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Underground Storage Tank lnspection Verification Form
MAVERIK COUNTRY STORES INC
880 W CENTER STREET
NORTH SALT LAKE UT 84054
DENNIS RIDING
IVIAVERI K #266
14416 S REDWOOD RD
BLUFFDALE UT
BRIAN NELSONOwner Contact:
Facility Name:
Street Address:
Last lnspd: 1 1 l'l2l2oog
[phone]
FacilitylD: 4002130
n4^- L
84065
[phone]
UTM Coordinates 420,285.26 4,482,4A5.02 onhoquad (mo) 1 m€ler lmas6
Comments: No tags.
ln LD compliance Yes ln Operation Compliance: l'lo
Tank Status:
Date lnstalled/Capacity/Loc:
Tank lvlaterial:
Tank lvlodificalions:
Pipe lvlaterial:
Pipe lrodifications:
Pipe Flex Connectors:
Pipe Type:
Substance Stored:
Spill/Overfill Description
Iank C P MeULast TesuPassed?
Last Line CP TesuPassed?:
Tank Release Detection:
Last TTT/Method/Passed?:
SIR Vendor
ATG Vendor/lvodel
lrin. Vol./Max. Cap.:
Max. Monthly Thruput:
Pipe Release Detection:
Date ALDTfiype/Passed?
Date LTT/Method/ Passed?
PSTFund: No Other:
1 E-Gen: No
Cunently in Use Manifold: No
21911997 10,000 Southwest
Fiberglass Reinior.€d Plastic
Fibelllass Reinfor.ed Plastic
Steel Flex in Sump
Pressurize Perm RO by: 2/9/2007
Gasoline Regular
5 gal. Spill Bucke Automatic shutolf
YES
ATG
212211W7 TEl4000 Yes
Veeder Root Simplicity CSLD
10% old 5% ne$,/ 45K
227,559 glmo
1. lronthly 2. ALD
9l8l2$5 Electronic Yes
9/8/2N5 TEI Model LT Yes
Yes OtherType: Self-insurance
Tank Status:
Oate lnstalled/Capacity/Loc:
Tank Material:
Tank Modifications:
Pipe Material:
Pipe Modifications:
Pipe Flex Connectors:
Pipe Typel
Substance Stored:
Spill/Overfi ll Desciption
Tank C P l\reuLast TesuPassed?
Last Line CP Tes Passed?:
Tank Release Detection:
Last T'fT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Min. Vol./Max. Cap.:
Max. Monthly Thruput:
Pipe Release Detection:
Date ALDT/Type/Passed?
Date LTT/Method/ Passed?
PSTFund: No Other:
3 E-Gen: No
Currently in Use Manifold: No
Agl1997 'l 0,000 North
Fiberylass Reinforced Piaslic
Fibsrglass Reiniorced Pbslic
Steel Flex in Sump
Pressurize Perm RD by:
Gasoline Premium
5 gal. Spill Bucke Automalic shutoff
YES
ATG
212211997 TEl4000 Yes
Veeder Root Simplicity CSLo
1Oo/" old 5o/" ne,t,r 45K
227,559 glmo
L Monthly 2. ALD
9/8/ ns Electronic Yes
9/8/2lNS TEI Model LT Yes
Yes OtheiType: Self-insur
2 E-Gen: No
Tank Status: Currenuy in Use Manifold: No
Datelnstalled/Capacity/Loc: 21911997 10,000 Southeast
At/' vo 5)t'r1t'"\M P"r{*t,x n *^{
CSLD {i{& - .V m. al/ 3 A+-d otL'
Tank Material:
Tank Modifications:
Pipe Material:
Pipe Modifications:
Pipe Flex Connectors
Pipe Type:
Substance Stored:
Last l-fT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Min. Vol./Max. Cap.:
Max. Monthly Thruput:
Pipe Release Detection:
Date ALDT/Type/Passed?
Date LTT/Method/ Passed?
PSTFund: No Other:
Fiberglass Reinforced Plastic
Fib€rglass Reinfo,ced Plasilc
Steel Flex in Sump
Pressurize Perm RD by:
Gasoline Regular ss
I
a't1d' 5
\J
212211997 TEl4000 Yes
Veeder Root Simplicity CSLD
10% old 57o n€w 45K
227,559 glmo
1. Monthly 2. ALD
9/E/2(nS Eleclronic Yes
9/8/2an5 TEI Model LT Yes
Yes OtherType: Self-insurance
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ho^ e-1" w"4{-
P
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Spill/Overfill Description 5 gal. Spill Bucke Automatic sh
Tank C P l\reyLast TesUPassed? YES
Last Line CP TesyPassed?:
Tank Release Detection: ATG
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Tuesday, November 03, 2009
6o*4 7tt vut6
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Own€r Namo:
Owner Address:
Mr. Gary Astin
March 18,2fi)9
Page2
3. Current-year tank tags are in place on the tank fill risers.
Photographic documentation is attached, together with a work request letter and sewice order from
Sump & Trap Cleaning who emptied the containment sumps.
Maverik Store #304 11415 Solrth 7(X) East, Draper, FID 4001503
L. Current-year tank tags are in place on the tank fill risers.
Photographic documentation is attached.
Maverlk Store #333, f04l9 South 27fi) West, Sorilh Jordan, FID 4(m544
1. The spill containment buckets, fill risers, and fill fittinp togetherwith thevapor recovery risers,
vapor recovery fittinp, and associated spill containment for all three USTs were replaced.
2. Current-year tank tags are in place on the tank fill risers.
Photographic documentation is attached.
Maverlk Store #352,46M West lrfr0iD South, Herrtman, Fm lfi:t374
1. Current-year tank tags are in place on the tank fill risers.
Photographic documentation is attached.
Please contact me if you have any questions or need additional information. If this submittal is sufficient
then please send me an acknowledgement that these compliance issues are resohed toyour satisfaction,
via e-mail to [e-mail] if you like.
Sincerely,
Maveriko Inc.
r
Dennis Riding, PE & PG
Environmental Director
Attachments
t
I
Photograph 1 - New spill containment bucket on UST 1 at store 266. Photograph 2 - Current-year tags in place on UST 1 at store 266
\
Photograph 3 - Current-year tags in place on UST 2 at store 266 Photograph 4 - Current-year tags in place on UST 3 at store 266
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Shane Adolf, Sump & Trap Cleaning
801-595-8151
801-527-2159
Dennis Riding, Maverik
21Nov2008
2
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ynoEnr(
MAVERIK INC.
88(J Wtst Ccnter Strcet
North Salt t rke. LiT 3J05+2913
Phone: (80 t) 335-3860
Far: (E0l) 936-9-t02
E-mail: [e-mail]
MemolFacsimile
To:
Phone No.:
FmNo;
From:
Date:
No. of Paga:
Dear Mr. Adolf,
Please schedule a service call to each of the following Maverik stores, to pump water and/or fuel
out of the sumps and secondary containment spill buckets installed on the fuel tanks. This
request is in response to recent inspections by Utah DEQ/DERR, and the comments from the
inspectors are mentioned below. But please just check all of the sumps and spill buckets
installed on the fuel tanls, and pump out any of them that need attention. Please also check for
water in the tanks byprinting a status report from the Veeder-Root automatic tank gauge (push
the "print" button and then read the line that reports on the presence of water). If you find emy
water in the tanks, then please call me and I'll probably ask you to pump and dispose of it while
you are there.
Maverik Store #227. 2650 South Main Street in South Salt Lake. Utah DEQ/DERR inspector
reported that the premium gasoline spill bucket was haHfull of water.
Maverik Store #264. 27 07 W'est 12600 South in Riverton.Utah DEQ/DERR inspector
reported that two of the spill buckets and two of the larger, submersible pump sumps contained
water.
Maverik Store #266, 14416 South Redwood Road in Bluffdale. Utah DEQ/DERR inspector
reported that all three of the larger, submersible pump sumps contained water.
Maverik Store #277. 3112 South Redwood Road in WestVallev City. Utah DEQ/DERR
inspector reported that the two unleaded gasoline spill buckets were full of water and that all
three of the larger, submersible pump sumps contained water.
Page2
Maverik Store #291, L927 3230 West in Salt Lake Citv.Utah DEQ/DERR inspector
reported that the south unleaded gasoline spill bucket was half full of fuel.
Maverik Store #323. 2680 South 2000 East in Salt Lake City. Utah DEQIOERR inspector
reported that the unleaded gasoline spill bucket was full of fuel.
Maverik Store #326. 710 East 2700 South in Salt Lake Citv. Utah DEQ/DERR inspector
reported that the unleaded gasoline spill bucket was half full of water.
Thanl$ for you help, and please call me with any questions. Please let me know when you have
completed the service calls.
Dennis Riding
Maverik,Inc.
880 West Center Street
North Salt l-ake, utah 8405 4-2913
801-335-3860 office
801-910-7061 cellular
801-936-9502 fax
[e-mail]
Sump & T[ap Cleaning
155 North 500 West
Salt Lake City, Utah 84116
Service Order
Date:
,r*", f :'24 ,o
Customer:
w. o.
/^t 5
BOL/IVIanifest ' ,6092
[phone] (80r) 521-2159 Fax
e-mail: sump_trap_cleaning @ msn.com
Z#2Generator:
Address: y'
CitylStatelZip:
Generator Phone:
4
,
.@4
<2 5 nPhone:
Contact:
(-/
-The
recovery / monitoring or ground water will be processed in accordance with all applicable state and
local regulations.
-The
UST /AST (s) listed below was cleaned in accordance with 40 CFR, Section 280, and all applicable
federal, state, and local codes.
-The
sump/separator(s) listed below was cleaned in accordance with all applicable federal, state, and local
codes.
_The fuel tank(s) listed below had bottom water removed.
The sump/separator(s) materials disposed at
The material containerized and left on site
Description Gallons
/q / R,n LolqA.
B.
C.
D.
All material is processed according to applicable federal, state, and local regulations pertaining to re-utilization, recycling, or disposal
Sump & T[ap Cleaning
Generator / Offeror:
S.L.C. County SWMF Permit No.
POTW Discharge Permit No.Title:
Utah Used oil permit No.o42-96
USDOT No.654891
#*I
U.AEPA ID No.uTo00000306'1 STC:
11
4g
Department of
Environmental Quality
William J- Sinclair
Acting Executive Direclor
DTVISION OF ENVIRONMENTAL
RESPONSE AND REMEDIATION
Brad T Johnson
Director
FIL T COP Y
State of Utah
JON M, HUNTSMAN, JR,
Goverdor
CARY HERBERT
Lieutenant Governor
Re
ERRU-O16-09
February 2,2009
CERTIFIED MAIL
RETURN RECEIPT REOUESTED
Gr?zr^ a*l -iu * ttoa / o sl
Dennis Riding
Maverik Country Stores, Inc.
880 West Center Street
North salt Lake, utah 84054
Notice of Non-Compliance for Underground Storage Tank Violations
Maverik #266,located at 14416 South Redwood Road, Bluffdale, Utah
Facility Identification No. 40021 30
Dear Mr. Riding:
The Utah Underground Storage Tank Act regulates Underground Storage Tanks (USTs)
and imposes certain obligations on the owner or operator of a facility having USTs. The Act
specifically requires the owner or operator of a facility with USTs to meet the following
requirements:
Register the USTs and file an UST Notification form
Pay annual registration fees
Demonstrate and maintain financial assurance meeting federal and state
requirements
Obtain and maintain a Certificate of Compliance for each tank
Meet specific technical and performance standards, including maintaining release
detection on the tank and piping, maintaining corrosion protection, and maintaining
spill and overfill protection
Maintain adequate tank records
Properly permanently close any UST not meeting these requirements
At the request of the Executive Secretary (UST), the Division of Environmental Response
and Remediation (DERR) performed a compliance review for the facility owned or operated by
Maverik Country Stores, Inc., (you). This facility is located at 14416 South Redwood Road,
Bluffdale, Utah. The designated Facility Identification No. is 4002130. This facility contains
three USTs.
168 North 1950 West . Salt take City, UT
Mailing Address: P.O. Box 144840 . Salt Lake City, UT 841l4-4840
Telephone [phone] . Fax [phone] 'T.D.D. [phone]
ww.deq.utah.gov
Printed on 100% recycled paper
a
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Facility ID #4002130
Page2
The compliance review indicates you have not satisfied the requirements. To achieve
compliance, you must do all of the following within sixty (60) days of the date of this letter:
Submit documentation to show that you have replaced the spill containment bucket
for UST #1 (10,000 gallon Unleaded - southwest tank). At the time of the
inspection, the spill bucket was cracked and damaged, and the upper support for
the bucket and the surface lid was gone.
Submit documentation to show that you have removed the water and/or product
from the containment sumps at the submersible pumps for USTs #1, #2 (10,000
gallon Unleaded - southeast tank), and #3 (10,000 gallon Premium).
Submit documentation to show that the current year tank tags are in place on the
tank filI pipes. They were not in place at the time of the inspection.
The Act gives the Executive Secretary (UST) of the Utah Solid and Hazardous Waste
Control Board (Board) the power to enforce rules made by the Board by issuing Notices of
Agency Action and/or Orders. The Act, Utah Code Axn. $$ 19-6-407 and 19-6-408, also gives
the Executive Secretary (UST) the power to assess a civil penalty of $1,000.00 if an owner or
operator of an UST fails to register the tank, assess $1,000.00 for failure to pay fees within
60 days of due date, and assess. interest on the unpaid balance. Other violations of the Act may
result in civil penalties of up to $10,000.00 per day. Failure to comply with the Utah UST Act and
regulations may result in revocation of your Certificate of Compliance under Utah Code Ann. $
19-6-414.
This letter will advise you that your failure to comply with the requirements of the statutes
and rules may result in the issuance of a Notice of Agency Action and/or Order and the
assessment of a civil penalty.
Please contact Gary Astin at [phone] should you have any questions.
Sincerely,
Brad T Johnson, Executive Secretary (UST)
Utah Solid and Hazardous Waste Control Board
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December 7, 2007
Page2
Qn"'d. {z-{ro{oz
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mmpliance inqpections done by the US EPA in other stateg EpA would have found the Haaec
test to be sufEcient and wor.rld not have e),perted to see another cathodic protection s5ntem test
until september 2Q 2009. Neverthelesg a reoent cathodic protection test has been completed
anyway and the report is attached, although we do not recogrize the time period between
October 29th and the date of this recent test as a lapse in the required testing schedule. Our
position is that the Haztec test in 2006 cwen any "gap."
4. The 2007 compliance tags were attached to the fill port risers at the beginning of the year, but the
plastic cable ties zubsequently failed and the compliance tags were apparently lost. we are in the
process norr of distributing the 2008 compliance tegs, and so current compliance tags will be in
place again shortly.
Maverlk Storc #265, 675 l/Yest Hyde Park I^ane, Hyde PBrL, FID ,il1005EE
1. & 2, The spill buckets and zubmersible pump sump6 at the facility have been emptied,
Maverlk Store #266, 14416 South Redrvood Rood, Blufidatg FID #{XDl30
1 . & 2. The spill brcket for the unleaded tank and the submersible pump sumps at the facility have
been emptied.
Maverlk Store #3St, llXl9 South 2700 West, South Jordan, FID #{1fi)544
1. The qpill buckets have been repaired, although it is possible that the repain wilt not tast due to
the age ofthe spill buckets. If the repairs do not last, then we will replace the spill buckets in due
course. The replacement of earlier model spill buckets involves the cutting of concrete,
excavation work, installation work, backfilling and concrete restoration. It is often not possible
to schedule and complete such a project and still meet the response deadline required in a typical
non-compliance letter.
2' The spill bucket for the diesel fuel tank and the vapor recovery sump for the premium tank have
been emptied.
3. It is our understanding that vapor recovery is not required for diesel fuel tanks. The vapor
recwery riser mentioned in your letter was formerly in use when the tank contained midgrade
(plus) gasoline. Now that the tank contains diesel fuel, the vapor recovery riser has been capped.4' we are in the process now of distributing the 2008 mmpliance tags, and so current compliance
tags will be in place shortly. Veeder-Root FMS has mrrected the database to shon, line 3 as
diesel instead of phs.
Meverlk Stom #352,4604 West l26m South, HenlmrainrflID #tlOU2314
1. The spill buckets for unleaded tank 2 and premium tank 3 have been emptied.2. The west dispenser was checked and has been repaired.
1
JON M. HUNTSMAN, ]R.
Govemor
GARY HERBERT
Lieutenant Governor
State of Utah
Department of
Environmental Quality
Richard W. Sprott
Exet:utive Director
DIV ISION OF ENVIRONMENTAL
RESPONSE AND REMED1ATION
Brad T Johnson
Director
October 26,2007
Dennis Riding
Maverik Country Stores, Inc.
880 W. Center St.
North Salt Lake, Utah 84054
Re: Non-compliance of underground storage tanks (USTs) at Maverik #266, 14416 S. Redwood Rd.,
Bluffdale, Utah; facility ID #4002130.
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 October 22,2007 , indicates you have not satisfied the requirements of
the Act and are out of compliance. To achieve compliance you must do the following:
At the time of the inspection, the spill containment bucket for UST #l (10,000 gallon Unleaded-
southwest tank) had water and/or product in it. All spill buckets must be properly maintained, and
must be kept dry and free of water, product, and debris, so they can function properly. Please
document that the water and/or product have been removed from the spill bucket.
At the time of the inspection, the containment sumps at the submersible pumps for all three USTs had
water in then. All containment sumps must be kept dry and free of water, product, debris, etc., so they
can function properly and protect metallic system components from corrosion. Please document that
the water has been removed from the containment sumps.
Please submit the requested information to this office by December 10r2007. If it is not received by this
date, we will commence the process to revoke the Certificate of Compliance for the facility. If you fiave
any questions concerning this matter or need any assistance, please contact me at (801) 5364103.
I
2.
ep"t Ah-UL
Gary Astin
Underground Storage Tank Section
168 North 1950 West ' PO Box 144840 . Salt L,ake City, LlT 841 l4-484O. phone (80t ) 536-4100 . fax (801 ) 359,8853
T.D.D. [phone] . www.deq.utah.gov
Sincerely,
tD 4002130
Release Detection
T Program
Checklist
Uta,-
ofL
Location Useanks tr
MAVERIK COUNTRY STORES INC Name MAVERTK #266 BLUFFDALE
880 W CENTER STREET 14416 S REDWOOD RD
NORTH SALT LAKE 84054StateUT BLUFFDALE 84065State UT
[phone]DENNISRIDING Contact SUZANNE 446-1180JENKINS
each tank.
Number of tanks
Tank lnstallation 21911997 21911997 21911997
1 0000
or
iJ
Tank is in use.No No Yes No Yes No No
Date last
tank are rnCurrent No No Yes No Yes
Material of construction of Reinforce Reinforce Rei nforce
Material of Fiberglass Reinforce Fiberglass Reinforce Fiberglass Reinforce
Pressurized Pressurized Pressurized
Prevention device
intact etc.Yes No No Yes No Yes No Yes No
Overfi ll Prevention device
driver can hear or see and isalarmorIS identified.Yes No
Containment free from water etc.No
The results of the last two tests are available n six months of Yes No
Date of lastProtection Tester UT
proper operation at least every
Its of the last three checks are
lmpressed Current Yes No Dates of last three checks:
Corr. Protect.
Method
Sacrificial
Anode lnstant Off
1
2
3
4
5
Tanks
6
1
2
3
4
5
Lines
6
1
2
6
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North UU
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Are A tlr-
EI::
riH,NW
3
4
5 W
Tank
Flex
6
td)+t t
Method:-i N
I
Disp.
Flex
lndicate below the corrosion protection method in place for each UST system component. ldentify each dispenser by pump number(s). Show readings
test.for the most
\,L 3
L
rIL
Comments
Dil
,fr, -
Utah -ST Program
Automatic Tank Ga lnterstitial Monito
lD 40021
!l tf ofL
TANK LEAK DETEGTIoN ATG
Tank method used:lnterstitial Mon
Manufacturer, name and model of system: Veeder Root Simplicity CSLD No Manifold
Circle Yes or No fof each question. ln the last column, explain and identify by tank any exceptions to the answers given in the first column.
IM Type of Secondary Containment used:Type of lM Documentation used:
ATG IM
Records on site document that the system is properly installed, catiUrate{
operated, and maintained (system and tank setup reports, maintenance
records). Written documentation of calibration, maintenance, and repair is
kept for at least one year after work is completed.
No@ fn.,,Lli,Lu utaot/
ATG IM
ATG console or other equipment used to take readings and perfonn tests is
adequate, accessible, and operational.No@ I I
ATG IM
Documentation of valid testing or monitoring is available for the last 12
months. Show results in table below.@*o
ATG @NoThe probe is located at the 7
center of the tank. \
lf not in center, show tilt factors
from the setup report.
Titr #1
b'oU
#2
6,a4
#3
Loa
#4 #5 #6
ATG
The tank was filled to at least the minimum level required to
leak test, and the tank size is within the allowed upper and lower size limits.
ensure a valid No@ Third Party Minimum Level: {7,.
IM System is capable of detecting a release of regulated suUstances frorn any
portion of the primary tanUpiping within one month of release Yes No
Shorv resultsof monitoring for each tanf
highest product level tested foreach monlh.
MoA/r 1ls 1 2l01 3la1 4la'l 5lo'7 6lo7 71e"7 8ke1 9leJ lole i 1',llot,12to 6
# 1"'z-P6ss
-# 1ut-;c fl
# 1?'a
#
#
#
P|PING LEAK DETECTION ALD Monthlytr Piping qualifies as Safe Suction. Documentation is available and verifiable to show that piping operates at less than atrnospheric pressure,
has only one check valve (under pump), and has proper slope of piping. lf all these criteria are met, no leak detection is required on the piping.
Piping method(s) used. Pressurized piping must have an Automatic Line Leak Detector
Manufacturer and model of each leak detector:
Date of last leak detector .o{lJo 1 " -
performance test i4rlo t frO Results:
lndicate type of test: Simulated Leak, 3 gph, .2 gph, .1 gph
(3, .2, .1- electronic LLD only)
u@o rt,l@o
,J L PI,T,
sL 3 .2 .'t s1 3.2.1
Cert. Number UT Test Method:
M oMEO MEO
sL 34.1 s1 3.2.1 s1 3.2.1
EO ME
Tank 6
Type(Mechanical, Electronic, Other)
Tester name:
sL 3(4.1
fc.rt
L?uct:.
El-Automatic Line Leak Detector,Tank 1 fank2
other form of leak detection,
Tank 3 Tank 4 Tank 5
Cert. Number UT Test Method:
Results:
tr Same as above . Tester name
tr Line tightness testing.
Date of last line tightness test:
El-Monthly monitoring.
lndicate the method used
w. GPH Monthly Testing tr lnterstitial Monitoring. Type of lM Documentation
D SIR tr GW Monitoring tr Vapor Monitoring
Show results for month.12 months. lndicate or No Results for
MoA/r 1t 2l 3l 4t 5l 6t 7l 8l 9l 101 11t 12t#l -:=#)t r€5r ''\ 't{'{..r }r V4 tL -v, lASt
#j l,i(< -<
#
#
#
\. a(UT
t;
i
COMMENTS UL t
7
A
APPLIED ENVIRONMENTAL SERVICES, L.C.
PO BOX 182 ROY, UTAH 84067 (801) 546-7s46
T.E.I. SYSTEM 4OOO / T.E.I. LT3 / T.E.I. ULLAGE
PRECISION TANK & LINE TEST RESULTS SU]\4I\4ARY
INVOICE ADDRESS:
MAVERIK COUNTRY STORES
BBO WEST CENTER
NORTH SALT LAKE, UTAH 84054
DATE:9-8-2005 TIME START:
TIME SYSTEM FILLED OR TOPPED:
TANK TANK PRODUCT
CAPACITY
TANK LOCATION:
MAVERIK #266
14416 SOUTH CAMP WILLIAMS RD
BLUFFDALE, UTAH
TIME END:
WORK ORDER # 05244
TECHNIGIAN: SM
TECH #94027 VAN # 8502
STATE TECH # UT 0121
GROUNDWATER DEPTH:
TANK FILL VENT PRODUCT LINE LEAK WATER INVAPOR LINE DETECTOR TANK
PUMP
TYPE
TANK
MATERIAL
1
2
3
4
5
6
1 0000
1 0000
1 0000
RYUL
S/UL
RYUL
PASS
PASS
N/A
PASS
PASS
N/A
PRESS
PRESS
PRESS
SWF
SWF
SWF
N/T
Nff
Nff
N/T
N/T
Nff
PRODUCT LINES TESTED AT 50
LINE RATES (GPH}
1 RyuL -.000
2 s/ul -.000
3
4
5
6
PSI FOR 15 MINUTES
ADDITIONAL INFORMATTON: VEEDEROOT PLLDS PASS 3 GPH FUNCTIONALITY TEST
THIS IS A LINE I\4ODIFICATION TEST , BOTH R/UL LINES WERE MANIFOLDED INTO ONE LINE WITH ONE
PLLD.
rHrs sYsrEM fti9^lEIi?:^T,=r=IiSFIf"F^'3.?'i+iiE'IiB'uUXiE'Slg."'* PAR, 280'
Digitally signed by Steven B. Martin
cERrlFtED rEcHNlclAN SIGNATURE: E?=,i,ff:f;,[Xk[i::]'::r. DArE: e-8-2005
Date: 2005.09.12 12,,21:.47 -07'00'
Reason: Document is certilied
GVR ID: 124208
Site Id: 266
Site:Maverik Country Store
14416 S. Camp Williams Rd.
Bluffdale, UT 84065
Report Created: 1011012007 02:38 AM
Tank Release Detection Results
Tank Product Test Date Period Tlpe
FMS Site Compliance Report
Period: 1110112006 to 1011012007
Customer: Maverik Country Store
880 West Center Street
North Salt Lake City, UT 84054
FullVol Result
I
2
3
1
2
J
I
2
J
I
2
3
1
2
3
I
2
l
UnleadedTank 1
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
UnleadedTank I
Premium Tank2
E. UNLEADED
UnleadedTank I
Premium Tank 2
E. UNLEADED
Unleaded Tank 1
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank 1
Premium Tank2
E. IINI-EADEI,
UnleadedTank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
UnleadedTank 1
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
01t0'7t2007
01to7t2007
01t07t2007
02/07t2007
02t07t2007
02/07t2007
03t06t2007
03t06t2007
03t0612007
04tMt2007
04/0612001
04/o6t2007
05to6t200'7
05to6t2007
05t06t2007
06t06t2007
06106t2007
06t06t2007
07t06t2007
07to6/2001
07t06t2007
08t0u2(w
08104t2007
08t04t200'7
09t04t200'7
09t04t200'7
09t04t2007
10t08t2007
t0t08t2007
tot08t2007
1UO7t2006
11to7t2006
t1/o7/2006
1U07/2006
12tO7/2006
12/07t2006
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthiy
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 CPH Monthly
0-2 GPH Monthly
0.2 GPH Monthly
01t200'7
01t200'7
07/2001
02tzN1
o2t2N1
02t2001
03t20u
0312001
03/2001
04/2007
04/2007
04/2007
05t2001
05t200'7
05t200'7
06/200'7
06/2007
06/2001
01t2007
ut200'7
0'7/200'7
08/2007
08/2007
08/2007
09t2001
09t2001
09tzUu
lo/2007
totzNT
10t200'l
11t2006
11/2006
t1/200,6
12t2006
12t2006
't2/2006
62Vo
367o
6lVo
497o
427o
5l7o
48Vo
447o
527o
621a
44Vo
52Vo
56Vo
37Vo
607o
56Vo
4l%o
55Vo
48Vo
45?o
49Vo
597o
407o
58Vo
49Vo
32Vo
507o
55Vo
24Vo
52Vo
50?o
3OVo
53Vo
65Vo
367o
627o
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
2
3
2
3
2
J
2
3
2
l
This repon docmlents tanl and litre tests perfomed at the above locution tbr the indicated date and period.
This repotr Md the tests pedbmred are pan of lhe Maverik Country Storc monitoring aDd reponing program, and
are itrtended to satisfy federal EPA UST relere detection atrd rccord keeping requirementsFuel Logistics Services
VR101: Page 1 of2
Veeder-Root Company 125 Powder Forest Drive Simsbury, CT 06070-2003 l-8D0-997-772s
GVR ID: 124208
Site Id: 266
Site: Maverik Country Store
14416 S. Camp Williams Rd.
Bluffdale, UT 84065
Report Created: 1011012007 02:38 AM
Line Release Detection Results
Line Product Test Date Period Tlpe
FMS Site Compliance Report
Period: 1110112006 to l0ll0l2007
Customer: Maverik Country Store
880 West Center Street
North Salt Lake City, UT 84054
Result
2
I
2
I
2
1
2
I
2
1
z
I
2
I
2
W. TJNLEADED
PREMALL DISP.
W. UNLEADED
PREM ALL DISP.
W. UNLEADED
PREM ALL DISP
W. UNLEADED
PREM ALL DISP.
W. TJNLEADED
PREM ALL DISP
W. UNLEADED
PREM ALL DISP.
W. UNLEADED
PREM ALL DISP
W. I]NLEADED
PREM ALL DISP
W. UNLEADED
PREM ALL DISP.
W. UNLEADED
PREM ALL DISP
W. UNLEADED
PREMALL DISP.
W, UNLEADED
PREM ALL DISP
0y06t200,
oU06t2007
02t05t2007
02105t200'7
03t05t2007
03t05t2ffi1
04to4t2007
04t06/2m7
0y04n007
05t041200'7
06t06t2007
06t05t200'7
0'7105t2007
07to5noo1
08to4t2w
08t04t2007
09t0v2007
os/ol/2ffi'7
tot05t200,
10t0'il2w7
tyo'tzm6
tlt05tz006
12t07t2006
la05t2006
0u2007
01t2w7
02t2007
02t2007
03t2007
03t2m,
04t200"t
04t2007
05t2007
05t200'7
06t2007
06t200t
07t2007
07t2007
08t2007
08/2007
09l2N7
09t2007
1012007
10t2007
1v2006
1U2006
12t2006
ta2N6
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
2
I
)
I
2
I
2
This rcpon docudrents tank and line tests perfbmd at the above location tbr the indicated date and period.
This report and the tests perfbmled re pafr of the Maverik Country Storc nrooitodng and rcponing progrm, md
are iilcnded to sadsry federal EPA UST rclede deEctioo and rc@rd keeping rcquirementsFuel hgistics Seruices
VR101: Page 2 of?
Veeder-Root Company 125 Powder Forest Drive Simsbury' CT 06070-2003 l-8OO-997-7725
Alarm History Report
Period: 11/01/2006 to 10/10/2007 Customer: Maverik, Inc.
880 West Center Street
North Salt Lake, UT 84054-2913
Created: 1011012007 7:10 AM
Alarm
266 02119107 08:33
266 02/12107 08:33
Auto-Dial Failed Alarm
Auto-Dial Failed Alarm
02/26107 02:10
02/12107 19:50
Address: 14416 S. Camp Williams Bluffdale, UT 84065
8 Auto-Dial Failed Alarm, FMS recieved Auto Dial
Failure Alarm" close 02/2612007 02:12"
8 Auto-Dial Failed Alarm, FMS recieved Auto Dial
Failure Alarm" close 021 121200'1 19:52"
)
)
Fuel Management Seruice
vRl06: Page I ofl
JON M. Hu,' ISMAN, JR.
Governor
GARY HERBERT
Lieutenant Governor
State of Utah
Department of
Environmental Quality
Dianne R. Nielson. Ph.D.
Executive Dtrector
DTVISION OF ENVIRONMENTAL
RESPONSE AND REMEDIATION
Brad T Johnson
Director
October 12,2006
To:Dennis Ridding
Maverik Country Stores Inc.
880 W CENTER STREET
North Salt Lake, utah 84054
Re:Non-compliance of underground storage tanks at Maverik #266, 14416 S. Redwood Rd,
Bluffdale, Utah. Facility Identification No. 4002130
The Utah Underground Storage Tank Act (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 (USTs) at
the above facility. The compliance review, performed on September 25r 2006, 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 the STP sumps associated with USTs #2 (East [INL)
and #3 (Prem.) are emptied and free from water.
The above information must be submitted to this office by November 15, 2006. If you have
questions concerning this matter or need any assistance, please contact David Wilson at (801) 536-
4138.
168 North 1950 West. PO Box I44840. Salt Lake City, UT 841 14-4840. phone [phone] . fax [phone]
T.D.D. (801 ) 536-M14 . www.deq.utah. gov
owner Name MAVERTK COUNTRY STORES tNC Location l13ms MAVERIK #266 BLUFFDALE
880 W CENTER STREETAddress Address 14416 S REDWOOD RD
6;ry NORTH SALT LAKE StateUT 7ip 84054 city BLUFFDALE state uT Zip 84065
Contact DENNts RtDtNG Phone [phone]
Number ol tanks at the facility: -{
SUZANNE Phone [phone]
Tank lnstallation Date ?,9h997 2t9t1997 2/911997
Capacity of Tank (in gallons)
.I UUUU 1 UUUO 1 0000
lndicate if tank is siphoned or compadmented. Show related tanks.fr.az lu^ l L.t )r?ha..1<,1
-
Substance Stored
uasoilile ffil
"^,,r^^.., L&i uaSQilne rremtum
Nodh
Tank is in use.Currently in Use Currently in Use Currently in Use Yes No
lf not in use, give date last used and depth of product in tank.
Current year tank tags are in place.)6)No {fe3) No tO No Yes No
Material of construction of tanks Fiberqlass Reinforced Fiberolass Reinforced Fiberolass Reinlorced
Material of construction of piping Fihar^laec Pai^f^r^ad Fihar l.cc P6i^I^r^6d Fiha16lace Rpinfar.a.l
Piping type Proecr rriu or{-Praeer rrizar{Preqqr rrized
Type of Spill Prevention device 1- {-,,.J
-\-
-.>
Spill coltainment bucket is intact, clean, and free of product, water, debris.Yes @ @No @s_ ruo Yes No
Type of 9verfill Prevention device lr,_+,,k e-
-
Ovedill alarm (audible or visible) is properly located so del ivery driver ca! hgar or see it, and is clearly identified Yes No N/A
(-.etc.sealed free from water Yes ffi-o]/R
The results of the last two cathodic protection tests are available (within si4 months of installation and every three years thereafter).Yes No N/A
Cathodic Protection Testing. Date of last test:Tester UT
lmpressed Current System is checked for proper operation at least every
60 days and the results of the last three checks are available.Yes No N/A Dates of last three checks
lmpressed CurrentCorr. Protect.
Method
Sacrificial
Anode lnstant Ofl Depolarized
1
2 Al11
J /1rfiTanks
4
1 /1/h
2 /Y/Yl
J /{1\
Lines
4
1 Lf
2 ('i-
J r)Tank
Flex
4
I Ls.,
,t/-/f
41 (q
Disp.
Flex
lndicate below the
for the most recent
corrosion protection methods in place for all UST system components. ldentify each dispenser by pump numbe(s). Show readings
test.
Comments
o
g
c
a
0
D
o
C
o
(e
L
Ia
)\
\
\'\
I zf^oson
Name of 44
Ldcheckl 205.doc
TANK LEAK DETECTION ATG
Tank method used: t I ATG Shutdown Testinq
Veeder Root CSLD No Manifold
IM of
Manufacturer name and model of
ATG IM
Records on site document that the system is properly installed, calibrated,
operated, and maintained (system and tank setup reports, maintenance
records). Written documentation of calibration, maintenance, and repair is
kept for at least one year after work is completed.
@*o
ATG IM
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and ooerational.@*"
ATG IM
Documentation of valid testing or monitoring is available for the last 12
months. Show results in table below.G)-N"
ATG
The probe is located at the
center of the tank.
If not in center, show tilt #3 #4No
ATG
The tank was filled to at least the minimum level required to ensure a valid
leak test, and the tank size is within the allowed upper and lower size limits.@*o Third Party Minimum Levet:) f 2
System isIM one month of release
1tol 2tDb 3tN 7to6
a ease any
Mol/r 51.6 6to6
Yes No
i,l,{,
n;;
1ts.,.I sto 1 11#l -_>\-#?-
#9 /
#
PIPING LEAK DETECTION flLD Monthly! Piping qualifies as Safe Suction. Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, has
only one check valve (under pump), and has proper slope of piping. lf all these criteria are met, no leak detection is required on the piping.
Piping method(s) used. Pressurized piping must have an Automatic Line Leak Detector and one other lorm of leak detection.
ff, Automatic Line Leak Detector Type (Mechanical, Electronic, Other):
Qp.z.r4t
M o
u
MEO
.2 .1 sL3.2.1
o MEO
Tank 4
lndicate type of test: Simulated Leak, 3 gph, .2 gph, .1 gph
Tester name:
sL3.2.1
Test Method:
Tank 1 Tank 3Tank 2
Manufacturer and model of each leaFletector:
Date of last leak detector performance test: ?* A Results:
.2,.1- electronic LLD only)
Cert. Number UT
44 E'7- 8-DI-,Line tightness testing. Date of last line tightness test:
Same as above Tester name:Test Method:Cert. Number UT
Results:
method used:
Show results of
tr .2 GPH Monthly Testing tr lnterstitial Monitoring. Type of lM Documentation
tr SIR n GW Monitoring tr Vapor Monitoring
lor Fail
U Monthly monitoring. lndicate the
monitori for the last 12 months. lndicate or No Results for each month.
4t _5/7l_613t 11tMo/Yr 1IDf,a
-{=>
elaF '10/
--12(#l -:>
#/r4
#?f
#
COMMENTS I *I
Distribution: While- DEBR, Yellow-lnspeclor, Pink- Facilitv/Owner Ldaloiml205.doc
/a
APPLIED ENVIRONMENTAL SERVICES, L.C.
PO BOX 182 ROY, UTAH 84067 [phone]
T.E.l.4000 / T_trt tT3/TFt I II I At?tr
PRECISION TANK & LINE TEST RESULTS SUMMARY
INVOICE ADDRESS:
MAVERIK COUNTRY STORES
880 WEST CENTER
NORTH SALT LAKE, UTAH 84054
DATE:9-8-2005 TIME START:
TIME SYSTEM FILLED OR TOPPED:
TANK TANK
(:APACITY
TANK LOCATION:
IUAVERIK #266
14416 SOUTH CAMP WILLIAMS RD
BLUFFDALE, UTAH
TIME END:
WORK ORDER # 05244
TECHNICIAN: SM
TECH #94027 VAN # 8502
STATETECH # UT 0121
GROUNDWATER DEPTH:
PRODUCT TANK FILL VENT PRODUCT LINE LEAK WATER IN
VAPOR LI DETECTOR TANK
PUMP
TYPE
TANK
MATERIAL
1
2
3
4
5
6
1 0000
'10000
1 0000
R/UL
S/UL
R/UL
PASS
PASS
N/A
PASS
PASS
N/A
PRESS
PRESS
PRESS
SWF
SWF
SWF
N/T
Nff
N/T
N/T
Nff
Nff
PRODUCT LINES TESTED AT 50
LINE RATES (GPH)
1 RyuL -.000
2 slut -.ooo
3
4
5
6
PSI FOR 15 MINUTES
ADDITIONAL INFORMATION: VEEDEROOT PLLDS PASS 3 GPH FUNCTIONALITY TEST
THIS IS A LINE MODIFICATION TEST , BOTH RYUL LINES WERE MANIFOLDED INTO ONE LINE WITH ONE
PLLD.
rHrs sYsrEM iIr'^M1?:^T,'r=Ii-"$Fii"'o="'.?'Jr'ofE'IiE'utX.'E'Slg.t'* PARr 280'
Digitally signed by Steven B. Martin
cERilFTED TECHNTCTAN STGNATURE: EX;i:iH:fi;%xH;3it?1"3i,. DArE: e-8-2005
Date: 2005.09.12 12:21:47 -07'OO'
Reason: Document is certified
\-.
App[_,IED -ENvrRo.NM_ENTAL srRVrcr s, L. c.
PO BOX.t82 ROy, UTAH 84067 (80t) 546-7546
T.E.I. S TEM 4OOO / T.E.t. LT3 / T.E.l.LLAGE
PRECISION TANK & LINE TEST RESULTS SUMMARY
INVOICE ADDRESS:
MAVERIK COUNTRY STORES
880 WEST CENTER
NORTH SALT I-AKE, UTAH 84054
DATE:11-12-2004 TIITESTART:
TIiIE SYSTEM FILLED OR TOPPED:
TANK LOGATION:
MAVERIK f266
1,1416 SOUTH CAMP WILLIAMS RD
BLUFFDALE, UTAH
TIME END:
WORKORDER# 04359
TECHNICIAN: SM
TECH # 94027 VAN # 8s02
STATE TECH # UT 0121
GROUNDWATER DEPTH:
TANK TANK PRODUCT
caDAeft.\/
TANK FILLVENT PRODUCT LINELEAK WATERINvLIE
PUMP
ryPE
TANKRTMATE
I
2
3
4
5
6
10000
10000
10000
R/UL
S/UL
R/UL
PASS
PASS
PASS
PRESS
PRESS
PRESS
SWF
SWF
SWF
N/T
N/T
N/T
N/T
N/T
N/T
N/T
N/T
N/T
PRODUCT LINES TESTED AT
LINE RATES (GPH)
I
2
3
1
5
6
PSI FOR MINUTES
ADDIIONAL INFORiiATION: VEEDEROOT PLLDS PASS 3 GpH FUNCT|ONAL|ry TEST
THIS SYSTEiI AND METHOD iIEETS OR EXCEEDS THE C IN USEPA,rc, CFR PART 280,
NFPA 329.87, AI{D ALL APPLICABLE ST AND LOCAL CODES.
CERTIFIED TECHNICIAN SIGNATURE:DATE: 11-12-2004
Alarm History RePort
Period: 09/01/2005 to 08/31/2006 Customer: Maverik, Inc.
880 West Center Street
North Salt Lake, UT 84054-2913
Created: 0910512006 3:00 PM
Alarm Tvoe FMS Close Alarm Dev,. Label Dev. No.Alarm Status and CommentsSite ID Console Time
266 06113106 16:11 Tank Probe Out Alarm
266 04120106 00:12 PLLD Gross Test Fail Alarm
06114106 03:21 Premium Tank 2
0412010602:23 W.UNLEADED
Address: 14416 S. Camp Williams Rd., Bluffdale' UT 84065
2 Tank Probe Out Alarm, DIALED INTO SITE AND
ALARM WAS CLEAR, T 2 TANK Premium Tank 2
PROBE OUT CLEAR 6-13-06 4:24PM
I PLLD Gross Test Fail Alarm, PvenF , Pon= , P l: ,
P2: Q I OTHER W. UNLEADED GROSS LINE
FAIL CLEAR 4-20-06 12: l5AM. John peterson from
Petroleum Equipment on site until 3:25 AM EDT
testing dispensers.
I PLLD Shutdown Alarm,
I PLLD Gross Test Fail Alarm, PvenF , Pon: , Pl: ,
P2= Ran gross line test(s), re-enabled line on FIRST
attempt.
I PLLD Shutdown Alarm,
2 PLLD Gross Test Fail Alarm, Asc On Site.
2 PLLD Shutdown Alarm, Asc On Site.
I PLLD Gross Test Fail Alarm, Asc On Site.
I PLLD Shutdown Alarm, Asc On Site.
2 PLLD Gross Test Fail Alarm, Asc On Site.
2 PLLD Shutdown Alarm, Asc On Site.
)
266 0412010600:12
266 1011210506:04
266 1011210506:04
266 09108105 19:32
266 09108/05 19:32
266 09108105 19:28
266 09108/05 19:28
266 09108105 19:27
266 09108105 19:27
PLLD Shutdown Alarm
PLLD Gross Test Fail Alarm
PLLD Shutdown Alarm
PLLD Gross Test Fail Alarm
PLLD Shutdown Alarm
PLLD Gross Test Fail Alarm
PLLD Shutdown Alarm
PLLD Gross Test Fail Alarm
PLLD Shutdown Alarm
04120106 02:15
l0ll2l05 08:29
I 0/12105 08:03
09108105 2l:32
09108/05 21:32
09108105 2l:28
09108105 2l:28
09108105 2l:28
09108105 2l:28
W. LINLEADED
W. LTNLEADED
W. UNLEADED
PREM ALL DISP
PREM ALL DISP
W. L]NLEADED
W, UNLEADED
PREM ALL DISP
PREM ALL DISP
)
Fuol Management Sewice
VRl06: Page I ofl
GVR ID: 124208
Site Id: 266
Site:Maverik Country Store
14416 S. Camp Williams Rd.
Bluffdale, UT 84065
Report Created: 0910512006 02:04 PM
Line Release Detection Results
Line Product Test Date Period Tlpe
FMS Site Compliance Report
Period: 0910112005 to 0813112006
Customer: Maverik Country Store
880 West Center Street
North Salt Lake City, UT 84054
,
Result
)
2
2
W. UNLEADED
PREMALL DISP.
W. UNLEADED
PREM ALL DISP.
W. UNLEADED
PREMALL DISP
W. UNLEADED
PREM ALL DISP.
W. UNLEADED
PREM ALL DISP
W. UNLEADED
PREMALL DISP.
W. UNLEADED
PREM ALL DISP
W. UNLEADED
PREMALL DISP.
W. I.JNLEADED
PREM ALL DISP.
W. UNLEADED
PREM ALL DISP.
W. UNLEADED
PREM ALL DISP.
W. UNLEADED
PREMALL DISP.
o1t07t2006
0l/05/2006
ozto6t2006
ozt06/2006
03to6t2m6
o4t07/2006
05t05t2006
05t05t2006
06to4t2006
o6to6t2006
ut06t2006
07t04t2006
08/Mt2N6
08to7tzoo6
0yl7noo5
ogt17t2m5
Lot06t2005
10i06/2005
11tO4t2005
11t0612005
12t07t2005
t2/07t2005
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH MontNy
0.2 GPH Monthly
0.2 GPH MontNy
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Montily
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0l/2006
0u2w6
02t2006
02t2006
03t2006
03t2006
aflt2006
04t20p,6
05t2006
05t2006
06t2006
06/2006
07t2006
0'7t2006
08/2006
08/2006
09/2005
09t2005
l0/2005
10i2005
tu2005
t1t20r5
12t2005
12t2m5
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
03to6t2006
o4t05t2006.
2
I
2
I
2
I
2
I
2
I
2
I
)
I
2
I
2
This repotr dtrunEnts tank atrd line tesls perfomed at the above l@ation lbr the iDdicaled daE and petiod.
This rcpon and the tests p€rfomEd tre pa( ofthe Mavetil CouDtry Storc nronitoritrg and rcponing program, aDd
are iiledded to satisfy lederal EPA UST relede detection and rccord keeping rcqliremenlsFuel Logistics Sewices
VR101: Page 2 oI 2
Veeder-Root Company 125 Powder Forest Drive Simsbury, CT 06070-2003 7-80O-997-7725
GVR ID: 124208
Site Id: 266
Site:Maverik Country Store
14416 S. Camp Williams Rd.
Bluffdale,Ir'T 84065
Report Created: 0910512006 02:04 PM
Tank Release Detection Results
Tank Product Test Date Period Tlpe
FMS Site Compliance Report
Period: 0910112005 to 08/31/2006
Customer: Maverik Country Store
880 West Center Street
North Salt Lake City, UT 84054
Full Vol Result
I
2
3
I
2
3
I
2
J
I
2
3
I
2
3
I
2
3
I
2
J
I
2
3
I
2
J
I
2
J
I
2
3
I
2
3
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
UnleadedTank I
Premium Tank 2
E. UNLEADED
ljnleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
Unleaded Tank I
Premium Tank 2
E. UNLEADED
UnleadedTank I
Premium Tank 2
E. UNLEADED
01t07t2006
01tu/2006
01t07/200,6
02t07t2006
02tut2006
0ao1t2N6
03tutzoo6
o3to7/20n,6
03t01t2006
Mt0'7t2006
04t0'7t2N6
o4to7/200/6
05t07/2006
05/o7t2006
05to7t2006
o6t07t2006
o6tut2006
o6t0'7t200,6
0'7t01t2006
0'7to712006
07to7t2006
o8t01t200,6
oSto'7tzm6
o8to7t2006
09/19t2005
09/t9t2m5
09figt2m5
toto7t2m5
10t07/2005
10t07t2005
I t/o1/2005
tt/o7/2005
tlto7/2005
t2to7/2005
t2/07/2005
t2t07t2N5
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 CPH Monttrly
0.2 GPH Monthly
0 2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 CPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH MontNy
0.2 CPH Monthly
01t2006
olt20M
oll2006
02t2w
o2t2006
02t2w
03t2006
03t20n,6
03t2006
04t2006
04t2w6
04/2006
05t2006
05/2006
05t2006
06t2006
06t2006
06t200,6
wt2006
07t2006
07t2006
08/2006
08/2006
08/2006
09/2005
09t2005
09t2005
l0/2005
l0/2005
l0/2005
I t/2005
I l/2005
I I/2005
tzt2m5
t2/2005
tu2005
517o
48Vo
527o
63Vo
57Vo
59Vo
5l%
347o
49%
5lVo
42Vo
527o
55Vo
63Vo
5l9o
537o
677o
47Vo
49Vo
41Vo
43Vo
527o
377o
6lVo
66Vo
45Vo
6l7o
59Vo
607o
63Vo
619o
44Vo
7 l1o
64Va
39Vo
68%
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
This repon deumnts tanf ed linc tests p€rfomed at th€ above leation for the indicated date and period-
This rcpoil and the tesb perfonEd e pan of the Maverik Country Storc moniroring and repof,ing prcgranr. md
arc iilended ro satisfy fe&ral EPA UST releGe detection and tterd keping tequirementsFuel lrgistics Senices
VR101: Page I of 2
Veeder-Root Company 125 Powder Forest Drive Simsbury, CT 06070-2003 l-800-997-7725
\..
t-
State of lItah
Division of Bnvironmental Response and Remediation
Underground Storage Tanks
D o c ume ntatio n of C one sp onde nc e
lnitials/Date ,,,u&]il4/+5
Section MGR: _
Branch MGR:
Facility lD 4002130 Project Manager Jason Wilde
Facility Name MAVERIK #266 BLUFFDALE Date lssued Date Due
Enforcement Action Compliance Records Sent to Archive llll4l2005
(Series 19803)
Commenls O/O submitted all pertinent documents as directed bv DERR prior to inspection: All records
meet resulatory requirements: Include: Monthlv tank and line tests, Annual line tests and
alarm historv reports.
llll4l200i 12:47:06Pl${
Owner Name MAVERIK COUNTRY STORES INC Location 116.s MAVERIK #266 BLUFFDALE
880 W CENTER STREETAddress Address 14416 S REDWOOD RD
StateUT6;ry NORTH SALT LAKE 7ip 84054 city BLUFFDALE State UT Zip 84065
phsng [phone]Contact DENNTS RIDING Contact SUZANNE 801 446-1 1 80JENKINS
Number of tanks at the facility:I I z z J J
Tank lnstallation Date 2,911997 ?,9/1997 21911997
Capacity of Tank (in gallons)1 0000 1 0000 1 0000
lndicate if tank is siphoned or compartmented. Show related tanks
^{D
+
Substance Stored
Cuneqtlyrin Use Currently in Use Cunently in UseTank is in use.
lf not in date last used and in tank
tn
of
No No No Yes No
Material of construction of tanks
FrElnlilass Hernlorced Frberglass Hernlorceo FrDerElassHernlorced
Material of construction of pipinq Fiberglass Reinlorced Fiberglass Reinlorced Fiberglass Reinlorced
Pioino tvpe Pressurized Pressurized Pressurized
Type of Spill Prevention device. Note on form if tank is filled by transfers
ol less than 25 oallons. lf so. no soill prevention is reouired.=FB -:>
fQ No fe) ruo CO No Yes NoSpill containment bucket is clean, dry, and lree of product, water, debris.k,\___&Type of Overfill Prevention device. Note on form if tank is lilled by
transfers of less than 25 gallons. ll so, no overfill prevention is required
*.Yes No#/t*"-Yes No
lf an overfill alarm is the primary overfill device: Alarm is located where it
can be seen and heard, and alarm is clearly marked.
Corrosion Protection method used on tanks
Alt^'Y >.Corrosion Protection method used on pipinq
At disoensersl tuAt tanks:xl tCorrosion Protection method used on flex connectors, swing ioints, etc.
AT NoNoATEnclosed containment sumps are present at tanks and dispensers
The results of the last two cathodic protection tests are available (within six
months of installation and every three years thereaftel)
are etc.Containment free from water,
volts volts voltsI f SvottsUT DateTank Tester
voltsAl / /l*,"volls voltsDateUTPiDinq Tester
volts volls voltst\I Y
',ors
voits volts volts volts
Flex Connectors/ Swing Joints
Tester
Al tank
At dispenserUT Date
Yeffio-For lmpressed Current Systems: The results of the last three equipment
operation checks are available (required every 60 days).
rl
iln.,tlllfrrc€rN ,to,n,. raciritv on 4l'lX / AqiII/S
e of owne
S
I
I
n
_Lt 7pL{|w t .
oft*(r5
A
N
K
tr
generator
tr USTs temporarily
tr USTs temporarily
COMMENTS
leak detection deferred.
empty; leak detection not required.
and secured.
Ntk --e
Yes No
.
tL tk
+er-Ne_t
trH
Fr
ATG
Automatic Tank Gau 1..
4002130
of -7-'
!D
(-
Utah UST Program
lnterstitial Monitori
Method used for tanks:
TANK LEAK D
Automatic Tank Shutdown Testi Automatic Tank Continuous T
Manufacturer, name and model of system
Veeder Rloot Simplicity CSLD
\ln Alanifald No
Documentation of performance claims
the is available.
Circle Yes or No for each question. ln the last column, explain and identify by tank any exceptions to the answers given in the first column.
IM Type of Secondary Containment used:Type of lM-Doeumentation used:
Records on site document that the system is properly installed, calibrated,
and maintained (system and tank setup reports, maintenance records).
'@ *oATG IM
ATG IM Device documentation is available on site (owner's manual, etc.)
ATG IM
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational.@*"
ATG IM
Documentation of valid testing or monitoring is available for the last 12
months. Show results in table below.
ATG Yes NoThe probe is located at the
center of the tank.
lf not in center, sho\q-fllf
factors from the setuo reoort.
Tilt: #1 #2 #3 #4
ATG
The tank was filled to at least the minimum level required to ensure a valid
leak test, and the tank size is within the allowed upper and lower size limits.(A-,ru"Third Party Minimum Level:
IM System is capable of detecting a release of regulated substances from any
portion of the primary tanUoioinq within one month of release Yes No
IM lf observation wells are part of the system, wells are clearly marked and
secured to avoid unauthorized access and tamoerino.Yes No nla
IM
(Bladder or
excavation
liner)
Secondary barrier is properly placed and constructed, designed for
groundwater considerations, has an acceptable permeation rate, is
compatible with the substance stored, is non-corrodible, is always above
groundwater, and is not in the 25-yr flood plain (per site assessment).
Yes No nla
10t04 11t04 1/05
or
Mol/r 9t04 12t04 2105 3/05 4t05 5/05 6/05 8/05
tests,
7105
#I A a7\
#il l1 lc I
#I )tl
t L-/ /
I I \
#(
Safe Suction Piping: Documentation is available and verifiable to show that piping operates at less than atrnospheric pressure, has only one check
deteqtq.r and one other method are required for Pressurized
lXpine Tightness Testing [ ] lnterstitial Monitoring
Piping)
PIPING LEAK DETECTION ALD
Used (Automatic line leak
c Line Leak Detector
Monthly
lM Documentation
Groundwater .2 GPH
valve and has of Yes No
N
ES MES
Results of last line
Test Method
Type (M-
Tester
test are
cert.
IE-EI S- Sump Sensor)
leak
Test Date
Automatlc Line Leak
Detectorc
Results of last leak detector are N
\
Test date:Tester name and cert. number:UT Test Method:
for piping for the last '!2 months. lndicate Pass, Fail, lnvalid, or No Results fcr each month.I
/r--610$f-Mol/r 9t04 10t04 't1t04 1_2104/.1/05 2105 n
-\,1
4t05 1 8/05
#tl t r/\
#I
,I
\(
#
COMMENTS I
Ldatoim0SO4.doc
&d *o
f"r )ruo
lvlu
Line Tiohtnass Tasllno- Llna Laak flelerJarrTacllnd:Tank-L--faak 2 -'^ Tan[.H-A-4ankU
Resulls
2
I
M E S._M _E -S_
Manufactut
.,,jrv ff sroS
4 .tr J-/11 )/< L
\
?*14'st
I -l
4- z t=,p
a,ppr,r] ENVIRoNMENTAL sLwtc
PO BOX 182 ROY, UTAH 8'1067 (80r) 5'16-7546
ES, L.C.
INVOICE ADDRESS:
MAVERIK COUNTRY STORES
880 WEST CENTER
NORTH SALT LAKE, UTAH 84054
DATE:9-8-2005 TIiIESTART:
TITE SYSTET FILLED OR TOPPED:
TANK LOGATION:
MAVERIK #266
14416 SOUTH CAMP WILLIAMS RD
BLUFFDALE, UTAH
TIIilE END:
WORK ORDER # 05244
TECHNICIAN: SM
TECH # 9rO27 VAN # 8502
STATE TECH # UT 012,I
GROUNOWATER DEPTH:
TANX TANK PRODUCT
l:ApacrTv
TANK FILLVENT PRODUCT LINELEAK WATERIN
VAPOR LINE DETECTOR TANK
PUII'P
TYPE
TANK
i,ATERIAL
1
2
3
4
5
6
10000
10000
'10000
PRESS
PRESS
PRESS
SWF
SWF
SWF
N/T
N/T
N/T
N/T
N/T
N/T
1
2
3
4
5
6
PRODUCT LINES TESTED AT 50
LINE RATES (GPH)
PSI FOR 15 MINUTES
R/UL -.000
s/uL -.000
ADDITIONAL INFORiiATION: VEEDEROOT PLLDS PASS 3 GPH FUNCTIONALITY TEST
THIS IS A LINE MODIFICATION TEST , BOTH RYUL LINES WERE MANIFOLDED INTO ONE LINE WTH ONE
PLLD.
THIS SYSTE AND IIETHOD EETS OR EXCEEDS THE CR,TERIA lN USEPA ,lO, CFR PART 280,
NFPA 329{7, AND ALL APPLICABLE STATE AND LOCAL CODES.
Digitally signed B. Martin
cn=Stoven B.
c=US
Oate: 2005.09.'l
CERTTFIED TECHNIClAN SIGNATURE:
Reason
-07'00'
DATE: 9-8-2005
T.E.I. SYSTEM 4OOO
'
T.E.I. LT3 / T.E.I. ULLAGE
PRECISION TANK & LINE TEST RESULTS SUMMARY
R/UL
S/UL
R/UL
PASS
PASS
N/A
PASS
PASS
N/A
State of Utah
Division of Environmental Response and Remediation
Underground Storage Tanks
D o c ume ntation of C ore s p o nde nc e
t'l nL1
lnitials/Date*Ju 4t44
Section MGR: _
Branch
Facility lD 4002130 Project Manager Jason Wilde
Facility Name MAVERIK #266 BLUFFDALE Date lssued Date Due
Enforcement Action Compliance Records Sent to Archive
(Series 19803)
Comments All records submitted prior to inspection
tUt6t2004
1111612004 3:09:19 PM
/n
Facility lD 4002130. Utah U$T Program
Release Detectit^ lnspeltion Checklist Pase )* 2
Ownership of Tanks Location of Tanks E state use
owner Name MAVERIK COUNTRY STORES INC Location xsms MAVERIK #266 BLUFFDALE
Address 880 W CENTER STREET Address 14416 S REDWOOD RD
City NORTH SALT LAKE StateUT Zip 84054 6ry BLUFFDALE State uT zip 84065
p66ns [phone]Contact DENNTS RIDING Contact suzANNE Phone (80'1) 446-1 180JENKINS
Complete for each tank. lf the facllitv has more than four tanks. comolr <s on a seoarate fr
Number of tanks at the facility:1L 2\3ia
Tank lnstallation Date 2t9t1997 2t9t1997 2t9t1997
Capacity of Tank (in gallons)10000 1 0000 1 0000
lndicate if tank is siphoned or compartmented. Show related tanks.A(O --'*F ------19
Substance Stored Gasoline Gasoline Gasoline
Tank is in use \/€3---->
lf not in use, qive date last used and deoth of product in tank.'tJli --F
Current year tank tags are in place.fr")No ({"? No rt"J No Yes No
Material of construction of tanks
FibeE{-ass Reinforced Fibe7glass Reinforced Fibetlfass Reinforced
Material of construction of piping Fiberglass Reinforced Fiberglass Reinforced Fiberglass Reinforc€d
Piping type Pressurized Pressurized Pressurized
Type of Spill Prevention device. Note on form if tank is filled by transfers
of less than 25 qallons. lf so, no spill prevention is required.77fi --E
Spill containment bucket is clean, dry, and free of product, water, debris Yes s1-9)6"9 No (%D No Yes No
A5oType of Overfill Prevention device. Note on form if tank is filled by
transfers of less than 25 gallons. lf so, no overfill prevention is required.
*--+
lf an overfill alarm is the primary overfill device: Alarm is located where it
can be seen and heard, and alarm is clearly marked.YES NO**--*-Yee-@ Yes No
Corrosion Protection method used on tanks ,!4n---Cx--
Corrosion Protection method used on piping ilttl --.>/
Corrosion Protection method used on flex connectors, swino ioints. etc.
Enclosed containmenl sumps are present at tanks and dispensers At tanks:No At No
Containment sumps are sealed. free from water. oroduct. etc.+
Cathodic Protectlon Testlnq. Show the results of the most recont test 1
The results of the last two cathodic protection tests are available (within six
months of installation and every three years thereafter).,Nlfir
Tank Tester UT Date tl /w volts volts volts
Piping Tester UT Date N/W volts volts volts
\olts volts volts voltsFlex Connectors/ Swing Joints
Tester
At tank
At disoenserUT Date volts volts voltsvolts
For lmpressed Current Systems: The results of the last three equipment
operation checks are available (required every 60 days).
\YdLtr/-
/
| s[X"r\t' tilfl*toe/teotnisraciritvon Jl / tt/ ht
siqnatur6-A--7 lU tt
ruame of owtrlooerator representatir", )C' )z bt',, rt lla r ra u ?-
sionature: D( I"-D^i^^,, .C,n Jwtazrz^-
tr Emergency generator tanks only; leak detection deferred.
tr USTs temporarily closed and empty; leak detection not required
tr USTs temporarily closed, locked and secured.
Site Drawing North I
COMMENTS rrrl z
L-/tlz
}ITN.
lr ai".on.oo [/ r
Utah UqT Program tD 4OO2'130
Automatic Tank Ga lnterstitial Monitori of
TANK DETECTION
Method used for tanks:
I I Automatic Tank Gauqinq Shutdown Testinq I I Automatic Tank Gauqinq Continuous Testinq I I lnterstitial Monitoring
Manufacturer, name and model of svstem:
Documentation of performance claims (third party certification) for
the system is available. Yes No
Circle Yes or No for each question. ln the last column, exolain and identifo by tank any exceptions to the answers qiven in the first mlumn.
IM Type of Secondary Containment used:Type of lM Documentation used:
ATG IM
Records on site document that the system is properly installed, calibrated,
and maintained (system and tank setup reports, maintenance records).Yes No
ATG IM Device documentation is available on site (owner's manual, etc.)Yes No
ATG IM
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational.Yes No
ATG IM
Documentation of valid testing or monitoring is available for the last 12
months. Show results in table below.Yes No
ATG
The probe is located at the
center of the tank.Yes No lf not in center, show tilt Tilt: #1 #2 #3 #4
factors from the setuo reoort.
ATG
The tank was filled to at least the minimum level required to ensure a valid
leak test, and the tank size is within the allowed uDper and lower size limits.Yes No Third Party Minimum Level:
IM System is capable of detecting a release of regulated substances from any
oortion of the primary tanUoioinq within one month of release Yes No
IM lf observation wells are part of the system, wells are clearly marked and
secured to avoid unauthorized access and tamoerino Yes No nla
IM
(Bladder or
excavation
liner)
Secondary banier is properly placed and constructed, designed for
groundwater considerations, has an acceptable permeation rate, is
compatible with the substance stored, is non-conodible, is always above
groundwater, and is not in the 25-yr flood plain (per site assessment).
Yes No nla
Show results of monitoring br eactr tank fur the last 12 months. lndicate Pass, Fail, lnrralid, or No Results br each rnonth. For ATG tesb, show the
hlohet oroduct level terted foreach month.
MoIYr 't2103 1t04 2t04 3104 4t04 5104 6104 7104 8t04 9/04 10t04 '11t04
#
PIPING LEAK DETECNON ALD MOnthIy
Method(s) Used (Automatic line leak detector and one other method are required for Pressurized Piping):
[ ]Automatic Line Leak Detector [ ] Line Tightness Testing [ ] lnterstitial Monitoring Type of lM Documentation
I I Statistical lnventory Reconciliation I lVapor Monitoring [ ] Groundwater Monitoring [ ] .2 GPH Monthly Testing
Safe Suction Piping: Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, has only one check
valve (under oumo), and has proper slooe of pipinq.Yes No
Llne Tlohtne$ T$tlns. Llne Leak Detector Testing:Tank 1 Tank2 Tank 3 Tank 4
Results of last line tiqhtness test are available: Y N Results
Test Date Tester name and cert. number:UT Test Method:
Automatlc Llne Leak
Detectors
Type (M- Mechanical E- Electronic S- Sump Sensor):MES MES MES MES
Manufacturer and model of each leak detector:
Results of last leak detector oerformance test are available: Y N Results
Test date:Tester name and cert. number:UT Test Method:
Shcnr results of monitoring fo piping for the last 12 months. lndicate Pass, Fail, lnvalid, or No Results for each month.
Mof/r 't2t03 'U04 2t04 3104 4t04 5t04 6t04 7 t04 8/04 9/04 10t04 11t04
#
#
#t
(COMMENTS 1
ATG
Veeder Root
se ic,-n
Owner Name MAVERIK COUNTRY STORES INC MAVERIK #266 BLUFFDALE
Address 880 W CENTER STREET Address 14416 S REDWOOD RD
NORTH SALT LAKE UT zi 84054 C BLUFFDALE State UT 84065
Contact MARK CHRISTENSEN ex pnone [phone] Contact susrE MILLEB Phone [phone]
than a
Tank Number:1 2 J
Tank lnstallation Date 219t1997 21911997 2/911997
ol Tank 1 0000 1
lndicate if tank is or com Show related tanks
Substance Stored Gasoline Gasoline Gasoline
Tank is in use.in Use Currentl in
lf not in use,date of in tank.
Current tank are tn
Material of construction of tanks
Material of construction of Fiberglass Fiberglass Fiberglass
Pressurized Pressurized Pressurized
Type of Spill Prevention on if tank is filled by transfers
than 25 ons. lf no IS red
ill containment bucket is and free of Yes No No Yes No
Type of Overfill on if tank is filled by fltransfers of less than 25 lons. lf so no overfill revention uired.
lf an overfill alarm is the Alarm is located where it
can heard and alarm is cl marked.ES Yes No
Corrosion Protection tanks
Protection method used on t,
Corrosion Protection used on flex swt etc.
Enclosed containment at At No At No
Containment s are free lrom water,etc.No
lndicate lin tank or cathodic
The results of the last two cathodic tests are available (within six
months of installation
Tank Tester Date volts volts volls
Tester Date volls volts volts
Flex Connectors/ Swing Joints At tank volts volls volts
Tester At volts volts volts volts
Systems: The results equipment Yes Nochecks are available 60
tr Emergency generator leak detection deferred.
tr USTs temporarily closed and empty; leak detection not required.
tr USTs temporarily closed, locked and secured.
Site Drawing (North i )
&
(I L
COMM
ry
U
TZ
)t flon
{',-'z
ah t'l 4)
,Jt
,n
il'U
Distribulion: Whit+DERB,Yellow. lnspector, Pink-
this fac
Ldcheck0703.doc 4or*(t^l
t9
d Piping
lrlethod used f or pipirB: ALD Monthlylr4etrod rced f or tanls: ATG
lVlaruf acturer, nane and nodel nunber of system Veeder Root System3d party cert. available ies MSimolicitu
Fbcords on site docunent thd the systemis properly installed, calibrated, and
naintained and tank npintenance records
ATG IM Bvice docunBnhtion 's available on-site (owner's nanml, etc.)t\ps No
Ail Quipnent used to acqdre dda, tale readings, perf orm test is adequde, accessible
ard f unctional. lrpl. ATG corcole, dipstick, etc.f\M
Ail Dcunentalion of valid testing or nonitoring is availdle lor the hst 12 npntrs. Show
bsting or nmitorhg results in grid below.Yes Nlo K
ATG the probe is locded atthe center d the bnk. lf not, the tilt correction factorf or each
Enk is shown on the tark setrp report.
No19
ATG The tmk w as f illed to at least the nhimtm levd required by the nanuf acturer's
equipnent protocol to ensure a vald leaktest and the tanksize is w ithin the allowed
rpper and loar er size lirits.
Yes M lA
K
IM Secordary barrier is poper! placed ard corstructed, designed f or gw
consiGratims, has an acceptable perneation rate, is conpatiUe w ih the substance
store( is nm-conodide, and is nd in the25-yr f loodplain (persite assessnEnt).
Yes 1\o
C MTG
SIR
hventrry readings f or prodrct inpts ard w ithdrawals are properly obtained ard
recorded. Badirgs are properly econciled.Yes f{o
Fbcords include he proper runber of water readirgs, ard w der readings are used to
adjust inventory balances as necessary.
C MTG
SIR
An appropriate tank calbratisr chart is Lsed and is arail$le f or reviqiv Yes Nlo
csR Dspersers have current calbratim stickers or proper calibratbn dmunBntation.Yes M
IC SR Dop tdres are present and o(tendto w lhin orB loot of the tankbottom Yes Nlo
Shqr results of mmitoring for each ta!k for the Iast 12 months. Indicate pass, fai!, no results, or inconclusive
N[offr 1010,'t1to2 12J02 1/03 a03 3/03 4t03 5/03 6/03 7t03 8/03 9/03
#L -,&.#4 ?/?_E
#I ?te
-tL#
and Line Tark 1 Tank 2 Tank 3
r,{/ml TlJt, I Test resultsDate of last t igltness test f or tanks:
Mne andcertlication nunber d tester:
Date of last ess test ftr Test results
Mne andcertlicatim nunber d tester:Test Nlethod
AutonEtic Line Leak Detector type and rnrdd
Test resultsDate of last leakdetector perforrrance test:
Safe Suction pping: Docunentation is avail$le and verif iabb to show that piping oprates at less than atrmsplerie-.
lcressurq has only one check valve (under punp), and has proper slope of piping.--*'Ytss-------1b--
{?ConnBnb I
I
h@Z ot2
Ttuuuut I )02't30
lcirde Y,r-r exceptions
[,"t.."
C SIR Yes l\o
Test lvbthod
Tank Release Detection Results
Tank Product Test Date
I W. UNLEADED 1110512002
2 PREMTUM 1110512002
3 E. LTNLEADED 1110512002
I W. UNLEADED 1210512002
2 PREMTUM 1210512002
3 E. LINLEADED I2IO5I2OO2
I W. LINLEADED 0I/05/2003
2 PREMTUM 01/05/2003
3 E. LINLEADED 0I/05/2003
I W. UNLEADED O2IO5I2OO3
2 PREMTUM 0210512003
3 E. LT{LEADED O2IO5I2OO3
I W. L,T.ILEADED 0310512003
2 PREMTUM 0310512003
3 E. LINLEADED O3IO5I2OO3
I W. LINLEADED O4IO5I2OO3
2 PREMIUM 0410512003
3 E. UNLEADED O4IO5I2OO3
I W. LTNLEADED 0510512003
2 PREMIUM 05/05/2003
3 E. LINLEADED O5IO5I2OO3
I W. UNLEADED 0610512003
2 PREMTUM 0610512003
3 E. LINLEADED 0610512003
I W. UNLEADED O7IO8I2OO3
2 PREMTUM 0710812003
3 E. LI{LEADED 07/08/2003
I W. L,\JLEADED 08/05/2003
2 PREMIUM 08/05/2003
3 E. LINLEADED 08/05/2003
I W. LNLEADED 0911512003
2 PREMTUM 0911512003
Period
nt2002
1v2002
t1t2002
tzt2002
12t2002
t2t2002
0l/2003
0 1 /2003
01t2003
02t2003
0212003
02t2003
0312003
03/2003
03t2003
04t2003
04t2003
04t2003
0s/2003
05/2003
05/2003
06t2003
06t2003
06t2003
07 t2003
0712003
07t2003
08/2003
08/2003
08/2003
09t2003
09t2003
Full Vol
56%
40%
62%
63%
43%
66%
38%
33%
57%
660/o
46%
72%
6t%
52%
1r%
66%
52%
64%
39o/o
34',
54o/o
57o/o
47%
68%
65%
40%
690/o
49%
4lo/o
68%
52%
43%
Result
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Tvpe
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 CPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
This rcpolt documcnts tank and linc tests pcrformcd at the abovc location for thc indicated datc and pcriod.
This rcport ancl thc tcsts pcrlonncd arc part ofthe Mavcrik Country Storc monitoring and rcporting program, and
arc intcndctl to satisfy fcdcral EPA UST rclcase dctcction and record keeping rcquircmcnts.H vEEDER-TT(O(DT
F ttezl lVtzr tczgez rrre t rt Se rvice
vR l0t
t24208
266
Maverik Country Store
144 l6 S. Carnp Williams Rd.
Bluffdale, UT 84065
Customer: Maverik Country Store
880 West Center Strcet
North Salt Lake City
uT 84054
Period: lll0ll2002 to l0/31/2003-R ID:
ID
Created: l1/05/0313:08
Vccdcr-Root Cornpan;- 125 Powdcr Forcst Drivc Simsbury, CT 06070-2003 l-800-997-7725
F*IS Site Compliance Re,:port
I
2
l
E. UNLEADED
W. LINLEADED
PREMITJM
E. LINLEADED
09fi5t2003
I 0/05/2003
I 0/05/2003
t0t0512003
Line Release Detection Results
Line Product Test Date
I W. UL DrSP. r-4 1110212002
2 PREM ALL DISP. \IIO4I2OO2
3 E. UL DrSP.5.6 11104t2002
I W. UL DrSP.l-4 1210212002
2 PREM ALL DISP. I2IO2I2OO2
3 E. UL DISP.5.6 1210212002
I W. UL DrSP.l-4 01/05/2003
2 PREM ALL DISP. OIIO3I2OO3
3 E. UL DrSP.5,6 0l/03/2003
I W. UL DrSP.l-4 02104t2003
2 PREM ALL DISP. O2IO4I2OO3
3 E. UL DrSP.s.6 0210412003
I W. UL DISP.I-4 0310212003
2 PREM ALL DISP. O3IO2I2OO3
3 E. UL DrSP.s.6 03102t2003
I W. UL DrSP.l-4 0410312003
2 PREM ALL DISP. O4IO5I2OO3
3 E. UL DrSP.s,6 0410512003
I W. UL DISP.I-4 0510312003
2 PREM ALL DISP. 05/03/2003
3 E. UL DrSP.5.6 0510512003
I W. UL DrSP.l-4 0610212003
2 PREM ALL DISP. 0610412003
-1 E. UL DrSP.s.6 0610412003
I W. UL DrSP.r-4 0710612003
2 PREM ALL DISP. O7IO8I2OO3
3 E. UL DrSP.5,6 0710612003
0912003
1 0/2003
1 0/2003
I 0/2003
Period
1v2002
11t2002
lrt2002
12t2002
t2t2002
12t2002
0 1 /2003
0 I /2003
0l/2003
02t2003
02t2003
02t2003
03/2003
03/2003
03/2003
0412003
04t2003
0412003
05/2003
05t2003
05/2003
0612003
06t2003
06t2003
07 t2003
07 t2003
0712003
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
Tvpe
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
55%
55o/o
38%
57%
Passed
Passed
Passed
Passed
Result
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
This rcporr docunlcnts tank and linc tcsts pcrformcd at the above location for the indicated date and period.
This rcpon and thc tcsts pcrfomcd arc pan of the Mavcrik Country Store monitoring and rcponing program, and
arc intcndcd to salisly fcdcral EPA UST rclcasc dctcction and rccord kccping requiremcnts.
ry/EL?I vEETDEII-FT(O(OT
F uel lufa r t.ctgSetftre|tt ServiceVRI{)I
t24208
266
Maverik Country Store
14416 S. Camp Williams Rd.
Bluffdale, UT 84065
Customer: Maverik Country Store
880 West Center Street
North Salt Lake CitY
uT 84054
Period: 1110112002 to l0/31/2003-R ID:
ID:
Created: ll/05/0313:08
Vccrlcr-Rixrt Corlparry 125 Powdcr Forcst Drivc Simsbury, CT 06070-2003 l-800-997-7725
rFM$l$ite Complian0e Report
08/03/2003
08/03/2003
08/03/2003
09t14t2003
091t4t2003
0911412003
10t02t2003
10t04t2003
t0t04t2003
08/2003
08/2003
08/2003
09/2003
09t2003
09t2003
1 0/2003
l 0/2003
I 0/2003
I
2
3
I
2
-1
I
2
-1
W. UL DISP.I-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.I-4
PREM ALL DISP
E. UL DISP.5,6
W. UL DISP.I-4
PREM ALL DISP
E. UL DISP.5.6
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
124208
266
Maverik Country Store
14416 S. Camp Williams Rd.
Blufldale, UT 84065
Customer: Maverik CoLlntry Store
880 West Center Street
North Salt Lake City
uT 84054
Period: 1110112002 to l0/31/2003-R ID:
ID:
ort Created: ll/05/03 l3:08
This rcporr documcnts tank and linc tcsts pcrformed at the abovc location for the indicatcd datc and pcriod.
This rcport and thc (csts pcrfonncd are part ofthc Mavcrik Country Store monitoring and rcporting program, and
arc intcndccl to satisly fcclcral EPA UST rclcasc detcction and rccord kceping rcquiremcnts.
ryIf=rl \/EEEDEFI-FI(O(O'T
F tt.<: I lt4tt t tczge: trt er', t Sazrwic<:\ titlt
Vccdcr-Root Conrpanl 125 Powdcr Forcst Drivc Simsbury. CT 06070-2003 l-800-99'7-7725
FMS $ite;Compliance Repolt
Owner lqnp MAVERIK COUNTRY STORES INC Localion lqpp MAVERIK #266 BLUFFDALE
Address 880 WEST CENTER ST Address 14416 S REDWOOD RD
City NORTH SALT LAKE sate UT zp 84054 City BLUFFDALE , _ state UT Zip 84065
Contact [\4ARK CHRISTENSEN ex Fhone [phone] Location cmtact 19ff ,K*WL2 plep [phone]
Nunber d tanks at f acility 1
'additioml tanks
2
Tank lnstallation Date 21911997 21911997 21911997
Capacity of tark (in gallons)1 0000 1 0000 1 0000
Substance stored Gasoline Gasoli ne Gasoline
Tank is in use (Y) or, if nd in use, give date last Lsed Currently in Use Currently in Use
lf nd in use, depth of prodLrct in hnk (in inches)
Cunent year tank tags are in place
Material d corstruclion of tanks (steel, FRP, conposite, etc.)rroergrass Helnlorceo
Plastic
rroergrass Hermolceo Fr0erglass Hernlorced
PlasticPlastic
tvlaterial d corctructon of piping (steel, FRB f lex plastic, etc.)Fiberglass Fleinlorced
Plestic
Fiberglass Beinlorced
Plastic
Fiberglass Reinlorced
Plastic
Hphg type (pressure, safe/US suction gravity, eb.)Pressurized Pressurized Pressurized
Type of $ill Prevention Ds/ice (.5 gal, >5 91, cmt. sunp, etc.) Note
if f iled by transf ers d less than 25 gallons. lf so, no sprll reqtired.z5qrr-
Type of Overf ll Prevention Devbe (slutof f, ball float, alarrn dc.) Mte
if f iled by transf ers d less than 25 gallons. lf so, no overf ill required.5 ^o,For overfill alarm: Ahrm is locabd w here it can be seen and heard,
and alarmis clearly narked +€s-*l!o-*
l\tlehod rced m tanks (Ntr{ CS, lt- C, SA, ND
I/ehod tsed on pipirg (NI\4 CS, C, SA, Nfl N ,'1
fi/ehod used m f lex connectors (8, CS, NC, Ce NM NP, f\yA)
Enclosed containrnent sunps at tanks (subptnp) and dispersers es No
lndbate dates d upgrades- linirp, tark or pping cathodc prdectim.
of he o tc are ava
lhin 6 npntls of irstalldlon and everv 3 Vears l\b
Tank Tester Dde
llping Tester Dde lI//
Flex Connectors
Tester
Sub punp
DispenerDte
I
\olts \olts !dts \olts
\ol ts \,olts \.dts \olts
For impressed current system: The resulb of tlre lastthree
equipnnnt opaation checks are avaihble. (requied every 60 days.)Yes M
t
I I
ngqt otL
I
\ -7--"7
Utah UST Program *
Release Detection lnspection Checklist Facility lD 4002130
Ownership of Tanks Location of Tanks
Currently in Use
AnEwerthe folloWirqg forsll tanks- lste any e)ceptions ,in the la*t column.
,w,
Gorrosion Protection. Answerthe followLrg forall lanks. lste xryelceptbns inthe I6t column.
Cathodic Protection Testing Com plete for each tank.
""1r
I
f
1
10,000
rogram
Nlethod used f or piping: ALD lvlonthlyIvlefrod rced f or tanls: ATG
lt/laruf acturer, nane and nodel nunber of system Veeder Root System3d party cert. avdlable Yes MSimolicitv
n,
Ail Fbcords on site docunent thd the systemis pruperty installed, calibrated, and
naintained (systan and tanksetup reports, nnintenance records).NoG)
ATG IM Dv ice docunenhtion b available on-s ite (ow ner's nanral, etc.)tGJw
Ail Quipnent used to acqdre dda, tale readings, pertamtest is adequde, accessible
and f mctional. lrpl. ATG corsole, dipstick, etc.Ilo{9
AI bcunBntation of valid testing or nonitoring is available f or the hst 12 nnntrs. Slrow
testing or nmitorhg results in grid below.I{o@
ATG The pobe is locded at the center d the hnk. lf not, the tilt correction factorf or erch
tank is show n on the tark setrp report.
(9Nb
ATG The tank w as f illed to at least the nhimlmlevd required by the nanufacturer's
equipnent potocol to ensure a vald leaktest and the tanksize is w itlin the allowed
rpper and lory er size lirits.
No€t
IM Secordary barrier is proper[ placed ard corstructed, designed f or gw
consieratims, has an acceptable perneation rate, is conpatiUe w itr the substance
stored, is nm-conodiUe, and is nd in the 25-yr f loodplain (per site assessnent).
Yes M
IC MI-G
SIR
hvenlory readings f or prodrct inptts ard w itMrawals are properly obtaired ard
rccorded. Fbadirgs are properly reconciled.Yes Nb
IC SlR Fbcords indude he proper runber of water readirgs, ard w der readings are usedto
adjust invertory balances as necessary.Yes t{o
C MTG
SIR
An apropriate tank calbratim chart is wed md is auaildle f or revisnr Yes M
CSB Dspersers have current calbratim stickers or proper cdibratbn drcunpntation Yes M
CSB Dop tr-lces are pesent and extend to w lhin orB f od of the tank bottom Yes Nlo
Shorar results d monitoring for each tank for the last 12 months. lndicate pass, fail, no results, or inconclusive
tvloffr 11/01 1UO1 1lo2 a02 3l02 4t02 5102 6l02 7lo2 8102 9l02 10t02
#l x _Jb
#P/p 7lP -!>olrl.f/p r>
#
Tank and Line Tightness Tt Ibtector Tmk 1 Tank 2 Tank 3 Tank 4
Date of last tightness test f or tanks ,A/ (a(r/l1t/Test results
Mne andcertlicatim nunber d tester:I Test lvbthod:
Date of lmt tightness test f or piphg:tL,\crlTllAl Test resutts
IMne and certlicatim nunber d tester:Test ltEthod
Aubnatic Line Leak Detector tvpe and npdd ll.? TtLD
Date of lat leakdetector perf orrrance test:a/ z /,bZ Test results 75o -e>(( - r t
Safe Suction pping: Docunentdion is available and verif iabb to show tlnt pi6ing operates at less than atnospheric
prgssure, has only me check valve (under punp), and has propa slope of pping.
Yes Nb
Conrrents
Z"?I%.c
Cirde Ye the l*t column, eroldn and o the answer in the first column.
7 d# e oa),t3 o
Site: Maverik Country Store
14416 S. Camp Williams Rd.
Bluffdale, UT
84065 Report Created: lll30l200l 11:06 AM
Veeder-Root Site ID: 124208
Alternate Site ID:266
In-Tank Results
Tank
I
3
I
2
3
I
2
3
I
2
3
I
2
3
I
2
3
I
2
3
I
2
3
I
2
3
I
2
3
Product
W. UNLEADED
PREMIUPI
E.I.]NLEADED
W. UNLEADED
PREMTUM
E.I]NLEADED
W. T]NLEADED
PREMIUM
E. UNLEADED
W. UNLEADED
PREMIUM
E. UNLEADED
W.I.JNLEADED
PREMIUM
E. UNLEADED
W.I.JNLEADED
PREMIUM
E. UNLEADED
W. T]NLEADED
PREMIUM
E. TJNLEADED
W. T]NLEADED
PREMIUM
E. UNLEADED
W.I'NLEADED
PREMIUM
E. UNLEADED
W. UNLEADED
PREMIUM
E.I.]NLEADED
Test Date
02-26-2001
02..26-2AAt
02-26-2001
03-05-2001
03-05-2001
03-0s-2001
04-27-2001
04-27-200t
04-27-2001
05-28-2001
0s-28-2001
05-28-2001
06-2s-2001
06-25-2001
06-25-2001
07-t2-2001
07-12-2001
07-t2-2001
08-27-2001
08-27-2001
08-27-2001
09-17-2001
09-17-2001
09-17-2001
10-18-2001
10-18-2001
10-18-2001
1 1-30-2001
I l-30-2001
I 1 -30-2001
Test Tvpe
0.2 GPH Monthly
0.2 GPH llIon+hly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPH Monthly
%Full Vol
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
unknown
50
38
6l
62
39
67
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Results
Passed
DEO
lesponse & BBmGdiatiol
Results
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Pasred
Passed
Passefipp - ? 2001Ybv J
Passed
Line Leak Detection Results
Line Product Test Date Test TvPe
tuis r$ort docJ?l(erUI",D[SPx[e4"sts performed at t0?*5e?&llon for the indicated da$ffiffiStnnual
This report and the tests performed are part ofthe Maverik Country Store monitoring and reporting program, and
are intended to satisff federal EPA UST release detection and record keeping requirements.H \TEEEDEFI.FT(OGDT
F ue I 7V artager/tertt S erviceVR101
Veeder-Root Company 125 Powder Forest Drive Simsbury, CT 06070-2003 1-800'997-7725
Period: 0210112001 to 11/30/2001 Customer: Maverik Country Store
880 West Center Street
North Salt Lake City
UT
84054
Site: Maverik Country Store
14416 S. Camp Williams Rd.
Bluffdale, UT
84065
Period: 02l0ll200l to lll30l200l Customer: Maverik Country Store
880 West Center Street
North Salt Lake City
UT
84054
Report Created: l1/30/2001 11:06 AM
Veeder-Root Site ID:124208
Alternate Site ID:266
,
3
I
,,
3
I
.,
3
I
2
3
I
,
3
I
1
3
I
,
3
1
,
3
I
2
3
I
)
3
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.|-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.|-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.L-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.I-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.l.4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.l-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.l-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.l-4
PREM ALL DISP.
E. UL DISP.5,6
W. UL DISP.l-4
PREM ALL DISP.
E. UL DISP.5,6
Required by 3l-DEC-01
Required by 31-DEC-O1
02-25-200r
Required l.ry 3 I -DEC-01
Required by'31-DEC-O1
02-25-2001
03-24-2001
04-rs-2001
05-25-2001
05-25-2001
0s-07-2001
06-25-200r
06-08-2001
06-08-2001
07-08-2001
07-08-2001
07-08-2001
08-09-2001
08-25-2001
08-11-2001
09-16-2001
09-02-2001
09-02-2001
10-16-2001
10-16-2001
l0-08-2001
tt-29-200r
Lt-29-2001
tt-29-2001
0.1 GPH Annual
0.f GPH Annual
0.1 GPH Annual
0.i GPH Annual
0.1 GPII Annual
0.1 GPH Annual
0.1 GPH Annual
0.1 GPII Annual
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPH Monthly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPII Monthly
0.2 GPH Monthly
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
Passed
This report documents tank and line tests performed at the above location for the indicated date and period.
This report and the tests perfomed are part of the Maverik Country Store monitoring and reporting program, and
are intended to satisfy federal EPA UST release detection and record keeping requirements.
NIfrrl vEEEDEFI-FI(O(OT
F ttel fvaltcagerrtertt S e rvice
vR101
Veeder-Root Company 125 Powder Forest Drive Simsbury, CT 06070-2003 l-800'997-7725
Loc
Owner 56n= MAVERIK COUNTRY STORES INC Locatim y6ne MAVERIK #266 BLUFFDALE
Addess 880W CENTER STREET 14416 S REDWOOD RDAddress
City NORTH SALT LAKE Sate UT Zip 8405A Oty BLUFFDALE State UT ZiP 84065
Confiact MARK CHRISTENSEN Fhone (801) 936-s557
Tank lD Nrrben
MILLEF 446-1 1 80FhorB
1 2 J
Location Contact susrE
Tank lnstallation hte 219t97 49197 219197
Gapacity of tank (in gallons)10000 10000 '10000
Gasoline GasolineSubstance stored Gasoline
Currently in Use Currently in Use Currently in Use
lf nd in use, depth of prodrct in bnk (in inches)
Cunent year tank tags are in place
Mabrial d corstruclion of tanks (sted, FRP, conposite, etc.)Plastic
Frberglass Hernlorced
Plaslic
l-rDerglass Hernlorced
Plastic
Irrlabrial d corstruclion of piping (sted, FRE f lex plastic, etc.)Fiberglass Fleinforced Fiberglas
Plastic Plastic
Reinforced Fiberglass Reinlorced
Ptphg type (pressure, safe/US suction, gravity, eb.)Pressurized Pressurized Pressurized
Type ot Sill Peventon Ds/ice (<5 gd, >5 gal, cmt. sun?, etc.) t\ob
if filed bytransfers d less than25 gdlons. Jf so, no spill reqlired.574--
Type of Oerf ll Prevention Devbe (stutoff, ballfloat, darrq dc.) Mte
if f iled by transf ers d less than 25 gdlons. lf so, no overf ill required.A, C,g'g,gq$Dz*r lusc
For overfill alarm Ahrm is located w lere it can be seen and heard,
and alarmis clearly narked
Mehod r.sed on tanks (NM CS, ll- lC, SA, NP)
Yes M
tvlehod rced m pipirS (1$4 CS, C, SA, NB
N4ehod rced m f lex connectors (B, CS, NC, CP, NM NP, wA)
Erclosed containnBnt surrps at tanks (subprp) and dspersers
lndbate dates d upgrades- linirg, tark or pping cathodc prdectim.
Cathodic Protection Tesiing Com plete for each:tanlc
The resdts of he last tw o cathodic protectim tests are availdle
(w thin 6 nnntls of irstalldion and every 3 years thereaf ter).
DdeTank Tester
Piping Tester Dde
<t Zoo ( tEha-
G* a\ r(qtb (
Mow.rrJ{, ,qe t\slor
Yes tlo
Yes Nlo
S$rclts Sub \olts Sub \olts Sub \olts
DdeFlex Tester \oltsDisp.\olbDisp.!dtsDisp.Disp.\olts
For impressed current system: The resulb of the lastthree
equipnert opaation checks are avaihble. (requied every 60 days.)Yes M
Connenb
t%ge
deJason
ner's du
nspector st rg,/
A Utah UST Program
Release Detection lnspection Checxlist Fscitiulp 4002130
Ownercfiip of Tanks
Completeforeachtank. lf facilityhamorethm4tmks,ompleteinformationforadditiona! tanksonsepratefiorm.
Tark Statrc:
Answsr thG followirg far all tanks. lbta my eleptions in th6 l6t coluurrt, ,,, : ,
Corrosion Probction. Answer the follow ing for all tanks, lste any erceptbns in the last colum n
A h
/4
MqJMethod used for tanks:used for
Manufacturer, name and model number of cert. available Yes No3'd
All Records on site document that the system is properly installed, calibrated, and
maintained (system and tank setup reports, maintenance records).Yes No
ATG IM Device documentation is available on-site (owner's manual, etc.).Yes No
Ail Equipment used to acquire data, take readings, perform test is adequate, accessible
and functional. lncl. ATG console, dipstick, etc.Yes No
Ail Documentation of valid testing or monitoring is available for the last 12 months. Show
testinq or monitorinq results in qrid below.Yes No
ATG The probe is located at the center of the tank. lf not, the tilt correction factor for each
tank is shown on the tank setup report.
Yes No
ATG The tank was filled to at least the minimum level required by the manufacturer's
equipment protocol to ensure a valid leak test and the tank size is within the allowed
upper and lower size limits.
Yes No
IM Secondary barrier is properly placed and constructed, designed for gw
considerations, has an acceptable permeation rate, is compatible with the substance
stored, is non-corrodible, and is not in the 25-yr floodplain (per site assessment).
Yes No
IC MTG
SIR
lnventory readings for product inputs and withdrawals are properly obtained and
recorded. Fleadings are properly reconciled.Yes No
IC SIR Records include the proper number of water readings, and water readings are used to
adjust inventory balances as necessary.Yes No
IC MTG
SIR
An appropriate tank calibration chart is used and is available for review.Yes No
IC SIR Dispensers have current calibration stickers or proper calibration documentation.Yes No
IC SIR Drop tubes are present and extend to within one foot of the tank bottom.Yes No
for each tank for the last 12 months. lndicate pass, faal, no results, or inconclusive.Show results of
Mol/r
#
#
#
Date of last test for tanks:Test results
Tank4
Name and certification number of tester:Test Method:
Date of last tightness test for piping:Test results
Name and certification number of tester:Test Method
U,7 €and model
l-jDate of last leak detector Test resultstest:
Y| '---?Sale Suction piping: Documentation is available and verifiable to show that piping operates at less than atmospheric
ly one check valve (under pump), and has proper slope of piping.pressure, has on
Yes No
Comments
I
,ro" .e ot ?
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner Ldall.wpd
-
:,,' Tank2,r
/r(
Underground Storage Tank lnspection Verification Form
Owner Name:
Owner Address:
MAVERIK COUNTRY STOBES INC
88O W CENTER STREET
NORTH SALT LAKE UT 84054
Facility Name:
Street Address:
Facility lD: 4002130
MAVERIK #266 BLUFFDALE
14416 S REDWOOD RD
BLUFFDALE UT 84065
Tank lD/Alt lD:
Tank Status:
Date I nstalled/Capacity:
Tank Material:
Tank Modificationsll
Pipe Material:
Pipe Modilicalionsl:
Pipe Flex Connectors:
Pipe Type:
Substance Stored:
Spill/Overf ill Description
Tank C P MeVLast TesVResult:
Last Line CP TesVResult:
Tank Release Detection:
Last l-fT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Pipe Release Detection:
Date ALDT/Type/Passed?
Dale LTT/Method/Passed?
PSTFund: No Other:
1 1 E-cen: No
Currently in Use Manifold: No
219197 10,000
Fiberqlass Feiniolced Plastic
Fibelglass B€in ol.ed Plasiic
Steel Flex in Sump
Pressurized Perm RD Date:
Gasoline UNLEADED
Yes
NESCO/AZI Encompasswith
ALD LTT
OVERDUE Mechanical Yes
2l20lo0 TEI Model LT Yes
Yes OtherType: Self-insurance
Tank lD/Alt lD:
Tank Statusi
Date lnstalled/Capacity:
Tank Material:
Tank Modificationsl:
Pipe Material:
Pipe Modificationsl:
Pipe Flex Connectors:
Pipe Type:
Substance Stored:
Spill/Overf ill Description
Tank C P MeYLast TesVResult:
Last Line CP TesuResult:
Tank Release Detection:
Last T'rT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Pipe Release Detection:
Date ALDT/Type/Passed?
Date LTT/Method/Passed?
PSTFund: No Other:
3 3 E-Gen: No
CurrenUy in Use Manifold: No
2t9197 10,000
Fibsrolass Fieinlorced Plastic
Fibo€lass Feinlored Plastic
Steel Flex in Sump
Pressurized Perm RD Date:
Gasoline PREMIUM
Yes
Yes NOT REO'D
NOT REQ'D
NOT REO'D TEI 4OOO
Yes NOT REO'D
NOT REQ'D
ATG
NOT REQ'D TEI 4OOO
NESCO/AZI Encompasswith
ALD LTT
OVEBDUE Mechanical Yes
2l2Ol0O TEI irodel LT Yes
Yes OtherType: Self-insur
Tank lD/Alt lD:
Tank Status:
Date lnstalled/Capacity:
Tank Material:
Tank Modificationsl:
Pipe lvlaterial:
Pipe l\rodilicationsl:
Pipe Flex Connectors:
Pipe Type:
Substance Stored:
Spill/Overf ill Description
Tank C P Met/Last Test/Result
Last Line CP TesVResult:
Tank Release Detection:
Last TrT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Pipe Release Detectionl
Date ALDT/Type/Passed?
Date LTT/Method/Passed?
PSTFund: No Other:
2 2 E-cen: No
Currently in Use Manifold: No
219t97 10,000
Fib€,olass Fe nlor.ed Plasnc
Fib€rqlass neinloeed Plastic
Steel Flex in Sump
Pressurized Perm RD Date:
Gasoline UNLEADED PLUS
YeS NOT REQ,D
NOT REO'D
ATG
NOT REQ'D TEI 4OOO Yes
NESCO/AZI Encompasswith
ALD LTT
OVERDUE Mochanical Yes
2l20l01 Yes
Yes OtherType: Self-insurance
Thursday, October 18, 200'l Page 1 ol 1
UTM Coordinates 420,334.53 4,4A2,27A.Oa Hand H€rd GPS wih Ease slaton ln LD compliance: M ln Operation Compliance: M
Last tnspection Date: ?t2lloo co'redions
Comments:
State ilutah
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATIO
168 North 1950 West
P.O Box 14480
salt Lake city, utah 84114-48480
(80r) s364100
[phone] Fax (801)
536-4414 T.D.D.
www.deq.state.ut.us Web
Michael O. Leavitt
Govemer
Dianne R. Nielson, Ph.D.
Executive Dirstor
Kent P. Gray
Dir€ctor
Wednesday, July 26, 2000
TO: Underground Storage Tank owner: MAVERIK COUNTRY STORES INC
880 W CENTER STREET
NORTH SALT LAKE UT
RE: Inspection of facility located at:MAVERIK #266 BLUFFDALE
14416 S REDWOOD RD
BLUFFDALE UT
840s4
FacilityI.n.ffi
84065
At the request of the Executive Secretary ruST), the Division of Environmental Response and Remediation
(DERR) performed a compliance review for the underground storage tanks at the above facility. The following
component(s) were inspected according to DERR protocol (check all that apply):
1. Release Detection requirements for all tanks and lines
2. Spill and overfill protection requirements.
3. Corrosion protection requirements.
owner or owner's ve present during inspection:
Date:7->)40
S
x
x
Note verifies witness of inspection only and implies nothing about agreement with compliance related issues.
b,.^wLal,tq i 7o r 7o{a,€\tT T,+{71 ,i (f,(( w4rz.
d
Date:
30-0f,-00 l3:18
IfWOICE AIX}RES{I:
TTAUEPIK CCI.$TTRY E.".SRES
6UTJyvE$1UEIq'EH
NORTH SALT I.A'G. [.TAH S4054
OArE: 2-2&2{100 TltilE f,IAET: -,,],.
NT'E ST':SIEtT FILLED OR TOPPEO:
TA}.IK TAI{I(
CAFAC]lrv
TANK LOGATION:
MAI€RIK#?ffi
r r Ar.rlalrr a rlar aIr+I IO EIJTJ I II U\MF WILTJAI'II, FIIJ
BLUFFD.ALE. UTAH
woRl( oRDER I 00033
-at
sratrrrItt",tlnilLulnt: sm
TEcltlJggJEInr#85@
STATETEGHT rrf til2t
GROUNDWA1ER DEPTH:
Fron-MAVERIK C0UIIIRY ST0RES. ltlc, 8019361406 T-047 P.06/08
APPLIED dNYIP-OF.BIEMIAL SDx.VICE S, L. C.
PO BOX 182 RoY, UTAfi t{Oii, {8ttl5,'*6-1546
T,E,L. qysrEF 4000 I T.E,!, LTS .r'r,E,!' trL!..AGE
PRECISION TANK & LINE TEST RESULTS SUMfulARY
F-0?7
TITiNE END:
PRODT.ICT TA,til( FI-LVEiIT PROT,[,CT LhIE LEAI( WAER N
DK'TEGTOR TAI}T
PI'TF TANfi H'IIERIAL
TYPEvaFctf,t
I
2
3
4
5
A
fofftr
rorm
'f 3900
Rf,JL
S/UL
Rit -
PRE'SS
PRESS
PREES
sltiF
S}1/F
cttE
IUr
irr
rdT
N'T
MT
Nrr
,t I'
PftODUCT Lii{ES TES1ED Aii
LINE FIATES (GPHI
'l l*l Ffl ll - r1r1a
2 #2 S,UL ,01,3
J #J RJUL..UU5
I
Fl
6
AODIIIONAL lNFOft frtATlON
.39 t st t-oH ]j irtr\aulEs
TTTIS SYSTEil A}ID TIETHOD ITE'IS OR
ilrPf; r?t+I. ello _crl
T'IE M U€EPA'IO, CfRPAfiT t0,
trtB tgcAl co0Es_
..Eqr-|Grgl1 A.Etrttt rFlr tr +tJ-lr rra rrre.',r-n . tt tr,.t a r-\-l tttr+-ta\.r .riirislr a rrfti,|iraTEr 't ?.l Tlrfrrl,ll.l r r-r a--a.(J-auul',
t
P^gS PASS
F SS PASS
PASS PAS5
12-2
12-O
12-O
't 1-2
11-1
11-0
1 0-0
1 0-0
1 0-0
o9-2
09-2
09- 1
o8-2
o8-2
o8-0
07 -1
o7-1
o7-0
o6-0
o6-0
o6-0
06- 1
06- 1
06-o
05-2
05-2
05-2
04-16-O0
04-o2-o0
04-o1-o0
22:1 8:00 TANK
O2:00:OO TANK
Premium
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Unleaded
Premium
Unleaded
Premium
U n leaded
Premium
U n leaded
U n leaded
U n leaded
Premium
U n leaded
U n leaded
Unleaded
Premium
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Premium
Unleaded Beg
Unleaded Regular
Premium
(CSTT)
(o.2 GPH)
(CSTT)
(CSTT)
(CSTT)
(o.2 GPH)
(CSTT)
(0.2 GPH)
(0.2 GPH)
(CSTT)
(CSTT)
(CSTT)
(CSTT)
(CSTT)
(o.2 GPH)
(CSTT)
(CSTT)
0.2 GPH)
0.2 GPH)
CSTT)
0.2 GPH)
0.2 GPH)
CSTT)
0.2 GPH)
0.2 GPH)
CSTT)
O.2 GPH)
o.2 GPH)
CSTT)
O.2 GPH)
o.2 GPH)
CSTT)
0.2 GPH)
0.2 GPH)
PASSED
FAILED.
FAILED
PASSED
FAILED
FAILED.
PASSED
PASSED.
PASSED.
PASSED
PASSED
PASSED
PASSED
PASSED
FAILED.
PASSED
PASSED
PASSED.
PASSED.
PASSED.
PASSED.
PASSED
PASSED.
PASSED.
PASSED
PASSED.
PASSED.
FAILED
PASSED.
PASSED.
PASSED
PASSED.
PASSED.
FAILED
FAILED.
PASSED,
PASSED
PASSED.
PASSED.
MAVERIK #266
Tank Test History 7l17I2OOO 2:37:00 pM
3-99
4-99
1 -99
5-99
4-99
1-99
9-99
1-99
1-99
5-99
2-99
7 -99
7 -99
o-99
3-99
o-99
o-99
1 -99
6-99
2-99
1-99
9-00
2-OO
8-OO
5-O0
4-O0
4-OO
23:
21:
23:
o3:
22:
03:
03:
22:
23:
Q2:
o1:
:OO
:OO
:OO
:O0
:00
:00
:O0
:00
:00
:00
:00
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
43
o2
).7
59
47
59
59
o8
51
22
23
55
57
47
59
o1
10
59
0O:'14
02:Q2
01:58
01:09
02:1O
03:59
22:58
03:59
03:59
23:11
O1:52
O1:51
O1:35
OO:38
06:18
2
1
2
?
1
2
3
1
2
3
1
?
2
1
?
1
2
J
2
1
2
1
3
a
2
1
1
3
2
5
2
2
1
2
2
1
2
2
Regu lar
Reg
Reg
Regu lar
Regu lar
Regu lar
L.R. =
L.R. =
L.R. =
L.R. =
L. R. =
L.R. =
L. R. =
L. R. =
L. R. =
L.R. =
L.R. =
L.R. =
L.R. =
L.R. =
L.R. =
L,R, =
L. R. =
L.R. =
L. R. =
L. R. =
L. R, =
L.B. =
L.R. --
L.R. =
L.R. =
L.R. =
L.R. =
L.R. =
L.R. =
L.R. =
L.R. =
PH
PH
PH
PH
o.2 G
o.2 G
0.2 c
0.2 G
-0.O1 sph
0.1 3 gph
0.1 8 gph
0.1O gph
O.1 2 gph
O.'14 gph
O.05 gph
O.09 gph
O.10 sph
-0.O2 sph0.01 sph0.09 gph
0.02 gph
0.01 gph
0.26 gph
-0.O5 gph
-0.01 gph
-0.03 gph
-0.03 gph
-0.02 gph
0.02 sph-0.01 gph
0.09 sph-O.06 gph
-0.01 gph
-O.01 sph-O.04 gph
0.25 gph
0.O6 gph
0.03 gph
0.O9 sph0.09 sph0.07 gph
0.13 gph
0. '15 gph
0.10 gph
0.O7 gph
O.02 gph
O.09 gph
23:08:00 TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TAN K
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
TANK
Regu lar
Reg
Reg
Regu lar
Regular
Regular
Regular
Reg
Reg
Reg
Reg
Reg u lar
Reg
Reg u lar
Reg
Regular
Reg
Regular
o1:
23:
00:
o3:
o2:
o4:
03:
:00
:00
:00
:00
:00
:00
:00
23:44:00 TANK
0'l :56:00 TANK
01 :59:0O TANK
CSTT)
03-03-00
03-01 -00
o3-01 -00
02-20-oo
o2-02-00
o2-o2-OO
o1-19-00
o1-03-00
o1-o1-00
:0O
:0O
:0O
:0O
:0O
:0O
:00
:00
:00
:00
:00
:00
:OO
:O0
:O0
L.R. =
L.R. =
L.R. =
L. R. =
L. R. =
L. R. =
30-05-00 l3:18 From-lIAVERll(C0IJI{TRY SIoRES. [{C, s019361406
MAVERIK #266
T-047 P 07/08 t-02t
Tank Test History 51261200,0 9:59:OO AM
(csTT)
O3:59
01r23
10-01-99
09-04-99
09-o1-99
09-o1-99
oa-27-99
08-20-99
12-23-99
1 2-04-99
1 2-01-9S
1 I -25-99
1 1 -02-99
'l 1-o1-99
1 0-o9-99
10-01-99
08-o3-99
07-24-99
o7 -22-99
07-10-99
o6-29-99
06-09.99
06-01-99
o5-24-99
22:18:OO
02:00:00
O3:59:OO
21:O2tOo
o1 :53:Oo
O3:59:OO
22:47:OO
03:59:OO
TANK 2:
TANK 3:
TANK 1 :
TANK 2:
TANK 3:
TANK 1 :
TANK 2i
TAN
Premium
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Unleaded
Unleaded
Premium
Unleaded
Premium
Unleaded
Premium
Unleaded
Unleaded
Unleaded
Premium
unle6ded
Unleaded
Unleaded
Premium
Premium
Unleaded
Unleaded
Premium
Unleaded
Unleaded
Unle6ded
Premium
Unleaded
Unleaded
Unle6ded
Pr€mium
Unleaded
Unl€aded
Pr€mium
Regular
Regular
Regular
R€gular
Regular
Regular
Regular
Regular
Heg
O.2 GPH)
O,2 GPH)
CSTT)
0.2 GPH}
0.2 GPH)
CSTT)
0.2 GPH)
0.2 GPH)
0.2 GPH}
o.2 GPH)
o.2 GPH)
CSTT)
CSTT)
PASSED
FAILED,
FAILED.
PASSED
FAILED.
FAILED,
PASSED
PASSED.
PASSED.
PASSED.
PASSED,
PASSED,
PASSED
PASSED
FAILED.
PASSED
PASSED
PASSED
PASSED
PASSEO
PASSED,
PASSED
PASSED
PASSED
PASSED
FAILED.
PASSED.
PASSED
FAILED
PASSED,
PASSED
PASSED
FAILED
PASSED
FAILED
PASSED
PASSED
PASSED
PASSEO,
:OO TAN
:OO TAN
:OOTAN
;OOTAN
:OOTAN
:OOTAN
03:59
Ol r53
O3:59
23:08
01 :55
23t57
02:26
04:18
03:59
23:25
00:49
23:54
23:37
02:ol
3
1
1
3
3
2
1
2
1
3
3
2
1
3
1
2
2
1
3
2
1
5
3
2
1
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
K
t\
K
K
K
K
K
K
K
L.R. = -0.01 Sph
L.R. = o.13 9ph
L.R. = O.21 9phL.R,:0.10 gph
L.R.:0.13 gph
L.R. = 0.14 sph
L.R. - 0.05 sph
L.R. - O.09 gph
L.R.=0.10 sph
L.R. = O. l0 sph
L.R. = -0.04 gph
L.B. = -0.03 gph
L.R. = o.02 gph
L.R. = 0.01 gph
L.B. :0.26 sph
L.R. = O.O0 sph
L.R. =0.O7 Sph
L.F. =-o.o5 OphL.R.:-0,05 sph
L.R. = -0.O4 sph
L.R. = 0.02 sph
L,R. = -0.02 sph
L.R. - 0.O6 sph
L.R. - O.O4 gph
L.H. = -0.O4 Sph
L.B. = O.13 9ph
L.R. = o.o3 9ph
L.R. = o.O2 gph
L.B. = 0,25 gph
L.R. = 0.06 sph
L.R. = 0.o7 gph
L,R. = O.oB gph
L.R.=0,13 sph
L.B. - O.OB gph
L.R.-0.13 gph
L.H. =0.o1 9ph
L.R. = 0.03 sph
L.R. = 0.07 sph
L.R. :0.09 gph
1
2
J
I
2
23:28
02:41
01:50
21 :56
:0OTAN
:00 TAN
:OO TAN
:OOTAN
:OO TAN
:0O TAN
:00 TAN
:oO TAN
OO TAN
OO TAN
OO TAN
OO TAN
OO TAN
OO TAN
OO TAN
OOTAN
OO TAN
OO TAN
OOTAN
OOTAN
OO TAN
OO TAN
Regular
Reg
Reg
Reg
Begular
Reg
Beg
0.2 GPH)
Regular
fiegular
Heg
Regular
Bes
Reg
Beg
Reg
(CSTT)
(CSTT)
(CSTT)
(CSTT)
(CSTT)
(0.2 GPH)
(CSTT)
(CSTT)
(CSTT)
(csTT)
0.2 GPH)
0.2 GPH}
CSTT)
CSTT)
O.2 GPH}
CSTT)
CSTT)
CSTT)
CSTT)
CSTT)
CSTT}
CSTT)
CSTT)
0,2 GPH)
O1:09
02:10
01:17
23:O2
23:11
O2:50
O1:46
O1:35
O6:1 I
nE- t 2-oo
05-03-99
05- 1 9-OO
05-03-oo
05-02-oo
04-23-OO
04-16-00
o4-o2-oo
03-19-00
03-19.00
03-08-00
02-23-00
02-20-oo
02- 1 4-OO
01-28-OO
01 - t 9-00
0 r -01-oo
03:1 I
23:10
OOTAN
OO TAN
OO TAN
Heg
Reg
Trnk
Yearly SIR Summary Report
Maverik
January, 2000 - Apri[ 2000
LEGEND.->P . PASS
INC. INCONCLUSTVE
rF.. FAIL
ND . NO DATA SUBII,TITTED
J|ll F.b M.r ADr Mty Jro Jrl Aug Scp Oca Nov lr.c
259 t 21
259201
268121
26E201
26832t
269101
26922t
269321
270101
27022t
270321
21\2t
27 t201
27 t321
272121
21220t
212121
P
P
P
INC
P
P
INC
INC
P
P
INC
P
P
INC
P
P
P P
PPPP
PPPP
PPPP
PP
Castledsle f260 - 2t5 East Maln - Crstledrle - UT
zil12t
260201 /-\
, Iluffdale #266 r! 2oetzt
26620t
26612t
l,1416 S. Camp Wllliams Rd - Fluffdrle - UT
oyERTON #267 - p.o' Box 750 - oVERTON - NV
26712t
26720t
261321
P
P
P
P
P
P
P
INC
P
P
P
P
P
P
P
INC
Winnemucca ll26t - 863 E. Wlnnemucca Blvd _ Winnemuccr - NV
P P
INC
P
P
INC
P
P
P
P
P
P
P
P
P
P
P
P
P
INC
P
Clinton #269 - 1800 N. 1036 West - Clinton _ LIT
INC
P
INC
P
P
P
P
P INC
INC
P
tNC INC
P
P
P
P
P
P
P
INC
II/ICCAJ,L #27I . 622 NO. 3RD STRXET - MCCALL - II)
P
INC INC
CoTTONWOOD #272 - 690 W. HWY. 89A _ COTTONWOOD - AZ
INC P
NAMPA #273 . 2516 WEST KARCEER RD. . NAMPA . ID
tNc
P
P
P
INC
P
INC
ND
ND
273t2t
213221
2?130t
INC
ND
ND
INC
ND
ND
INC
Mountain View #274 - Htghway 410 & 7th - Mountain View - \My
274t21
27420t
21432t
P
P
P
P
TNC
USTMAN Techologies, Inc. r Undergrould Storage Tark Maragement
12265 w. Bavaud Ave. ' Suite t l0 ' Lakewood, co aozzg . l-8oo-253-8054 r (303) 986-80I I * FAx [phone]lo1t20oo Dedicated to protecting the environment p.go, t
Lovell #270 - 2ll W. Mah St, - Lovell - Wy
a a
Yearly SIR Summary Report
Maverik
January, 1999 - December, 1999
Tank
LEGEND ->P . PASS
INC - INCONCLUSIVE
rFT. FAIL
ND . NO DATA SUBNTITTED
Jan Feb Mrr Apr May Jun Jul Aug Sep Oct Nov Dec
est
PP
P
P
P
P
PP
PP
PP
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
?*FrP
25422t P P
Ephraim #251 - 89 North Main - Ephraim - UT
25712t P P
25720t P P
Springville #258 - 309 North Main Street - Springville - UT
258 I2I P P INC *Fr
25820lPppp
Burley #259 - 1209 East Main - Burley - ID
259I2IPPPP
2592OIPPPP
Castledale #260 - 285 East Main - Castledale - UT
26012IPPPP
PPPP
14416 S. Camp Williams Rd - Fluffdale - UT
INC
26620r
26632t
rFr IFI P
P
P
P
P
P
P
P
P
P
rF*
.F+
*Fr
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
TNC ?
P
INC
INC
P
P
INC
P
P
P
P
P
P
+F.
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
INC
P
P
P
TNC
P
P
P
INC
rFr
P
*F.
rF*
PP
P
.F.INC
26020t
Fluffdale #266/\---356+4-/INC INC
P
P
P
P
P
P
P
P
*F.
P
P
P
P
P
P
INC
INC
P
INC
INC
P
P
INC
P
INC
INC
P
INC
INC
P
INC
P
P
P
INC
INC
P
P
INC
P
P
+F*
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
rINC ?
rNc P
rNc i-
oVERTON #267 - p.O. BOX 750 - OVERTON - NV
26T12IPINCPPINC
26720IPPPPP
267321 P INC P INC *F*
Winnemucca #268 - 863 E. Winnemucca Blvd - Winnemucca - NV
268121 *Fr INC INC P *F*
268201 .Fr .Fr *F* *F. *F.
268321 *F* *F* *F* P *F*
Clinton #269 - f800 N. 1036 West - Clinton - UT
26910IPPPPP
269221 P INC P INC tNC
269321 INC P INC INC P
Lovell #270 - 211 W. Main St. - Lovell - WY
2TOIOIPPPPP
270221 P INC *F* INC P
270t21 P INC INC rFr *Fr
MCCALL #Z7I - 622 NO.3RD STPJET. MCCALL . ID
2TII2IPPPPINCIFTTNC
2Tl2OlPPPPrFr*FrP
2TI32IPPPPPPINC
coTToNwooD #272 - 690 W. HwY. 89A - COTTONWOOD - AZ
2'I2I2IPPPINCINCP}FI
2722OIPPPPPPP
USTMAN Technologies, Inc. * Underground Storage Tank Management
12265 W. Bayaud Ave. * Suite I l0 * Lakewood, CO 80228 {' l-800-253-8054 * (303) 986-801I t FAX (303) 986'8227
0l/2El2000 Dedicated to protecting the environment Page: 8
TNC P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
INC
*F*
*F*
P
INC
P
P
P
INC
P
P
P
P
INC
INC
P
rNC ?
P
P
P
P
P
P
P
P TNC?
TNC P
P rNCT
.Fr
P
rFr
+Fr
P
P
a
FACIIJITY ITJ.t-ka)z1 30
USTs 2trs
PST PROCESSING CHECKIJIST
Year q)
Not
Appl icabl e
Non-Marketer DiscounL
Previous PolluEion Incidents
LUST File
Form Included
Y /@---"-
@ N \./
TTT
- Verify tsank/ lines
vs registered
- DocunentaEion ok?
- Rate ok?
Y/N /
v/N /
Y/N "/"
aid
1
P
9
9
9
9
9
9
9
2
3
4
5
5
1
QL-'Q2-o3-Q4-01_Q2-Q3-Q4-o1_Q2_Q3-,Q4_
Q1-Q2-Q3-Q4-QL-Q2-Q3-Q4-.\-t 6) r\? aL
Q1_Q2_Q3-Q4 -'
Fees Paid
93
94
95
96
97
FY
-EI
FY
FY
FY
88
89
90
97
92
FY
FY
FY
FY
FY
Compl j-ance
- Compliance OuLst.anding?
- Leak detection required?
- Spi11/overfi11 required?
- Corrosion protsection required?
- Notification up tso date & complete?
- application submitted?
Date QualifiedDate Issued
N
N
N
N
N
.-'
-7-
Review completed and certsificate issued by
lo
Dslproc. frn A5/1A/95
Unacceptable Acceptable
-t uno
-FY
-FY-FY- rr
-FY_FY
_FY
\---'
lr/
-
Y/N
".''
Michael O. Leavin
Gorcrr
Dianne R. Nielson, Ph.D.
Ex€cld\€ Dir€cbr
Kent P. Gray
DL€cror
Srarnof {Jrah
\N
RONMENTAL QUALITY
{ENTAL RESPONSE AND REMEDIATION
Paul Weisenbourn
Maverik Country Stores, Inc.
880 West Center Street
North Salt Lake, Utah 84054 FROM:William Moore
Your application for coverage under the PETROLEUM STORAGE TANK FUND for the three new
UST(s), is incomplete. The following additional information is required before your application can be
processed.
tll A copy of a Tank, and Line Tightness, and Lrak Detector Tests performed within the last 6
months, with copies of field reports, must be submitted to DERR.
12)You must document what form of Release Detection you are properly performing on your:
(X ) Tanks and/or (X ) Product Lines.
t3l - A Notification Form, registering your tanks, needs to be filled out and submitted (use Form 7530
(Revised 9-89)). This form must be signed by the Utah Certified installer who installed the
systems.
You have not completed the form declaring "PREVIOUS POLLUTION INCIDENTS." Please
complete the enclosed form.
You have not completed the "PETROLELIM STORAGE TANK FLIND APPLICATION" form.
Please complete the enclosed form.
Annual REGISTRATION FEES remain unpaid. Please submit a check for $405.00. This would
cover the fiscal years 1997.
Facility LD. # 4002130
DATE:2lIA97
t4l
tsI
t6l
t7)
t8I
Annual Fees for the PETROI,EUM STORAGE TANK FLIND remain unpaid. Please submit a
check for $750.00. TESGiie cover the fiscal years 1997.
Please return a copy of this speed memo with the above items to speed processing.
Please note that you will not be covered under the PETROLET M STORAGE TANK FUND, or
allowed to receive product, until the above-mentioned items are completed. If you are currently a
LUST site, and your Fund application has been approved, any further releases will be covered by
the Fund. If you have any questions concerning this, please
Response and Remediation at [phone].
noN
e frEr4EDu
Division of Environmental
February 25,1997 t
MAVERK CIT'NIRY STORES, INC.
880 W€st C€nt6r St.
North Sat Iab City. &ah 84081
801-295-565'/
RE: PSTF Memo, Maverik #266, Bluffdale, Utah (FlD #4002130)
Dear Mr. Moore:
Enclosed are the items requested in your memorandum dated February 12, 1997. Required
fees are included.
The site will utilize an Encompass automatic tank gauge system and line leak detectors to
perform tank and line leak detection.
With this submittal, it is our understanding that our application for coverage under the Petroleum
Storage Tank Fund is complete. We appreciate your continued assistance as we seek to
comply with all applicable regulations. lf you have any questions, please feel free to call me at
801/295-5557 ex. 934.
Sincerely,
Maverik Country Stores, lnc.
Paul R. Weissenborn, P.G.
Environmental Manager
Utah Certified UST Consultant #CC0086
Mr. William Moore
Utah Department of Environmental Quality
Division of Environmental Response and Remediation
168 North 1950 West
Salt Lake City, UT 841'16
I I
I
Facility lD * 4(nLl30
This tetteL or an equivalent, must be signed and ncluded with your aPplication and lees.
PBEVTOUS POLLUTION INCIDENTS
To:Mr. Kent P. Gray
Executive Secretary (UST)
Utah Solid & Hazardous Waste Control Board
Dear Mr. Gray:
As by paragraph ,t9-6-413 of the Utah Underground Storage Tank Act' I have pertormed a trank and
line test on each underground storage tank at my facility, and based on this test, there has not been
a of petoleum. AdditionallY, based on 'customary business inventory practices standards' I am @l!
ol any ol petroleum from my tanks.
OR
I have had the following releases of pefoleum (detailed bdow also mention any action you took to clean up
the release).
signafure of owner/operato r
Faitwe to Eport previous teteas* autd wid ywr average un&t tle Petoleum Storage Tank Fund.
oi
p3.p9,trn 05/lg9a
OWNER OF T
Owner Name
Address
Facility lD #
PETROLEUM STORAGE TANK FUND APPUCATION
Facility Name
Address
City
Co unty
Zp Code State
City
County
State
Contact
Zp Code
Phone
Contact Person
I
TYPE OF OWN
Marketer, or non-marketer with facility average monthly throughput greater lhan 10,000 gallons.
I I Non-marketer with facility average monthly thrcughput less than 10,000 gallons (must vedfy).
DESCRIPTTON OF UND U D RAG KS
h l\S
-ilq t,
tD,6d!)
dhs
TANK TIGHTNESS TEST
Tank #
PasJFail
I
?a*\}P6S
3
=6-
L
CERTIFICATE OF
tr All Underground Storage lanks (USTs) at this facility have been registered.
All tank registration fees have been Paid.
COMPLIANCE WM{ UST BEGULATIONS
ls the applicant curEntly in compliance with all Federal, State, and Local UST regulations?
t Kl yes I I No lf 'No' please describe item(s) of non'compliance:
PREVIOUS POLLIMON I CIDENTS
Has a pollution incident ever occured at your lacilM
[ ] Yes ll Yes' please provide LUST (Leaking Underground Storage Tank) information:
t[ r'ro
NT
I have met the financial responsibility requirement ,or the first $25,000 per release by the tollowing
method:
1N
t
t*€elt lnsurance
[ ] Risk Retention Group
I certify under penalv ol law
t
t
Guarantee [ ]Commercial lnsurance [ ]Surety Bond
Letter
made by me are true and
Owner/Opetator
the
Date signed z-
4n7,t
Phone
Tank #
Age
Capacity
Substance
t
t
lf 'No' please attach a letter s ning that under customary business inventory practic€s standards
you are not aware of any release from any tank(s) at this facili$. The PREIIOUS POULffiON
INCIDENTSlorm may be used.
Credit il Other
PETRO 'JM STORAGE TANK FUNO CHEC'- ISTTT
1 c c OF BEG N
All Underground Storag e Tanks (USTs) have been registered- EPA lorm 7530-1 (Revrsed 292).
IXJ Tank registration lees have been Paid- Fi scal Years 1988'89= $25llanvYr',Fiscal years 199G'92'
$45/tanldyr Subseque nt fiscal yearF $60 or $'t35/tanlc/yr.
2. co LIAN U REG
I am in compliance with release detection requirements.
I am in compliance with all other Federal, State, and Local UST regulations.
OLEUM RA
PST Fund fees have
t I Fiscalyears 1
D D
been paid.
gS1-iii= $iSOlt" nklyr.or$12,llanuyr. (with non'marketerdiscount') plusaPplicable
process fees.'n.*ivr"ilsg4= slso/tanuyr. or $7s/tanloyr. (with non-marketer discount') plus applicable
process fees.
'Sr-U""qu"nt fis."l years= Based on facility throughput S5O, $150 or $175/tank/yr plus applicable
process fees.
' For non-marketer discount
t l I am a non-marketer with facility averagernonthly througlpl{l9iil1{-]i:000gallons'
i j I have comptetedthe AppLtciTtoN FbR N2N-MARKETER D/scoUNrform(s).
4. TAN ANO TI
I All systems Pass the tank and line tightness tests.
I am submitting th e results of the tank and line tightn ess tests and a copy ol the field report.
tlAlltanksdonotmeettherequirementssetbyruleregardingtanktighhesstesting.
i i i ;;;;;;;6t d rre state UbT otnce anct wiit submit evidence of a plan for review.
P o
I have completed the PRilIOUS POLLUTION //,JCIDENIS f orm, which states whether under customary
business inventory practices standards I am awa re of any release lrom the tank'
6.ET.IT
I have met the financial
method:
ttS6tt lnsurance
[ ] Risk Retention GrouP
U E
responsibility requi rement lor the first $25'000 Per release bY the following
I I Guarantee
[ ] Letter ot Credit
[ ] Commercial lnsurance [ ] Surety Bond
[ ] Other
"See explanations under'How do I get started?'
Uf Install-ation/Upgrade Pe^it
/,Nclr PalDlt t I Pcnlt uodl.flcatLoa
I
Certs
Cert.
Cert
463-t?rustellatl,oD
lddlcs o
Phoa. *
Ccrtlf,icd Iar't on Pro
Name
FaciliEy rD*f not. a,t lit.y)
Tark
Contact per
Eacillty
Contact,
Ilnucual or cxtaauatJ,ng ci,rcunata!,cc8 a:.pacted!
NO:
*Exp. da
Exp. da*aL
# 3L-- Exp. da
v. 60{," sfso fqt
{_
yy' rn=.rt1/Replace t I upgrade
Ci STaE t*t. z,n.".Ft c7 I
Ci SEa z
Phone * (_)
ToEal Installation Tank Fee/Permit 6oo.oO
UrO A
Taaka fDvolvcd ia Iastallation / t Dqredc
Tank *I ?--3
Install /Upgrade T^.r1r ll -
Capacity (gaI1ons)l0K loK l0K
Type (FRP, Stee1, etc.)€ee FK?trK?
Subst.ance to be Stored Cfi-s o t-LxiL-
-
Piping T)4)e (Press
Suctsj-on, Gravitsy)'pfes s ll tl
Install/Upgrade What?
(Tank, Lines. C.P.. ... )ru{f;tl l(tt
Ttrpa of fnatallatLon/IrDdrad..
DeecrLDtlon lilirllb.r
{u"hlJL Aed s w4l< ur()-l-L,-3
€. 8, ?, *a.rnJca Ar'*;!- 0 /iffi(ies,I
158 North 1950 WesE, 1st, Floor
Sa1E. Lake City, U.tah 84115
Date Approved & ,a glb(qL App. By
Ut.ah Department. of Envi-ronrnent.al eualj.ty
Division of Environmental Response and RemediaEj-on
/lh.*
a
State Use Only
cK+t1.t L
Date Permit. Mailed (lula
I I
Date work will commen." <rl ' 2C - ? A
t(rll c@D1ct.d lorD to!
APPLIED EhIVIRONI},IEhTTAL SERVICES. L. C.
PO BOX {E2 ROY, UIAH 0,f067 (S0tl 5lrG-7S{6
T.E.t. SYSTET .O00 / T.E.t. LT3
PRECISION TANK & LINE TEST RESULTS SUMMARY
INYOICE ADORESS:
I{A\ERIK COUNTRY STORES
880 I&EST CENIER
NORTH SALT LAHE, UT 84054
DATE: 2-22-97 IME START:
TIME SYSTEM FILLED OR TOPPED:
TANK LOCATION:
MAVERfl( #268
I4I75 SOUTH REDWOOO
ELUFFOAI-E. I,JTA}i
woRK OROER r 80036
TECHNICIAN: Sltl
TECHr94027 vAN !}8502
STATETECH' UT OI21
l6:30
l-2r}'S7
TIME END: 20:00 GROI,JNDWATER OEPTH- 10'+
TANK TANK PROOUCT TANK FILL VENT PROTXJCT LIIVE LEA'( WATER IN PUMP TANK i/I,ATERIAL
,|
?
3
I
5
6
r0000
r0000
r0000
R,UL
SAJL
R/UL
PASS
PASS
PASS
PASS
PI6S
PASS
PASS
PASS
PASS
0.0'
0.0'
0.0'
PRESS
PRESS
PRESS
SWF
SWF
SWF
}UT
N/T
NIT
PROOUCT LINES TESTED AT
LINE RATES JGPHI
1 RJUL EAST -,OOO GPI.I
2 5,,U1,.0C0 cPH
3 R^iLWEST-.!Uil cpH
1
5
6
50 PSI FOR 15 MINUTES
AODffiONAL INFORMATION: TANKS TESTED ON 1-29S7 & UNES TESTEo ON 2-20_s7
THIS SYSTTI AXO IETUOO IIEETS OR.EXCEEOS TIIE CATTERiA III USEPA .o, CfR PAffr 2 ,rfpa 3zt{7. A,.O atL appltcAalE STATE ano Loini-tii-ois
CERTIFIEO TECHITIICI.AI{ SIGHATURE :DATE: 2-22-97
.t
1 ,Eqcility Number: \ o oz l7o
INSTALI,ATION INSPECT ION
ll.rfOS
or il.s
(J
I Business ooly I Tank only Same rs Scction I:
-pany Site ldentifier. as applicablebr
G.
City
F
treet
Contact
! Property fl Business only flTank onl-'-
Owner Narne (Corporation. Individual. Public Agency' or other
Zip C.ode
rl ress
State
Countv
entlty)
Cert #:UST INSTALLER Companl':
o 7
1-- Tank No. 3 Tank No. Tank No.
o * Ner.+'Tanks- Removed Tanksvious Tanks
Tank No. t Tank No.
->
Dl. Estimated Total Capacity (gallons)
2. Type: FRP, Steel. Composite
3. Suhstance Stored
lV{nA)*.1. New or Used (must be recertified)
fl Tightness Test and Inventort' Control E GIY I\lonitoring
I lllanual Tank Guaeing E]Oth.t-
. Type: FRI'. Coated Steel. Composite
I Automatic'I'ank Guaging
! Interstitual Nlonitoring
5. Ty'pe of leak detection
!Vapor Ivlonitoring
2. Ty'pe: Suction, Pressure. Graritl'
fl Tightness Test and Inventorv Control E GW IUonitoring
l. Spill device installed (T1'Pet
Other! I\'Ianual'fank Guaeing
3. T1'pe of leak detection
apor
fl Automatic Tank Guaging
fl Interstitual lVlonitoring
(2. Overfill device installed (T1Pe)
SPECIFICATIONS
Distance from tank(s) to nearest property line (5' miflimum)
Distance from tank to nearest structure (5' plus 45'from surface to tank)
Estimated dePth to groundn'ater
Do tanks have at least 18" spacing between tanks (stable conditions)?
If unstable walls, are tanks spaced at least l/2 times the diameter of the tanks from each other?
Can groundwater raise into the bottom of the tank excavation (must anchorl?
Does depth of installation conform to planned Anchoring, Surface and TralTic conditions'
groundwater conditions and piping run slope requirements?
Has TanX and Piping Cathodic Protection svstems been checked to verify theJ" are working
ProPerl!'?
Does the amount of Tank Deflection meet specifications?
ft.
ft.
fr.
I\D
YES IiO N/A
I.Ownership of Tank(s)II. Location of Tank(s)
TANK
PIPING
GENERAL
\-,FACILITY SITE PI-AT \-,Facillty lD No.
NORTH\^r-
d_t'g-fiaFt-_*r*_}B
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I
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I
I
il
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Show rocaljcns ot all Dulldtngs. streets. tanKs. ptptng ano Orsoenser tslanos. lnolcate locallon anO Cecln o, all samples co
the tocauon or anv regonec, PIO or FID reaolngs.
ecrec Dy tne and rrEpector. AIso indicate
A
Potentral Receptors- lndicate distance (in feet) to the nearest: Residences
Active water well
-
Surlace water
-
Buried utilitiesBuildings
Other
e ,
(./t^4*,J*v,-l--
C,onr,n\r-
q
s!,
(
L,rLt Con"-er**f
t^J
\ o"t an^S
S\^
ts
Date: (
the above.named facilitY on
cert#-
1b
a Lnaret
lnsoectors S
t
u
U
US fnstallation/Upgrade Pe,-.,it
NO:
gtat
* u, 6@{Exp
* TL Exp
*TL Exp
" rfsofqt
I NGw PalrEit,t I Pcnl.t rrrodLficatlon
,1r*.t Servic,<^,.Ll 63-/?IDsCallatloD e
lddrca C
Pbotr. li
Datse work will commence
Facilj,ty ID*fnot,a 1i ty)
Tank
Addres
Contact. per
Eacility
Addres
Contact
I
UDusual oa e:lt6auatl,sg circu.nctaaccs o<Dactad:
CerE
CerE,
Cert
daE
daE
dat
I I tn..ut1/Replace
Ci
ci
t I upgrade
Stat
Phone
Sta z
Phone * (_)
Tota1 Insta1latsi.on Tank Fee/PermiE.6oo.oO
a
UJO O
Tapks Involycd lE lastallatioa / Illrgrade
Tank #I 7-3
Instal 1 /Upgrade x;tll -
Capacity (gallons)l0lK lo l<t0K
Type (FRP, St.ee1 , eE.c. )€R" ?rk?tr&?
SubsE.ance t.o be Stsored Cfts o r-L*t €- -
-
Piping T)G)e (Press..
Suction, cravicy)pfes s.ll tl
Inst.a11 /Upgrade What.?
(Tank, Lines, C.p., ... )vtwt l(lt
of fnstallatlon/trrErad8
De6criDtioB lnrDber
'fus4at-l- tLtul s wql<- uJo.,lL 3
€.3,P . U*rrJr-s
( v*r-4*S,I
Ual,l c@DlctGd fo::D to!
Sa1t. Lake City, U.tah 84115
Date Approved & ,a SIW(qL App. By /tA_
Ut,ah Department, of Environmental QualiEy
Division of Environment.al Response and RemediaEion
158 NorEh 1950 West., 1st Floor
State Use Only:
CK#11,1L U
Date Permit Mailed (l-tloe
I
Ccrtificd Igrtaltcr,t on projecr:1
Name |,Ua*nc l.OuLLctL<-
J
V),
,?ot1L
DEPARTMENT OF ENVIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box lzt48zt0
salt Lake city, utah u1144840
(801) 5364100 Voice
[phone] Fax
(801) s364414 T.D.D.
Michael O. Leavitt
Cownror
Dianne R.Nielson, Ph.D.
Executirc Dk€cbr
Kent P. Grav
oirct&
Paul Weisenbourn
Maverik Country Stores, Inc.
880 West Center Street
North Salt Lake, utah 84054
Facility I.D. # 4002130
DATE: 2ll2l97
t1l
12)
t31
t4l
tsl
t6l
t7l
FROM: William Moore
Your application for coverage under the PETROLEUM STORAGE TANK FUND for the three new
UST(s), is incomplete. The following additional information is required before your application can be
processed.
A copy of a Tank, and Line Tightness, and l€ak Detector Tests performed within the last 6
months, with copies of field reports, must be submitted to DERR.
You must document what form of Release Detection you.re properly performing on your:
(X ) Tanks and/or (X ) Product Lines.
A Notification Form, registering your tanks, needs to be filled out and submitted (use Form 7530
(Revised 9-89)). This form must be signed by the Utah Certified installer who installed the
systems.
You have not completed the form declaring "PREVIOUS POLLUTION INCIDENTS." Please
complete the enclosed form.
You have not completed the "PETROLEUM STORAGE TANK FUND APPLICATION" form.
Please complete the enclosed form.
Annual REGISTRATION FEES remain unpaid. Please submit a check for $405.00. This would
cover the fiscal years 1997.
Annual Fees for the PETROLEUM STORAGE TANK FTIND remain unpaid. Please submit a
check for $750.00. This would cover the fiscal years 1997.
t8l Please return a copy of this speed memo with the above items to speed processing.
Please note that you will not be covered under the PETROLELIM STORAGE TANK FUND, or
allowed to receive product, until the above-mentioned items are completed. If you are currently a
LUST site, and your Fund application has been approyed, any further releases will be covered by
the Fund. If you have any questions concerning this, please call the Division of Environmental
Response and Remediation at [phone].
r,...n :i '11i ri., ,li:
.'"",,, r ,i;li ,i-,';,,., ,, i ii' .. i f- r tii']l
DEPARTMENT OF ENVIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
Michael O. kavitt
Govcmor
Dianne R. Nielson, Ph.D.
Executive Dirfftor
Kent P. Grav
Dirmttir
168 North 1950 West
P.O. Box 144840
salt Irke ciry, utah 841144840
[phone] Voice
[phone] Fax
(801) 5364414 T.D.D.
ERRU-33-97
January 17,1997
Mr. Dan Murray
Maverik Country Stores, Incorporated
880 West Center
North Salt L,ake, Utah 84054
RE: Underground Storage Tanks (USTs) located at Maverik#266
l.ocated at 14175 S. Redwood Rd., Bluffdale, Ut.FacilitytofF
Dear Mr. Murray:
According to the provisions of the Utah Underground Storage Tank Act (Act), Utah Code
Unannotated (UCA). Section 19-6-412, all owners and operators of petroleum underground storage
tanks must have a Certificate of Compliance by July l, 1991 . Any petroleum distributor who delivers
to a tank that does not have a Certificate of Compliance will be subject to a civil penalty of up to $500
per occurrence (19-6-416, UCA).
The Division of Environmental Response and Remediation (DERR) has received your request
to receive one delivery of fuel to test your tanks at the above reference facility. This letter is NOT a
Certificate of Compliance but allows you to obtain petroleum products for testing your tanks.
This letter applies to fuel being delivered from Maverik on or about February 9, 1997, through
February 15,1997. A Certificate of Compliance cannot be issued for the non-complying tanks. If after
our review, your tanks are found not to be in substantial compliance with federal and state rules and
regulations, a certificate cannot be issued.
If you require further assistance, please contact William Moore at [phone].
Sincerely,
Kent P. Gray, Executive Secretary (UST)
Utah Solid and Hazardous Waste Control Board
KPG/TVETU/jd
+ .v
gF-::/
,,'/
T'NDERGROI,'ND STORAGETAAIK PROGRAT{
Forzr
,
DaE: I 7=nil<
(drdco:caur)
Reason for : ADFTSIMENT REFIJND DELETE CHARGES
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Fac(lity Number:Toozt 3a
INSTALII\TION INSPECTION
s
Movudlc 6u^{r, S{rvas Sr."
Agency, or
Street Address
County
Zip Code
Area Code Phone Number
Contact Person At UST l.ocation
City Stete
Phone#
VNa
Strcet
at
re
Slte ldentifier, as appllcableFacllity Name or
(If same as
'* VJqllac,'tnolu,,^ Gsl. r Ser,;.Cert #: 4i rLooorTANK INSTALLER:Company:
D o 3 3Previous Tanks - Removed Tanks + New Tanks
TankNo. I TankNo. A-- TankNo. 3 TankNo. TankNo.TANK INORMATION
1. Estimated Total Capacity (galtons)ood o
2. Type: FRP, Steel, Composite
3. Substance Stored c
4. New or Used (must be recertified)
5. Type of leak detection
PIPING INFORMATION Nd( r,t^
1. Type: FRP, Coated Steel,
2. Type: Suction, Pressurg Gravity
3. Type nf leak detection
GENET{AL INFORMATION
1. Spill device installed
2. Overfill device installed
Distance from tank(s) to nearest property line
Distance from tank to nearest structure (5' plus 45 from surface to tank)
Estimated depth to groundwater
Do tanks have at least 18" spacing between tanks (stable conditions)?
If unstable walls, are tanks spaced at least l/2 times the diameter of the tanks from each other?
Does depth of installation conform to planned Anchoring, Surface and Traflic conditions,
groundwater conditions and piping run slope requirements?
Has Tank and Piping Cathodic Protection systems been checked to verify they are working
properly?
Does the amount of Tank Deflection meet specifications?
ft.
ft.
fr.
YES
SPECTFICATIONS
I
3o
79'r
?
certlfy that I have inspected the above named facility on
lnspector's Signature: 6".19
(Fior@)
T
ootb. d.y, yca. tir
Date:
I
Et
^FACILITY SITE PLAT Faclllty lD No.
NORTH
I't4oct 5"4'^
J-toc
'5|*^*'
{w*s RJ*,$2l
'Qtfl,',,s
U\J t !'
rm
\rrf \
Potential Receptors- lndicato distance (in teet) to the nearest:
Underground utilities Active water well
-
Residences
Surlace water _
Commercial buildings
Other
S{
&ULudYT
tu
.l
bisi
fi4ats )
fsrus\ b - [
rcla \
cerlily that I inspecled the above.named facility on
Cert#
( ffirh. d!y, )0r, !m)(Dfitlm)
lnspector's l'lala.
)
I
the location o, any r€poned PID or FID roadirEs.
I Ft-)i
US'fnst.allation/Upgrade Pe- it
4 N.r P.mlt
Iastallatloa
C
t I Pcral.t uodlfl.catloa
eu
Ccrtifl6d IDatallcr.! on proiect:,
Name U\la*nt- LDULLbC<-.
t No:463-/?
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u
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Ta,lk {r
Addres
Cont.act.
Eacillty
Cont.act pers
Ulurual or cxtcDuatLag cLrcuaetaDccr c:qrectcd !
+
*
* TL Exp
Exp
dat
daE.
dat.TL
t I upsrade
DLd
Phone
SIaE
Phone # (-)
Total Installation Tank Fee/Permit 6oo.oO
,ry' ,.,,trurl/Replace
t3o7 t
zci
ci.U)O d
TankE lDvolvcd :ln In3t'e].lat:lon / IrDcrrade
Tank *I L 3
Install /Upgrade T^tll -
CapaciEy (gallons)l0K loK l0 K
TlDe ( FRP, St.eel , et.c . )€R?trR- ?trk?
Subst.ance to be Stored Cftsoc LxtL-
-
Piping I'ype (Press
SucEion, Gravity)pfes s.ll tl
fnst.aLl/upgrade what?
(Tank, Lines, C.P.,... )ffiwt l(lt
fyDc of lastallatioE/UDqrado
Deecrr,DEioa Dlrrrbor
{ut*a-r!- ^9, s wqLg LDo-!-l*3
€.8 , ? , *a-tJcs A^-il- |t/d l*te!.
(v*l.-eS I
lfar,I c@Dlct.d for.a to!Ut.ah Department. of Environmental QualiEy
Di.vision of Environmental Response and RemediaEion
ll-
168 Nort.h 1950 west, lsts Floor
Salt Lake CiEy. U-tsah 84116
state Use only: Date Approved & ,6 glU(lC App
cK#t1Yb
By
a
Date Permit, Mailed (luloe
Dat.e work will commen"" * ';)C'? A
"
' ,, .. "l .
,,
DEPARTMENT OF ENVIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
Michael O. lravitt
Govemor
Dianne R. Nielson, Ph.D.
Exeutivc Dirctor
Kent P. Cray
Diretor
168 North 1950 West
P.O. Box 1214840
Sdt Lake Ciry, Utah 841 14-4840
[phone] Voice
[phone] Fax
(801) 536-44t4 T.D.D.
Dear Underground Storage Tank Owner/Operator:
The Division of Environmental Response and Remediation received notification that one or more
underground tanks (USTs) (tanks / associated
Before regulated USTs can receive deliveries of and be put into operation, they must qualify for the
Petroleum Storage Tank (PST) Fund and receive a Certificate of Compliance. To qualify the tanks for the
Fund and receive a Certificate of Compliance or maintain your current Certificate of Compliance, you must
do the following:
Register the changes in the tanks using EPA form 7530-1, Notification for Underground Storage Tanks
(Enclosed). Tanks installed after December 1988 must have the following in place when installed: leak
detection on tanks and piping (including automatic line leak detectors on all pressurized piping), spill and
overfill devices, and corrosion protection. The Utah Certified Tank Installer must sign page 5 of the form
to certify a proper installation.
2. New Tanks or Systems Only: Complete the PST Application (yellow) and Previous Pollution Incidents
(green) forms from the enclosed PST Fund application packet. You must indicate on the PST Application
form the type of financial assurance you will use for your share of eligible cleanup costs for each release
covered by the Fund.
3. Conduct a tank and line tightness test and send a complete copy of the results to the DERR. The tightness
test must be conducted by a Utah certified UST Tester for any new tank, line or system installed.. A list of
certified UST Testers is included in the PST Fund application packet. All portions of the tank and piping
system which could contain product must be tested. To receive a delivery of fuel for testing, you must
contact DERR for authorization of a one-time delivery for testing purposes for new USTs. Contact the
DERR office at [phone],24 hours in advance, to ,urange for this authorization.
4. New Tanks or Systems Only: Pay UST registration fees and PST Fund fees for all new tanks installed. These
are: registration fee- $135 per tank; PST Fund fee- $250 per tank. These fees must be paid before a
Certificate of Compliance can be issued.
Dare , O-Zt*?C
From , U' l/t/a*+-
ID#
When the above items are completed, send the forms, test results, and any fee payments to the DERR at the
above address. When the necessry information is received, the DERR will issue a Certificate of Compliance
when applicable. Timely completion of the needed forms and other requirements will facilitate the process
and help you avoid loss of the use of your tanks. The Utah Underground Storage Tank Act (Utah Code Ann.
tg-64o1 etseq.) requires that a certificate of compliance be issued for new tanks before they are put into use.
Please call the DERR UST office at [phone] if you have any questions.
Undergiound Storage Tank Section mwinsd.ltr 07O2196