DERR-2024-006293

Michael O. l.eavitt
Govcmor
Dianne R. Nielson, Ph.D.
Exccutivc Dirccttr
Kent P. Gray
Dir6tu
{ t I I f e ) r i *hrr. ts r-t "t- *n 1-,.'r - I "i' {-, &q^t ;4 4 ) V , *E i { 4 g fl
^j WU'* .)\- ^-"P k as' EJ{,-&i[.3-
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West lst Floor
Salt Lake City, Utah 84116
[phone]
[phone] Fax
(801) 536-'1414 T.D.D.
December 12,1994
TO Southland Corp.
Attn: Bud Good
7167 South Alton Way
Englewood, CO 80112
RE Non-compliance of underground storage tanks at 7-Eleven 1862-24855, 1600 North State, Orem,
utah. Facility I.D. #10w294
The Utah Underground Storage Tank (UST) Act provides that the Executive Secretary (UST) may
revoke a Certificate of Compliance if it is determined that a facility is not in substantial compliance with
all state and federal UST statutes, rules and regulations.
At the request of the Executive Secretary (UST), the Division of Environmental Response and
Remediation (DERR) performed a compliance review for the underground storage tanks at the above
facility. The compliance review, performed on August 15,1994, indicates you have not satisfied the
requirements of the Act and are out of compliance. To achieve compliance you must do the following:
Submit documentation to show that you have had a qualified cathodic protection tester
test your cathodic protection system within the last three years.
Submit evidence that proper Automatic Tank Gauging (ATG) is performed on all USTs
by documenting that the ATG system performs a leak test at least once a month. The
inspector reported that leak test records were not available for May, June, and July of
t994.
Please return a copy to this speed memo with the above items to speed processing. The above
information must be submitted to this office by 01-15-95. If it is not 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 Therron Blatter at [phone].
I
2.
Printed on recycled paper
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13
Owner Name
Addrsss T streot Address t ra o a d, S*rA<.
Facility Name
ZgCrc,de
Certificate ol Compliance on sit6?No Erpiration date: 5d-^qf
StatoCity
I II1
{-Ya No Yes No,6 No ,,{dIHOZ(Yes )No ,G) No Yas Nofr?\No
lq33
lO k-e"drM"4 u.^
,:>\<t7 P3Material ol construction ol tank Ictael FFIP ctc I
FRP
?r*"x**x
ffi#ffi
-".j
#
dltll#f1, ji.: \.j l \.',+_Si#ri
li&Ior eedr'titiifi'd
//
Automatic Line Leak Detector
Groundwater Monitorino
City Stats Zp Code
Area Code Phone Number
Contact Person At UST Location Phono #
, (-'{?)certily that I have inspected the above'named tacility on
lrspocto/s
Slgnatrre of Owner or Orner's Repressntatve Present Durlng
v6a
Tank listad on Cartificata ol Comoliance
ll nnt in ilGa drle lael rnan'l
__)
iilanlh and vear tank installed
Canaeilv rrl tank fin oallonsl
Silhstanee stored
_)tO'J-tlatarial al rnnslnrr.lion ol oioino (steel. FRP.atn )
ffi
'&<*..'- j:lii).:1jrr-'"!ill:
l'f ffi ':,;,i;1,*,!t!t:t1,!..11.:,1:7r;.\
Ar*mafia Tank Gatmino
llenrral Tank Gauoino
Vanar Mnnilorino
Gmr rndwalar fulanitorinn
I ^ta?clitirl lrmil.1rint't
Statictical lnvenloru Flaconciliation (SlFll w #
Ai;. X''Y:'..r"r j1i 1r i :"iir; j:',i
?XS.ii; !: :- : i ;,:l r't 1:1 :t :" : t 1: I
I ine Tidhlneqe Tastino
ven.lr Monitorino
lntarstitial Monilorino
Statistical lnventorv Et*nnailiatinn lSlEll
other nnnrnved method (indicate nama al mthrv{l
lC
(ffi.oy.F...wl
\t'
lcV
I
Tank 3Tank 2Tank ISet I
L$ 2000 KP LD(P-DAutomatic FIow Restrictor (il yes'indicat€ mod€l in comments sec{ion below)
Automatic Shutofl Device (il indicate model in comm€nts section
Continuous Alam SYstem indicate model in comments section below)
Yes NoYes NoYes NoY€s NoRecords o, last Une Leak Detector
Date of last LinE Leak Detector perlormance tost 10
test available on-sit€
Pass Fail Pass FailPass FailPass FailResult ol last Une Leak Detector test
Sot 2
NoGJ Yes NoNoc)No(G)Records of last Une Tighh€ss on-site
to-fi-q;.'Date of last Un€Te'st
zG) rair Pass FailFail6)(@ FailResult of last Line Tighhess Test
Vapor Monitoring (if yes, use Vapor Monitoring checklist)
Groundwater Monitoring (if yes, use Groundwater Monitoring checklist)
lnt€rstitial Monitoring (if yes, use lnterstitial Monitoring checklist)
Statistical lnv€ntory Reconcilialion [Sl R] (i,y€s, use SIR checklist)
Yes No Yes NoYes NoRecords of last Lin€ Tightness Test available on-site
Other approved mothod use other method
Date ol last Line Tighhoss Test
Yes No
Pass FailPass Fail Pass FailPass FailResult of last Une Tighhoss Test
Vapor Monitoring (lf yes, use Vapor Monitoring checklist)
Grorrndwater Moniloring (if yes, use Gror,rndwater Monitoring checklis$
lnterstitial Monitoring (if yes, use lnterstitial Monitoring chectlist)
Statistical lnventory Recorrciliation [SIBI 0 yes, use SIR checklist)
Other approved method (if yes, use other m€thod checklist)
,j,rU,L;ik:Der6dbn'ffi;;iftiliia riiiiiiiivlr.to'iriii{m'roird*iii'g'irr!'ie
Yes No Yes NoYes No Yos NoOperates at less than atrnospheric pressur€
Yes NoYes No Yes NoYes NoSlope ol piping will allow ALL ptoduct to draln into tank when suction released
Yes NoYes No Yes NoHas only ONE check valve, localed direcdy under pump
Yes No Yes NoYes NoAll above information on suction Piping is VERIFIABLE, usB comm€nts section
,1(u1lr
Yes No
Yes No
#
\[nlrrr^a,!tn
lnspeao/s Signatrre:
Signatrre ol Ovmer or Owne/s Representative Present During
Tanlr/
-t
-_
-
4
17
*
Manufacfursr, narn€ and model number of
-T"d!)
Have any ol the leak test reports indicated a failed t6s1. It tail, specify in comm€nts section
what actions have been taken to conect th€ prcblem. Has DERR been notified?
Doqim€ntation ol perlormance claims lor lhe automatb leak t€st roature is available and
shows ths ability to detoct leaks ol 0.2 gph wift 95olo or gr€ater probability of detectiofl and
5% or less probability ol lalse alarm (3rd Party cettific8tlon)
Tank 2 Tank 3 Tank 4Tank I
No6)(".]J r.ro Yos NoNoG)Device documentation is available on'site (€.9.'manufac{urer's brochures, owne/s manual)
No@ Yes NoNo@@*"Becords on site document that the system was installed, calibrated' and maintained
according to ths rnanufacturer's instructions (if no explain below)
No6'Yes NoNo@No@A pmbe is present in the tank (checked by inspection) '
Yes NoNo6)@; No66) ruoDevice can measur€ the height ol the product to the n€ar€st 1/8 ol an inch
@No Yes NofG) uo NoroDevice monitors the in-tank liquid levels over lhe full range ol lho lank's intemal height
Yes [e-mail]@@*oA rronitoring box is prosent and there is evirJence that lh€ device is working (i.e., tlo dsvlce'
is equipped with roll of paper lor resutts docum€ntafion)
No@ Yes NoNo@No@Documontiaton is available demonstating that the Automatic Tank Gauge was in leak test
mode at least onc€ a month lor the last 12 rnonths __.>aq,A1q{t4qQrl-ll no, which months are missing? (specity months and year)_:-\
Q.1 No Yes NoNo@No@The tank was filled to at loast the minimum level required by the manufacture/s oquiPm€nt
protocol to 6nsur€ a valid lsak l€st
Yes No'6)No NoG)No@Tho tank capacity is within the upper and lower size limits required by the rnanufactlre/s
equipment protocol to €nsure a valid lsak t€sl
'c)Yes Yes NoYes@Yes@
Yes NoNo€9 NoNo€9
,tl lr L ,UU
vtnspoctor's
Signatjre of Owner or Orner's RePros€ntative Present Dudng
Tenk 3Tank 2Tank 1
Yes NoYes NoYes NoYes NoTh€ UST systsm is fill€d by transfers of no more. than 25 gallons at one
time. ll yes, splll and overfill prsventon is not required.
Yes No Yes NoYes NoYes Nols there a spill containment brcket or anotler device that will pr€vent
release of product into tho onvironment?
Yes' NoYes NoYes NoYes NoAn overlill pr€v€ntion device is installed on tho tank. lf yes, indicate
th€ t.!pe of device in the space below'
Yes NoYes NoYes NoYes NoFor ovcrllll alarm only: ls the alarm located where it can be easily
seen and head bY the delivery driver?
Yes NoYes NoYes NoYes NoFor ovcrlill alarm only: ls the alarm clearly marked to indicate what is
m€ant wh€n tl€ alarm sounds?
Tnnk t!Tank 3Tank 2Tank I
td
Yes @ Trt
Yes No
trt
Yes @
T.d(
Yes @
No6{Lh
No60tta
No6",
Tanks and/or lines are made ol a nonconodible rnatedal (such as
fiberglass) or erc made o{ steel clad with a nonconodible material' ll
yer, cathodic protection la not requircd.LlI
Yes
Tn
Yes No
Tr*
No64tt
Nof"")
Tr*
No6D
Lfr
Yes 6il
lL
Yes No
tL
Yes
l,ri.
Yes 6C
Tanks and/or lines are made o{ unProtoc'ted bar€ sieel and were
installed prior to May 7, 1985. ll yes, cathodlc protection b requlred
on or by Decsmber 22, 1998.
--------7-5Alndicate type ol cathodic protection: lmpressed Cunent (lC) or
Sacriftcial Anode (SA)
Yes NoNoNo@No@The results of th€ last two cathodic protection tesits ar€ avaihble'
(fests are required within six months of installation and every three
years th€roatter).
Trt
vots- I )9&on.
Td
- I J_b 9rort"
Tr*
- l3O3 ,ons
tft
Lh.
vohs-Al1 uffi
Itr
- gfo"Y
t,rrth
- 5 tt volts
Yes NoYes NoYes NoYes NoFor imprc$ed currcnt !y!tcm: The results ol the last three
equipm€nt operation checks are available. (Equip. check required every
8lnspectot's
Signaure ol Ovmer or Owne/s RePrss€ntauve Present During
Tonl
f.)verf,ll Alam
/-e
@
Results (in volts) ol most recent cathodic protection tssl
Name ol person who performed t""t, E&ti].t\
f".r O"r"'
a
CUSTOMER: SOUTHLAND CORP (7-11)
ADDRESS: 3146 GOLD CAMP DRIVE
CITY:RANCHO CORDOVA
STATE: CA ZIP: 95670
SITE ID: 24855
ADDRESS: 1620 N STATE
CITY: OREM
STATE: UT ZIP.
looo)?{
Testittq Evaluation RePort
The USTest 2000 System declares a tarrk to be leaking when the measured leak rate exceeds
the thresholcl of .05 gallons per hour and has a probability of false alarm of <1% and a
probability of detection of >99%.
TANK,I TANK 2 TANK 3
SYSTEM
INFORMATION
VOLUME VOLUME VOLUME
DIAMETER DIAIVIETER DIAMETER
FUEL TYPE REG UNLD FUEL TYPE PLS UNLD FUEL TYPE SUP UNLD
TANK TYPE TANK TYPE TANK TYPE
FUEL LEVEL FUEL LEVEL FUEL LEVEL
WATER IN WATER IN WATER IN
WATER OUT WATER OUT WATER OUT
SYSTEM
RESULTS
*LEVEL
ULLAGE
LEAK
DETECTOR
LINE
VAPOR II
E
PASS
N/A
PASS
N/A
PASS]
N/A
PASS/.OOO PASS/.OOO PASS/,OO(
N/A N/A
TANK 4 TANK 5 TANK 6
SYSTEM
INFORMATION
VOLUME VOLUME VOLUME
DIAMETER DIAMETER DIAMETER
FUEL TYPE FUEL TYPE FUEL TYPE
TANK TYPE TANK TYPE TANK TYPE
FUEL LEVEL FUEL LEVEI.FUEL LEVEL
WATER IN WATER IN WATER IN
WATER OUT WATER OUT WATER OUT
SYSTEM
RESULTS
LEVEL
ULLAGE U
TEC
LEAK
DETECTOR
LINE
APOR tI VAPOR II
ATG functional: YES tr NO O
' Producl line and mechanical line leak deteclor lesls olrly
TECHNICIAN: DALE SIMMONS C E R T I F I C A T I o N # : _U S T:!.QQ._DAT E : S ep!_e1$r e r![!!!{
LEVEI- I
. ULLAGE ULLAGE
LEAK
DeTecron
LEAK
DETECTOR.. .
, ,tlNE i.r, .,,.r .
VAPOR II
LEVEL ,,,..,. LEVEI-r,:,:::,.,...,....,.
ULLAGE
LINE LINE i
"":::' '
VAPOR II :..
lcoo 71f
May 5,1994
Theron Blatter
Department of Environmental Response and Remediation
150 North 1950 West
Salt Lake City, Utah 84116
l,r
g I 1011
[: Eugineerirtg
Cotpot'(,1tion
q
N
t
Dear Theron:gz
This letter is in response to your correspondence to the Southland Corporation regarding the Notice
of Intent to Revoke Certificates of Compliance, because of the failure to provide sufficient
documentation on annual line tightness tests and leak detector tests for 7-Eleven store
#2485 5 (facility I.D. #t00029 4).
SEACORhas been in contactwith TheresaBahrych of Region 8, Environmental Protection Agency
(EPA) in Denver, Colorado and Randy Carlton of Tidell Engineering, Inc. in Carrollton, Texas,
manufacturer of the Tidell2000, 3000, and 3500 Automatic Tank Gauging System (ATGS). Each
representative has stated that the ATGS system would give sufficient data without requiring the
monthly reconciliation of the 130 gallon plus 1% (see attached statements and references) as stated
in CFR 280.43 (a)(d)
SEACOR is providing you with copies of all third party certifications, current annual line tightness
tests and leak detector tests. This information should be adequate for the requirements that need to
be fulfilled. If you have any questions or concerns please feel free to contact me at 266-7100.
Sincerely,
Science & Engineering Analysis Corporation
v
Russell D Hamblin, R.G
Principal Geologist
cc:Southland Corporation - Bud Good
SEACOR - Stuart Miner
SEACOR - Shelly McMurtrey
4001 sotrtb 700 East, suite 250. salt Lake citt,, LrT 84107-2178 [phone] pb [phone] \-ax
b -oo\\" ,\
*
04/lL/94 L5:42 FAX 909
Michacl O. I-eavin
Govmu
Dia.nue R. Nielson, Ph.D.
Ercudve Diets
Keot P, Gray
Dirrctr
4J{ s5s5 REDLANDS/STIILND ++; SLC @otz
State of IJtah
DEPARTMENT OF ENVIRONMENTAL QUALTTY
DIWSION OF EN\IIRONMENTAL RESPONSE AND REMEDIATION
158 North 1950 West lst Eloor
Sa.lt Lake City. Ut h 84116
(801) 536-4r00
[phone] Fax
[phone] T.D.D.
so)
ry
I
be.=''',.d.t
$.NTO: THE SOUTHLAND CORP,DATE: March 23. 19%
ATTN: BUD GOOD FROM: Therron Blatter
7167 SOUTH ALTON WAY
ENGI,EWQQD,IS, 80122
9zsz
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE
16@ North State, Orem, Utah. Facility ID# 1000294
AT 7-ELEYEN #r8s2.248ss,
To continue to maintain a valid Certificate of Compliance, the facility must be in compliance with Federal
and State Rules and Regulations. A review of our records has shown that the following information is
lacking:
Submit the results of a precision line tightness test for the lines associated with tanks #1 (10,000
gallon gasoline), #2 (10,000 gallon gasoline), and #3 (10,000 gallon gasoline).
Submit a copy of an annual test for proper operation of the automatic line leak detectors on the
pressurized lines associated with tanks #1, #2, and #3.
Submit evidence that you are properly using your Automatic Tank Gauging system by:
a. Documenting that the system is properly installed, calibrated, and functioning,
b. Documenting that the system preforms and records a valid leak test at least once a
month.
Please return a copy of this speed memo with the above items to speed processing.
The above information must be submitted to this office by O4-n-r4.If you have-questions concerning
this matter or need any assistance, please contact Therron Blatter at (801i 536-410d.
F}
I
2.
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Prinled on recycl€d paper
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T!DEL INSTALLATION AND START.UP
CHECK.UST
EM5-3500
TIDEL ENGINEERING, INC.
94-qsENGINEERING,INC.
WARNING: THIS DOCUMENT MUST BE RECEIVED WITH A
BEFORE THE SYSTEM START.UP CREDIT IS ISSUED.
SERIAL NUMBER)
TELEPHtrtt<
)- Lg/..LTELEPHONE #
crry
ONE #
STATE
LOCATION
ADDRESS
oL)e6
ztP
PHONE #
TECH. NAME
STATE
CERTIFICATION #
COMPANY
ADDRESS
TELE
CITY
Ail ol the following questions must be answered.
1. ls the console powered by a dedicated circuit?
2. ls the console supplied with a secondary earth ground?
3. ls the conduit routed through the AC raceway?
4. Are any tanks manifolded? lf so, explain.
@ru
@N
Ygp
Y_@
5. Are all conduit runs filled with an appropriate sealing compound?
6. Are any probes mounted within three reet ol the submersible pump?
ll so, were they instailed in drop tubes? Explain.
o N
Y
5oo t6 nEv.0 326/s3
t
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MAINTENANCE REPORT AND WARRANTY REGISTRATION CARD
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MODEM
MODEL
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Affiliote Test Report
2727 Koliste Soloom Rood, Lofoyetle, LA 70508
Phone: [phone] Fox (31 -0355
!
.ACGURACY TANK TESTING
.917 W. Belleview
, Porterville, CA 93257
Customer
'Site /D;
Sife Address;
ctU:
Sfafe:
Zp:
Testing Evaluation Report
The USTesl2000 Syslem testing method declares a tank to be leaking when the
measured leak rate exceeds the threshold of .05 gallons per hour and
has a probability of fals€ alarm of <1% and e probability of detection of >99%
SoUTHLAND CORP(T-11).
#2/r855
1620 NORTH STATE
OREM
UTAH
TESTRESULTS - LEVEL
L'A'E TESTRESULTS
1 P UNLD;PASS;RATE:-.002
R UNID;PASS; RATE : -. 0O 5
S UNLD;PASSRATE:-.004
- , COMMENTS: Line end leak delector te.ts were perfornEd orly.
UNE LEAK DETECTOR
I PASS;XPLD;#N/A
2 PASS;LD2000;#N/A
3 PASS;XPLD;#N/A
4
5
6
I
2
3
4
5
6
I
2
3
4
5
6
2
3
4
5
6
TAN 2
DIAMETER
VOLUME
FUELryPE
TANKTYPE
FUEL LEVEL
WATER LEVEL
GROUND WATER
4 5
!
II
iJ
iI
TECHNIGIAN: NED HOLDAWAY CERT#: UTe147 DATE: 10114193
IESTRESULTS . ULLAGE
7,^L t)t,c ura
7
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DEPARTMENT OF ENVIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAT- RESPONSE AND REMEDIATION
168 North 1950 West lst Floor
Salt Lake city, Utah 84116
(801) 5364100
[phone] Fax
(801) s36-4414 T.D.D.
TO TIIE SOUTHLAND CORP.
7167 SOUTH ALTON W AY
ENGLEWOOD,80t22
:
I
'l
Michael O. Leavitt
Govemor
Dianne R. Nielson, Ph.D.
Excutive Dirctor
Kent P. Gray
Dirrctor
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE TANKS AT T.ELEVEN #1852.24855,
1600 North State, Orem, Utah. Facility ID# 1000294
To continue to maintain a valid Certificate of Compliance, the facility must be in compliance with Federal
and State Rules and Regulations. A review of our records has shown that the following information is
lacking:
Submit the results of a precision line tightness test for the lines associated with tanks #1 (10,000
gallon gasoline), #2 (10,000 gallon gasoline), and #3 (10,000 gallon gasoline).
Submit a copy of an annual test for proper operation of the automatic line leak detectors on the
pressurized lines associated with tanks #1, #2, and #3.
Submit evidence that you are properly using your Automatic Tank Gauging system by:
a. Documenting that the system is properly installed, calibrated, and functioning.
b. Documenting that the system preforms and records a valid leak test at least once a
month.
Please return a copy of this speed memo with the above items to speed processing.
The above information must be submitted to this office by 04-23-94.If you have questions concerning
this matter or need any assistance, please contact Therron Blatter at [phone].
1
2.
3
Printed on recycied PaPer
DATE: March 23. 1994
ATTN: BUD GOOD FROM: Therron Blatter
:--f
^r/
Leak Detecti on lnspection hec Ist
\?
!. Ownership of Tank(s)ll. Location of Tank(s)
Ornor l{uno Publlc Agency, or other Bndty):
St c.t AddreEr
Phono I
County
Stato
l-oesdoo
cht
Araa Codo
Contac"t Prrnofr At
__84esZ
VgCadcClty (near6st)
.)
OI
0.r"P.*
Sta!r
Numbor ol Tenkr et Thlr Locatonl 3
Faclllty t&r:
lll. Tank lnformation Pbaso ffim$ors &,1 inforfirstion for eacfi tar{<' lf tfih tacillty tus nrorp lfian 4lanks;,
plsrsa photocopy-tbic{cqe and complgllallQ @ tHnlc.
Q"llg/Tank Fr€ssntty ln uao 1 (ranr 4_)Tank 4
It n0( datc la![ us6d
tl emptlect. verify 1' or less ol producl in tank
Month ard Year Tank lnstalled (E-estimate or K-known)(q8?
fi?zMatorlal of Constructlon {E-6stirnate or K-known}
i0LCapacity of Tank (in gallons) (E-€sitirnato or K-krrcwn;
lV. A. Flelease Detection For Tanks ch€{r( rre meurod(a) usod lor ra"t tan* or N/A lf tste
n
Manual Tank Gauglng (only frcr tanks und6r 1,0O0 gal.)
Substenco Stored or
ManualTank Gauging and Tank Tightness Testlng
(mly lor Enks und6r 2,000 gal.f
Tant< Tightness Tedlng and lnvontory Control
\/,tu omatlc Tank Ciaugirq
Vapor Monhoirq
Groundwatry Monitorlng
lrtarsilitlal Moniloring
Otrror approved method {'rvrilo in nanE ot method)
lV. B" Flelease,Detsction For Piping chec*<troreteasc method(s) uced
Prt.r.ntrad Ptoag
srrqrcn Prdno
Ch€c& On€ Type ol Ptplng fpr 6aoh Tank
GaLrnn;ze-A \
aod
Vapod Monitodrlg-
Grerundwater fdonlp{tno
Secondaly Qglglngpnt with Monitorin0
Urw Tighffigq'i]g$!4$.
lV. S. Gorrosiott attd 6pill/CIverfil! Protection
lhs4,i'urdd {lrtdic6to dale)tn4Crrmi*ii8tl
,'QUAI.ITY
D
V. Slte lnformation
pfCIksffefi hst&ll€d (indisrb dsto)
GsriGrd slte observations and comments (vich,ty obeervations. ground watsr levol, ,b.)
J
L
l c€dily(prtltnltrl inspocted the
Dato:
DIV. C'}:
Sri$rPl
5Lt 74fi'r"
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loe
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lt75
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[-eak D etectircn for Pi ping
Fecility lD fi too 0 e1f
Sol t ( ranxr a- :g9L2,{ tanxy'
funornatic Flow Flo$ricior X-s-{antrUtu,-r€\
? 9.s.q2-
Set 2
ALnomailc Shu{fi Devics
Oontinuous Alarrn Systom
and
Annual Llne Tightness Testing ,l
Vapor Mcnitoring
lf Vapor Monitoring. <Jocumontation of monthly
moniloring ls available
hlerBlitial Mcnitoring
lf lntorstillal Monitoring, documerttalion ol monthly
monitorino is available
Ground-Waler Monltorlng
ll Ground-Watsr Monitorino, docutnontation of rnonthty
rncnitorino ls available
Othu Approv€d Mothod (spocity tn comrnonts
Lino Tightness Tasting (rcquired evory 3 years.)
soclion)
Vapor
Socondary Contalnment yrith lnlerstitial Monitorlng
Grounl-Wator Monitoring
Other Approvod Md,frod ln comments socllorl)
No Loak Dotactton Roqulred
(must answor ye3 to all of the follcwlng ques$ons)
Op€ral@s al l6s than atmospheric prossuro
Has only ono clrrck valvo, whiclr is locatord diroctly
urrlu plmP
SIOpO Of piprng allOwS product ro clrain b,.rck into tarrk
when suction rslea8od
All above informalion on suclion piping is veritiablo
Pressurlzgd Piping A rnorhocr nrusr bo Gor*rod from oach set wroro appllcabls indlcato dats cl lasl tost ll lhb tadllty hso rnrr thsribnk*, plmqo pfobcopy utls pago orxJ oddiUona,
Tan[ 4
SuCtion Piping lndlcato d&to o( rw)st rrxxmt brst
On the back ot lhis sheel, plo€so skotch ths sito. nothg all piping runs, tanks (tnclucling sizs & substancss s,tored)and location ol wellS snd tholr distanc€ from tanks andpipihg. -
l.
CommenB:-farrl4 3-*-qI
| - - ,=t- =t. cerl'fy(J)rl|taItE)I haw rrspsctod the aborvo narnocl lacilrty on
rbrnlt. drr. Fr, th.
Nncpoctdr'r Slgnstum:
0t0.t
.I^)"Urr^-Doto:yt lB 113'
L
Artt 9,
-.
--r
I "\
Automat ic Tank auglng
r)
o
f10yes
h o nfornoeacnsweraorpattlnriquestiye8
ownersbrochures,manual)manLfiacturer'ssitsaliSdocum€ntation available (a.9.,DBvico
Manufactlrsr. nam€ and rnodel numtrer of system:
Facility lD lf
y6s n0hoightproductono€ighth anof inch.nearest10measureofcanDevice y6sl/
Doc.um€ntation shows that waler in bottom of tank is checked monthly to nearost one*eighth
of an inch.. nolY6l ,./of inventory reconciliation
monthly basis.
5?(
o/o1excaedsifonbasisthsdiscrepancywilladeclareloakDsvico
on301offlow-through,plus gallons
month.mtnta aotoncsmum,TGA inwas mod€tsstthslhatavailableISDocumentation
noyBS
noy6
Chocked for presance of gauge in tanks.
yeFl r'nolpr+:sance ol
is equippEd
monitoring box and
with roll of paper for
thateviderrce lSdovics workingforCheckoddocumentation).resultsdevice.e.,(i
no l'/v* L_
1{1 nov-ves [_*tomaintainedaccordingandcalibrat€d,installed,wa5thalsyst8mdocumentationCh6ckedq1instructions.manufacturgrs5
.t
1 mofiths.for thoavailablea16 pasandrscordst6stingMonitorin0
Maintenanco records are available upon roquest'noy6s
noyes
-4 A,ut ,..-(,L " - ox., /"/t7f13
lnsp€ctor's Signaturo:
Comments:
51oo5H
'),
a
t.
t (7 (' (') f4
,l
r
-1g'2-
(*
n>lrrs
\ rr.t id 4 )
by::::!- ai'l '.')---.--i
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FACrr rrY rD. I 0 OOZq q
PST PR,OCESSING iIECKLIST
rear ql
Unacceptable Acceptable
Not
Applic ]e
,.1.
I'lon-I,larketer D i scount
Previous Pollution Incidence
LUST File
Porm Included
Y/N n
Y/N M-
TTT
- tlerify tank/1inesvs registered
Documentation ok?
- Rate ok?
\'\lY/N
.'\Y/N '
{
Y/N ..
.:;;W
Fund Paid
- FY 9l_Y/N
Fees Paid
FY 88?
FY 89?
FY 90?
Y/N
-FYst? I----t--
Compliance
- Conrpliance Outstanding? y /N l\/
- Leak det-ecti on required ? y,/ll Y ;t0 "g\u\'lfl
- Notification up to date & complete? y/N '/
k apprication?
Date QualifiedJ
ilAY 0 I lggl
Review completed and certificate issued by
SUPPORT\ CE\ CHECKI,T ST. PST
7tt,V
1000294\
PETROLEUM STORAGE TANK FUND APPLICATION
FACILITY INFORMATION:LOCATION OF TANKS:
Owner Name: 7-ELEVEN sALES coRpoRATtoN Facility Name:
Street Address
City
Cou
7- ELEVEN 24Bss
Street Add rESS] 427 LAWNDALE DRIVE
City SALT LAKE CITY
SALT LAKE
TYPE OF OWNER:
1600 iiortE-3tate
State I Utah
Ph one: 8A1/262-6484
e: 840s7
Contact ffit',i'
Ix] Marketer, or non-markete
[ ] Non-marketer with annual
r with annual monthly throughput greater than 10,000 gallon
monthly throughput less than 10,0-00 gallons (Must veiity;.
S.
DESCRIPTION OF UNDERGROUND STORAGE TAN KS:
RECULAR NO LEAD PREM I UM NO LEADTank #
Age 1983 19 B3
Capacity
Substance
10,000 10 000
19 83Tolo-0-
TANK TIGHTNESS TEST
Tank #
Pass/Fail
CERTIFICA OFR ISTRATIO
-----,.r:-. ir -I:.E:::]:
APRot ffif
rl17:.'r ?- . .., .-,,,ii f': a, I yl"l
i
l* All Underground Storage Tanks
6.L All registration TANK Fees have .(UST) at this facility have been registered.
been paid.
COMPLIANCE WITH UST REGUI.ATI ONS:
ls the a pplicant currently in co mpliance with all Federal, State , and Local UST regulationsYes tlNo--lf "No" please describe item(s) of n on-compliancetx
PREVIOUS POLLUTTON INCIDENT (s)
Have yout I Yes--rground Storage Tank) lnformation:
Ix ] No -- lf "No" please attach a letter stating that under customary business inventorypractice standards you are not eware of any release fiom any tank(s) at this facility
PST FUND FEES
every-tank at this facility is included with this application.
nt(s) for every tank at this facility are included witn this application.
I I Full payment for
[x ] Quarterly payme
I certify under penalty of law that the above representations made by me are true and correct.
Applicant's signature:Date signed:1l I
State:UTAH 84115
JOHN P. CHIRBY
ever had a
lf "Yes"
K4l un
re Registration Tank Fees have been paid - 1988/1989 = S2s/tank/yr, 1990/1991 = $4sitanklyr
2, COMPLIANCE WITH UST REGULATIONSI
f( am in compliance with release detection requirements.
Tanks installed belore tgAi or unknown: releese detection by Oec. 1989,
I I Tanks installed 196+1988: release detection to be compleled by my compliance dale.
I I Release detection completed upon installation.
fi| I am in compliance with all other Federal, State, and Local UST regulations.
3. PST FUND FEES - ANNUAL FACILITY MONTHLY THROUGHPUT:
1ru'than
am a marketer, or I am a non-marketer with annual facility monthly throughpur greater
10,000 gallons.
ll $250 payihent/tank: Fiscal year (July 1, 1990 - June 30, r991).
ll Ouarterly payments @ S52.50/tank (Due the lst day ol Jul, Oct, Jan, and Apr).
I am a non-marketer with annual facility monthly throughput less than 10,000 gallons.
I have completed the APPLICATTON FOR NON-MARKETERS DTSCOUNT form.
I I S125 paymenl/tank: Fiscal year (July 1, 1990 - June 30, 1991).
I I Ouarterly payments @ $31.2s/tank (Due the 1sl day ol Jul, Oct, Jan, and Apr).
4. TANK & LINE TIGHTNESS TEST.. ACTIONS REQUIRED AFTER TEST:
zlAll systems pass the tank and line tightness tests.
[l am submitting the results of the tank tightness test and a copy of the field report.
[ ] All tanks do not meet the requirements set by rule regardlng tank tightness testing.
[ ] I have contacted the State UST office and will submit evidence of a ptan for review.
5. PREVIOUS POLLUTION INCIDENTS:
fi I have completed the PREVIOUS POLLUTION |NCIDENTS form wnich states whether
'unler customary business inventory practice standards, I am aware of any release from the
tank.
I NDEPENDENT FINANCTAL ASSURANCE Kee records at our facili
I have obtained financial responsibility requirements for the first $25,000/release:
,ks.tt tn"urrn""
I I Bisk retention group
ftt have obtained independent third-party financial assurance bv mv comoliance date.
[ ]]will obtain independent third-party financial assurance oy my comptiarice date.
[ ] Guarantee [ ] Cornrnercial lnsurance [] Surety Bond
I I Letter of Credit I I Other:
*See explanations under "How do I gel started?"
PETROLEUM STORAGE TANK FUND CHECKLIST'
1. CERTIFICATE OF REGISTRATION:
FAqIITY LD.1000
PREVIOUS POLLUTION INCIDENTS
To:Mr. Deruris Downs
Executive Secretary
Utah Solid & Hazardous Wastes Committee
Dear Mr. Downs:
As requirgd by paragraph 26-74e-4O4 of the Underground Storage Tank Act, I have
performed a tank and line tightness test on each underground storage tank at my faciliry
and based on this test, there has not been a release of petroler*. naaitionaliy, basea
on "customary business inventory practices standards", I am not aware of any release of
petroleum from my tanks.
qL
I have had the following releases of petroleum (detailed below; also mention any action
you took to clean up the release).
signature of owner/operator
Failure to report previous releases could void Jrour coverage under the Petroleum Storage
Tank Fund.
-gE l,uerr 1B : 1z S|fIJTHI.-trlF.Irr M}<TT^F'- Ei:2
.t : l
CBR.TIT'ICATE OF FI IIANEIAf, FESPONSI BII.ITY
rhe SouEhIand Corporation hereby cerbifies that tt i s incomolianee wtth bhe requi rement* of Sul-rpart H of 40 CF,R pare ZgO,
The ftnanciar assurance meehanism use5 to rcemonstrate ftnanetaLresoonsilrtltty unrler Subpart H of 40 CEa Part 280 ls as f ollows r
rrrevocabre standbv [,etter of cr:e,t it \o. 92sd9, tssuad bvNCNB Texas r-latlona'l- gankr on Janrrary 24, 1989r DrJrsnant lo40 eFR 280.q9, uo rlemonstrate Einanciat responsihtlitv forf-,aki?q _?orreebive acLion ancl/or comoensabing thirrr parhtes
f or bodity in jury and property danaqe ciuse,.l by acctd"nt, treleases ln t.he amounb of a't 'i-enst $i, () OO',n00.00 ' ;;;oecurrence and fi?,000,000.00 annual ae?regate.
THF: SOIITHI.A\ID EORPORATION
Bv:
rlame s
Ti rt &l .
l)a Ee ! l,la rt-h 16. rqns
9 ATE OF' TEXAS
COI'NTY OF NAttAS
s
s
s
-.\ SUBSERIBED ANT)ll-U*cJg, rege.
[,tv Com,n t sS ton Expt res s
/Cd-u ay oFSI{ORN TO BEFORE I"IE IhtS
I
hrulu'lA C. i:ll,i:;-.:' l'1, li i r/ Pri':lic
,n ,..'1 {i:i. [:i,'s :
_;,1,,;r]tillfg,,fMy Cln':rn!sri'rtt [";:;';r ';3 L
BFSGR3I
TANKNOLOGY CORPORATION I NTERNANONAL5225 Hollister', Houston, Texas 77040-6294 Phone: (713) 690-'TANK Fax: [phone]Gertificdeof Trghhess SeMce Order # 23556 , Test daE 3126 /gt
Undergrurtd sbr{E trtk Ey*m(s} ElEd md tburd tgttfa
l3lTank(g&piping,
Quan-[ ]Tank(s) Only,
Ouan-[ ] Piping only.
Q uan.
Tank Owner/Address SOUTHLAIID C0RPORATION 7L67 S. ALTON WAY, ENGLEWooD, CO
Test SiE Address
1,t27-LL ll24 855,16 20 N. STATE, OREM. UT 84057
Tank sizes & products
TANK TANK 31 PI]N
Piping Tested T,TNES:1A- 2A- 3A
TCI //01 22-L0 / 92
- UT {0154 V r4-.A.q :b^--^€c,!* . iGdituint l eqidmm , uattr.E ,ilre-
!.. Sr Plt9lt . #2249, Crnsdirn prtcnt . I tO569J, Europlln prtcnt lgptf. tOiZaSrANKNor-oGv & VrcuTcct rc lrade*ks of rANKxaoov cmior*rroN inrffrerrrinll--i&: See VanTect Teat R€port tU r!r* ibdificdil.ird e; lii;Em CauiE.Form&n.3/€9
Valkt onlywith
CorporaE Seal
TANK IOK RIIN./I2 1OK REG^
.;
'tl!n l. ,- -'r!'
A^a i!;,;r ar. ,:. ru: \.r
oLo
VacuTect " TANK TESTING REPORT s.o.n
',,ss6Customer SOUTHLAND CoRpoRATroN Site *24855
lnvoice Narne/Address sourHLAND coRpoRATroN, 7167 s. ALT9N 14Ay, ENGLET^799D, co 801 12 Phone
Attn:
Date 3/26 /sL
303-740-9333
Site Name/Address 7-rr 1241ss 1620 N. STATE OREM ur 84057 GARRY WOOD]"IAN
VICK A LANCASTER IIOTZZ_IO/92ur /10154
TANKNOLOGY Regional Office:92 Unit Number 3l
TANKS and LINES Tested to
cFR-40 Parts 280-281 and
NFPA 329 Spec's.
Other:
TAN KNOLOGY CORPORATION INTERNATIONAL
4960-F Allison Parkway r Vacaville, CA 95688
(7071446-2494 r [phone] . FAX [phone]b
TAT'I KS LII{ES Leak tlet
Exist
LD
Pass
(P)
Fal
(F) cr
tIONE
NEW
PrrTud
tDt
SOLD
Yes/No
Sx
DlC
For
Le.
Tank,Tank
Product
Tank
Dia.
Tank
Gallons
Tank
Mat'lr
sT/
FRP/
Lirrcd
Dipped
Water
LevelI
START
END
Dipped
Product
LevelI
STAHT
END
Probe
Water
LevelI
START
END
Water
ingress
DetectedI
YeVNo
&rbUe
ingress
DotectedI
Yes/No
tflage Ar
lngresa
Detcctcd
I
YeVNo
Tight
rr)
or
Fail
(F)Line#
Line
Mal'l
I
ST/
FRP
Deliv
Syst.I
PS/
SS
Tight
(.r)
or
Fail
n
1 RUN
Start l
End T:
96
lme:
me:
10K ST
0 60 .16
NO NO NO T 1A ST PS T P NO Exiat LD SN: 30882-0735
1B NerLD SN:
0 60 .16
1C PumP Mlr': RED JACKET
1D
2 REG
Stafi l
End T:
96
rme:
me:
10K ST
0 66 .32
NO NO NO T 2A ST PS T F NO Exist LD SN: 39 tg1_27 7 O
2A NewLD SN
0 66 .30
rc Pump Mt
RED JACKETnT"rard il,- r'DRI ;:?f
3 PUN
Start 'l
End T
96
lme:
me:
10K ST
0 67 16
NO NO NO T 3A ST PS T F NO Exiet LD SN: 1969r_ 4314 (l1lqt
3B NelY LD SN:
Pump Mfr.: RED JACKET
0 67 .t6
rc
3D f^qzbl ,*r> st)T
4
Start 1
End T
lme:
rme:
4A Exi8t LD SN eltlot
4B N6{LD SN
&,furnp Mlr
4D
NOTE: Original VacuTect Data recordings are revianed by fanknolgy's Audit Control Department and maintained m file.
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