No Yes Pp'ng No Yes Pipns No Yes PiPnc No
The results of the last two cathodic protoction tests are availabl€. (within
6 months ot inslallation and every 3 years thereatter).Yes No Yes No Yes No Yes No
volts volts volts volts
volts volts volts volts
Results of the mosl recent cathodic protection test.
Tank
Piping
Flex
Name of
Test
volts volts volls volts
For lmpressed curront 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 b6en retrofit (lined or cathodically protected), indicate the
dale the retrofit was completed.
lnspecto/s Date
items musl be completed by
lity m€els
7-
requirements.
(Corrosion protection lor tank(s)'
-{ Corrosion protection for pipinguflex assoc. with tank(s)*
7
(print nam)
4spill prevention forDecember 22, 1 998 in order to meet the 1998 upgrade requiremenls:
.p Overfrll prevention for tank(s)#
understand that the following
or Owne/s Presont Du
Oistribution: White-DERR,Rsvis€d 08/08197
a
UTAH UST PROGRAM
Spill, Overfitl, and Corrosion Protection Inspectio Ghecklist
Facility ID
Plsse corptele all lnlornat{on for ssti fenk , Usc addltlonal lorms a! n€sBssary lf the laclllty hae more th rn 4 tanlrs.
@(y
lndicate lhe type of corrosion protection: Non-metallic (NM), Composite
steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacrilicial Anode
(SA), or Not protected (NP).
Yes rtnk Nolf the UST ls not protected, was lhe tanupiping lnstalled betore May 7,
1 985? ll yes, corroslon protectlon ls not requlred untll Dec. 22, ,99E;
do not complete the remalnder of thls sectlon.
988UPGRADE
t ..\xJ{ AI4Q4-01I
()*rt*4-,"-tr Fac
]RAMINDERGROUNDSTORAGETA. iPRO
lorcle
Reason for: ADJUSTMENT GE.OFF
I^AA,,J
b
w l*")t
.0
b*+
Ad ustrnent Tra
b tfoo
-l/--
OWNER:t L\^-
n-
b
Form
Facirirv *, f,aootSl
Date:-LA 1+
otrRe-bill Yes
I
,-91 6x.-d d\9 +
r1_7-j
(t s tur
IIrri4
IIJ
-l
U
<lt lIJql zf
I&
o
tllI
U
l-ra
lJz
EtI
o
z
Fz ctEIl'..
li!'.'F--z:I!:.i
- -,-
c.-A.
I
.
,In Y ww
::
rlrr
rr I IIrrrrl rITr
tr Ir
IIrI
rI
Totol:
v.s.c-
T.EIADIST (REV 6/2,/9n
ADDRESS:
*l-
a-/neil!*{
I
.-_l
(httlrltih.r.aptaaltri't;.
2
I
Yt
FACITJTY ID#6c'oer a 8(
PETROLEUM STORAGE TANK
FINANCIAL RESPONSIBILITY DECLARATION
Complete one form for each facility
Return completed fonn by May l, 1997
ll,-FACILITY NAME
FACILITY ADDRESS
\
i)7 b }!
'D "J&.- 0u P7 ) 7 7
Check On One
N I
"hoo."
to continue to participate in the PST Trust Fund.
O Submit this Financial Responsibility Declaradon form by May l, 1997.
O Submit the Fiscal Year 1998 Facility Throughput Declaration (blue form) by May l, 1997.
O All tanks including aboveground storage tanks (ASTs) located at this facility may be required
to participate in the PST Trust Fund.
O Indicate number of ASTs, if any, located at this facility
E I
"hoor"
another Financial Assurance Responsibility Mechanism(s)
O Submit this Financial Responsibility Declaration form by May 1, 1997.
l)-3i- E
7
lD Indicate your Company's " Fiscal Year" ending date
--Dor,r*l ,r ?)(tt
,l
(&t 33;- 73.r /
Print name of owner/operator or
r-;Y.-::ff"L
Title Phone
1
DateilshrdrFt--
* SEND NO PAYMENT AT THIS TIME *
)
O By June 15, 1997, submit acceptable financial assurance documents and $1000 processing fee
per mechanism (Use the exact format required by federal regulation, 40 CFR Part 280,
Subpart H.).
. HILLS & HOLLOWS BOX 1449 BOULDER,UT.84716
UNLEADED PLUS TANK#1 RECONCILATION. 1996
(801)335-C ooolg k
A B C D E F G H
1 I stk qals.Dlv+/-
2 4251 -5
3 sbb i 3
4 't91
5
6
7
-10
4
-12529 i
621
7
8
I
r0
1l
12
13
14
15
16
17
1B
19
.B
461
B
2
2
3
I
415
439
33s
776
439
743
643
345
304
14
-6
20 664 -5
21 s96
?Z 564
23 514
-17
l._6_
-t
24
date del.start totalizer stk.in.
7/1 46 430 19.7
7/2 425
366
363 17.3/4
7/3 175 1 1 11.1
7/4 24.4 776
7/5 1 617 26.3/4
7/6 79.6 541 23.1/2
7/7 71.4 4 z1 1
7/30.1 431 20.3/B
7/9 104.?16.5/B
7 /10 335 39.2 296t 1 .1/2
7 /11 3 .2 774 3?.3/B
7 /12 776 35.4 741131 .1
7/1 743 92.2 651 27 .1/2
7 /14 7 435 ?o.3/B
7 /15 closed
7 2,3.2 416 19.1/?
7 1 7 4'l 5.6 349 17
7 /18 345 7 1 .1/2
7/1 453 304 87.9 669 zB.1/4
7 /20 664 5'1.4 613 25.7 /B
7 /21 s96 ?
7/?564 49 515 23
7 /23 464 2 I 1
7 /24 471 35-,-8-43 1/2
7 /25 443 35,2
s0.2
408 19.1/4
7 /26 539 407 896 37 .1/4
7 /27 898 90i .'t /4
7 /?B :799i 7?7 ,30.1/B
7 /?9 716 89.5 i 6261
61 5 i 26.5/87 /30 628 13.2i
7 /31 618 43 575 2 5,11.4
total mtr
1973.4
water no 19 +130 =149
471 7
25 443 B
26
?7
28
29
407i -1
2
-9799
7161 -1 1
898i
30
31
32
33
34
35
36
37
628 i 2
3
4
i
6t 8i
s79 i
t-'--'.-'--'
..--+--.-----.-----...-------.+-----------'
49j
\
' Hrlrs & HoLLOWS BOX 1449 BOULDER,UT .84716 [phone]
UNLEADED PLU$ TANK#1 RECONCILATION - 1996
A B c D E F G H
38 date del start totalizer stk. book end stk.in.end stk gals.DI
579 i 10s.2 474 21.5 471
8/2 471 54 417 19.3/B 411i--- - -- - ---:-----Q
118=3
814
8.1
8/6
411 B 65 18.1/B f 376'
471 376 78.1 769 31.1/2 7s3 l -16
1 1 27 4 6
8/7 650 139.1 511 23 514
B
8/9 514 18O.7 333 16.1/2 331
B/10 331 178.1 153 9.3/4 159
/"11 1 601 2 .1 /2 sB6
B/12
B/13 586 21 3 1 7 -4
B/14 376 58.5 317 16 317 0
B/15 317 80.4 237 12.3/4 2 -5
1 "t74.7 57 5 60
B/17
B/18 Q0s_60 65.6 26 600
B/19 600 73.6 i s26 14 -12
B/ZA 514 75.8 438 ?o.1/z 443 5
I
2
8/21 4431 54.8 i 3BB 19.1 /4 r 407
1?2 407 101.21 306 15.1 /2 304
B/23 304 45.1 259 13.1 /4 245
B/?4 2 4 4
8/?5 ?o4 s4.6 i 149 9.1/2
8/26 153 131.5 2.1 3 28
B/_27
B/28
507 4 4 449)
449 77.5 371 1B 372
B/29 372_5s.3 317 16 17
0 317
207
1 14.3 ?o3 11.3/4 247
B/31 407 1 22 -2
total del 9982
2s90
water:trace 26 .+130=156 tlo -39
2A2i1',t.s/8 204
1s3
39
4A
41
42
43
44
45
47
4B
49
50
51
52
53
54
55
56
57
5B
59
60
61
62
63
64
65
67
6B
69
70
71
72
73
-1
out
.*1o/o
46
66
\. HILIS & HOLLOWS BOX 1449 BOULDER,UT.84716
UNLEADED PLUS TANK#1 RECONCILATION - 1996
[phone]
A B c D E F G H
74 date del start stk. book end stk.in.stk
9/1 s03 136.7 366 1B
372 319 16 , _3_:17 . 12.
17 156.2 1 10 164
't64 59.4 755 31.3/8 7
750 713 30 712 4
712
9/8 tt tt rt
9/9
1
9/11 712 99 612
533
26,1/?
23.5/B
614 2
614 .?525 B
s04 5 64-2 1 3
9/14
9/15
19O.Zl 3 793 5
793 111.4 6BZ 28.1/B 660 -?2
9/16
9/17
660 i B ,4 575 25 571
471
-4
71 101.3 470 21 .1/Z
/1 471 |437 20./2 6
9/19 443:
372i
80.2 3 18i 372
9/20 63.4 309 15.3/4 311 2
9/21 311 i 597 /8 B9 -8
9/22 39.4 549 23.7 /B s39 -10
9/23 s39 119.7 419 429 10
9/?4 429 70.2 gsgir7.l/?3s9
232
0
912s
e156
9/27
1?7.7 231 12.3/4 1
232 73.9 158 10 lE4
28
6
140.1 24 4
/2 s02 28 1 381 | 18./2 5
9/29 286 141.9 z44l 13 238 -6
9/30 81.5 1 6 164
total del 25r 8.3
2194 *
rwater NO 25 .+130=155 l{o
75
76
77
78
79
BO
81
B2
83
84
85
86
87
8B
89
90
91
93
94
95
96
97
9B
99
100
101
102
103
104
105
106
107
108
9/13
92
537 I
20:
I
HILLS & HOLLOWS BOX 1449 BOULDER,UT.84716
UNLEADED REG. TANK#2 RECONCILATION - 1996
(801)335-734s
A B C D E F G H
1 date del.start stk. book end stk.in.end +/-
7/1 427 153.1 274 12.3/4 284 10
7/2 ?84 1 193 11
7/3 193 112.4 73 -8
7/4 1 '1167 -19
7/5 1167 306.8 3
7/6 863 19 14i 972i
1,3 i t?7_i
z3:'t /5
17.3/8
668 -4
7/7 440 3
7/8 440 211 ?29 11 11
7/9 230 124.8 6.1/4 10r -4
7 /10 545 101 1 51.6 494 18.1/Z 4Bl -1
7 /11 11 1 4 14-5!43,1/8.1 7 -14
7 /1?1437 1r0.3 1327 40.3/8 1 333 6
7 /13 133 7 1 096 34,318 1 097 1
7 /14 1 286 811 27 804 7
7 /15 closed
7 /16 41.2 663 23 ,318
.3/8
663 0
7 /17 663 143.6 519 19 s22i 3
7 /18 522 230 g2 12.7 /8 2BB1
111?1
-4
7|1e
7 /20
1153 288 31.11 34.3/4 -1
1112-16?3s0 343/4 9s3
i
819 i933136.4 817 7 /4
7 /22 B1 203.3 616 22.1/8 615
i
37917 /23 615 232.8 382 1 s/8
7 /?4 379 :!-3-0i
182.6 i
249 11 .1/?24 -4
7 /?5 ?45
67
62 4.1/2 62 0
7 /26 1 1?3.1 1342 40.1/2 1323 1
7 /27 1323 1 1191i36 4 11 1
7 /?B 1 129.8 1062 i 33.1 r 063 1
7 /29 1 063 205.6 857 ?8.3/B 8sB 1
7/30 i B 675 23 677 i
7/3 1i 677 't7 22,3/B 625ii 7
554 1l 19149 4970.8 200?4
9941.6
water NO *.A1Vo 99 .+130=229 t()-48
2
3
4
5
6
7
I
I
10
11
12
13
14
15
r6
17
18
19
21
2?
23
24
25
26
?7
2B
29
30
3r
32
33
34
35
36
37
38
20
182.9i' "-'-'-" i
E_9_,0 i
i
205671
1
-1
'a
HTLLS & HOLLOWS BOX 1449 BOULDER,UT .84716 [phone]
UNLEADED REG. TANK#2 RECONCILATION. 1996
A B C D E F G H
39 date del.lend stk.in.end stk
8/1 625 165.1 460 17.1/4 43
B/?2 230
155.9 6 95
B/4 1 208 95i 47.5 1 1B 1241
B/5 1241 19 1 1 043 32.7 /8 1 038
B/7 1 038 412.3 625 22.3/4
B/B
639 445.4 194 9.5/8
B/10 189 1 1 4.1/2
8/11
8112
B/13
1341 2 214.1 1 193 36.3/B
1',t77 818 27.'t /2
B/14 142,6 681 24 687
8/r 5 687 101 .4 sB6 21_1/8 577
1 577 1 448 17.1/?445
8/17 265.2 180 9.3/193
193 1 39 1
B/19 224.1 1 056 33.1 058
8/20 1 058 175.6 ?9 883
21 -8-83 ?21 667 ?3 3/4
B/22 677 144.4 s33 1 s26
B/23 526 156.2 3 70 5 3/B 371
?4 371 12 1 244 1 1 .1/2 74
8/?5 144.9 !00 6 95
B/26 95 17 7
10"7
B6
5.1/4 7
8/27 i 070 1s0"8 3 1 068
r 068 1 I 28.5/B B
B/29 868 155.6 712 24.3/4 716
716 142.3 74 21.1/B 577
B/31 77 ?16.1 50s ?2.5_/B 503
5661 1 6900 5281.4 1 16778
5Z +1 30=182 I\D
Dlv+/-
40 -24
0
?.1
41
42
43 -14
44 5
45
46 14
-5
5_
-16
13
47
48
49
50
51
52
53
54
55
56
57
58 2
59 6
1560
6l -7
6Z 1
63 I
64 -5
55 0
66 -10
67 1
68 4
69 3
70 -6
71
72
.+4
73
74
stkgals., 1 lgtqli4qt gd9.l9!k boo!
i 230i
-3
9,3/4
24si
*
za3 i
a'
HILLS & HOLLOWS BOX 1449 BOULDER,UT .84716
UNLEADED REG. TANK#2 RECONCILATION - 1996
[phone]
1
A B c D E Flc H
75 date del.start stk.totalizer stk.book gxd stk.in.end stk
9/1 1058 164.4 894 291/4 893 -1
9/2 893 18r.6 711 24.1/2 706 -5
9/3
/4 71 304.4 402 16.1/2 409 7
9/5 1 289 409 99.4 1 599 47,11!1 7 -1
9/1 1 7 1 401 !2:1/4 1 405 -4
9/7 1 405 160.1 1?45 37 .7 /8 1 236 -9
9/8 1236 329.906 293/4 1 7
9/9 913 193.4 724 4 716 4
9/1A 71 z 477 1/?_481 4
/11 481 200.7 280 1?..3/4 4
9/12 284 152.6 131 27.7 s/8 i.----' --_-_-"_'_ _ _ _ -1__
135 4
9/13 144 1 108.5 1 459 44.1/4 1 479 1 0
9/14 1479 132.6 1346140.1 12 1 B
9/15 1 338 137.8 1lBB 36.5/B 1187 1
6 11 207.6 878 1 003
9/17 1 003 32s.8 677 23.1/2 j I
9/18 668 224 444 17 .1/2 1
9/19 445 187 2 7 12 260 3
9/?A 69 si 73 4
9121 1 406 73 91.8i 1387 i41 .1 1 1
9/22 1 144.9 1231 37.1/4 12.1't
9/23 1211 261.9 949 3 14
9/24 2 727 24 716 1 1
5 71 55O120.1/2 554 4
9/?6 554 175.2 379 3/4 383 4
9/27 383 298.7 5
9/28 1 857 28 844 3
9/29 844 171.7 672 23.7/B 582 10
9/30 1 7 5tt 20.1/B 540 -4
total+/-
1 4 22474
water no 56 +1 30=186 t{o -5
76
77
78
79
80
81
82
83
84
B5
86
87
88
89
90
91
92
93
94
9s
96
97
9B
99
100
101
102
103
104
105
105
107
r08
109
110
111
190.6 i
22s76i-'.-' --,---,--..i'
r 66.1 i
Srage of iitah
Michael O. l-eavitt
Govemor
Danne R. Melson, Ph.D.
Exrcutive Director
IGnt P. Gray
Director
DEPARTMENT OF ENI/IRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West lst Floor
Salt Ilke City, Utah Mll6
(80r) s36-4100
[phone] Fax
[phone] T.D.D.
TO:
RE: NON-COMPLIANCE OF UNDERGROUND STORAGE TAhIKS AT HILLS AND HOLLOW
SERVICE, BOIJLDER, UTAH; FACILITY ID# 6000286.
To continue to maintain a valid Certificate of Compliance, the facility must be in compliance with Federal
and State Rules and Regulations. An inspection of your facility and a review of our records has shown that
the following information is lacking:
tA ] Submit a copy of a precision line tightness test, performed within the last three years, for the lines
associated with tanks_l an$ L .
tBI Submit a copy of a precision tank tightness test, completed within the last three years, for tanks
I, and2 ..
tcl Submit evidence that proper Inventory Control is performed on USTs,l a!g!_L , by;
(l) Documenting that the liquid volume in the USTs is measured, each operating day, to
within one-eighth inch, including measurement before and after each deliyery, and
reconciled to daily withdrawals.
(2) Documenting that inventory records are reconciled monthly to determine the total overage
or shortage for each UST, and the variance is compared to the allowable of 130 gallons
plus one percent of the UST's monthly throughput.
(3) Documenting that the water in each UST is measured to within one-eighth inch, at least
once per month, and the water measurements, converted to gallons, are used to corre0 the
monthly inventory reconciliations.
The above information must be submitted to this offlrce by lll5l97. If it is not received by the date
specified, we will commence the revocation proces of your Certificate of Compliance. If you have
questions concerning this matter or need any assistance, please contact Mark Bertelson at [phone].
Robert and Donna Owen
Hills and Hollows Service
P.O. Box 1400
Boulder, UT 84716
DATE: gll6tg6
FROM: Mark Bertelson
Printed on recycled paper
Number of tanks at facilitv:
3N/be
Person At UST Location Phone #3.f^)lode
Area Code
State -a/!yn"
Facility
-1-a 7/*)" 'v-
Certificate of Compliance on site?
County
,V,,
Tank listed on Certificate of Comoliance Yes No
Yes No NoYes Yes NoTank oresentlv in use
lf not in use. date last used
lI not in use. deoth of oroduct in tank (in inches)
7,/ro t/nMonth and vear tank installed
//-*/<-Caoacitv of tank fin qallons)
c)t ro/n,d! +Substance stored
/a-/'r/o / '/lilaterial of construction of tank (steel. FRP. etc.)ia-/'r-/2e-/
Material of construction of oioino (steel. FRP, etc.)
J,
Emeroencv Generator tank (leak detection delened)
{rlnventorv Control/Tank Tiohtness Testinq
IAutomatic Tank Gauqinq
Manual Tank Gauoino
Vaoor Monitorino
Groundwater Monitorino
lnterstitial Monilorino
Statistical lnventorv Reconciliation (SlR)
Automatic Line Leak Detector
V ,(Line Tiohtness Testino \\Vaoor Monitorino
Groundwater Monitorinq
lnterstitial Monitorino
Statistical lnventorv Reconciliation (SlR)
the above-named facility on
dsy, yur, tme)
l/Comments
certity
Signature ol Owner or Owne/s Representative Present During lnspection:,
lnspecto/s Signatu
Distribution: White-DEBR, Yellow-lnspector,
ReEeS "BetEctidffiifi sF6dtffi : checki ist'i',,*r.d-#,ffiH]ffi recilry
l:l;',,.,OHn iChiP:',61 16' X1 1 lll] tffitloilj6t,,t k(#)
Vac Nn
Yes Nn
J, t-r/Pinin.t tune [nressrrre. suction. oravifu- etc-)
rv Hataacd':nb;;il;'li"fir,rarrkc,, ,r.nrr-* *l*orroi '*oa *. *ei,'iin .i:nri$; *" ;**r*e:ioxa;mtt ir+ *o,*'ir*,u,*,ro*
l,)thar ennr^vad mothnd lindieata name af mathndl
V Clalaaoa lllataetirrn Far Plnlna enmnlela nlrlna r.lranktlst anrl ennronrletA tenk cha;klisfls\ lor eanh methrrl irtillzerl
nlhar ahnhvad math^.i /indinato nama nf mathaall
2s""0
This method of lsak detection roquires both monthly inventory control reconciliation and tank tightness testing. lf the UST has not been upgraded
(upgraded means that the tank and piping are protected from corrosion and that spill and overfill prevention devices have been installed) the tank needs
to be tightness tested annually. lf the UST is upgraded the tank nesds to be tested every five years. lnventory records must be kept for each operating
day.
Record of last Tank Tightness Test available on-site Yes 0O Yes (-9 Yes No Yes No
*\(3Date of last Tank Tightness Test 'Hq,y'/ /a/ 4/
Pass !{,,Pass Fail Pass Fail Pass Fail
'v
Result of last Tank Tightness Test. lf fail, specify in comments section what
actions have been taken to correct the problem. Has DERR been notified?
Tank Tightness Testing method:
Name and company of tank tightness tester:Utah Tester Certification Number: UT
Documentation of performance claims for the Tank Tightness Test method is available and shows the ability to detect leaks of 0.1 gph
with 95o/o or greater probability of detection and 5olo or less probability ol lalse alarm (3rd party certification)
lnventory volume m€asurements for regulated substance inputs, withdrawals,
and the amount still remaining in the tank are recorded each operating day
qy No NoG Yes No
Yes No
Yes No
Yes NoYesa)Yes \.)Yes Nolnventory is reconciled monthly (sum ol daily overages and shortages for each
month is loss than 1% ol tank's flow through volume + 130 gallons)
ln,t ltuonr,l l,;1,i,, ^)tl,/,V) /,ll no, which months were not? (specify month and year)
NoYes Yes No Yes NoYes Nolnventory Control records are maintained and available lor the past 12 months
for each tank
Yes No Yes NoYesYesGRecords include monthly water monitoring to the nearest 1/8'
Yes No Yes NoYes G,Yes @Monthly water readings are used to adjust monthly inventory balances
Yes No
Yes No
\Ygs--- No NoC",Yes NoAppropriate calibration chart is used for converting product level measuremenl to
gallons and is available for review
No@ NoG Yes NoDispenser pump has a current calibration sticker or appropriate documentation
Yes
Yes No Yes NoThe drop tube in the fill pipe extends to within one foot of tank bottom
Owner/operator can explain inventory controlhethods and figures recorded
Yes Yes@e/
G)NoBooks appear used and evidence of recent entries is apparent
@1 NoOwner can demonstrate acceptable gauging techniques
NowThe gauge stick is long enough to rsach the bottom of the tank
(-/NoThe ends of ths gauge stick are flat and not worn down (
The gauge stick is marked legibly and the product level can be determined to he nearest 1/8 of an inch over the lull
r's Representative Present During lnspection
No@
TC
Date:
range of the tank's intemal height
Signature ol Owner or
lnspector's Signature
Distribution: Whits-DERR, Yellow{nspector
Please: glrc[6 Yo3:ioi,,illc:fOt::gaoft f0f::gaoh ltllk,,.,,,,,,.,,,;rii::r:r,lUts::edditi .. ffi'.ae
triik {,TANK TIGHTNESS TESTING TaBI( 2 lrenk'3 Tenk 4
,,rllfank,.,il'Tsnk 2 ifank:$;Tank * r,INVENTOBYCONTROL,,:'{! .! 'l ' ''f
G')
FIC{ . CrciE,.f .iut.,:Nc:,lui,,secft :que6tlan ;-\
(*",)
Tank I Tank 2 Tank 3Set 1 Tank 4
Automatic Flow Restrictor (if yes, indicate model in commonts section below)
Automatic Shut-off Device (if yes, indicate model in comments section below)
Continuous Alarm System (if yes, indicato model in comments section below)
Records of last Line Leak Detector performance test available on-site Yes No Yes No Yes No Yes No
Date ol last Line Leak Detector psrformance test
Pass FailResult of last Line Leak Detector performance test Pass Fail Pass Fail Pass Fail
Set 2
Records of last Line Tightness Test available on-site Yes No Yes No Yes No Yes No
Date of last Line Tightness Test
Pass FailResult of last Line Tightness Test Pass Fail Pass Fail Pass Fail
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklist)
Statistical lnventory Reconciliation [SlR] (if yes, use SIR checklist)
Yes Go Yes No Yes No Yes NoRecords ol last Line Tightness Test available on-site
Other approved method use other method checklist)
/o-tDate ol last Line Tightness Test 244 .1/ /fr) "
Pass Fail Pass FailResult of last Line Tightness Test Pass Fail Pass Fail
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (if yes, use lntsrstitial Monitoring checklist)
Statistical lnventory Reconciliation ISIR] (it yes, use SIR checklist)
Yes NoOperates at less than atmospheric pressure
Other approved method use other method checklist)
Yes No Yes NoYes No
Slope of piping will allow ALL product to drain into tank when suction released Yes No Yes No Yes No Yes No
Has only ONE check valve, located directly under pump Yes No Yes No Yes No Yes No
All above information on suction piping is VERIFIABLE, use comrnents section Yes No Yes No Yes No Yes No
Signature of Owner or Owner's Representative Present During lnspection
lnspectols Signature:
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner
Fndlff lBUTAH UST.PHOGHA.M
Helease Det6cti6n:.F6i
Sucti6nrnnd ---=ity"Utuw' PipihU
No Lsah Detoction Requlred (mGt aniwei ,es to ,ii oi ttrs toilo*ing:quEstloffi)
Tank 3Tank I Tank 2
Yes @ ves G Yes No Yes No
Yes No
The UST system is filled by transfers of 25 gallons or less. lf yes, spill
and overfill prevention is not required.
Yes Yes G)Yes Nols there a spill containment bucket or another device that will prevent
release of product into the environment?
Yes No Yes Noa/Yes Yesls there an overfill prevention device installed on the tank? lf yes,
indicate the type of device: Ball float (in vent line), Automatic shutoff
(in till pipe), Alarm, or Other (specity)
Yes No Yes NoYes No Yes NoFor overfill alarm onty: ls the alarm located where it can be easily
seen and heard by the delivery driver?
Tank 2
Yes No
Tsnk 3
Yes No
Tank 4
Yes No
Tank I
Yes NoFor overfill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?
Tank Tar*Yd//p i,?
Llm Umth,l/l/P Llmru
lndicate the type of corrosion protection: Noncorrodible material (FRP)'
Composite steel (CS), lntemal lining (lL), lmpressed Currsnt (lC),
Sacrificial Anode (SA), or Not protected (NP). lf FRP or CS do not
complete the remainder ol this section.
Yes No Yes NoG-.-""Noolf the UST is not protected, was the tanuline installed belore May 7,
1985? ll yes, corrosion protectlon is not required until Dec. 22,
1998; do not complete the remalnder of this sectlon.
Yes No Yes No Yes No Yes NoThe results of the last two cathodic protection tests are available
(within 6 months of installation and every 3 years thereafter).
Tank
volts
Tank
volts
Tar*
volts
Tar*
volts
LIm
volts
Llre
volts
Um
volts
Results of the most recent cathodic protection test.
Name ol
Test
Yes No Yes No Yes NoYes No
Llm
volts
For impressed current system: The results of the last three
equipment operation checks ars available. (Equip. check required every
60 days.)
lnspector's
ll the tank has been retroftt (lined or cathodically protected), indicate
the date the retrofit was completed.
#
understand that the lollowing marked be completed by
7{Spitt prevention forDecember 22, 1998 in order to meet the 1998 upgrade requirements:
Q Corrosion protection for tank(s)ffOverlilt prevsntion for tank(s)#
,p Corrosion protection for piping assoc. with tank(s) #
Signature of Owner or Owner's Representative Present During lnspection
I Facili$ meets 1998 upgrade requirements.
Distribution: White-OERR, Yellow-lnspEctor, Pink-Facility/Owner
::::::::
5-tc*
fE-E\t.rf.
w-v"A W
k;G-r
I qq,r^*^^ )
)
)
/11 vI
OWNER:
LOCATION:
TANK DATA
ROBERT AND DONNA OWEN
HILLS AND HOLLOWS SERVICE
6000286
5L2L
2
FACILITY ID NUMBER:
OWNER ID NI'MBER:
TANK ID NUMBER:
DATE CLOSED:
HOW CLOSED:
SITE ASSESSMENT:
LEAKAGE EVTDENCE:
TANK RELEASE DET. :
PTPE RELEASE DET. :
OVERFILL PROT. :
SPILL PROT. :
In Use
1,6
1, 041 callons
Bare Steel
GaIv. Steel
Common Suct
Gas REGULAR
Not Applicable
Not Applicable
Not Applicable
Not Appl icable
TTT
LTT
5000286
5L2L
l-
Not
Not
Not
Not
App 1- i cab 1e
Applicable
App l icable
App 11cab1e
r.c
Not SpecifiedNot Specified
TTT I
LTT
Not
Not
Spec i f ied
Spec i f ied
STATUS :
AGE:
CAPACITY :
TANK I'{ATERIAL:
PIPE MATERIAL:
PTPE TYPE:
SUB. STORED:
In Use
16
2, 000 calfons
Bare SteeL
GaLv. steef
Common suct
GAs UNLEADED
JUNE ss GAs FrcuBES ilr=oorD eLUS (tank 1)HILLS& HOLLOWS Boulder UT
eoa- fiyyuf'{
A B c D E F G H I
1 DATE
June 1
start stick gals. delivered itl. qals. pumpec stk.book invent end stk. inchi endstk. qals.daily' +
2 486 53 433 z't.zs,435 2
3 2 435 89 346 345 -1
4 3 345 380 92 633 632 1
5 4l 63?13 619 618 -1
6 1 537 -8
6 543 29 14
7 511 l 148
372 30
324 tql
38
223
24s 666 -14
1 68 57 575 0
12 575 71 504 514 1
7
I
9
10
11
12
13
14 131 514 104 410 4',t1 1
15 14 411 58
3Z 4
0
16 15
16
17
34s j 12O)225
17 238 142
101 73
742
688 7
51
682 i
18
19
..1.e_
20
20 613l 600 -12
21 549 s36 -13
22 21 s36 101 43s 439 +i
23 439
2 331
24 213
104 335 331 4l
24 124 ?o7 213 6
134
60 36
664 -4
47 621 4
25
26 25_
26_
27
88l
361 734
664 i
27
28
29 28 621 91 530 i 543 133029-
30
543 122 421 404 -17i
31 404 s3 351 352 1l
32
2275 1 2399
Leak ?1.t.0.=
^1 54
Water no color
33 1 253
34
35
5 81 543
5't1 3
363 37?II
I
342 3?4 -18
24s 23
10 459 643
643
3s3 34s
238 13
101 5
28
18 3?5?688
600
22
79 88 I
28 B
82 688
617
!ot4e 2407 12402 18
Jut - lqt;-
JULY GAS FIGURES UNLEADTD PLUS [tank 1] HILLS& HOLLOWS Boulder UTAH
U,'l^ cl"d, €L,{h} tt+ 4 # * c,?t (-/-4 t //
A B c D E F G H I
1 Onffistart stick gals. delivered itl. oals. pumpec stk.book invent end stk. inchr endstk. oals. idaily' +
2 julv 1 35?124 228 -3?251
3
4
5
6
7
I
I
10
11
12
119
98
703
6
-1
1 00
10
2
3
4
6
7
5 1
5-1
115
13?
1
110
456
602
77
99
147
461
386
60
557
68s
5
-1
-2t1
13
12 38
113
?87
137
225
153
119
153
579
284
386
1
68s
557
58
60 686
444
617
284
153
13
14
14 443 79 364 366 2
r6 15 366 95 ?71 271 0
17 80 191 194 3
18
61
I
271 |
194 148 46i 54 8
19 t8)54 603 82 575 i 557 -r8
20 76 481 478 -3
21
It9l
103 i 375 383 8
22
23
24
25
26
27
?8
29
30
31
3?
s39
416
61 250
148
-131 0548 ?764 1 0354 1 0379
227
7
2 7
557
2958
2
28
0
2
28
72
3
1
21 closed
2 1 1
22
24
383
557
?29
6?1
77
7?3
28
156
82
51
39
7
21
734
311
251
. l4_l
992-9_
30
33
34
35 leak check(ok)?9 ' ,+130 (no) ^159 l
9
615 579 -2?
5
384 25
-3
16
I 1 .51 153 2
I 102 9
77
6B
443
15
557
20 474
229
78 -5
723 -11
26 626 621 -5
18
407 -9
407 308
311
31 2s1 103 t{2 I -atB
I
AUG. 95 GAS F IGURES
.t(S-,
UNTEASED PLUS [tank 1]HILLS & HOLLOWS Boulder UT.
A B c D E F G H I
1 DA start stick delivelg{!!, gatq,stk.book end +
1 3 704 124 7 3 7?9 -4
3 7?148 1 79 -?
4
5_
6_
7
I
9_
57_e_
492
3_t I
277
r03 476 482 6
316 311 -5
36i 27 277 z
63s 84 828 819 -9
819 630 639
639 125 14 514 0
514 82 432 4?9 -3
82 347 1
12
13
103 245 245
245 91 154 164 10
4 154 98 -6
15 33 't?9 128 -1
16 128 79 49 52 3
594 48
2
3
4
5
6
7
I
9
10
11
12
13
14
15
16
17
18
19 18 593 r 34 559 561 ?l
20 19 111 450 443 -7
20 443 1 37?10
21 37?104 2 -4
?64 104i 160 176 16
23 176 101 12
24 101 682 121 662 646 -16
21
22
23
24
25
26 25 646 52 594 s93 -1
27 26 s93 108l 485 478 -7
28 271 47Sl 136 3
68 277
2341 ?38
123 115 109 -6
68 754 746
29 28 34s
30 29 ?84
31 30 238
32 31 109 713
33 0
34 't1132 3s30 2938 117241 117?5 1
^1 5935Leak dreck(OK)29.+130
LuR.ler c,,*c,Gk)
fiO Co\tt Ca^A^'5€
endstk. iS
2
166
189 9
10
t1 429 348
348 o
66 60
60 202
17 52 598 s93 -5
561
36?
268
22
87 89
342 345
284 7
50 4
-8
tlqs
JUNE GAS FIGURES UNLTADED [tank 2]
t/)>zs -)3v?
HILLS & HOLLOWS Boulder UT
IABcDEFGH
endstk. qals.dailv' +1 DATE start stick qals. delivered itl. qals. pumpec stk.book invent end stk. inchr
2 JUNE 1 324i 186 i 138 119 -19
3 35 34 -1
9Bs 913 -341 079
119 84
128
5 913 125 788 794 6
6 794 192i:602 591 -1 1
1?7 591 17?l 41 9i 43'l
148
:
2921 8283)8
5
6
7 431
I 106 186 -6't8?l
1784ir011567
59 1 352
i
1ZO1 1
:
?ol111
't82
84
-4968121201229972
840 8441 3i13e68 i 128
103 74114844
01
740
15 :
141 740 149 591
4?9 436 716162591 i15
304 -31716436129't 308
75 101817304?39 6si
135 i 1 196 1182 319t8751256
156
I
1026:1018 -920191182
799 9212010r 8 228 790 i
682 -92221799108 i 691 i
118
I
564 i 573 B2322682
24 155 418 423i,5
25
23
24
573
4?3 180 ?43 -6i237
s6 62 62625
1102 1272616?1 1 79 1 8 "t't23
't017 1018
I
1i2827I
11021 85
8s6 863z9281018i162
692
7i
1302917?863 l 691
557 540 -173130692135
32
17790 353347234386 i 1 8029 r
43 ,+130 it*l ^113't ,=34
Totals 17574
Leak check (ok)
c bQ,rffit
2
3 34
4
I ?92
I
10
11
12
-113
?37 181
JULY GAS FIGUBES UNLEADEuI [tank 2]
U-/e*^ "1r,,/,
A B c D E F G H I
1
2
3
4
5
6
7
I
9
10
11
12
I3
14
15
16
17
18
19
20
?1
22
?3
24
25
26
?7
28
29
30
3l
32
33
34
35
DA start delivered tl.stk.book end stk.
JUL Y 7
2 409
3 230 1 055 1 96 1072 -17
4 1072
5 765 197
-!38
111
+39 440
32974403?9
I 329 147 18?186
I 186 127 59
10 651 1229 119 1 175 1147
11 11+7
923
221
151
9_?3i
12
t3 779
15 253
16
1
t8
t9_
20
62:
1't42
1003i
11 114?-8
1 003 -1 1
16
2l
22
23
0
9s8 i
508
s08 1
2!s;
471
0
203 1
1?18 1 175 1162
1162
9981
159
1 8 860 878 18
28t
29
?615 629 14
I -14
t_6-:l
231
s33 333 *0
333 102 107
0
174?7 4666 51 14 1 6994 15
Leak check +1 30 ^181
endstk. oals.dailv' + -' r
540 151 i 389
18s i 2?41 2301 6l
1 089
30s 767 75s -?l
568 577 9l
1i
4
65 6
-28
926 -3
101
687 193 -1481
481 236
177
17 20
76 11s01
1?8
24
25 47 90
26
27
. -"-....":-t
878
629 494
3(.494
31 q
51
AUG. GAS FIGUHES UNLEADED [tank 2]HILLS & HOLLOWS , Boulder UT
A B c D E F G H 1l
1 DA start stick delivered tl.stk.book end stk. inch endstk.+
2 107 1179 310 _e_7_6_
826
988 12
3 988 16?8?4 -2
4 824 s33 540 7
540 ?.58
2_60
84
185
28
t5t
191
I
7 1254 Oi 1 309 1
I 1 309 1 158 1162 4
11 971 973 z
10 973 838 834 4
11 834 738
12 -16
13 sB2 463 9
l4 4721 3s3 34'l -"t2
15i 341;,
1648i
1 634 14
1413 1414 1
1 228 1186 1162 -24
1
1226
1_8_9_j 74 7 4
1 Z'.t4 7 7
20 254 s01 512 11
?t
22
191 321 316 -5
:!e8
65
11 1
23 44 45 1
24 199 1072 1077 5
2 ?2 1
26 119 734 7?6 8
?27 499 s08
175 i 333 l 3241 -9
150 174 189 15
129 60 6??
1 1114 1 I
1 5369 20892 2091 9 27
Leak 53+130 r83
?
3
4
5
6
7
I
9
10
ll
12
13
14
15
16
17
18
19
20
21
?2
23
24
25
?6
27
28
29
30
31
32
33
34
35
Azctfgr cl.cc/.(of)
Ua (cttf ci.lrge
AUG.
291
5i 282 260
e 75
c
135
96
755:157 s9E
1r9 4721
119
1 461 168
16 235
't414
1162
978 -9
755
512
316 -9
109
45
8s4 8s3
27 I
2t
2S 3241
_63:
1
I
I
I
\r, f- .^rlJ *t 5-":." 2
DATE: 9ll5l95
FROM: Mark Bertelson
Michael O. I-eavitt
Govmor
Diame R. Nielson, Ph.D.
Exeutive Dirctq
Kent P. Gray
Dfetor
TO:
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
88 East Fiddlers Canyon Rd.
Cedar City, UT 84720
(80r) 586-2437
(801) 5864851 Fax
(801) 5364414 T.D.D.
Donna Owen
P.O. Box 1400
Boulder UT 84716
RE: NON-C0N{I'LIANCE OT UNOPHGROUND STORAGE ANKS AT HILLS AND HOLLOWS
SERVICE, BOULDEn, UTAH; FACILITY ID# 6000286.
your response to the Non-Compliance memo of 414195 was received 9114195. The inventory control
information you submitted is incomplete and difficult to understand for the following reasons:
l. No dates are given for daily entries.
2. Explanation of columns is either obscured or missing.
3. The total of overs and shorts is missing.
4. The allowable variance of l% of the USTs monthly throughput plus 130 gallons has not been
calculated.
5. The total of overs and shorts has not been calculated.
6. There is no record of monthly water measurement.
please resubmit the invenrory control information with the above deficiencies corrected. I suggest you
follow the format described in the brochure included with the 414195 memo.
If you have questions conceming this matter or need any assistance, please contact Mark Bertelson at
(801)s86-2437.
Printed on recycled Paper
/t._
^'' \*'(, $o bh,*
'
$oooufi
l/.' . -,t A) "p *L /ti /ac/,'tua4J ? /''"'*
-.sL/ka4X t4u*f'7" )"^ L*'-/ "'4
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4tr "/
e1,L,
JL,T / /.4.. ,r.^"" ,f
/*-L L.,o-,ZJ a*f*ly"- / q*_.,Jul'r4.. #
Z/^.,<r,-44 y' 2""
z-.-1 &r?-bL?-?,/.^ dr-/ "r4-*//'-''t
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Dp.^O*".-
(<") =r-- zz,r7
I
H ER
i
:
)
I
A B C D E F G H I J KISmnth95-S
2 UtLca)e.l 9Lu s QaA.3 JUNE r 1 end bIT s 1 mete gals dr +#2end,sfc me gals dt +4 ##tt 435 53 2 il9 t86 t95343B9I3484I663292380I9131281079376tBr3I794r25A
B 543 BI 8 59r 192 1lI5il29343117212103721489292l48o(_)lt 324 30 l8 182 r06 6122451022384l15t7l364338459141201591I20920145756B009682294l55147tr0844tzB3l6411104I740105It73455B859t14900IB238120l34361621
t9 t0r 142 5 304 128 z
-)20 32 73 4 75 239 r02168832702001 182 135 1 256 5 B226007512I0t8r569235365ll3799228I24439l0l4682l0B92535r1044573IIBB26213124A423r55527B8134I237lB062B3660B62lBl6296648273441 t02 ilB ll179 I30621474r0 tB 85 I3l5439lt5863162 732404122t76921721if $rl 352 53 I 540 r35 1734JUNE
55 Totalr 12399 2407 2275 117 99 17790 4386 4730 117 9736
Ss1 33.f- rcyq
3 MONTH GAS STICK }1ETER / HILLS HOLLOWS Be,.t&,, ilttA
Page I
ltril-.1!
54321 6 7
il
ii
il
il
lt
lt
il
il
il
tt
ii
il
tl
11
lt
lt
il
il
98 10 11 t2 l3 t4
il
il
il
-
5 I"IONTH GAS STICK XETER / HILLS HOLLOWS
A B C D E F G H I J K37JULY1 end st *r 1 mete gals dr +r2end stk me gals dr +38 **t 225 124 2J 4069 l5l 20l19115I230185A
579 132 6r5 23 1072 196 r 075 3741
42
461 123 5 765 305 3386772577197 I284993440t38Ir55147l632900t53t00982r8614744660102965127647685777035| 147 l19 1229 448589682892322t35573B6779t5l750443il5I68710rI5l36679248t195l35227195002=3 236 B55194BOlBI1775
=4 r48 a 62 20 1557B2603-I 142 76 I164 t256478762r 00J 128 ll57385103B9586tl65B229562508449I5972t5t6249258I602B5l747203I6l723t9745l9t359lr2l844626219749q8r59563557B2R878t581364407t4tI629263t4653lr993494121t4662316lI333l6t006#*#l85 r05 5 l07 231 5JULY
69 Total 10379 2858 2764 129 77 19627 5114 4686 l3l 14270
Page 1
59
40
43
45
55
6B
^3I"IONTH GAS STICK HETER / HILLS HOLLOWS
I
72
73
7
75
B
79
A**B#l nd st
729
579
3il
27
819
6t9
514
429
C*1 met
124
l48
103
t65
6
B4
t88
125
207
D
S
l7
635
+
6
B
0
F
24
2
5
2
t0
0
5
6
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Michael O. Lravitt
Govmor
Diarme R. Nielson, Ph.D.
Exmtive Diretor
Kent P. Gray
Dietor
TO
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
88 East Fiddlers Canyon Rd.
Cedar City, UT 84720
(80r) 586-237
(801) 5864851 Fax
(801) 5364414 T.D.D.
Donna Owen
P.O. Box 1400
Boulder UT 84716
DATE: 414195
FROM: Mark Bertelson
RE: NON-COMPLIANCE OF TJNDERGROUND STORAGE TANKS AT HILLS AND HOLLOWS
SERVICE, BOULDER, UTAH; FACILITY ID# 6000286.
To continue to maintain a valid Certificate of Compliance, the facility must be in compliance with Federal
and State Rules and Regulations. An inspection of your facility and a review of our records has shown
that the following information is lacking:
tl I Submit evidence that proper Inventory Control is performed on USTs_!. an!.L , by;
(a ) Documenting that inventory records are reconciled monthly to determine the total overage
or shortage for each UST, and the variance is compared to the allowable of 130 gallons
plus one percent of the USTs monthly throughput.
(b ) Documenting that drop tubes extending to within one foot of the tank bottom have been
installed in USTs 1. and 2 .
(c ) Documenting that you have obtained a gauge stick that is capable of measuring product
level in one-eighth inch increments, is legible, is long enough to reach the bottom of the
tank, and is not wom on the end.
(d ) Documenting that the water in each UST is measured to within one-eighth inch, at least
once per month, and the water measurements, converted to gallons, are used to correct the
monthly inventory reconciliations.
Submit 2 months of information for items la, and ld. A booklet describing inventory control
procedures in enclosed.
The above information must be submitted to this office by 7ll5l95.If it is nor received by the date
specified, we will commence the revocation process of your Certificate of Compliance. If you have
questions conceming this matter or need any assistance, please contact Mark Bertelson at [phone].
Printed on recycled paper
{a/rZt{
P:non Conacteci:
Title:f
{',:"
C Manuai Tank Gaugrng -
Inventory Records for one year ( weckly stick recordings d4 vanances ,
Tank Tightncss Tests (if over 1000 gailons capacity)
3rd parw evaluation summiw shcets for each test merhod used
Automadc Tank Gauging -
Daiiy inventorv pnntours
Monu.lv Test printouts rnciicaung pitsslng tests
Wrinen instailation. Caiibratron. Mainrenance recorcis
-lrd pany evaiuation summiw shees tbr ATG
//to /rr
1$/je
Date:
?hone
Date or Aopoinrment:.{pprox
INSPECTION INFORMATION NEEDS
Inventory Conrrol & Tank Tiehtness Testing -
Inventory Records for one year ( stick recorclinqs, mercr readines, reconciliarionst
Tank Tightness Tests (iasr rwo tesrsl
3rd pan_v evaluadon summarv sheec tbr each test merhod used
aJi
//w /hb,/b.^9fi,) .
Groundwater or Vapor Monitor Wells -
Site assessment documens thydrauiic conductivir.v tess. driil logs, etc.)
Monuly monitor records. or log of opcrationai chek on condnuous momor
3rd pan-v evaluation summarv tt..tr ior each automatic device used
Wrinen Insullation. Calibrauon & Maintenance records
Intersur;:: Monitonng -
Montnly monitor records. or log of operational chek on continuous monitor
3rd pan-v evaluation summarv sheets tbr each automatic device used
Wrinen Installation. Calibrauon & Maintenance records
C Statistical Inventory Reconciliation (SIR)
inventor.v Records for one year {stick readings, meter readings. reconciiiadonsl
Protocois tbr SIR method
; prcssure;r,::
evaluauon summiw shees for each method used
-/ , + . Line ughtness test results (one each year for last 2 yearst 0J f.lrrqndo^''t4Jlf, 4/L< [.eak detector test results (one each vear for last 2 vearst ./
*,i4,,..3rd panv evaluation summarv shees rbr.""i *rir.rrroa used /;t 1y''
- l''L' Ic suction ?ii:il[.',",T::.:il:"::. each vear rbr rasr 2 r,ears)
3rd oany evaluadon summrw shees rbr each test menod used
Corrosion Protection - , Steel tanks & Iines insulled after I l/g4)
Corroston Protection t.sa J6il-*ithin 60 davs of instailation (after il/88)
Corrosron Protection lesu Jone everv 3 r,ears ('last 2 tes6)
Loe of last three O0 dav cneks of
o
o
insDector Signature
Imoresseo Current svstems
Date
q/.
S
\C
\
\
\
i
I
U
B
s>
\
Certif icai6 of Compliance bn !iter (veBl t to
cou;v r;r--lr//
o
L
Street
/t
Zio CodePltt d
Facility Name
"'* o4or,/r/n- ;tr
y't y ,1/
OwnerName , / t tfin&-f )a,r'
,/f,,r,/ ./7/
Zip Code
e/
Phone #At UST Location
Number ol tanks at facilitv:
City
^/n^n, Dt.B,n
Addressvr. ./o* ,/?oo
frl No ftJ No Yes No Yes NoTank listed on Certificate ol Comoliance h")No Y.;No Yes NoTank oresentlv in use Yes No
lf not in use. date last used
lf not in use. deoth of oroduct in tank (in inches)f/-+il/lonth and vear tank installed
,//.LACaoacitv of tank (in qallons)
LrA/ +t/A / ,L4Substance stored
-G y'ez /_+Material of construction of tank (steel. FRP. etc.)
.r,/aj
--+Material of construction ol oioinq (steel. FRP. etc.)
dEff ft:.il iel*
Emeroencv Generator tank (leak detection defened)
lnventorv Control/Tank Tiohtness Testino -V
--_+Automatic Tank Gauoino
Manual Tank Gauoino
VaDor Monitorino
Groundwater Monitorino
lnterstitial Monitorino
Statistical lnventory Reconciliation (SlR)
Automatic Line Leak Detector
Line Tiohtness Testino ++
Vaoor Monitorino
Groundwater Monitorino
lnterstitial Monitorino
Statistical lnventorv Reconciliation (SlR)
that I hav6 inspected the above-named facility on
(moth, day, ye.r, tm)
Signature of Owner or Owne/s Representative Present During I
lnspector's
Distribution: White-DER ', Pink-Facility/Owner
usridrfifI:lHHg$Hff[T
Pinina fune lnrassrrrc srlclion. oravifu- etc.)
Other annroveri method /indicate name of method)
V Clalaaeo Fla?aetlan Far Plnlna f:^mhlata nininn nhonkli<t ,n.l ,nnrnnrlata t^nk .hacLlicl/cl lar aanh mathrwl r rllllrarl
Olher annrovcd method {inclicate name of method)
I
This method ol leak detection requiros both monthly inventory control reconciliation and tank tightness testing. ll the UST has not been upgraded
(upgraded means that the tank and piping are protected from corrosion and that spill and overfill prevention devices have been installed) the tank needs
to be tightness tested annually. lf the UST is upgraded the tank needs to be tested every five years. lnvenlory records must be kept for each operating
day.
6> No @No NoG,Yes NoRecord ol last Tank Tightness Test available on-site
fur-An, */ ,
--7
Date of last Tank Tightness Test
Result of last Tank Tightness Test. lf fail, specify in comments section what
actions have been taken to correct the problem. Has DERR been notified?
Fail Fail@ Pass Fail Pass Fail
Tank Tightness Testing method: SZ
Name and companyof tanktightnesstester: J./; ZZ-, h n Utah Tester Certification Number: UT
Yes No
No@
with 95% or greater probability ol detection and 5olo or less probabili$ of false alarm (3rd party certiricatlon)
lnventory volume msasuremonts lor regulated substance inputs, withdrawals,
and the amount still remaining in the tank are recorded each operating day
No6e Yes No
Documentation of performance claims for the Tank Tightness Test is available and shows the ability to detect leaks ol 0.1 gph
Yes 0 Yes No Yes NoYes@lnventory is reconciled monthly (sum of daily overages and shortages for each
month is less than 1olo of tank's flow through volume + 130 gallons)
ty'/. z-, *lf no, which months were not? (specify month and year)
Yes o @-a
Yes Yes No Yes No
Yes No
lnventory Control records are maintainEd and available for the past 12 months
for each tank
Yes (.)Yes (9 Yes NoRecords include monthly water monitoring to the nearest 1/8'
Yes 6q Yes 6r,Yes No Yes NoMonthly water readings are used to adjust monthly inventory balances
No@ No@ Yes No Yes NoAppropriate calibration chart is used for converting product level measurement lo
gallons and is available lor review
Yes No Yes NoNo@No(DDispenser pump has a current calibration sticker or appropriate documentation
Yes
Yes No Yes NoThe drop tube in the fill pipe extends to within one foot of tank bottom
Owner/operator can explain inventory control methods and figures recorded
Yes Yes
€",NoBooks appear used and evidence of recent entries is apparent G)NoOwner can demonstrate acceptablo gauging techniques
6}">NoThe gauge stick is long enough to reach the bottom of the tank
Yes 6r'-Th€ ends ol the gauge stick are flat and nol worn down
Yes
VComments:
The gauge stick is marked legibly and the product level can be determined
range ol the tank's intemal height
tbe nearsrt 1/8 ol an inch over the full
./,bt-
Signature of Owner or Owne/s Representative Presenl During
lnspector's
Distribution: White-DERR nspector, Pink-Facility/Owngr
iti
iF tilry
:Teilk
:,::,:::::,,,:..:'.,:!!!.,_.
UTAH UST PROGRAM
Piee5e..ClitiC,Y*.6r::,llofoiii.E h,,iqt stl6nfor,.Ee tahk Use additiona! lorms as n0c6scary ff moro thaft four tanks.
:ii:: iiiititilt,,,:::::::::::il
:::::,:,,:,, lTdnlf, f,',,',,,,r,:ill
: , , : : : : : : ! : i i i: i i: 1: : : j : :.:
':
, I i: l i: : i: : : i:: r:"' 'IAnKir,,::,,
: i :!i:::::: .ta.. . :,t::: I ,
TANK TIGHTNESS TESTING
@
::Tenkll i..... LtrtrN Z" j' ..i.,:
::::::::::!::i r, rt ru:: !:: !::::::::ii...S k;$:..;;:iiiiiiiil ffi8H$iiUufi*fru:fi: :fi piiiiilliii /
(Q *"
ro r*)
Please clrcle Yes oirNo for each Euestiort
6/
U
*rir,6
Tank 2Set 1 Tank 1 Tank 3 Tank 4
Automatic Flow Restrictor (il yes, indicate model in comments section below)
Automatic Shut-off Device (if yes, indicate model in comments section below)
Continuous Alarm System (if yes, indicate model in comments section below)
Yes No Yes No Yes No Yes NoRecords of last Line Leak Detector perlormance test available on'site
Date of last Line Leak Detector performance test
Pass Fail Pass Fail Pass Fail Pass FailResult of last Line Leak Detector performance test
Yes No Yes No Yes NoYes No
Set 2
Date ol last Line Tightness Test
Records of last Line Test available on-site
Pass Fail Pass FailPass Fail Pass FailResult of last Line Tightness Test
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (it yes, use Groundwater Monitoring checklist)
lnterstitial Monitoring (il yes, use lnterstitial Monitoring checklist)
Statistical lnventory Reconciliation [SlR] (if yes, use SIR checklist)
ffi
irtt:ttiiiiiil,.,t:rll;li::::tttl.t...,i:ii:rl1l,,&
6) No Yes NoNo
method (if yes, use other method checklist)
Records of last Line Tightness Test available on-site
Other
Yes No
APt -nm fq ------2Date of last Lin6 Tightnsss Test
FailrGA (€"4 Fait Pass Fail Pass FailResult of last Line Tightness Test
(if yes, use Vapor checklist)
Groundwater Monitoring (if yes, use Groundwater checklist)
lnterstitial Monitoring (if yes, use lnterstitial Monitoring checklist)
StatisUcal lnventory Reconciliation [SlR] (if yes, use SIR checklist)
Yes No Yes No Yes No Yes NoOperates at less than atmospheric pressure
Other approved method uso other method checklist)
Yes No Yes No Yes NoYes NoSlope of piping will allow ALL product to drain into tank when suction released
Yes No Yes NoYes No Yes NoONE check valve, located directly under pumpHas only
All above information on suction piping is VERIFIABLE, use comments section Yes No Yes No Yes No Yes No
Signature of Owner or Owne/s Reprssontative Prosent During lnspection
lnspector's Signature
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner
:l;r::;i:;:;1;;;;;1,;;,1 ,,,1;;,:tl:;l':,::it TA'H:.:U$i...PROGHfiMl,,
D 6Gti6qlf6i
has more than 4 tranks, compiete lnformation for all additisral piping on separate {orm.
'
gUliUfilatfil eiauttyr#ia#,pi$ififi,lil'l
Gs
No
Tank I Tank2 Tank 3 Tank 4
Yes @ Yes o Yes No Yes NoThe UST system is filled by transfers of no more than 25 gallons at one
time. lf yes, spill and overfill prevention is nol required.
Yes @ Yes @ Yes No Yes No
Yes No
ls there a spill containment bucket or another device that will prevent
release of product into the environment?
Yes NoYesoYes@An overfill prsvention device is installed on tho tank. lf yes, indicate
the type of dovice in the space below.
Ball float valve (in v€nt line)
Automatic Shutoff valve fin lilt oioe)
Overfill Alarm
Other Svstem (soecifu tvoe)
Yes No Yes No Yes NoYes NoFor overfill atarm only: ls the alarm located where it can be easily
seen and heard by the delivery driver?
Yes No
Tank 1
Yes No
Tank 2
Yes No
Tank 3
Yes NoFor overfilt slarm only: ls the alarm clearly marked to indicate what is
msant when the alarm sounds?
Tar*
Yes ,#)
Tar*
Yes No
Tmk
Yes No
Tar*
Yes 6)
Yes
Um
d0
Llm
Yes No
Um
Yes No
llm
Yes (\)
Tanks and/or lines are made of a nonconodible material (such as
fiberglass) or are made of steel clad with a noncorrodible material. ll
yes, cathodic protection is not required.
Tank
Um
Yes No
Yes No
No6*Nofe*Tar*
Yes No
),8-No
Llm
Yes No
Um
Nod")
Tanks and/or lines are made of unprotected bare steel and were
installed prior to May 7, 1985. ll yes, cathodic protection is required
on or by December 22, 1998.
lndicate type of cathodic protection: lmpressed Current (lC) or
Sacrificial Anode (SA)
Yes No Yes No Yes No
Tr*
volts
Yes NoThe results of the last two cathodic protection tests are available.
(Tests ars required within six months of installation and every three
years thereafteo.
Tar*
volts
Ta*
volts
Ter*
volts
Llm
volts
Llm
volts
Um
volts
Um
volts
Results (in volts) of most recent cathodic protection test.
Name of person who Performed l6at.
Test
Yes NoYes No Yes NoYes No
Signature of Owner or Owner's Representative Present During lnspection
lnspector's
For impressed current system: The results of the last three
equipment operation checks are available. (Equip. check required every
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner
SPILUOVER FILL PHEVENTION
CORROSION PHOTECTION
TaaL I
.UTAll .::USTIPHOG HA M iiiFacllltu
: i i:', ' :::f: : i:l: :,::i
OverfiH,,Eildr,Coirosion : Pr6teetion lnCgeeiion ::Checkfist
o3/7O/92 --- UTAH DMSTON OF CORPORATIONS & COMMERCTAL CODE ---
* * CORPORATION INFORMATION* *
098749 COTTAM OIL COMPANY
STATUS: GOOD STANDING DATE: 00/00/00 CODE: O TypE: 15
FOREIGN CORP. NAME:
REG. AGEIiI]I: DOYIJE V. COTTAM
170 WEST FIRST NORTH AGNT- CHG-DATE:
ESCAIJAI{ITE , UTAH PREV- RES - DATE :84726 AGENI-ADDR:
INTENT TO: RESfGN-DATE:PRESIDENT VICE PRESIDEIiTT
DOYIJE V. COTTAIU BRENT S. COTTAM
170 NORTH 1ST WEST P.O. BOX A
ESCAIJANTE, IIT ESCAI,AI\]TE, IIT
13 :20 : 50
UT
PROFIT: P
ooloo
0 0,/0 0
ooloo
ooloo
/00
/oo
/00
/00
INCORP-ACT.DATE:
REINS-DATE:
INACTIVE-DATE:
ANN-RPT-DATE:
SECRETARY
SHERRELL OTT
135 CENTER ST
TROPIC, IIT84776 RES
05/17/]-9e2
05/Te/84
oo/oo/00
06/17 /et
00/00/oo84726 RES 00,/00/00
TREASI]RER
RES 00/00/00
RES OO/OO/00
CORP-TYPE: D
BUSINESS - TYPE : 15
PROF-NONPROF: P
CORP-KIND: 4
847 20
SIC:5541 GASOLINE SERVICE STATIONS
REMARKS: Y
CORPORATION TYPE: D
. CORPORATION KIND: 4
PROF'ESSIONALT: N
=REMARKS; D=DIRECTORS; M=MERGERS, N=NM CHGS; G=GS CERT; CTRL,'B,=EXIT
OpEion Menu F2 NUM CAPS Connect.: 00:01:14--- UTAH DIVISION OF CORPORATIONS & COMI4ERCIAIT CODE --- 13:21:01
* *CORPORATION INFORMATION* *
COTTAM OII.,, COMPANY
DURATION: OO/OO/OO
0987 49
STATED CAPITAL
C],ASS
COMMON
2=PG
Help
03 /10
Help F1
03/lo/92
PAR VAI,UE
10.0000
.0000
oo/oo/oo
00/00/00
DATE
05/77 /91
oo/oo/oo
5, 000
0
00 : 01:20
11 :21: O7
2;R
F1
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DOMESTIC
OIIJ, GREASE, PETRO.
PROFIT
PROFIT
0
5, 000
0
Option Menu F2 NIJM CAPS Connect.:
- - - UTAII DIVISION OF CORPORATIONS & COMMERCIAL CODE - -.** DIRECTORS **
DOYIJE V. COTTAM
170 NORTH 1ST WEST
ESCAIJAI,.TTE, IIT
84725
1=SCREEN #1; 2=SCREEN #2;
BREIiII| S . COTTAM
P. O. BOX A
ESCAIJAI\TTE, UT
84720
R=REMARKS, M=MERGERS;
SHERREIJII OTT
13 5 CEI{IER ST
TROPIC, UT
8477 6
N=NAME CHANGES; CTRI., NB =EXIT
AUTHORIZED
DATE NUMBER
ISSUED
NI]MBER
1=SCREEN #1; R=REMARKS; D=DIRECTORS; M=MERGERS; N=NAME CHANGES; CTRL ,B"=EXIT
098749 COTTAM OIL COMPANY
Help
03/10
Option Menu F2 NI,M CAPS Connect:--- IITAH DIVISION OF CORPORATIONS & COMMERCIA], CODE ---** REMARKS **
F1
/e2
00:01:26
1-3 :21 : L2
01
o2
01 DB
02 co
03 r..,P
04 co
05 co
05 DB
07 co
08 co
09 co
10 co
11 COt2 co
13 TM
14 LP
15 DB
15 DB
17 DB
18 CO
09 4552
088973
005811
025842
0987 49
774776
054282
o 457 99
127 019
L22050
117031
142324
032543
0 013 11
085 652
090373
037795
L449 54
07/92
00/oo
oo/oo
00/00
oo/oo
ool00
ooloo
0L/92
00/00
02 /91
o7 /91
12/9L
1=SCREEN #1; 2=SCREEN #2; D=DIRECTOR;
Help F1 Option Menu F2
NM TP NLIMBER ENTITY NAME
M=MERGERS; N=NAME CHANGES; CTRII trBtr=EXIT
NUM CAPS Connect: 00: 01:3b'
DIS-DATE ST
COTTAM AND COTTAM
COTTAM COMPANY
COTTAI'I FAMI IrY FARM , I-,TD .
COTTAM HAFEN VFW POST 2628
COTTAM OIIJ COMPANY
COTTA},I SERVICES
COTTEIiTT TNCORPORATED
COTTER CORPORATION N S IJ
COTTER INSURANCE AGENCY, INC.
COTTEREI., FARMS INC.
COTTEREIJ FARMS INC.
COTT].,E CORPORATION
COTTIJE CORPORATION " OIIR REPUTATION IS BUIITDINGI WORD
COTTIJE FARMS PARTI{ERSIIIP
COTTITE HOMES
COTTIJE ROBINSON
COTTON BOTTOM ASSOCTATES, A PARTNERSHIP
COTTON BOTTOM BABY, INC.
M
E
E
E
12-31-83 SUSPENDED FOR FAILIIRE TO FTI-,E AN ANNUAL REPORT
5-18-84 REINSTATED
19
SEI,ECT NI]MBER HIT N RETT]RN'i TO SEE MORE;
Help F1 Option Menu F2-
03 /91,
02/92
CTR], 'B' TO GO BACK
NUM CAPS Connect: 00:01:54
E
E
DB
DB
086735
077573
COTTON CIJUB DANCE
COTTON CIJi]B GRAPHICS
\,
6e)2<eFACILITY ID.
PST PROCES8ING CIIECKLIST
Year 1 >-
unacceptabLe Acceptable opplil.ul"
_/
Previous Pollution Incidence
- LUSr File u t6l
Form rncluded @tx (olq-'
4tp(rz--TTT
- Verify tank/Iines
vs registered
Documentation ok?
- Rate ok?
"t* '-/
Y/N r
Y/N /)
Fund Paid
Fy s2 %}-{z_/62_Zaq_
FY er. aL-6243 lqqZ
Y/N
"/'A
--7
-
Fees Paid
FY 88?
FY 89?
FY 90?
FY 9L?
FY 92?
Compliance
Compliance outstanding?
- Leak detection required?
Notification up to date & comPlete?
\/ Apprication?
Y/62--/
&tw
alx
zlPl?z-'
llp Date QualifiedDate Issued
Review completed and certificate issued by
SUPPORT \ CE \CHECKLI ST . PST
z_-
Non-Marketer Discount
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llHH lA'31 '<\Z/ PtttR HtNS0N
Hr
Oor
Please CaII 1-800-735-7314 hfore senrd{.ng a fax.
PHUE.UI
UTAH DEPAHTMTNT OF
ENVIRONMENTAL OUALITY
r4AR I 0 l9g2
DIV, OF EN\IIRONMEIITAL
RESPON$E A}IU IIEMESiATION
I f)r l<lt)
'.:
3-10- clL i .r1
ltrr ,'i'DAIE:
TO:
COHPAITJ:
rN( NUT.IBUII
+ oF PAGES (lnctuding
FRO}I;
m[0{ENrs
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ll
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I'IIIR I b '92 '\( iJU PE IER UE,NSUN
13.lr.) !r:l 1 r I1 it.\' t..- J39 tsl3 Dil' ENV RESP REll
PAtiE . bt
PETROI.EUM STOFAGE. TANK FUND APPUCATION
FACIIJTY II{FTANKS:
Owner Nams:NJN':
Stre?r Ao
Qlo,
urrY:C,ty:
Ph 0ne:
erson:
SEtoi
Phoas:
contact
p oo6:
TYPE OF OWNER:
{ Marerer, or nol}mgkglgr wih anilal monlhly dToughpu gr€asr thar 10,000 gsllons.i - Non.n-afigre? unth annu!.I momily t.trougnplJt iarr $rn 10.m galot'.s (Mu$ vcnfy).
DESCRIPTON OF UNDEBGROUND STOHAGE TANKS:
I anK #
Aoa
C5oacry
Ssoslance
TANKTIGHTNEES TEST
Tank'
PassrFail
CEST!FICATE OF REGISTRATION
'<tt4ic a
a
llll All unoorEround Sto?age Ya,nkE
ul,i Arl regr$ndon TANK Fees navr
(U$t') at this tacility have baen reglctercd.
brln peicl.
COMPLIANCE WITTI UST HEOUIITIONS:5T1ra$[e-mail]5lregulatIotl5.-:X' YEs . I No - l, "NO" plcasc darcribo ircm(g) ot non.complrancr:
pREVTOUS POLLUTTON TNCIDENT(S)
Have you arrar had a pollrJuon inddEil ar your taglitr?' i Y;s - ll nfcs' pleisc prwide LUST (Gaking Uriderground Storaoe Tank) htormation:
Mt No .- rf 'No' oleas€ atacli a llttfi Btitlno that und8r ougtoma bugincs8 |tNltilotYv\' praarcE stanctar6s you are not Errare ol alry release trom any tank(s) al thls fac.
I N D EP ENDEI{T FINANCIAL ASSURAN CE:
,0 r havB odre6 finmd,l ,.lponsibi&y requrrmentt tor the firct s25.0(n/telease:
!0s.ll I'rrtttE llou.rtttLa ll Commacld lnrurncr ll Sur.tv B(
I I Bitr rr sn grorJc t l l-6r ot crdx a ! orirt-
I I I have odlE indeP€tld€.I Uird-pafty financial .rsurl1c. 9y my @mpriancc oEte,' r I w,fi nDEn ruaEtltlt E'tr6rparty firE t8t slorEEr Dy my cEtlDtirE 6E
I cqtily fr# - E* E #o * b9 *ttrir d aa
oBnerl()t.l.rto? Slfrtlt'
StatE:
{'rYr'' ,.n'*"-3/a/a*
r1HR tCI '32 Ai zB PETER BENS0N
lir, t(], rr: lrr,1; F.lI i ,,9 B8t3 .DIl' [St RESP AE]l
T?ACILITY !D.
PtlrrE . A3
|(l u,,
0004b
(ttl!irletici,: oi; enri+'rr-,yalHt$, iiif;ffi#Hi' d;if,li;di$tuTrHeil;ivrirt*:*p$;rc8iii"'eii9,ii'iffi$ff
PREVIOUS POLLUTION INCIDENTS
To: Mr. Kcnt P. Gray
P-xe.otrive Secrctary (USf,)
Utal Solid & Hazerdour Ws$es Comolttce
I
Dear Mr. Gray: .
peroleurn from my ta*s.
ts requlred by paragqh 2(-t4c404 of rhc Undcrground Storagc Tank Ast. I have
perr'ormed a ,atli
"nO-fii*i
righmess test on each undciground stora8e. l."lL n:. my iricili-ty,
an6 OASSO On tnls teSr, rnere-nls $ot DEetr r rcleirss u! pcrrulcr.rut. Ar.ltlirilrlral[,r, Lovrl uu
"customary businesS inventoty practiceS Staudards", I am ggl awarc of any rclease of
ll
(
OE,
I larv 1<,.1 r1,., ft7lts-irr5 ,,,trg.*.,rlyvb.rt..r.r. (J-t^i[-J Lcl.7,+i alsc ileatisn aqr rrdoayou
took to clcan up the release).
(-.
tor
!:aiture ,o repon previous releues couhJ void yottt envc"t gc und'er the Peuoleum Storage Tank
Fund.
..aa a -- .t,,&- ^...--
,44
I
I
I'IHR IA '92 \A3 PETER BENSUN
, ,, ,. f.t.r ;rou EEE! DIl. ESl. Rttr REl.
PE6E , A4
@r
I-"c,'1,xt cEmFlcAlEN O'Ca rxxoE (coIPtElE rcl AlI trEyy Arao upGArDeD TAN(S AT rxS LgC To{t
Tulr t .rdtElll Nslrbf T.,*l$--
OA?H: i qrtty rh. rrio6det orrdl t$&n Ur b porldrC xti !r,Et irtdSa,!!Er.)lir* lvnnan
PtPI
fftr
f
tr
trf
Ermrf
t *ls.I h^b,L Irrl ib.
-
Trt lb.
-
AE|[anSryt|,t|r!lbl! mrrurrhrii
E trrlbrorlt5r lbrr.C tI!bP.-.da.a._.rt
c. rrrlll5Erlr.E ryrn0trtd.qlb.
D.mlhqtE-Errd ryhimd.rt.t nq
tr llmulsrrlrCd&ncElEArYrriargltd
F. Ancth[ nrrH rbrld by &rtrl.|E.Fb.rEty.
l.EEr
I:-
TAT{T
aaEEEE
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E
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PPIIE
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EfaE
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aaEEtlE
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trl
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?rrfi rDn(,?rfiK
trf
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?^llXZ H.Lc orlEbn ll/bh r,l !i8Et/l
a ll.-'.-r.-+ r-ral.t
E. Trnl tgttm.r! trrhi
0, lannDry crEli
D. fl,Earburf !! rtlrE
E YrFr mcror'nt
F. Grourtrrat r ltEaloda0
G lmonddd nrnlrctrg.tbcDa rrl-
ururDDt,!
H. horfl id nrnltria,lrrrdry€ ahltx
l,
^l,tirlh. Lrl(dtr.Ao
'r. Un. rEilrE Ld!
X. Orh., n.rE abr.a
lrndanantng AEarE .r-lr.',tb.l.
t. 3p0 .d O.,tn P'rdbtr
A O,.rtlll d.tb i.t laa
B. SDll6artt ltltrlE
lrdlc
lllnR t a , 92 g I a5..-____ Fla r aso 66Ea 6^^- -A
b
tl tl
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II
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rtl
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I I
I'1nR tv ' tz * zs PE I L, R EE, NSUN PH6E. . U5
Mor',-h 10, 1992
I{E: Facility No. bu)0z86
I'hc attached fax page6 are teets performed ln Junc, 1991. Otese tests
were l)errorflpd ty Precision EqulprlEnt in h'scalanu€r utdh.
Afber teslinE fle tEre told the paPcr trorl< nould bo ccnt in by the
atrrve e(,npany and we would receive notification. It has fec€nt1y clme
tu uur aLLerrLlcnr LItaL rrelLher owtle[ lras ener receivecl any such
d<rcumertation-
dl-i.- sg.:+gr..!e rrs y!-gnL1.J -J ^- ---r-1 . --'2 -.-r-l: l!-.3 ue gacsr- srlz L'h<
maEcer, we are aflare of the delay and ltould appre&Bate your under-
standing of the olrious misunderstanding.
It there is rpre informarion rthich I have ol7erlool<ed ln sendlng Uo you,
plcase let me know. In the meanlimer please fa;i bacf to us a lcttcr
stating that L'e are in canrpliance. I understand that this can tn rtseri
to receive fuel untll lre recelve our actual certlflcate.
thank for your
Klm or
I(im's IIiltop serrzice
Blulder, IIT
I'1AR 1E '92 I I4A PETER BENSON
The follotring dates and gallons trave been delivered by:
CoTTAI'{ oIL Ct).
BRB.rT C!ryTAI.{
ESEATANIE, IJTItrI
826-4232
PNGE. A6
- 7-11-92
-'7-).O-$
-7-28-92
-8-06-92
-8-tt-92
- 8-20-92
'8.-29-92
- e-t5-92
- 9-21-92
- lo-1I-92- 7(r-t9-92
-Lt-t4-92
- 12-t4-92- 1-18-92
-2-06-92
- z-L9-92
1500
126r.)
lo27
768
1678
1641
1938
17I0
t782
1459
1520
450
349
300
300
3't3
gallons
P:t.ease let me know if you need copies of the actual lnvolces, and I'1I
copy them and send them up to you.
HnR tA '92 I lr{p PETER BENSON
I
PFGE. A?
PRECISIoN EQUIll,ll;N',r, INC.
P 0 Dox 1r9
ESCALAIITE, UTArr 84726
PrroNE 825-428'
f,j.m L,Ynan DBA
KlmrB Hlltop Servico
Soulder, Utah 84716
TEST
DAIE
PR0DU(:'r TIS'r
cuilTA llil!u I(Bt;uLI's
t{tl'lllt{ I'tcIt''l'Alrli I'An^nl!l'lllr(i
Yee
Tee
6h/e1
6-7-9t
Regula.r Gaeollne
Unleadeil ieg Gas
-0.009 GPH
+O.0o, GPH
p lcase contrct u!
lnfoEriotLorr.
lf you trcsd addltlorrol osslstrnco or
Sittc er o lY,
or o
TlxK OTNER
TANK
GArACtlr
1041
201'
1'lt!i'r DA'rA Allr,'l'uEI'lill5uL',r'l;
CUSI0!'!ER Nl,l'tBER---DA'IEJtA*l-
lolloultrg ls a sunnaty of tho prcclslorr te3tlng re rcceiitlycorrrluct,od on youa underjround rtora3c tank(s).
llncloscd ore coples of te3t xortsheets and 6rn;rhs gellc-rstcd for your subnlttEl to tho approprtote govornnoiltrl rge cy,
A tank sf!ten ls consldcrod tlght, accordln2 to ttr6 crrrrcntrula!, lf ths loss or Boln l! loss thnrr .05 gnllorrs pqs orre hourof tostltli. If thc r.!ult3 aro beyorrd there paranetcr3, you
should consldet tEklng 3o!tc ro|r€dlal actlon,
IIIIR IA '92 4.: UU PE IE,R UENSUN
IRIiI TITTAH DDA
tlll!0 gl,l1oP sERvlcE
soulogn'tltttt 6+7I6
rrrttk tiBitl vER z.ol
FUBL tlPt: UNLEADED nEO OASoLlNt
CAPACITI TANK 2: 2OI3 UAIIONS
TET PERATURE C0EFFICIENT: 703 ppn/deg F
TEST CIITERIA: +0,000 GPH 1o +0-000 GPtl
06r07/et TEsr flHE FROI{ 10:02 T0 ll;09
DATA ANALTSTS INDICATES:
A 6R0ss goLUltE CIIANOE 0P: -0.000 6ALL0NS
A voLUHE CHANGE DUE t0 TEHFERAfURE 0F: -0.09T GAL!0NS
A LIQUID vOLUl'lE RAIE 0f CHAN0E 0F: ?0.005 GPlt
tllTH A 99 ? coNPtDgNcB INIERVAL OPr +/-0.000 GPll
(+0.005 T0 +0.004 GPH)
PHUE. UU
TEsrER. a r'.rl"r- R. ax.*f
c(rsrouER.k t r..., . lg^ o,
c ttl.ddt "
I'1HR IA ' 5Z \: U I PT, I E, H UI NSUN
Ittl LltlAN DDII
KIHIS HTTTOP SERVICE
buurbbn trmn ot7l6
IANK TECTER VER ErOI
PUEL ITPT: NEGULAN OASOLINE
CAPACITI TANK I: IO41 CALIPNS
TEIIPEBAfURB COBffICIENT: 709 pprldcg F
rEsrn'Atu!!4{'4(3' d d"r # a'*' c' o o s
cusTor{ER. k.ir^.L;**
I'IIUE, " US
IEST CRITERTA:+0.000 cPH T0 +0.000 GFH
ObtOTlgl tEGr TIHE ERotl 10;02 TO ll:09
DATA ANALTSIS INDICATIS:
A GRoSS voLUilE CHANGI 0P: -0.006 0ALLONS
A 9OLUUE CIIANGE DUE Io TEUPERAIUBE 0F:.+0.003 0A[loNs
A LIQUID VULUHE RATE of CHANoE or: -o.oo9 GPll -/
HITH A 99 t CONI'IDENCE INTERVAL 0F: +/-0'000 OPH
(-0.009 TO -0.009 GPH)
Kln Ll'man DBA
KlDts lltltoP Scrvioe
Boulder, Iltah 8d715
I'ollor,rln6 le e eunurrnry of tltc preelolou teatllrg tln ro(:etrLly eottrlrtcbad
orr your urulerground produo! llnes ttrat rwr Itun Joul utlder6rgultcl stornge
tarfts to your dlapouoero on tlrc lolartda.
Jt lllre nynten ls oonntrlarad tlgtrt, aecortlltrg to tlra eurrelt[ rules' ll'
t,l,v lr,..,v v- t)-1.. .L- l--' ll.--. -O, ,r-tl-"- t'--' -r L--L!"'r t t ll'-
reoult6 are 5eyorul tbeso 1rarameter6r Iou ahould couulder t(tkllt8 Eottts renrcrllttl
ac tlotr.
t'ltoDuc'J: t,lllr.! tFs'[rtlc
Tllu;l,lt0Dtt(;'l:
+ (34)tl
: fil'rlIIEAI,INO r'AcIolt
and I f Iootlett r,nd kelrt ur),?):
rIHR LA ' 9E ,A: 34 PE TE R EE NSCIN
llulclgl0ll E(ll,ll'l'ttlll'[r J,llg'
P o UoX lr9
ESOlttrllllTti r U'l^lt
62$Q1281
ItEAUl,l.G
tl0r
INNIIIG
en has a
PllrrE . A I
utitfiT DA'IA lill,
'Ifiiltt' ltuliuu.t:j
erefore 1i.uea I ?e
.00,
,UU,
.0(t,
GN',N-
LOSg
ent . Io_9t.1._.!-t
Thls sys
tlre eame
tlrc nane galn or I
.u(),
.0O,
Tr:li't' IIU5UL'I5 +0.0o5
Pleaae eontant uf, lf you nged goilltlonal astluuurtcg or lttforlnotlol''
SlttcerqlY
EHDINO
. 'fhe
)EB es tlr
ructlon Jt
r.a the te'
=
I
-
bam.r tenk eyr
I'1HN IV '3C J<\:U4 PE. IL,R HI.NSUN P?trl , A'1
Re.sults of Ihe Ptrfirrnxrncs Evuluirliorr
Con(tuclc(l r\ccortlhtg lo EPA Tt.sr l)r'uclrhrrcs
Pipaline Lcnk Dctcction S.r,stcnr
Userlns r
Linc TtghtncstTcst
This forin Eum'narizos the rccults of art cvoluation to detcrminc whoher tlrc pipclLrc tsdr,. detcction 6y8tcm narncd below nnd dcscribcd h Atrachmcnr I colnplies wirh fedcral regularions
for conducring a tine tightncss tesr, l}rc cvaluotion war conductsd eccordLtB lo tlts Unircrl Strres
Environnentnl Protection Agcttcy's (pI'A's) cvaluation proccdulc, spccifi<rJ u Stondord Tcst
Pntcctlules fitr Evdluatino l-t,ok D(tttion blnh,v!.c' Fist,,li,,o I tnl'll,.t,,t,tt,tr c,t,cr.t>, 'Dr.- A.tt
cvaluotlon rePon inclutles sevrtr atrrctlnrents.
T;urk ly.srent ownels who use this pipcline ler* dcrcctlotr Bysrenr shoutd keep lhis fonn on
fiJc tu sltow cotupllance wlth thc fcderal regutatiorrs. 'l'ank systeur orvners should chcck whlr
, litlllc and local ag€ncics lo mit.l<e sure lhis fomr sntisfies the requkernenrs of llrese agcocics.
Systcrn Evlluaterl
Systcrlr Namc:Horher E7y Chek - I.tne (Manual )
Vcrslon of Sysrcrn:slqhu- Gcg.e_
Manrrfacturcr Nrune: - [t n-a-or (.f cat t qe p'r.'du,.t g. . trt
2l Ll.lo-r:Lon SLr'rrot -.-...._.(srntl nddressl
I M 706
lc 1ly. tilitl(ri cods)(5r7)8 3-3360
lrslsplrurs rrutlltlcr;
Eualuoliun Results
l. 'l'tre petfonnrncc of rhis rystem
(X) mcets or axceeds( ) dorr not mRGt
llte tctlcrol ttanrlnrdi cstablished by the EPA rcSrulstion for linr rlghrness rclt.
The EPA segulation for a linc tightness test rcguires rhnt rhe sysrrm be capable of detccring
n lcali 0! small os 0.1 galrh t ith a prcbahiliry of detection (Pr) of 957o aad s probsbillry of
false dam (P'^) ors%,
2. Tltc cstimatgd Pr^ h this cvdurtion it -0- '7o rnd the Gitimated P9 agalnsr I leak roro of
0.t galflr defured !t a pipclln! prcsrure of
!f,nsi
in this evdurtion [ ] 00' 7r.
Pipclhe l,rl Dctecdoo Systcm. Rcsutrr Porm hsolofI
IT1HR 1U '92 ^: U5 PEIER BENSON PHUI,. UU
Crilcrion for Doclaring a Lcali
3. Thb syslem
( ) ulcs I Prcrtr thrcsheld
ixi -"*rt.t lnd rcpons rhc ourput quantity utd cotnparus it to
l prcdctcrmlncd thrcrltold
,u ,1r1.1,,1!lc whethcr lhc pipcline is loakhg'
4. 'This rystcm
(x) uscs !,5Lrtle lcsr
. (-'i uses a muiriplc.tcsr scqucnce consisring of _ tesrs (specify number ol rcsts
rr,luiJlJ) rwf{,'ted bJ
-
h"" ('1""llv rL- oimr iarrnral h'l\rle'n lesltl
ro detclrtlirtc whcthcr thc pipclinc is lcnking'
5. This sj.stcnr dcctares a tcek lf rhc outpur of rhc mcasurcm0nt systcm excecds a llucshold of
--.At- (spccify llow rrte in gatlr) ir 1. - out of I le$ls (sn'cify' for cxa'nPle' I
out of 2. 2 out of 3). Pleosc glie additional detdls, if necesclry' in rhc sprcc providccl'
tivnluntion n PProach
6. Thete arc fivc oprions for collefling th? datr uscd in cvalunllng thc pctfourutrce of thls
syrron. Thls sYslrm wr3 cvdurl'd
g) rt c apcc iol resr frsilirY (OP.ion t)
( ) or onc or morc hslrumsnlcd o[ctst lond srorrg! link facilitics (Opllon 2)
( ) ill fivc or nlorc oPctillionol $oI08!rant' frcilhics vcrificd lo hc llght (OPtion 3)
( ) ar l0 or rrlotc oP$tlrionirl storogc t onk fscilhies (OPlion a)
( ) r,ith ln cxpcrirnent ly validotcd cotnpu rcr simulrtion (Option 5)
7. A total of
-2t-
tctl, wcrc conducrcd o nnonr..riBgl?f*tslttr.,rrn-0.qg.2!.(o,rret
cJld ldarc), A dcscnPtion cf rhc piplhe conligrrrntion used in th! lvrluStion isAIIFl.qO
givcn in Altacluucnt 3.
At fii'?r qucttiortl 6 ond 9 il OJtdon I ,2, or I Not uted'
t. Thc piprlilc utctt h thc cvalulrion wns -:-!-in' h dioneter' I0'l-ft long rnd
conslruflcd of j-g- (fibcrgloss, srccl' or othcr)'
9. A mcchoricd lhc lcoX dcrcclot
( ) was
(x) w83 nor
Prcsrnl h ths PlPclhc srstcnr.
A,rst'?r qtat,i.t,tt l0 ond I I il Optlon 3 or tl s'at usod'
t0, Thc cvduation *os condrrctod on
-l-
(how many) DIFlltnc syrtc,ms rurslng h
dionctcr from -),!-h, ro -Il-- in.t rangln8 in hngrh from.J-9J- ft lo
10 I ft, nld const ructed of iron (+!ciry milctialr),
PiFlinr fru Drlsadoo Syllam ' Ratu[t Porm Prge 2 ol!
HRR lA '92 l1^Q5 PETER EENSoN PAGE. A4
t I . A mechanical linc leal rlctcctor
()w8s
. (x) wns not
prcsenr ln thc nrojoriry of thc pipclinc systcms uscd ir thc cvoloutlon.
I 2. Plcase sDccifv how much time elapsed bctween the delivery of oroduct sr'rd rhc $orr of rhc
(x)0ro6h
'( )6ro12h
1 ) 12ro?4h
( )24hormqrc
'l'cur1rerat u re Con ditions
Th[s sysrcm was evnluatcd under thc ronge of tcrnpcraturc conditions spcclfied ln Tabtc l.
Tltc diffcrcncc bcmcen thc tcmpcroturc of dre product circutotcd rfuough rhc plpclhc for I h or
.morc tnd rhc cvcragi tcrnpcrarurc of rhc bsckfill ond soit bctwcen 2 nnd l2 ln. ficm rhc pipcllnc
is surnrnuized ln Table L If Option 1.2 or 5 was uscd a morc detailed sunvnlry of the ptoducr
ternpcloturc conditions gcncrotcd for rlrc cvulurtion is ptescnted h Arrachncnr 4. lf Oprion 3 or
4 wus uscd. no arrificlal trmpcrarura condirlons wcrc gencratcd.
Tlblc l. Summlry of Tc rrturc Conditior Utcd ln tht Evdu{lon
'Tl r colu.nn ahould bc fiUert out cnty lt Opdoa l. 2, or 5 vrr urcC.
"6T lt drs dl(arcncc b.F,ccn lhc tcmpErnrult otrhc product Cirpcosed rhr9ush rh! plpcfh! Ior over u hgu.rrirt
ro Oc cofirucr of I rGfl md E lvcngi rrrnpnrurc of lhr backfil,l urd soU ruiounUhil Utc ppc,
Dutn Used lo Make Pcrfonnrnce Estimutes
I 3. ?hc Induced leak rotc snd lhc tcsr rcsults used to esttnote rhe p?rformBnce of this system arc
tummsrizcd h Attoclrmcnr 5. Were .ny terl runs tcmovod ftom the dara rct?
(x) no
( ) ycs
lf yas, plcose spcclly thc rcason and Includc whh Arrachmcu 5, (If morc rhur onc tosr wa!
removcd, spccify coch reason scpararcly.)
Minlmum Nunbcr of
Conditions Itclulrcd RonEc of6T ('F)-
I I ar <.25
1 {.2l5AT<.15
5 5 -lt s !T <.S
5 6 ,5saT<+l
t 6 +S<6T<+rj
4 I '+15!aT<+:!
I I 6T > ?,1
Piplhe t ert Dctccdoo Syrtcm . Rcsultr Forn Pr3c ! of 3
Nunrbcr ol CooCltlonr Urcrl'
SertsitivitY to TraPPed VaPor
14. 1x) According ro rhe vcnttor, thls systrrrr can be uscd evcn if tr0ppcd v3POr ls prcstnl ln the
PiPclhc during I ltal,
()Ar,r-urdingtotlrcvendor,thisrystemshottlrluotberrscrliftrappcdv.pofhprcscntinthe
pipethe.
15, . The ssnshiyhy of rlris systcm to rroppcd vlPo( ls intticared by rhe tcst tcsults suinrnartzcd h
. Tsbtc 2. rlrcsc rcsrs wcre conducrcd ar j0- psi witlt I0o nil of vapor rappcd h thc
lhe nr o prorruriif 0 p.ri. The ttrn snd re* conhitions'arc rcponed h Atrachmcnt 5'
FIFIR I@ 'SE A:36 PETER BENSUN PtIEE . A5
Tlblc 1. SumtnuY of'the Resultr of Trsppltl Vrporltsr
Tcet No.AT('!'f
lnduccd Lerk Rale
(goUhl
Mtoturcd Rrte
(
I -I7 .2ll .I9 6I
. r056 -.1I8
-.20
2 .+7
3 +2 .2r l
16. Sr:rte bclow thc pctfOnnnncc cheroctcristics of rlrc prirnoly meafu(erntnt tystem(s) uSed tO
collecr rlre rl:un. (Ptcrsc tpcclfy thc urlils, for cxtunptc. gsllons. lnches')
l'orfonuanse Char$ctcriillcs 0f th0 In.sl rurnonlntion
(luantlty Memurcd:I pcr uni! o t ttne (Ieak )
ationRcsolution:
Prccision:
Aecuracy:
003? qal Ion pe rqr
02 sal ns per hour
+ .002 gallen E/hour
Minirrrum Detectabte Quulily: -:.9'
016 al n
Rcsponse Tlrne:irnmodi at e
Tlucshotd is crescded when the flow ratc due to a lcBk e*cccdr q Eol/lt.
Allpticatiun 0l' tlre SYstcrrt
I ?. This lCak dcrcction lysrcm is htended lO lEsl pipetinc-systetns thol Ut ls3ocillcrl wltlt
undergrouno '.rigli;* i*ili i.r, thot eonraii perrcleum or othcr chamicol producti. thal
are ryplcdly cunrtircred of fltrerglosl or stcel, end thot typiedly rnt'surt Z ln' ln dlmetcr
and 200 ft or tcsl h lcugrh, Thc performanec cstimrt.t atc valid whcn:
r the system tho1 rv6 cvoluorcd has not bccn lubgtantiatty chan3cd by subsequcltt
moditlc$lonr .
. the mtnu(lcrurcr's hsfrucfionl lor USing the Systcllt uc followCd
r I mcchanical lhe lcck dctcclor
( , ts Prcsmt ln
G) has becn rcmovcd lrom
the piSrcllnc (chectc borh tf epptopriatc)
?ipltnc koh Dsccdcn Sytcm ' Bcrulu Fom hgc I of 5
,
rNR Ig 'S2 II4E PETER EENSON FAGE. U 6
. the wairing tirnc bctween tlrc last dclivcry of product ro tlre undctBround storogc tnil(
nnct rhc srurr of <tara collrction for tlte tcsr is -!( h
r tlrc waiting tima bctweaa the hst dlt|ensing of product lluough the pipelhrr eysrcnr
and ttrc stnn of darr collcction for lhc lcst Is -IlL h
. ttrc toral data cotlccllon thrc for rhe lesl ls I h
. tlrc volumc of tlrc product in rbe pipchnc syrtctn is less than twlce the volunre of rhr
producr h rhe pipellne gyslem used in lhc cvaluation, unless o rcparate writtot" Jubilficarion for tcsring largcr pipclinc systems is prcsenrd by the miuufacturcr,
co;cured wirh by tlrc cvaluatgr, and lttached ro rhis cvaiunrion ss Anrchment 8
. plcrse give any orhe, Iirnirorlons lpcclfied by tltc vendor or delcnnlned durlng drc
cvrlultion:
Disclalmer: Thls resr procctlurc only addrcstcs the isia€ ol the sys,.'tt' t obiliq' to Cerca lcaks ln
piptllues. It dott not tc$t the cqui4rrrant for sofcr.t hatortlt a.t'assctt the opo'atioual
lunnioualir;t, rcliobtlhy or uaintahpbilit.l of tha cquipmcut.0 t nlc
t
Attrchtttcnls
Aurclrnrcnt I - Dcrcriprion of the Systern Evaluntcd
Arrrchmcnr 2 - Sumrnry of tlre Pcrformance o, rhc Systenr Eva.lurtcd
Arrachmenr 3 - Summory of rhe Configurarion of thc Pipclinc Systcm(s) Uscd in tlrg,,ffi
Attflclrnrcnt 4 . Dtta Slrccl Surnrnuizhg Product Ternpetittul€ Conrlitions UseO in rllEv
a
a
LtC iGAll
[1lL i:il
ljc.
2l?'-1
t!,l.
a
flAL
u
.'.'. jt, i.-r'.;r '. '-"r
iUuation
Arrirclurrcnt 5 . Dota Shcet Sununrrizing the Ttst Results :rnd thc Lcali Ratc.s Used ln
thc Evuluction
Allircluilcnr 6 - Daro Shect Summrrizinn rhc Tcst Results and tlre Traooed Vaoor Test:
Arruiiiiiiini 7 .- D-iraTiictrsunrm.uizing the Test ResurrsfUlelc-idCiielf*rriiRiioiio-nsst ip
Supplicd hy the Murufacrurer for Combhing the Signal and Noise
Certilicatiun of Rcsulls
I scnlfy rhat the pipelhe lerk dctcction system was operatcd accordhg to thc vcndor'i
hstructions, I also ccnify thot thc cvaluation ws pcrformcd according to the proccdure
spccificd by thc EPA and rhot rhc rcsulr prcscnted above are thosc obtoincd durhg the
cvo.luution.
Harvey D. Farrand t{.A. xlbbe & As3oclatel' Ine'
(niulra ( pron pc :rtion)(organh ion Frformin8-rvaluitiont1024 N. Hichlgan Avenuec
(signetttn;
(dnt.)
r 90
(strccl.rddr,!rt
S ag lnaw,Mtchlgan {8602
(517)753-2t125
(rclsnhott nunrb!r)
Piplhc lr.* Dcractio. Syacrn . R.rul[ Fotrn
(ciry. rrntr. dp)
Prgr 5 of 5
I'IHR IA '92r{\:37 PETER BENSUN FH6E. A7
" Resutts oI U.S. Epn Standard Evaluailon
Votumetric Tank Tightness Testing Method
TLis fur ru tclls rvhcther the tanli tightness resrint method described below ssmpljss rrilh 15spcrforntlnce rcquirctttcttts uf rhe fuderal underlround,rn.rg" rinL i.grr.ti"i.h. iui't*,ion,*r,
:gldy-tgq by-rhc cquipmcnr manufacrur cr r.rr a ionsurranr ro-the mrnu"frcir*i ,..orJi* ,o ,n.U.S. EPA's "Standard Tcst Proccdurc for Evaluatirrg L,cuk Derecrion t"teinoJir vo'i"iln?ri. r:rntTi6l'r-ooa T-.ri^5 l.{e rLorl,.r' T1.-.t-lt - '..t.,,,(lu,r rey-ur r otre rl,.r"J.i-" ruiii,-uir.iioin!'ii.,'. r.,nou
arrd a for ur sumrnarizing the test data.
Tar* owners using this lclk detection system should keep this form on file ro Drove comoliancc
wirh.the federa.l regulations. Tar* ownCrs should check riith State and tocaf if.ncieiio f,rk. tur.thir form satis[ies their requirements.
Method Description
Name HornGr Ezy Chek II
VprSiOn O_verf llI - 100t Capacity (Volumet-ric )
2I2 Hort,on sLree!
(srreet address)Bay City Hichigan 407 0A (517)8el-3.'.)60
(city)(state)(zip)(pnone)
t-800-441-07II
Evaluation Reuults
This method. which declares a tank to be leaking wherr tlre measured leak rate elceeds rne
threshold of .05 gallon per hour, has a probability of false alarms [p(FA)l of .fi er
Thc corresponding probability of detecrion [P(0)] of a O.1O gailon per hour teak is i e. e sql..
Therefore, this method E does E does not meet rhe tederer rJerformance standards
eeioblished by-the U.S. Environmenral Prorection Agency (o.10 gailon per hour ar p(D) ot 959/c
and P(FA) of 5%).
T est Conditions 0uring Eyaluation
The evaluarion resring was conducred in a 8, 000 gallon EI steel E fiberglass rank
tnat was 9 6 inches in diameter and _L inches long.
The ternperature dllference beueen product adc,ecl to till thg tank and product
akeady ln the tank ranged trom
-l::Lop
19 -6.77 op,
The tcsts were conducted with the tank l0 o percent full.
wlth a Stanclard deviation ol lt.606 0F
Volunerrlc TTT Method - Be sults Form Paoe r o, 2
Vendor Horncr Creative p roductc
ThE product used ln tho ovaluatlon wag f uet oil .
I'IAR I6 '92 1!48 PETER DENSON
" dVolumetric TtT Method overf ill - volumetric
PNGE . @B
ttoI
a
a
a
a
a
a
The method has not been substantially changed.
The vendor's instructions for using the method are followed.
The tank is no larger tha n 12,000 gallons.
The tank contains a product identilied on the method description form.
The tank ls at least l_9-9__ percent full. (overf ill )
a dt,Tlre waiting time after adding any Substantial amount of product to lhe tank ,
is at least 6 hours.
fAt
r The tdmperature of the added product does not dilfer more than
o The waiting time between the end ol "topping off,r if any, and the start ot
lhe tesl data collection is at least 3 _ hours.
. The total data collection time for the test is at least t.7 hours.
Large vapor pockets are identilied and removed (for methods that overlitl rhe rank).
This method E can D cannot be used if rhe grouncJ.water level is above
tlro bottom of the tank.
Other limitations specilied by the vendor or determined during testing:
Ground !^,ater must be stable Prior to and during tesls'
Salety disclaimer: This tesl procedure only addresses the lssue ol the method's
ability to detect leaks. lt does not lest the equipment for salety hazards.
Certilication ol Sesults
D. Farrand williarn A- Xibbe & Associates, Inc.
flnte name (o rg anizalion pe dormin g etalu ailo!
o/ay'xo
a
a
I
M
clry, statB , ztq
(5L7',)753-242s
48602ignatUre
t
e numDer)
ROEENT
iIONGAN
MILLEB
No.
21151
In
e
te
mbar l8 1990
a
pnon
** TOTFL PNGE . AE ,K*
I certity that the volumetric tank llghtness lesting method was operated according to the
vendor's instructions. I also certity that the evaluation was performed according to the
standard EPA test procedure for volumetric tank tightness testing methods and that the results
presented above aie those obtained during tre evEluation
STATE OF UTAH
DEPARTMENT OF ETWIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
FAX NUMBER 801-359-8853
FAX COVER SHEET
DATE: J- 10-'12 LOW ORG: q.<{L1O ACT #:
Kir,,.. = l-/,'l(+t s Q v'\,/( c
AGENCY/FIRM:
FAX NUMBER:33 s -73 t>-
6 oat2U".
3f rflaz-
Y--
C/; /1,o,<
PAGES TO FOLLOW:
COMMENTS:
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T.d( ld.rdfr.don Nuorb.r Trrf( lb.
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fihgnarutalrn
e"h.rrlLr c.ll|fr.d c hr..d by trhrC.ir.dirg{..q
C. hrtd$on hoprard by r
]lebt.lrd .llgirlr
D. hrtrlhon lrprard rd.F ov.d by itlplf,n.nlhg {a.ra,
E U.nuhr-t lniddbn dr.d(.llt he. b-n aofipLtad
F, Ano0rr rncfrod.Id by $.f.
.g.ncy. PLer. rpcily.
t.MrEbo
TAI{K PPIl{G PPlt'lc TAIIX PPIl'IG PPII|G PIPINGZ R.L!r. Oetedbn (t$!rt rlt lhd Fly)
A lhnualrank gargl,rg
B. Tsnk rightn ss t.srku
C. lnvenOry contob
O. AibmdbLr* g{rglng
E Vepor modOring
F. Grcudwaer rnonltodrp
G. lnLEdlilt nEniortrg.dorjbL wdLd
tank Dprng
H, lnl.rltli8l nEnio.itl,lErdty
contrhmont
I Affmdb In Ld(.r.t Gbrr
J. t-h.llghtr..r f.drg
K Oh.rm.thod rMby
lmplementlng Agcncy. Plclr.
P.dfy.
3. Spl[ and Ovcrlifl Purctbn
A Or.iln dcvic. illLl.d
& SpIld.Yir httdS
t,ID
Xr CERTIFIC TPN OFOor^ -I^XCE (CO PIEIE FOR ALL NEIV A DUPL ,{DED T l{KS ATTHS LOCAIpil)
Trr* ib. _
OATH: ic.rfiylhe fiiormdon onming hdrllllln tira I FurLd h t adotXlanatolla!..rotrwD.ll.frfiir,E l-9..
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FACILITY I.D. #
PREVIOUS POLLUTION INCIDENTS
To:Mr. Kent P. Gray
Executive Secretary (UST)
Utah Solid & Hazardous Wastes Committee
Dear Mr. Gray:
As required by paragraph 26-l4e-404 of the Underground Storage Tank Act, I have
performed a tank and line tightness test on each underground storage tank at my fdcility,
and based on rhis 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.
signature of owner/operator
q.
I have had the following releases of petroleum (detailed below; also mention anv action you
took to clean up the release).
signature of owner/operator
Failure to report previous releases could void your coverage under the Petroleum Storage Tank
Fund.
n
JocThomFon
trucklng & excavalion
679-8193
ba007 &6
M4"u>
Guy Thompson
llcensed plumbcr
679-8732
/?J
a/\A-#*s
aaZ/L *,
.L4/L
.,e /OM-?,U(4//1_
a,
BRYCE IALLEY BUITDERS []ID $PP /b* t1
Cannonvllle, Utah 84718
GeorgcedAdr Thompson
llccnsed contreclor
general merchandisc
679-&tt2
sl q, //f s+//b-06 7o
WrL,/77/
flat,+,, r(rU1l,
t 1 _--atUaz4u
b7a
4 6 l4u
t;";*il*lfL#
R:Bzeti3? u
,|dltl.$'.#ti{shff^I'*l!.^.Tloll
Jnfu'
Po /
d)--
,W Y1""-
Yt
/'l
ct>*to/r;l d/)-Lb ofup-'\//-@A edY\h Ur,rfz
--L
0 a<-{t'nla^oat-tg.Az a-
/U
N
Ci#*h O'/fu-*/r-Jz-
JIb4 u,M@,fr
,1"-/,-.-
/,4/L 'r-Ue ,
u./i
- /'-*J-E-nd- (7-'+:{5u'a4
{"/**1A-*A.Ltt LL
A is,,<)
to
trx4
ld5,-
Norman H. Bangerter
Govemor
Suzanne Dandov. M-D.. M.P.H.
Exeutive Dirctor
Kenneth L. A]kema
Diretor
APR o 8 1991
a
Bureau of Environmental Response and Remediation
288 North 14ti0 west, P.u. Box 1669u
salt Lake city, Urah 841 16-0690
(801 ) 538-6338
(hrryt .,ttpo;id h G"\
tlnrqsa^ 4lzrrla t
Lub',pi(.( Lu
'CfunfucL.
Twba w;/1 ta cba,wl \4& \na,*
-:
DEPARTMENT OF HEALTH
DTVISION OF ENVIRONMENTAL HEALTH
Re
Kim Lyman
Ki-mrs HiIltop Service
P.O. Box 382
Bou1der, UT 8471-6
Closure Plan for Underground Storage Tanks located at Kirnts Hilltop
Service, Highway 12, Boulder, Utah
Facility Identification No. 6000286
Dear Mr. Lyman:
The Closure Plan for the above-referenced facility, received by the
Bureau of Environmental Response and Remediation on February 25, L99l,
has been approved subject to the noted modifications, if any. Local
health and fire departments must be notified 72 hours before beginning
closure activities. These agencies may have additional requirements for
closure or may charge inspection fees. The Bureau of Environmental
Response and Remediation must also be notified 72 hours before closure
begins.
Any proposed change to an approved Closure PIan must be submitted in
writing and approved by the office of the Executive Secretary before
implementation. If contamination is suspected or found during closure
activities, you must report it to the Bureau of Environmental Response
and Remediation within 24 hours of discovery.
Enclosed is a copy of the lrClosure Noticett form which must be completed
and submitted to the Executive Secretary (UST). The closed tank records
may then be removed from the fee billing lists. Please submit Sample
Analysis data and Chain of Custody forms with the Closure Notice as soon
as possible, but no later than 90 days after tank closure.
If you have any questions, please contact Gary Astin between 1-:00 p.m.
and 5:00 p.m. at (801-) 538-6338.,dW
Fvaarr# i rza Canra#=rrr /Tlqrn\f \ ve*,
Utah Solid and Hazardous Wastes Committee
cc Mark Nielson, Southwest Utah District Health Department
Boulder Fire Department
Wayne Thomas, D.E.H. District Engineer
Guy Thompson, Garfj-eld Mechanical
KPG/GI(A/ce
Benr\ce\#5\c Iosure. 5- 1 0
l/,n
UNDERGROUND S]'ORAGE T.{NK CLOSURE PLAN (rev. 12190)
LHD USE ONLY
Date Received
Reviewer/Date Receive
Reviewer Recommendations
Date mailed to State
of (company name)6rr,firt a 4rc(artrtc4{
aciiiry lD #
Received 1r-
ewer/Date Reviewed
ewer Recommendation
M Review /Date
ludsl *e
.*r$3iffi lfii#;trJ1sffi i#d,##ii/:'!:^
0* lz, &*y *sa,,7t'-7 rV
tor (identified below)
Address P? frtf
by 6o //a.u,asaaz
e ,Afu I
a zr/.y'adr')/* /fZ,/Phone #o )6 2r- 7 25:
A Contractor may act as the owner/operator's agent to prepare this Closure Plan. The Contractor must act with
the owner/operator's knowledge and approval.
This Closure Plan is submitted in compliance with R451-202 Subpart G and R45l-204 (U.A.C.)
SITE INFORMATION
Owner's Name
or corporation)
(note if owner is a sole proprietorship, dba, partnership
847tb Phone #
).t
Contact perso
Facility ldentification Number (found on billing forms, 7 digit #)
Total number of underground tanks at this site
Total number of underground tanks at this site to be closed
TANKS TO BE CLOSED "/
_,y'ATank# 2 z
Ase of tank
Capacity /r ort Ttcdp
Subs. stored* dki* i* t-
* Indicate the specific substance stored in the tanks to
For waste oil tanks: Have degreasing or other types o
be closed (regular, unleaded, diesel, waste oil, etc.)
f solvents been stored or mixed with the waste oil?
No Unknown
Phone #(_)
artYes (identify if known)
Shw\ust\all\clplfrm2 Reviscd 12 /U ln
K,N lv ,,aP rd
3q
Site Name Address
t
{t,
tv
TA\K HANDLER Name
Address P-o gl/ 7l ,
SOI L/GROUNDWATER SANIPLER Name 6 rz.r 7ar4?5az Cert. #6s.0z67
.\ddress PO 2t4 ./,A-c/)/.ar/ltth /r,r,g u?/2?r'
DISPOSAL INFORMATION
Tank(s) rvill be disposed at:
.\ddress
slafu. @f^(' {o* 6ustil* alooue 0,Nuoi .lq
Facilin' ...:.'r
|funOst* -1uu dileA fqAls fu 6/ca ailaa, utw wlft trst-
{*1tskrry: lwhr{,,e! , {rq\,t t;'il.;.'
n
Contact Phone # ( 't\
Prociuct lines will either br, /removed or
-
secured in place and capped.
Vent lines will either be:
-lremoved
or
-
secured open.
azl
Piping will be disposed at: Facility Ca ,C;Z Yt s,c
Address 2:
Contact K .,lX Phone # ( \
e e,frfr*.)Z 2)s //5*U/i4 (company)
companv)htu' \u"L-
The tank(s) will either be j' ' purged or
-
rendered inert by the following method:
/ E .1,3, . D,,qrz ./r r 2E-f aaa {,a ZrgpScrZ
Residual sludges rvill be disposed at the following facility:L p5
Address
Contact
4.t -ay',c?'9
Phone #(?ar\ {5/-D,a fr'
If the tank(s) are to be cl
Date approval granted
osed in-place, approval must be obtained from the Local Fire Department.:,
,4 !'
/i.'
Contact
TIJ E E.r.fI f fIWINr1 rl/t TFPIAI S, R/ TICT E'nIeD^SEn A'Tr AN AB r n F^/-rr rTv.
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. .)bpasa/ plrn o*r.1, url" ga*
Contaminated soils are to be disoosztle /afut4 f E'y
Address
ed at the following facility:,{fu yt a /qty'a Pooa "f*gFP,
/*',t j, ^V.b I s z.e ,/arr//. L)/
contact /-y,I Phone #()^ 422 ?
Contaminated_wgter is to be dispose{at the following facility:F '7/'ti C< {Oat.t4)( - #a:.fC ---o // r. Pc
Address
Contact
t/e ,2,/,
Phone #( ) (4 ddrs 4
If contaminated soils are to be aerated, the necessary permits must be obtained from the Bureau of Air
Quality (538-6108). In addition, a detailed aeration plan must be submitted to the Executive Secretary
(UST) before this Closure Plan can be approved.
t\
Cert.# T/P35o "
9* ,?e un
E,l
Eo Kns { <.2*
Tank(s) will be emptied by:
Tank(s) will be cleaned by:
Za,/b-tt /^ - 4r/./4
t
CONTACT LOCAL HEALTH DISTRICT Name of Dist Saulr u{r:Date )- /5^ F/
Title /.t Phone #Contact k
Contact ,)t,,//a Pal/oc4 Title ZV/s,.,Phone # f :t
SITE ASSESSN{ENT
.L site assessment must be performed for all UST closures and change-in-service. Site assessments must br
performed as outlined in R451-202, Part 280J2 and R451-205 (U-d.C.). If contamination is suspected
additional samples must be collected at the location where contamination is most likely to be present.
Approximate depth to groundwater in the viciniry of the tanks:Feet.
Groundwater sample lab analysis to be used:Appropriate 8015 modified method
EPA 413.1 EPA 418.1 Other
Soii sample, lab analysis to be used:Appropriate 8015 modified method
EPA 413.1 EPA 418.1 Other
State Certifred Laboratory to be used:
Address
zip 4 ,/a Phone #Contact / /',
'--= -- ( fu'^bcl' Cl''Vt y il"f J'l**Iat'c* '(tof* fl/"--
CONTAMINATION INFORMATION
If contamination is detected or suspected, based on the site assessment, the information must be reported to the
Execurive Secretary ruSD at [phone] within 24 hours. The Bureau of Water Pollution Control must be
notified at [phone] if contaminated groundwater is found. If contamination is confirmed, a qualifieti
environmental consultant should assist in the remediation process.
In the event that contamination is found, the environmental consultant wiil be
Name Comoanv
Address City
State zip Phone #
The Closure Notice Form, sample results, and Chain of Custody Form must be completed and returned to the
Bureau of Environmental Response and Remediation within 90 days following UST closure.
I certiS under penalty of law that I am the owner/operator of the facility referenced above and that I am
familiar lvith the information on this form and that it is true, accurate and complete, and further, that the
procedures described herein will be followed during tank closure.
Signature of owner/operator
nL\,!N ZZ 7LTitleDate

:/,
CONTACT LOCAL FIRE DEPT. Name of Dept. B?irle&,7 /7 o-.' -f,).rr; "t.,'7 Oate2 *2-21
,X
#r,a? t .r.bz
A,a---d/
'-?/.-E
sT6
ur7fr */\
t
SITE PLAT
The site piat must show all buiidings. tanks. Iines. dispensers, underground utilities, proposed sampling locations
lincl cleprhs. substances stored in tanks, and other important features./-z r'?a-/,/Drarvn ey 6ay fre nara:a./
/
Facilitv or Location ID No._Date
t
North
N
\,1
-W
Y/ - \4/- "7u/w
i7
o,t/' oQPov
6*,
bdwt*.
, t.nilcs
\r1-,}
$
\.1
\
\
$
\
\rJ
5 \r)
\
\
f5
o",
$u.9
-P-P-P- = Power
-w-w-w- = Water
: z,.o1a_
s4 s5ftr,lr dt:,fun<z' ' ,o-tq'#z
s[u(tt U$&* $1ulu*gr"r, - Xa,"h' w qyze
6.8'*pcr#: p.prq-he )slodd d a4prur to-t'( {'e21
Wfd)**{,(,"i u,\U s,0l"t (* a'il. ,Yr1f P,-
<rtria,ro(r .^. frf-t^ {a,^lzs 16 Slwo *cav*k,ai -
tLk
Building, etc. outlines
Tank & Line outlines
Creeks, Rivers
-s-s-s- = Sewer
-g-g-g- = Gas
0 = Monitoring Wells (MW-#,)
X = Sample Locations (SS-#, WS-#,)
[ ] = Water Wells (domestic, livestock, etc.)
f
-t-t-t- = Telephone
-d-d-d- = French Drains
$
ple locations, depths and sample type (soil,groundwater , unified soil classification).
number that corresponds with information given on page 1 of the Closure Plan.
{cy
l
fr
:(F
l. Indicate s
2. Indicate t
Lines
,/IN]
I
II
/
$
^+
N
I
---___l
I
Contaninated Soi1, Water, and Sludgeclosures at facilit.ies 6000433, 6000286,and 600031-0, from phone conversations
h^ndlAr\ ^n 1/A /q1 ^h.l 1/'1 1/o1
disposal plan for tank
6000023, 6000292, 6000410,with Guy Thompson (tank
Contarninated soil fron all six sites vril1 be stockpiled at
Lincoln L)rmants construction yard in Escalante until next spring or
summer, when it will- be used to rnake asphalt. It will be mixed
\^rith other materials, spread out on a flat area and sprayed withenuLsified asphal-t to create asphal-t to use in road construction
and patching. The location where the soil will be stockpiled isout of the way, and security should not be a problem. Some old
renoved asphalt is presentty at one of the rnixing sites; some ofthe contaminated soiL \^rou1d be nixed with it to rnake new asphalt.
Contaminated water (mostly water fron rinsing the tanks- only
one location has much possibility of encountering groundwater) and
sl-udges fron aII six locations would be held in an unused 2000gallon bulk oi1 delivery truck until all six closures were
completed, then would be taken to USPCI . Mr. Thompson has been in
contact with PhiI Burns of BSHW, who indicated that he would not
need any hazardous waste permits if the material were kept lessthan 90 days. He told Mr. Thonpson that he should get in touchwith USPCI to see $/hat requirenents they have for testing thematerial before delivery.
DEPART\IENT OF HEALTH
DIVISION OF EN!'IRONMENTAL HEALTH
\orman H. Bangerter
sEP 1 B 890
Kim Lyman
P.O. Box 417, Highway #12
Boulder, UT 84716
Re: Closure PIan for Underground Storage Tanks located at Kim's Hilltop Service, Highway 12,
Boulder, Utah
Facility Identification No. 60002U6
Dear Mr. Lyman:
The closure plan, received by the Bureau of Environmental Response and Remediation, on August(r, i990 for the above referenced facility has been approved ai proposed. Local health and fire
departments mLlst be notified 72 hours before closure begins. Closure of underground storage
tanks referred to in the closure plan may commence after notifying these agencies-.
Enclosed is a copy of the Closure Notice form which must be received by the Executive Secretary
before the closed tanks may be removed from the fee billin-e list. Pleas" titt out all the requested
information on the Closure Notice form and submit the form after all the sample analysis dita and
other information is available.
r\nv cleviation from an approved closure plan must be reported to the Bureau of Environmental
Response and Remediation immediately. If you have anr.questions, please contact Gary Astin at
-i38-6 170.
Sincerelv,
Suzanne Dando!. I'1.D.. 11.P.H
Bureau ol Sohd & Hazardous Waste
288 North 1 460 vlest P o Box 1 6690
Salt Lake Crty Uiah 841 I 6-0690
(801 ) 538-61 70
E{e.uove [)ir{r'tor
Krnneth L. Alkema
[)ircclr)r
n
Gray
ve Secretary (UST)
Utah Solid and Hazardor,rs Wastes Committee
Enclosure
KPG/GKA/cb
,s hrv\su pport \cc\t n k-clos.3-5
t+rK{nt P.
lrxecLltl
William J. Coffman, N4.S,P.H., Director, Southwest Utah District Health Department
Wayne Thomas, D.E.H. District Engineer
Boulder Volunteer Fire Department
I
1
UNOERGROUNO STORAGE TANK CLOSURE
RHil;ilt,.,t'fm
BSHW-o853U-2-3 A,UG (ifi 1990
:'*'l 'i'i 8s)
vi I1(l4
IN OROER IO EX PEDITE TH REVI EI,I
OF YOUR CLOSURE PLAN. PLEA SE FILL
STATE USE ONLY
/ Date Received
/ Revieuer/Date Reviewed
/ Re.vi ewer Reconrnendati on-
&./IN ALL BLANKS COI{PLETEL Y. THIS
CLOSU PLAN SU PERSEDES PRIOR VER SIONS./ EHl4 Revi ewlDate
Closure Plan Prepared tY
)-i,*- ,t ,-r
il Add res s
q-2b'
SITE INFORI.IATION
f-bd! Trtomas or t"ft1 #-6i4 (b?
Stts'tz r.t c7s7ip
b54-4 51,1
tla
0wner Name R r^ L*-rr- a^.,Add res s
z:p 74 7/ b I
Site Name Address Sap*-
Zio (Contact person)tel. #
Tank Location Identification Number (found on billing forms, T digit #)
Number of tanks at this site & Number of tanks at this site to be closed Q
TANK RI.IATIO t&
n? Z4)
/aofi zMo
fu*rgLJL
T
GA OOAFG
fank #:
Age of tank
Capac i tY
Subs. stored
0ate last used-
-SITE PLAT ATTACHED Located on the pjat should be bui'ldings, tanks, lines,
dispensers, underground utilities, proposed sampling locations, sampling depths'
substance stored in tanks and other important features.
cLosuRE NOTICE FoR!,t This must be filled out and returned to the Bureau when c'losure
is completed.
-rdtl/J t, 6,i[*,4* tfullo Usul dt^h$oL' wovll6l'
,n1-"1, t*lrrd, qhwtl 4*+y*DW @drlu;.1s,1,/ ,ffiy,kefrffl,f#*rtJ,Y
!l4u* t^4tuil,tA. t .t/ l'a& gb' l, SL-< g kA - '
iA NK HAN[)LER Nana Afi/d<
Add ress 2-3" so
Certi fi cate #€ag#
z:o ///, f??;t
7y
oa Co /
zio
),5+vse 0,h",
ridl M+rry v{d
vsnltt-x^p "lpoSlu
4u r*bl wt"Lk L{{,'p')4f,,.)uc(4,
1, qrt 6,u . i!.il t it uD ablr,t .
"Itlel u*, oiu tr{. 5u oc) dbP
&*f
0Is INFORI.IATION
Tank(s) wilI be disposed at: Facility o
Address contact
Product lines will either be jlremoved or
-secured
in place and capPed'\
Vent lines will either be -Xlremoved or
-secured
open.
4./rt
611 b\ J,^I'e
Pi ping wi lI be disposed at: Facility
j
tel. #
Tank wi 11 be emP ied by
contact
t
I
.7 ( company) and
cleaned by 3 ( company
The tank will be either purged or rendered inert by the following meth od:
DnV tce
If tanks are t
ve5 no
eF ire 0ept?J;f-
, ttr^f
l
LI,Luru'
olto
,r,rld s".farr ,r* but!-
ySs o'a t*t*,*
iHE FOLLOWING I
I f found, contami nated soi ls are to be
add res s
d i sposed at the foliowing faci li tY:
Jo*{ ( so-trl'loui ng
,l"u lt"L
facilit
no
t-f-' Eiltfi(mer,rhr H eul*l l contact
E5c
contac
I I f oun
tel . #53K -ri:Ot(
d,contani na water is to be disposed at the fo
E Sa old \^t{
addres s
contact -rJ"t e I .a--LttoL-
Residuai sludges a o be disp osed at the fol lor.facili ty:
ircc^t0.fu C\ l"u1 E-"+-
t
S
tel. #llt,l co - t\iod. Leldq
rrnler Bib WSt v,.at
Pu+ dqrru. b y ,r >,k)te,
IF CONTAI.IINATEo SOILS ARE IO 8E AERATED, CONTACT BUREAU OF AIR QUALITY FoR AlilY
NECESSARY PENilITS AT 538-6108
SOIL/GROUNDWATER SAMPLER Nane gofl 'Try'nrno.
Certificate # (after 12/31/89) GS O 2-@€. Address-Agtze-
h&sbw
Te1.#fu
add res s
uala, slulett uiU
t* coud l;Ll t, t<"^ Ll*^
obtained fron
5.;6tvr<,r oi lLJu*1 alro
Soil s.
Ju
ul l't t "k ra tett"{a z14
,J ft-
4 btll"1 '9(k
(
1
IF CONTAI,IiNATED GROUNDIdATER IS FOUNI), CONTACT BUREAU OF WATER POLLUTION CONTROL FOR
ANY NECESSARY PERI.IITS AT 538-5'I46
COI'ITACT LOCAL HEALTH OISTRICT Name of 0ist.
^A
contact "h'*-J< ht i e i sort/ ri t'te
CONTACT L0CAL FIRE 0EPT. Name of 0ept.
te
6 u peN tj tgoR tel # 8o' G,?ry '-zs*:.{
0..0ate
# 37f ?7*za
x aot 5 (modified),-EPA 4]3.1
Contact Ii t'le tel
SITE ASSESSI.IENT
A site assessment must be performed on al'l tanks to be closed. At a minimum,
protocol found in ntrSO-205 UAC should be fo1lowed during closure assessment.
Groundwater samp I b I ab ana'lys i s to be used :
other
Soi'l sampie,1ab ana'lysis to be used:-}L aOf5 (modified),-EPA 413.1
other
State Certified Laboratory to be used:i:,* n A al t-Y Tlcat L AA
Add res s ip ?ttlt.,
tel * V b(b 67at contact
CONTAI,IINATION INFOR!.IATION
In the event that contamination'is detec'ted or suspected, Vou must report a release to
the Executive Secretary, Solid and Hazardous tJastes Conmittee at 801-538-6170. If
contamination is suspected or detected a gualified environmental consu'ltant should
assist you in your remediation. In the event contamination is found the environmental
consu I tant wi 'l 'l be : Company
Ci ty Lo q
vlf, zi Kl3Ll tel.g)t 752*o?--
add res s
State p 4ti
1
SITE PLAT
Locati onID No.
NOTE:
g-__
Li nes :
6t4l1E
N
N
99
9'
n6
1[
V
Z
t,l
t[r(
tuS(-
t U5<
.- --4-+
oW
\
/,
\(,otpilr'[
\l
1?.1tlw ntl")lo 0a Yhti&t
(rN
l\ P@' usc
wnt k hht^ Ft
olt*,$.wl fM
C:r-mp+
"t10*1b
(.-
\}/
ou'n+' ,t
w*-a i+catn6' a'l
9p1> wl.g h |rlw ao
cln t( h corx* dtP41,,
ae yutol-1, S"f4 L
wfubli* lq Sa/wl
\tj r&,tu
drY.ut4/)
a**(t, ca'(,
,11d'itPsa'e a'lh, -'\ ?Lk\
Ind i cate samp I e 'locati ons and depths .
Indicate tank number that corresponds with information given on page 'l of the
Closure Plan.
Building, etc. outlines 0 = l.lonitoring tlel'ls (HW-#')
Tank & Line outlines X - Sample Locations (SS-#, t^ls-#,)
Creeks, Rivers [] = hlater t{el'ls (domestic, 'livestock, etc.)
-s-s-s- = Sewer; -p-p-p- = iower; -t-t-t- ,. Telephone; -g-g-g- - Gasi
-rr-w-u- =!{ater; -d-d-d- o French Orains;
louse
g5')
@
)fry
tpb -
BSHrd-0863-5-6
CLOSURE NOTICE
Locati on l0 #-
TANK OHNER
Phone:NA!48
STREET
CJTY STATE ZIP
Name :Title:
EUSINESS NA!.IE Phone:
STREET
CITY COUNTY zl P
Phone_
IYPE OF C LOSURE [] Temporary [] Penflanent [] Change-in-Serv'ice
Substance stored for Change-i n-servi ce
Pernanent or Change- in-Servi ce
oate Closed:-[] Removed [] In-P l ace
tllas fuel emptied? Sludge removed?-Tank cleaned?-
Was tank Purged or Inerted?
Location of C I osure Records
TemDo ra rv
0ate of Closure:- Was tank emptied?:-
Residue depth remaining in tank- or Ztdt of total capacity of UST:-
Corrosion Prot. ?- Release oetection?-
3 mo.: Vent Ljnes 0pen?- Cap/Secure: Iines-purnps_
Extenti on ? :
ma nwavs
l2mo. : Perm. CIosed?:
TANK INFORIIATION
New/Upgraded?:
Tank #:
Age
Capaci tY
Subs.
OISPOSAL
Tank:
Sludge:
Locati on
Locati on
TANK OPERATOR
TANI( HANoLER Name ' c er1. - #--
r
SITE A <(c<Q HENT (Copies of 1ab analysis report should be attached to this notice)
Grounduater sampi es-TPH-STEX. Resu I ts :
Soi 1 samp 1es-TPH-8TEX. Results:
Na,ne and Iocation of Laboratory
;HE ABOVE INFORI.IATIOI'I iS TRUE ANO CORRECT, TO IHE BESI OF MY KNOWLEDGE
S j gnature of owner/operator
Title oate