DERR-2024-006396

DERR Facility lD:
rzooilo<L_
WEBER.MORGAI{ HEALI}I OEPARNNENT
477 23tt' SInEEr, OGDET{ UT 84401
OrFlcE: (8011 39+7160 FAX: [801) 39]7163
APPLICATION FOR UNDERGROUND STORAGE TANK
tNsTAuATtON, CLOSURE, UPGRADE OR REpAtR
Contact:
Malllnt Address:
)
(,
Faclllty Name:tt verJ z le eJ tort
Mailint Address:Llt Ri"".r\,o lp OA
qtv:Oivu.o\p State: UT zip:
Contractor:t Ow1
Contact:
9tltl o E Phone:9ot -A?q -
?l\aNo.
oo8
Meiling Addre3s:3e.7 dt
Clty:k/e<{0Aat sr:rlcl AT zigl 8,to 8C Phonet er)/ 17 T
eo t- a3) aa66-0
s-3Y7{-
Approxlmate date work ls schedul€d to betlns /b -rC- t
"1
I tnstall, fl of tanks: _ &/Gosure, fl of tanks: _
SGnature:7-Date: /A'//-/q
OTFrcE UsE ONIY
lnstafl (S250/tiot, includes piping inspectionl: f tank _ r S2so =
Oo5lrc (5350 to. 1{ rank + slq, each addttlonal tanl):
S3g) r (fl addtttonat tanks _ r S10o) . g_
Up86de/rcpal. (3t (, per lispectbnlr 9140 x , inspecttons _ o 3
Amount Owed: S_
Amount Pald: S
Date Paid:
UST Owner:
otv' (zl* Lakc state: Af AgtS'//tl vnone: ful '?.,7-2@A
E Upgrade or repair, brlefly descrlbe the work to be done:
UNDERGROUND STORAGE TANK CLOSUR-E Pl-llN (rov- ?/13)
LHD USE ONLY
Rcvicwcr
Datc LHD Approved
Datc mailcd to SEte
FACILITY ID#
STATE USE ONLY
Dstc Mriled to LHD
D8te Rcccivcd From LHD
Revicwcr/Datc Approved
Mgr. Revicw/Date
loaoogfrq
Closurc Plan at thc uest ofthe
Phonc f 801-78247a8
H v e ltir EEf,
A Coatnclor ot8y prlP8re this cloBurc Plstr as thc owner/opcrsto/s sgcnt, ln pepsfing thc closurc Phn, thc conl'acior musl8ct wilh
the ocm€r/oDcratot's Inowledge and approval. Thc owner/opentor mr3t sign tbe Closurc Pla!. Submlt clorur! pl to: DERMTSTT
P.O. Eor l/f8t0, Sdr Lrk€ Ctry, Utob 84t t{-{t40
Thls Closure Plaa is submincd in conplillcc rrith the tEquireoElts contiined in 40 CFR 2EO Subpod G and R3l l-204 (U.A.C.)
FACILITY INFOR]UATION
f3al1 @yasl DRH Co.Phone # [phone]m
5445 S.Dr.Salt Lako C Ststc ur
NtEe Rlwd6l6 chovron
4 Rivo.dalo Statc
Spsncer ConneuyCoolrct Phonc # 00't-274-2008
t8[k3 arToolof ite 4 12 wo.s rsrnovod i,l 2005)
Totsl numbcr of closd 4 (2 rc.E r€mov€d in Z!05)tants a Ois site
Pipiry clocurc only I rai?trl 1 2 3 4 5
Tsok Typ! (SEcl,FRP,clc.)Sl!€l (CCPI Sloel(ICCP)R6l'lovsd Rernovod
Pipi!8 TyDe (Sncl.FnPrE.)Fb ble Plas[c Florhle Phetb FRP Floxibb Prastic Fhribb Plostrc
DrlG llsLll.d 1n4n973 1124t19t3 'tr25r1983 1D4t1914 1t25t19A7 11r28n005
Crpacity 10000 6000 Removod 5000 r2000
Suboancc rtortd'GarDllno Gsso0no Gssolino Oiosol Ga3olirE
Dglc la$ opc,rlcd Unhnown unknosrn 823/2005 Unknowi dnStmos Unklown
Scrvicc (crs)?
Rcmovauh PlacctCt gc io Removal R€nroyal Cbsod elBl/o5 R6nroval Closed 8/31/(}s Reanot/al
@t
'bdic.tc sutlEG dorEd aacb Eal ro bc cloacd G86lin.,lrs oil. ell! oil aa.l
For rvaste oll asnks: Have degtasing or o6cr t)?es ofsolveau bcco $orcd or mixcd wirh thc wasre oil?
Yes (idediry if howr) No E
Amlysis for lcad or other conramiraDts may be requircd prior !o dbpossl ofconraminatcd soil or othcr marcriat. (Check with yourdispossl facility.)
Not Known fl
I
Dslc Rcccivcd Dste Reccivcd
of(company namc) E'K Bailoy consln,ction.
Addrcas 1243 N. w8shington gtvd.
I;i"-*
uutes!
D!fsot
6
Sle€l (ICCP)FRP
Flexlbb Ph.ri.
4000
G€solino
TANK REMOVER cc**rs.379 Exp. Dgtc <- Zo
CoDlpalv Polrgloum lnslsusllorlspoci8li6lg I Phorc# 8o( 67r-3"rt
Addr6s 3075 ttsun Dr City wesr Jodsn zip 84408s
I
(
Date -tatSOI UGROUNDWATE& SAMPLER Namc
Itb' wt
caa E}r?f,rcS
Phonc r Eol g7l-67 bb
^ddr6
qy7 E Silur. Cre.k T c;sanc t4T zie g?d?{
lil|rr{',till
CONTACT LOCAL IIEALTH DISTRICT; Namc of DisL Hoal[r Date 0g/3ot2ot9
Phqrcfl E01€04.0003
CONTACT LOCAL FIRE DEPT.Name of
o r l(at3Titlef I
DISPOSAL TNFORMATION
looa. ft clcrgwill be 8t:
RJ69". E c Jen
Sc.lc hooreContact Phorc#
Product llnes will either bc:rcmoved or sccutd i[snd
Ve[t lines will eithcr rcmoved or clcaned rnd secured
FP-D.r^{,ill bc at: Facil
Ad&€ss State
Contsct
Iwill bc g-Phone#I
awill bc dcsrcd
Conturinrrcd waacr il| thc unk/rinsate will bc al:T{2*
Conlact e Phonef 8o/€a{-8t{t
D !will be:meftod:or lhcinen
will bc ar the +
a64rgss 6rt s. +o'ow.e Surc Q E+to,f
9AConlact _E?t- 67f(Phonc#
lttE:I
FOR CLOSUNE IN PLACE ONLY
lhis subjcct which5-302-2(6),
documcDtrtionsubmitting information
For closrrc aremc&o4 to theyou UACof IR3requiremcnr the ritlercquirxrnnou ing andPropertythelovtsioDDiofSolidandHaz:rdous Wsste For howoll(DSHW).to thesewithcomply
contact the SolidDSHW L8ndfilWasle ls Section at I 536{200.
has b€cn thc Local Fircfor m
Ftur Phonc#Contact Date
closure has bcco tbc Local Hcalthfor
Hedth Phonc#Coooct DslcSubstsrcetanks:lo be used fito II
2
G-
Bcfore the clocrre plan is subui8ed for approval the locat hcstah and fire d.partmr 3 wherre the ficl[ty b locatcd
DuJt be conaocaed.
CoaraO Stery Wateri Title
Date^ oqr::o,aorq
Citv ziq
I
Citv Zis
Pbonc#
Phone#
E
DCfs]Ot
et
rYl
>3q
tt
SITE ASSESSMNNT
A site assessnrent must b€ perfomed for rll UST closutts aIld change-in-service. Site asscssmcnts musr be pcrformcd as outlioed itl 40 CFR
2E0.72 atd R3l l-205 (U.A.C.). lf cortsmination is suspcc-ted, addirional samplcs must bc colletcd r: rhc locarion whcrg contasioatiotr is
Eosr litely to bc prcscnt. lf grourdwaEr is ocouotere4 s soil srmplc must be collccrc4 in lhe unssnrrarcd zonq in addition to esch
grouldwater s.tDplc. Soil 8rd goundwste, srmplcs stust be analyzcd for thc coopounds shox,D ir thc foflowist rablc, usi[g spproprisE lab
mclhods.
SBbstlrcc or
Product Type
Gasoline
CortrEbara ColIpouD& to bc Ardlzed for Erci
Sobstalcc or Pmduca TyDe
ANAIYTICAL METHOITSI
SolL Grolldrlal€r
or Surfscc Wlter
Totrl Perolcum Hydrocarbons (puneablc TPH as grsolitlr
ra[8c orgrdca C6 - Cro)
Baucne. Tohcsg Etiyl bcnzcru, Xylcncq Naptrthrkne,
(BTEXN) snd MTBE
EPA 8015 qr EPA 8260
EPA 8021 or EPA 8260
Diesel
Totol Peoolcur Hydmcartoos (cxrsctablc TPH 13 diGscl
rangc orgorics C16 - C1)
B.nzcoc, Tolua|c, Ethyl bcnzcnc, Xylenes, and Naphthalcnc
(BTEXN)
EPA tOI5
EPA 8021 9s EPA 8250
Used Oil
Oil and Grcasc (O&G) or
Toul Rcmvcnblc PcEolcum HydmceftoDs (TX,PH)
Bcozcnc, Tolucne, Ethyl
(BTE O{) & MTBE; sld
Conpoud! (VOX)
benzcnc, Xylcrcs, Naphthalcoc
HaloBcrsacd Volatile Org|nic
EPA 1654 gr
EPA t664 (SGT.)
EPA 802 I a! EPA E260
New Oil Oil nd GGas€ (O&G) or
Totol Rccovorrble Pctrolcum Hydrocartoos gRlH)EPA 1664 a!
EPA 1664 (SGT.)
Other Tpo ofanalyscs will bc based upon the subuancc or product
3tore4 snd &e approvcd by the DERR Divisin Director
Mc0od will bc besed upon rhc
substamc or product ry?c
Unknown
ToEl Pciolcun Hy&ocsrtorB (ourlcablc TpH c gssolioc
nngc ogrnica C{ - Co)
rout Pctrotcum ttfii.ii:ard6irs Gdiiii[[-riii;'dffi i " " "
nagc organics C;6 - C21)
' irii ;'iii'c;;'ao}iii; " " " " " " " " " " " " " " - " " " " "
1
Tolal Rccoveoblc Pcrrolcum Hy&ocatoDs (TRPH)
Bcue_*, rotircac, E iri-il,,e_;, iy6A;i n.iiiirilfi;"'
(BTE)(N) sd MIBE; ggg! HatogEosrcd Volaritc Oryanic
Conpoudr (VOX)
EPA &l I 5 9r EPA E260
EPA 8OI5
EPA l66d qr
EPA 1664 (SCT.)
EPA t02l or EPA 8260
! Thc following &odifcsriorB to thct ccnificd sEuo& r,. coflri&tld lccrDrsbrc by D€ DERR Divilio! Dirlctor:r Dual coluoo conlilDltion BEy not bc rcquiroa for tpH aaa BmiNnfniS aratyds.
' A Eicto''rE.lioo orscslcdou lcchaiquc msy bc uscd for squcorB s&plar, bui s,U for !c dcrciDirEdo! ofcxElabbtc TpH ss diascl r!!gcor8aricr (Cro - C!).. Hcr8n. Ey bc la.d s! 8n cxtr.ctio! Eolvclt.. .Silica GGlTrcaiinnr (SGT) mly bc us.d in $! dacmi*tion ofToblR*ovcrable pct olcum Hydroclrbori.
NoTE: Thc sa,nplc P.plr.tio! Ectbod ntd lrry modilicado*) !o ! ccrtilied trctiod o,usr bc Gponcd by thc hborrtory.
3
CONTAMINATED MATSRIALS MUST BE DTSPOSED AT AN ACCEPTABLE FACILTTY:
All tlatcrisls tcocrarcd frotn UST closr.s musa be m8lagcd a8d dbposed i[ a mstlncr thlr docs not placc thosc rratcrists i! diEc] contacr
wirh the cnviionncot. Oo.sirc $ockpiling of contaminotcd soils may be GquL€d prior to 8ny soil a(iiitia- lny person
remedial a&rislance o o em I i o n o nd otrer- ercatv t lon than 50 must bc a UST Coasultanl
Conplcte lhe Faclllty Sile Pltt.rd SaEpb Ioformetion Tlble or prges 4 rDd 5 to provlde slte assdstreDr ltforrtatioD.
CONTAMINATION INTORMATTON
lf G![lrniDstion st thc fuility is susoected or confirmcd rhc information musr be tlported to thc DERR Division DiEctor 8t (801) 536-
4100 within 24 hours. Thc Divisiou ofWgtcr Quality nust be norificd at (t0t) 5364300 if Frcc Product is €ncountercd or ifsurtlcc warq
has bcco impacted lf conamination is confirmcd, any pcnor assisdB in lhc rcmcdistion proccss for e fee must bc a Ccaificd UST
Consulnnt.
SAMPLE INFORMATION TABLE
Complete lable for all samples to be tsken for closure,
I Soil (SSI Grorylqlatet (GWL or Unified Sdl ClrssificrrioD ruSct-
3 *f,hffifg$*iffig#tm*,mm*s.Dplcsml3tbctltcosr0-2fcclbctowtcbqckuy!$iwroilhrcrtiE!.
4 ADFopriaG rorbab nslf,o& for conblttillrr coopriud(r) in cach suiplilioo oble oa p. 3).
of trmk t€moval Irc lo bc E.'ti Tcc\ucConbminated soils at thcas facil ,83 ( rrc
A"teAddrcsstoal.'Are lot
rmac 0al 97 - 2o6
Sample
*
Substanco
stond ln
tank
Sample
rypor Deptha Gompoundss Analysls mothod(s)'
55-|gtt/di..rl 5c il ,uB7E,6r-qao-DQo Sors 7925,
9S-L I t,,o f+
U3,L.I UTC to +t UTC U3L
5r-3 3ol I ,z ++lu B7&Y.' -6Pb'o-eo Eotg / 8260
93-.1 a,t?-0t
t9-5 u 1€t
33-b lr 4*,t lt
1<-7 ll tl l+&
9S-g t,48r ,t _ tt-
e.- q {f}tl -uTt-,o 1l '+8r t, -o*-2 +u9a q++ulc usc
rIIIrIIIrIrIrIIIII
rlrr
IIIIITIIIIIIIIII
I ITII
II IIrI
4
CirY < r-2.sate ufl
Contact pcrson farl (-*..-..L.,-o
tz *+
lt
Frdllly Slae Plar (Closurc Phtr)
The sirc Plar must bc draern to sn aprrcpriste idcntificd scslc. It must shou, planncd sampliog locarions, substancrs storcd in 133*s, and
other rclevant information. Tank and samplc idcltificltion numbcrs EUst bG consislctrt wifi tlrc informatioo BivcD on psgcs I atd 4 of6c
CloBuE Plrn.
95 I
Nonh
fisss/os,z E[rf"-
['ro [ ".
Sclle. 1,,= _ Fcct
t s3+x s5?
(,
A
5 E s9 to
Aas
s53
*rsz/usc I
C4
P
\^,
A(
H
OLDf heuaol
B(&
G
A
5
DTt
2
L
ID:o Datc:I
X = Slnplc loc.tio8 (SS4, WS-i. USC*). = Ilrodlorhg Wclls (MlY{)
O- Soil boring (S&#). or Geoprobc Boriog (cP*)
E - W.tn wclls (doDcsric, livqrocta, clc.)
Slo0e of Surfacc TAoSnDtf N,Ny,VSWS.SEgNE)
Irod Ulc Ar Sic: _Rr*to:irl _ConDacirl _h&rsritlSurtlllldttg lrod; -Rlridlrlid _CorllDcrcis! _IdurEbl
SItc Pbr M8t tldIc.orc ApprodErtc Lo.adonr of:
{)lrEnt & fomcr llnts, piping & dispcnscts
-Lqtioo of sll tlmDlcs lo b. ral(cd
-Buildi!8s, fcac6, & pro!.Or bouldrd.s
-Uiility conduiB (scr{crs, gr!, waIer, sto,m dr.in!, clcctdq.l, ctc,}
5
I c.tdry u8d€r peErlty of hw thlt I .p the o$lerloperstor of the tuk(s) referenced .bove &d that I au foullhr wilhtte informadoa oo thls forn rnd thst lt ls true, rccurrte aad complele, tnd furth€r, thrt t[e procedures dcrcrlbed herelnwlll be followcd duriDg trnk cl6ure.
Approirnarc dcp6 to groundwdcr in the vicinity of tbc tar*s:&d. ea
Addrcsr tZO 65 ON, RA cityifl Iolrcf srar7a/zjpTltZZ
?honc6l','la?- a'rtz
uauqral or lhs sile ssscasmcnt or clo6urc:Please crrEu[ttt8[oes
Signatue oftaok owaer
Full Name ofaok owner Datc
6
Regionat groundwatcr flow direcrion: tfled
St8t. Ccfii6rd Lsbtr low ro bc ur.d, f?Ce Analgrl&al
Co act Pcrsoo Clrr la W?iA
A Utility Testing Laboratory
1615 W. 2200 S. Suite A
Salt Lake City, Utah 84119
Toll Free: [phone]
Phone [phone]
Fax (801 ) 467-0065
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Client Field lD: SS #1
Laboratory lD: 080509-01
Attn:Dave Hansen
Analysis: TPH DRO/GRO
MBTEXNMatrix: Soil- Dry % Moisture = 19
Sample Received By: Becky Holubek
Date Received:
Date Collected:
Collection Time
08/05/2009
08i05/2009
12:55
Date Method Reporting Test Results
TPH DRO (C10 to c28)
TPH GRO (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
Dilution Factor Used:
08/07/2009
08t07t2009
08t07t2009
o81o712009
08t07t2009
08t0712009
08t07t2009
08t07t2009
SW-846 80158 Modified
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/5030A
10.00
10.00
0.170
0.170
0.170
0.170
0.510
0.1 70
< 10.00
10.40
< 0.170
< 0.170
< 0.170
< 0.170
< 0.510
< 0.170
GRO
DRO
MBTEXN
,|
1
't70
1rr'- -*,,.L-
Digitally signed by Eecky
Holubek
DN: cn=Becky Holubek, o=UtiliU
Testing Lab, ou,
email=[e-mail], c=US
oate: 2009.08.1 1 'l 7:40;30 -06'00'Approved by:Date of lssue: 11-Aug-09
Becky Holubek, Laboratory Director
All analyses perfomed in compliance with National Environmental Laboratory Accreditation Conference (NELAC) standards Page 1 of 1
\-
A tjtility Testing Laboratory
1 615 W. 2200 S. Suite A
Salt Lake City, Utah 84119
Toll Free: [phone]
Phone (80'l) 485-8941
Fax [phone]
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Glient Field lD: SS #2
Laboratory lD: 080509-02
Attn Dave Hansen
Analysis: fPH DRO/GRO
MBTEXN
Matrix: Soil- Dry % Moisture = 10
Sample Received By: Becky Holubek
Date Received:
Date Collected:
Collection Time:
08/05/2009
08/05/2009
13:10
Date Method Reporting Test Results
Limit Limit
TPH DRO (C10 to C28)
TPH GRo (G6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
Dilution Factor Used:
08t07t2009
08t07t2009
08t07t2009
0810712009
08t07t2009
08t07t2009
08t07t2009
08t0712009
SW-846 80158 Modified
sw-846 82608/50304
sw-846 82608/50304
sw-846 8260B/5030A
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/50304
10.00
10.00
0.'160
0.160
0.160
0.1 60
0.480
0.160
< 10.00
< 10.00
< 0.'t60
< 0.160
< 0.160
< 0.160
< 0.480
< 0.160
GRO
DRO
MBTEXN
1
1
160
Digitally signed by Becky Holubek
DN: cn=Becky Holubek o=Utility
Testing Lab, ou, email=becky@ut-
labs.com, c=US
Date: 2009.08.1 'l 'l7:40:46 -06'00'
Approved by:
Becky Holubek, Laboratory Director
1rr*ra=+;*'t*L-
Date of lssue: '11-Aug-09
All analyses performed in compliance with National Environmental Laboratory Acdeditation Conference (NELAC) standards Page 1 of 1
A Utility Testing Laboratory
Date Received:
Date Gollected:
Gollection Time
08/05/2009
08/05/2009
13:25
16't5 W. 2200 S. Suite A
Salt Lake City, Utah 841 19
Toll Free: [phone]
Phone (801 ) 485-8941
Fax (801 ) 467-0065
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Client Field lD: SS #3
Laboratory lD: 080509-03
Attn:Dave Hansen
Analysis: TPH DRO/GRO
MBTEXNMatrix: Soil- Dry % Moisture = 2
Sample Received By: Becky Holubek
Parameter Date
Analyzed
Method Reporting
Limit (mq/Kq)
Test Results
Limit (mq/Kq)
TPH DRo (Cl0 to G28)
TPH GRO (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
Dilution Factor Used
08t07t2009
08107t2009
08t0712009
0810712009
08/07/2009
08/07/2009
08t07t2009
0810712009
SW-846 80158 Modified
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 8260B/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/5030A
10.00
10.00
0.140
0.140
0.140
0.140
0.420
0.140
< 10.00
< 10.00
< 0.140
< 0.140
< 0.140
< 0.140
< 0.420
< 0.140
GRO
DRO
MBTEXN
1
,|
140
3r*.-t-l,"..'u'-
Digitally signed by Becky
Holubek
DN: cn=Becky Holubek, o=Utility
Testing Lab, ou,
email=[e-mail], c=Us
Date: 2009.08.1 I 17:40:58 -06'00'Approved by:Date of lssue: 11-Aug-09
Becky Holubek, Laboratory Director
All analyses performed in compliance with National Environmental Laboratory Actreditation Conference (NELAC) standards Page 1 of 1
v
A Utility Testing Laboratory
1615 W. 2200 S. Suite A
Salt Lake City, Utah 841 19
Toll Free: (BBB)485-8941
Phone (801 ) 485-8941
Fax {801 ) 467-0065
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Glient Field lD: SS #4
Laboratory lD: 080509-04
Attn:Dave Hansen Analysis: TPH DRO/GRO
MBTEXN
Matrix: Soil- Dry 7o Moisture = 14
Sample Received By: Becky Holubek
Date Received:
Date Collected:
Collection Time:
08/05/2009
08/05/2009
14:15
Date Method Reporting Test Results
Limit
TPH DRO (C10 to C28)
TPH GRO (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
Dilution Factor Used
08t07t2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
10.00
10.00
0.170
0.170
0.170
0.170
0.510
0.1 70
< 10.00
10.72
< 0.170
0.225
0.673
< 0.170
< 0.510
< 0.'170
SW-846 80158 Modified
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/5030A
GRO
DRO
MBTEXN
1
1
170
Approved by:
Digitally signed by Btrky
Holubek
DN: cn=Becky Holube( o=Utility
Testing Lab, ou,
email=[e-mail], c=US
Date: 2009.08.1 1 17.41 :14 -06'00'
Becky Holubek, Laboratory Director
1rr""'w^*-
Date of lssue:'11-Aug-09
All analyses performed in compliance with National Environmental Laboratory Accreditation Conference (NELAC) standards Page 1 of 1
A Utility Testing Laboratory
Date Received:
Date Collected:
Collection Time:
08/05/2009
08/05/2009
'14:30
1615 W.2200 S. Suite A
Salt Lake City, Utah 84119
Toll Free: [phone]
Phone (80'l) 485-8941
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Client Field lD: SS #5
Laboratory lD: 080509-05
Attn: Dave Hansen
Analysis: TPH DRO/GRO
MBTEXN
Matrix: Soil- Dry % Moisture = 8
Sample Received By: Becky Holubek
Parameter Date Method Reporting Test Results
TPH DRO (C10 to C28)
TPH GRo (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
Dilution Factor Used:
08t0712009
08/08/2009
08/08/2009
08/08/200s
08/08/200s
08/08/2009
08/08/2009
08/08/2009
SW-846 80158 Modified
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
10.00
10.00
0.1 50
0.1 50
0.1 50
0.150
0.450
0.150
Date of lssue:
< 10.00
<'10.00
< 0.150
< 0.150
0.212
< 0.150
< 0.450
< 0.150
11-Aug-09
GRO
DRO
MBTEXN
1
I
150
Digitally signed by Becky Holubek
DN: cn=Becky Holubek, o=Utility
Testing Lab, ou, email=becky@ut-
labs.com, c=US
Dater 2009.08.1 1 1 7:41:28 -06'00',
Approved by: _eeckyHotuoe@
3r-rN,^L-
All analyses perFomed in compliance with National Environmenlal Laboratory Accreditalion Conference (NELAC) standards Page 1 of 1
A Utility Testing Laboratory
1615 W. 2200 S. Suite A
Salt Lake City, Utah 84119
Toll Free: [phone]
Phone (801 ) 485-8941
Fax (801 ) 467-0065
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Client Field lD: SS #6
Laboratory lD: 080509-06
Attn: Dave Hansen
Analysis: TPH GRO
MBTEXN
Matrix: Soil- Dry 7o Moisture = 12
Sample Received By: Becky Holubek
Date Received:
Date Collected:
Collection Time
08/05/2009
08/05/2009
14:40
Parameter Date
Analvzed
Method Reporting
Limit (mo/Kq)
Test Results
Limit (mo/Kq)
TPH GRO (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
08/07/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 8260B/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
10.00
0.160
0.160
0.160
0.160
0.480
0.160
Date of lssue
< 10.00
< 0.'160
0.282
1.',t'l
< 0.160
0.743
< 0.160
11-Aug-09
Dilution Factor Used GRO
MBTEXN 160
Digitally signed by Becky Holubek
DN: cn=Becky Holube( o=Utility
Testing Lab, ou. email=becky@ut-
labs.com, c=U5
Date: 2009.08.1 'l
1 7:41:45 -06'00'
Approved by:
Becky Holubek, Laboratory Director
lrr*" d.t-i^*L'k-
All analyses performed in compliance with National Environmental Laboratory Accreditation Conference (NEIAC) standards Page 1 of 1
A Utility Testing Laboratory
1615 W.2200 S. Suite A
Salt Lake City, Utah 841 19
Toll Free: (B8B)485-8941
Phone [phone]
Fax (801 ) 467-0065
Client:
Date Received:
Date Collected:
Gollection Time:
Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Attn:Dave Hansen
0B/05/2009
08i05/2009
'14:50
Analytical Report
Project:Lighthouse
Glient Field lD: SS #7
Laboratory lD: 080509-07
Analysis: TPH GRO
MBTEXN
Matrix: Soil- Dry 7o Moisture = 12
Sample Received By: Becky Holubek
Parameter Date
Analvzed
Method Reporting
Limit (mq/Kq)
Test Results
Limit (mq/Ko)
TPH GRo (c6 to c10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
08t07t2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/50304
10.00
0.1 60
0.1 60
0.'160
0.1 60
0.480
0.160
< 10.00
< 0.160
< 0.160
< 0.160
< 0.160
< 0.480
< 0.160
{Matrix Spike RPD outside acceptance limits- biased low
Dilution Factor Used:GRO
MBTEXN 160
Digitally signed by Becky
Holubek
DN: cn=Bsky Holubek, o=Utility
Testing Lab, ou,
email=[e-mail], c=US
Date: 2009.08.1 I 17:42:01 46'0O'
Approved by:
Becky Holubek, Laboratory Director
Date of lssue:11-Aug-09
AII analyses performed in compliance with National Environmental Laboratory Accreditation Conference (NELAC) standards Page 1 of 1
A Utility Testing Laboratory
'1615 W. 2200 S. Suite A
Salt Lake City, Utah 841 19
Toll Free: [phone]
Phone (801 ) 485-8941
Fax (801 ) 467-0065
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Glient Field lD: SS #8
Laboratory lD: 080509-08
Attn Dave Hansen
Analysis: TPH DROiGRO
MBTEXN
Matrix: Soil- Dry % Moisture = 10
Sample Received By: Becky Holubek
Date Received:
Date Collected:
Collection Time:
08/05/2009
08/05/2009
14:55
Parameter Date
Analyzed
Method Reporting
Limit (mq/Kq)
Test Results
Limit (mq/Kq)
TPH DRO (C10 to C28)
TPH GRO (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
08/07/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
SW-846 80158 Modified
sw-846 8260B/5030A
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/5030A
10.00
10.00
0.1 50
0.1 50
0.150
0.150
0.450
0.1 50
Date of lssue
< 10.00
< 10.00
< 0.150
< 0.150
< 0.150
< 0.150
< 0.450
< 0.150
11-Aug-09
Dilution Factor Used:GRO
DRO
MBTEXN
Digitally signed by Becky Holubek
DN: cn=Becky Holubek, o=Utility
Testing Lab, ou, email=becky@ut-
labs.com, c=U5
Date: 2009.08.1 'l 17142:16 -06'00'
Approved by:
Becky Holubek, Laboratory Director
1
I
150
3.r.'.-{-u.*'t^l'-
All analyses performed in compliance with National Environmental Laboratory Acsedilation Conference (NELAC) standards Page 1 of 1
A Utility Testing Laboratory
',l615 W. 2200 S. Suite A
Salt Lake City, Utah 84119
Toll Free: [phone]
Phone (801 ) 485-8941
Fax (801 ) 467-0065
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Client Field lD: SS #9
Laboratory lD: 080509-09
Attn:Dave Hansen
Analysis: TPH GRO
MBTEXN
Matrix: Soil- Dry % Moisture = 14
Sample Received By: Becky Holubek
Date Received:
Date Collected:
Collection Time
08/05/2009
08/05/2009
15:00
Parameter Date
Analvzed
Method Reporting
Limit (ms/Kq)
Test Results
Limit (ms/Ks)
TPH GRO (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
Dilution Factor Used
o8t07t2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
08/08/2009
sw-846 82608/50304
sw-846 82608/50304
sw-846 8260B/5030A
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/5030A
10.00
0.160
0.1 60
0.160
0.1 60
0.480
0.1 60
< 10.00
< 0.160
< 0.160
< 0.160
< 0.160
< 0.480
< 0.160
GRO
MBTEXN
1
160
dl-W--JJL
Approved by:
Becky Holubek, Laboratory Director
R*-
Digitally signed by Becky
Holubek
DN: cn=Becky Holubek, o=Utility
Testing Lab, ou,
email=[e-mail], c-US
Date: 2009.08.1 1 '17:42;31 -06'00'Date of lssue: 't 't-Aug-09
All analyses perlormed in compliance with National Environmental Laboratory Acgeditation Conference (NELAC) standards Page 1 of 1
A Utility Testing Laboratory
1615 W. 2200 S. Suite A
Salt Lake City, Utah 84119
Toll Free: [phone]
Phone (801 ) 485-8941
Fax (801 ) 467-0065
Analytical Report
Client:Rockwell Soultions
718 E. Bridger Ln.
Elk Ridge, UT 84651
Project:Lighthouse
Client Field lD: SS #10
Laboratory lD: 080509-10
Attn:Dave Hansen
Analysis: TPH GRO
MBTEXN
Matrix: Soil- Dry % Moisture = 10
Sample Received By: Becky Holubek
Date Received:
Date Gollected:
Collection Time:
08/05/2009
08/05/2009
15:05
Date Method Reporting Test Results
TPH GRO (C6 to C10)
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
08107t2009
08/1 0/2009
08/1 0/2009
08/10/2009
08/1 0/2009
08/1 0/2009
0811012009
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/50304
sw-846 82608/5030A
sw-846 82608/5030A
sw-846 82608/50304
10.00
0.1 60
0.'t60
0.160
0.1 60
0.480
0.160
< 10.00
< 0.160
< 0.160
< 0.160
< 0.160
< 0.480
< 0.160
Dilution Factor Used:GRO
MBTEXN 160
Digitally 5i9ned by Becky Holubek
DN: cn=Becky Holubek o=Utility
Testing Lab. ou, email=becky@ut-
labs.com, c=US
Oate:2009.08.'l I 17:42:49 {6'00'
Approved by:
Becky Holubek, Laboratory Director
b*. ->*tt**-
Date of lssue: 11-Aug-09
All analyses perfomed in @mpliance with National Environmental Laboratory Accreditation Conference (NELAC) standards Page 1 of 1
\,
tjtilitv Testin€ Laboratory
FAX: BO1-467-O0651615 w. 2200 S. SuiteA Salt Lake
SAMP L(_).UESrLE RECOR D/ AI'IAL YSIS R
, Utah 841 I 9 Phoner 8Ol-485-8941 hs.com
Number:
icr's
L t"-xt'€
Project Na,-ne:
/1 I
t-la+,'.^.(J. Number:No
of
cont.alrix REMARKS
.9fJht ,$ t-ldentification / LocationTime
5
,a t0 2S
-03F-s3
xIIg
I q0 &6
-o?L/TD E
.*
Eio
Date/Tirne:
9-5-q
llt'7c
SEND RESULTS TO (Company Name)
(o i "drtal?-{-*t r6
Received (signature)
o the attention o[:U re)Reccived Date/Tirrre:ished (signature):Date/linre:
AddressDate/Iime:Received (5iBnature)nquishxJ (signalure):Datcy'l'ime:
Date/Time
Phone:
Datefiirne:Receivcd (signature)Reli nquished (signature):
-C..OXDITAALOEIAMEIS
Preservatiorr lndicated: D Yes D No
Rernarks: A/\ , C-L
;{ ves o No
BYes trNo
Sampies Chillcd
ls l0tact:
e-rnail / Fax:V AKT
Iteport To l"v
)
)
Date Sampled
r€t6-rr IrFog-*-{-oq
1,I-c.'2K*I
'Kti2f
t-6tl*
'trFtAnI'liD 'i#t-d,x
x
-o9xxiqcr<<&?
-gl,<t rtJd V_\r)Vxl// (of
e_p o%
L?**r
SS#2
)
USC #2
SS#1
SS#9 SS#7
S
S5#6
SS#1
jss#3
a
SC
Store
)
--
.00 40
Approx. scale infeet
Lighthouse No. 2
4104 Riverdale Road
Riverdale, Utah
O Closure Sampling Location
Site Map Figure I
t
I
SAMPLE INFORIVIATION TABLE (Closure Notice)
Complete table for all samples that were taken for closure. Sample ID numbers on the table must be consistent with the sample lD
numbers given on the site plat and in the lab analysis report.
Sample
#
Substance
stored in tank
Sample
tyDel Depth2 Compoundsl Analysis method(s)a
ss#r Gasoline,diesel SS ll-12 MBTEXN, TPH.GRO, TPH-DRO 8260b,80r5b
SS#2 Gasoline,diesel SS I l-12 MBTEXN, TPH.GRO, TPH-DRO 8260b,8015b
SS#3 Gasoline,diesel ss ll-12 MBTEXN, TPH-GRO, TPH-DRO 8260b,8015b
SS#4 Gasoline,diesel SS ll-12 MBTEXN, TPH-GRO, TPH.DRO E260b,8015b
SS#5 Gasoline,diesel SS 4-5 MBTEX]\, TPH-GRO, TPH-DRO 8260b,8015b
ss#6 Gasoline SS 4-5 MBTEXN, TPH.GRO 8260b
SS#7 Gasoline SS 4-5 MBTEXN, TPH-GRO 8260b
SS#8 Gasoline,diesel SS 4-5 MBTEXN, TPH-GRO, TPH-DRO E260b, Eol5b
ss#9 Gasoline SS 4-5 MBTEXN, TPTI-GRO 8260b
ss#I0 Gasoline SS 4-5 MBTEXN, TPH-GRO E260b
USC#I Gasoline,diesel TlSC ll-12 USC field analysis
USC#2 Gasoline USC 4-5 USC field analysis
I Soil (SS). Croundwater (GW), or Unified Soil Classification (USC).
2 Final'debth (in feet) below grade d which samples were taken.j C'oniaminani compirund(s) Inalyzed for cach sample (TPH. BTEXN' O&G' etc).
4 Appropriate analysis methods for contaminant compound(s) in each sample
State Certified Laboratory used utility Testing
Address 16.15 West 22fi) South, Suite A City satt Lake city State uT 84119
Contact Person Becky Holubek Phone # aouts+gcl
I certi! under penalty of law that I am the Owner of the tank(s) described above and that I am familiar with the information on this form
and that it is tme, accurate and complete and further, that the procedures described herein were followed during tank closure.
of UST owner
Date
Return completed Closure Notice form, Facility Site Plat and Sample Information Table, SoiUGroundwater sample lab analysis results,
USC sample results, and Chain of Custody form within 90 days of UST Closure to:
State of Utah Dept. of Environmental Qualiry
Division of Enviionmental Response and Remediation / UST Section
P.O. Box 144840
168 North 1950 West
Salt Lake City, Utah 841l4-4840
4
Full Name of owner
Lighthouse #2, UST No. 12O0109
USC Results:
USC#1, 11-12 feet: Silt (Mt) with sand, no plasticity, medium brown, wet
USC #2,4-5 feet: Silty clay (Ct) low plasticity, dark brown, damp
I
Department of
Environmental Quality
fuchard W. Sprott
Executive Director
DIVISION OF ENVIRONMENTAL
RESPONSE AND REMEDIATION
Brad T Johnson
Director
FILE COPY
State of Utah
JON M. HT]NTSMAN, JR.
Governor
GARY HERBERT
Lieulenant Governor
ERRU-138-08
September 25,2008
CERTIFITIED MAIL
RETURN RECEIPT REOUESTED
Cameron Bashir
Destiny Enterprises, L.L.C.
4104 Riverdale Road
Riverdale, Utah 84403
Re:Lapsing of the certificate of compliance and Coverage under the
Petroleum Storage Tank (PST) Fund for underground Storage Tanks (USTs)
Lighthouse chevron #2,located at 4104 South Riverdale Road, Riverdale, Utah
Facility Identification No. 12001 09
Dear Mr. Bashir:
The Utah Underground Storage Tank Act (Act) requires that Underground Storage Tank
(UST) owners and operators pay yearly UST registration fees, Petroleum Storage fant gSf;
Fund assessments, late penalties, and interest. The Act states that if any of the assessments remain
unpaid 60 days after the due date, the Certificate of Compliance and coverage under the pST Fund
lapse.
Our records indicate that you have not paid Regrstration fees, PST Fund assessments, late
penalties, and interest, in the amount of, $1,070.60 which are now more than 60 days past due.
Therefore, you are hereby notified that your Certificate of Compliance and coverage
under the PST Fund for Facility Identification Number 1200109, known as Lighthouse
Chevron #2, has lapsed.
Without a Certificate of Compliance your tank(s) cannot receive delivery of product.
Without coverage under the PST Fund, you must demonstrate financial assurance using another
allowable method and costs of investigating and cleaning up releases becomes yo.,. r"rpo.rsibility.
I 68 North 1950 West . Salt lake Ciry, UT
Mailing Address: P.O. Box 144840 . Sah lake City, UT 841l44g40
Telephone[phone]. Fax [phone] . T.D.D. (801) 5364414
www.deq.utah.gov
prilted on l00o1o recycled paper
Facility ID #1200109
Page2
To obtain a new Certificate of Compliance and renew your coverage under the PST Fund,
you must:
1. Document that you are in compliance with release detection requirements. Contact
our offrce for the specific leak detection records required for your facility.
2. pay all past due Registration Fees, PST Fund assessments, penalties, and interest.
3. Pay a $300.00 re-certification fee.
4. Submit a new application to the PST Fund'
5. Conduct a site assessment as explained in Utah Admin Code R-3ll-205-2(c).
please take care to monitor your own records to ensure compliance. If you have any
questions, please call Jason Wilde at [phone]'
Sincerely,
Brad T Johnson, Executive Secretary ruST)
Utah Solid and Hazardous Waste Control Board
BTJ/JTW/lkg
cc:Gary House, B.S., M.P.H., Director, weber-Morgan Health Department
Riverdale City Fire DePartment
1
Facility rD lhlbq
This letter, or an equivalent, must be signed and submitted as a requirement for receiving a
Certifi cate of Compliance.
To Mr. Brad T Johnson
Executive Secretary ruST)
Utah Solid & Hazardous Waste Control Board
Dear Mr. Johnson:
As required by paragraph 19-6-413 of the Utah Underground Storage Tank Act, I have performed a
tank and line tightness test on each tank at my facility. Based on this test, there has not been a release
of petroleum. Additionally, based on "customary business inventory practices standards" I am not
aware of of petroleum from my tanks.
Or, if a release is known to have occurred at this facility:
I have had the following releases of petroleum (detailed below; also indicate the actions you have
taken to clean up the release):
S ignature of owner/operator
Failure to report previous releases could invalidate your Certificate of Compliance
ppifonnl 205
Utah UST Program
Previous Pollution Incidents
Urreo Srqg6q( TBEqGg1lTQE:tr-1" ' q;f
tfl I.-$:1t Ire-t, ;t[i In6' 1?]1
' Sender: Please print your name, address, and ZIP+4 in this box '
DIVISION OF ENVIRONMENTAL RESPONSE
JASON WLDE
POBOX 144840
SALT LAKE CITY, UT 84114-4840
Il,,i,,l,,l,,,ll,,,ll'i,,i,l,,li,,l,,l,,lll,,,,l,,lil,",,l,ll
x
B.
Item 4 if Restdcted Dellvery ls desirBd,r erint your name ana aOai"lr.-on ttte rEverse
so that w9 can retum the card to you.r Atach this card to the back ot the mailpiece,
or on the front i, space permits.
r Complete itoms 1, 2,3. Also completo
SENOER: ooMPLETE sEcrroN COMPLETE THIS SECTION ELIVERY
L -t
Agent
E Addresseo
C. Dato of oolivery
D. ls delivery address differenffiom ttem t ? EYes
l, YES, entsr delivery addrBss bclow: E No
CAMERON BASHIR
DESTINY ENIERPRISES LLC
4104 RIVERDAf-E RD
RIVERDALE UT 84403
3. S€.vio€ Typ6
I Certned Mall El EAr€$ Mall
E Regbfd€d I Retum Rec€ipt for MorctEndlee
E lnsurrd Mall El C.O.D.
4. R66tncted Delivery? (&tra Fe6,)O Y€s
2. Ardcto Number
Ianstetfton @wb lM)?0Eq 1IbE 8005 0'{17 al5+
6tPS Form 381 1, February 2oo4 U Dom€sllc Rotum R6c6lptAdo loq u,l 102595-02-Mr 540
l. Article AddrEssed to:
State of LItah
Division of Environmental Response and Remediation
Underground Storage Tanks
D o c um e ntatio n of C one sp onde nc e
grunch MGR: ,,-___
Archive: _
Section MGn:
lnitials/Date
PM:
Facility lD 1200109 Project Manager Jason Wilde
Facility Name LIGHTHOUSE CHEVRON #2 Date lssued Date Due
Enforcement Action Inspection (Verification) 91912008
Comments visited site: contacted o/o: verified correct contact information: owner requests invoice be
faxed
911012008 7:01:4E AM
'2/ 05 08 : 59 FAX [phone] DEQ DERR E oor
TRANSMISSION OK
TXIRX NO
CONNECTION TEL
SUBADDRESS
CONNECTION ID
ST. TIME
USAGE T
PGS. SENT
RBSULT
* * ** * * * ** * X * * *** * r& ** r$
*{r* TX REP0RT *{<*
*,t{* * {r {r * *,IilI{* ** * * * * * {. ]B *
113 5
18013997170
ll/22 08: 59
00'48
t
OK
I
JON M- I{I.JNISMAN, JR.
Ootymor
GIRYHERBERT
Lieilonal Goycraor T-!r/rh-ag
Qosf *
P*'t
a thl. Q.uL<State of Utah
Department of
Environmental Qanlity
Diumc RNiclson, Ph-D.
FfidttHr Dileaor,
pivrsroN oF EwTnoNMENTAL
REsPoNSE A|.lD nslcoiAuoH
Brad T Johnson
Dlrya1*
X'AX Number:
From:
Pages to tr'ollow:
Comments:
wou [?'t-
FAX COI{ER SITEET
{
It- ^>-ofDate:
To:/\w\"lle CroL-
ubr,y4n*XAgeucy/irirm:
3c,* Ea
Qc:l 3q ?oI
6ry\.eA
o^p +c,^k- J/ :1",1Q
Z lh on g-zl- or.
hvrlle {u + t0.ootoq
d I kvA "{
YL
t I .- .y'r -r1 \lt
U
l^/),.t1+.. -A t-o
t
State of Utah
Division of Environmental Response and Remediation
Underground Storage Tanks
D o cum e ntatio n of C orre s p o nde nc e
Facility lD 1200109 Proiect Manager Jason Witde
Facility Name LIGHTHOUSE CHEVRON #2 Date lssued Date Due
Enforcement Action Personal Contact (Telephone)12t22t2008
COmments Talked to Cameron Bashir. sa),s he's been in the process of transferrins
ownership from previous owner. has not been selling gas. Exoects to be
back in business in january. knows he has to get back on the fund to eet a
COC. will shop for soil samplers.
1212212008 4:28:30 PM
A?---ffi-@7zzz
.^
ID:
Owner Name Location Name
Address Address
State UT
PhoneContact Other
surrounding area:
lndustrial
Tank No.Tanks Closed Tank No. ,tr Tank No.Tank No.
Capacity (gallons)li r:rrl->1'^. rnYr>
Type (Steel, FRP, Composite)Q*t,e I
Substance Stored /, xa.(o r+5
Date last used t t\t<t r -( t,,r t1
Date Closed 8lz,cf ffir-E -+*+,r44
How closed (Rmvd, in place, CIS)rrA
Original# of tanks 5 - Closed tanks Q + !!9w tanks @ = # of tanks remaining 3
& SoilSampler:Expiration Date:Cert. #: GS
Expiration Date:ST Remover Cert. #:TR
Owner/Operator has an approved closure plan:Copy of closure plan is on Site:N N
Product removed:at 4.\N By:
Sludge removed \NBv
N By: tJ disposed at:leanedc
Non-explosive atmosphere inside tank obtained by: _ Purging lnerting. LEL or % Oxygen obtained:
Product lines were: _ Cleaned, secured in place, and capped '( Removed, disposal site:
ank disposal site p e-(llrLnA.
PID or FID meter readings (indicate location on the site plat.)
Calibration specsTypeGain or span
Depth of contamination: 0 - 3 feet AJ S Creater than 3 feet ruI contamination is evident: Y
contamination is evident: Y Depth to water table:t t A l6+ope direction of sufface topography:
Number of samples collected GWt USC: A Certified Lab:Soil:
Analysis Methods O&G TRPH HOC Other:
lnspector observed collection of samples:N lndicate location and depth of samples on the site plat.2
lnspector collected duplicate samples and submitted them to the State Lab for @analysis: Y
lf yes, confirmation samples were collected: Y NContaminated soil was overexcavated: Y N
White-DERR, Yellow-lnspector
,
Ownership of Tank(s)Location of Tank(s),ry<*I
/ ^,.r,l*arrrl i /^, t*AttA*i R , I LL . ,^
^. ^ i1) <fr6J, , -ll
,,r {1,
Cleaning and Removal:
Assessment:
Pco
eJo\c
tfJ
NORTH
2
il
:J
><
cAft4 #
?'*p*N ,A
UTlr/ Northinq:Easting
+
J
s
urr\/
Ulr{-
Show locations of all buildings, streets, tanks, piping, and dispenser islands. lndicate the product in each tank. Show locations of tank manways and identify
each: submersible pump, fill, ATG probe, vapor recovery, etc. For closures: lndicate the type (soil, GW, USC), location, and depth of each sample collected
bvthecertifiedsamole(ortheinsDector. AlsoindicatethelocationsofanyreportedPlDorFlDreadings.
\ \<) b v r-t,^,r-..1 r,\:c^-fi,^- SR ru.n[ ar U.xvrl )*t?rtComments
-"\- \.',\l- r^)\ { cvt)-tr*t^ +fl s.h\). Cr\rm,ol re.\
6 r I I
Utah UST Program
Facility Site Plat Paoe i of ,a
n
oc9
)4-
4
i)
J
S
F
A
I
o(J.t.St",ne->S
Pump
Fiil
(specify)
Rec.
Probe
. Probe
I
PROVIDING COMPLIANCE SOLUTIONS SINCE 198S
I
I
[rua
nufle
September 11, 2005
lVls. Ruth Shoil
Wells Fargo Bank
4350 East Camelback Road, Ste. 100 E"
Phoenix, Arizona 85018
Subject: Underground Storage Tank Closure
o0unn 1
Jllht "
br$
&r
6,L ("-t
$8
6av
Or{,4
,taq(
g5s'
..J
\
cl."
L1
\
\('\
Former Tri-tVlart Chev ron
4104 Riverdale Road
Riverdale, Utah
Facility lD 12000109 ?
r o'1
b t)oc"Ms. Short:
Please accept this letter and the attached supplemental information as
documentation of site conditions during the September 2005 underground storage
tank closure activities at the above referenced site. Turc steel underground
storage tanks (USTs) u,ere removed at this time. Three USTs remain at the site.
Additionally sampling \Mas performed to evaluate four former dispenser islands and
the associated dispenser piping. A site map is presented as page 5 of this
document.
Based on review of the required soil sampling performed as paft of the UST
closure process, it is my opinion thatthe Utah Department of Environmental
Quality, Division of Environmental Response and Remediation will not require
further action at the site. This opinion is based on the soil sample chemical
analysis results, which are attached to this letter as paft of the previously
referenced UST Closure Notice. All petroleum hydrocarbon concentrations
measured at the site are below the most stringent Utah regulatory action levels
Our services consist of professional opinions and recommendations made in
accordance with generally accepted geotechnical and environmental engineering
principles and practices. This rararranty is in lieu of all other warranties either
expressed or implied.
Utah 84118 : www.hazlec.net
-2632 r:, watts 888 323-2653
2506 Easton Street r Salt Lake City,
voice 801 968-6632 r fax E0'l 967 il I
I
HAZTEG OFAMEFIIGA, INC.
I a
Should you have any questions, please do not hesitate to call my home office at
[phone], or via cell phone at 801-518-2839.
Sincerely,
Haztec of America, lnc.
'&*,,b"{,
Darin Worden, Principal Environmental Manager
Utah Certified UST Consultant
Copies:1 - Addressee, email
1 - Addressee, regular mail
1 - Utah DERR
1 - Mr. Giovanni Guanuna, Destiny Enterprises
?
Haztx of Am*ica,lnc.
UST Removal Report 09-11-05
UNqERGRoUND sToRAGE TANK PqFVANENT CLOSURE NOTICE (rev. 3/4/03\ FACILITY ID# Ia dO O \O't
Use
Date Processed by(
Date Mailed to LHD
LUST ID#
Date to LUST Review
2-t-Phone #
State(;tF$e.-*
Closure Notice
of
at uest of the
name
Address
FACILITY INFORMATION
L,I+
tanks at this site before closure
tanks at this site closure 3
Tank Owner I
sole
Address
Name
Contact
Total number of
Total number of
u
{e
Phone #
n corporationE partaership
State Co
{^
stateU Pveu
Phone #
Tank #bZ Its
,\o Sfu*r
Date Installed ,-)s- ,7 7 l:)1,- 67
lJ.rtr (r.rcc,'
Substance stored'6As.dns
Date last operated .t*.gtgr,a)
Date Closed 9-l-oS Q- t-o$
Removed/In Place/ Change in
Service (CIS)?Rat*r*.*A N"gu^,rr-a
CLOSED
*Indicate the specific substance each tank to be closed (regular,diesel, waste etc.)
TANKREMOVERName cen.#TR638l Exp.DatelO 'l,06
C I c Phone #8o/-%8-Gos z _
Address L State
TER SAMPLERName d c"n.*GdO tt.,6.Exp. Date / - /54 4
CJ Phone #
Address State Ut zioS'.lltY
CLOSURE INFORMATION
Tank was cleanedSludge was removedFuel was
iCMethod Used:Tank was Inerted
o4.Location of Closure Records:
For In-Place Closure: tanks filled
For Change-In-Service:Substance to be stored:
I
t-Lr)en.t
\I
. t Jit rt,rrrl
D-,us+o1) q\t^."-b zip Y*t lY
m
Pursed L l
DISPCSAL SITES USED
Contact Name Date Amount
Tank(s)r*r-uS.{pvr.J lr\.el$fs ? -/-of Tank #
Product From Tank(s)
Contaminated Water From
Tank Cleaning \e\oJ
s?s- -6ts/8€t*,>
Sludge U U Ud C$,nsl-?t'r 7-3 t
Contaminated Water From
Excavation l..Ot".l r-
Coutaminated Soil |)oo.c-
Locatiou Name
SITE ASSESSMENT
complete the Facility Site plat (closure Notice) and Sample Information Table (closure Notice) on pages 3 and J to show the locations,
depths, aud other information on all soiVgroundwater r"rrrpi". taken for closure. The samples must be consistently identified by sample ID #
on the site plat, table, and lab analysis report.
fuompteted Facility Site Plat (Closure Notice) is attached.
The following must be included (enteithe distance, and direction (N,S,E,W) from the area of contamination or, where applicable,
use OH for overhead, NP for not present):
_Water Line
-Sewer
Line Natural Gas
-Storm
Drain Telephone Electrical Property Line _- Buildings
@ Completed Sample Information Table (Closure Notice) is attached.
El Certified lab analyticat environmental sample results are aftached.
E UnineA Soil Classification (USC) sample results are attached.
filchain of Custodv form is attached.- Su*ples *.re p.operly: QloCollected ffiltabelea fllPackaged _ (! Transported
{ Samnles were in sight of the pirson in custody at all times or in a secured locked place.
I certify under penalty of taw that the closure site rssessment at this facility was conducted in accordance with R31l-202 (parts
2g0.52 and 280.i2) "ni mtt-zos U.A.C., and that any additional samples required by klll-202 parts 2E0.52 and 280.72 and R311-
205-2(a)(f ) were properly collected.
of Certified Groundwater/Soil -orDatef,'ull name of Certified
If contamination at the facility is confirmed, any person providing remedial assistance for a fee must be a Certified UST Consultant. The
Certified UST Consultant providing assistance is:
CERTIFIED UST CONSULTANT
Name Cert. #CC Exp. Date
Company Address
Citv State Zio Phone #
Please the site assessment or closure:unusual or circumstances
2
Phone #
\
Feciltty Site Plst (Cfosure Notice)
The site plat.must be drawn ts an approp,riate ioentified scale. It rnust show planned sampling locationq substances stored in tanks, and
other relevanr information. Tank ana sarnple identification numbers must be consistent with the inforuntion given ou P ! and 4 of thc
Closrre Notice.. .
North
fr
Scble: l'L _- Feet
.h$
,?
e\J :.^-(bnller disPenser
istand locations
f,- .;\{... |..,1
',
fonncr location of building
locttion of.
tcmoved
preduci piping
/*L
,::
to\"1
PlPlns lu^n\
*&
p3
Faciiity IDi Drawn By:Dafc:
X = Sample loeations (SS-#, WSJ#, USC+)
r r= Monitoring.Weils WW#).
' '= Seil boring (SB#), or Geoprobc.Boring-(CP-#)
o = Water Wells (donrestic, livestoalq'etc:)
Slope of Surhcc. Topography: (NINW,W,SW,S,SE;ENE)'
Land UseAt Site:
-Resideotial -Commercial ;tndusttial'
Stirrounding Land:
-{egidential _Commercial . Induatrial
SitePH Most fldlcatc Acffrl LAcltiohi Of:
{ Currenr& foimer tanks, piping& diiponaem
{ Location ofill samples to be takcn
{ Buildinga, fences, & propcrty boundaries
{ U$tity conduits (sewers, Bas, water, storrr drains, electtiical' etc.)
{ Uepttr to S5ciuDdwater (if eircountered)
.J-Excavations, GW rnonitoring welh &- soil itdckpil'es
3
(
Sep OB 0'5 O5: O7d
Sep QB O5 lO:O{a
Gigqanni Guanuna 858-\78 1z9s
gol-5 -2632
P.1
P. I,
SA!{PLE INI'OIMATIONTABLE (Cloferc Nodoc)
Cri$e hHc fr all ruplcc tra ltrulcu fr chnrrc. Srmpli lt,rinbar c l}c ubta ulr bc eorrdgut with tllFsrEDf. Q
ouddts givco on rhc site plat ad lir ilrc hh inalysis repo*.
BfDtN.OeG,!tc)
ooporulrlinc*hrrmptp
Satc
I cct@ rdcr lqlttf of hw.tbr I anrtc Oumcr.of ttr trn(s) drscribd abovc rtrd ftor I aor turiilhr with lhc hfdniltioD o $is frsll
ltd th it ii Errq, mflnic md ooqllcrrild@ &r tr pr.oegqrGs &Gribdkcio *crr frlfrt6d:dubg mlc ctoauo.
2 oo:t
ncur corytcr* €lonn-.t{otice ftrrq hcility {iirc- Phc [e-mail] frffi- SqnlGsoududcr saudc. bb eadyris. cadts.
US-senflc lcntllf gdChaiD of GEto+fom, wilhin 90 dsys-of UST Cloflrg B:
Shtc of LItr[ Dcot of Eavlrmmtal (}di&
pi*8boof Erviimocot[rrpoorc.rid.Rcocduiu, uSiI Sccrior.
P.O. Bor I'Ut4{l
l6ENrh[ I9SOUrcd
Sdt ldcCit1i lJut'84t1ffi.10
I
2,
a
4
Srrple $rDrtr.-ncc
:rlrrtl il trdc. '
S&ipbtrcl'Dcpth'Comgornde!
I Gss's5 ll.llH rtl t{ lteArsil-rH.SS , tL'rt..tt7 - - r-l tt3 rr tlf}Is SS ll-A Ff 'l rr fl tt lf,f tt. t I6rs.9..l Ittl F tltt U' tl 0r.s <irs 'rA,sc-SS lr4i,F'rIs,c -ffia,aes4 --{D ffi0l.o6.rs SS 3..rLF
ttt\7 6rs -hd."l,SS 3 *$t It rl l( rr tfIr*7-- ai S.S . t t._ tt?r(.ff rl \l r[ .t tt
t\tl.tl(ss Lq Fr.tl,Ltlll{1.U,tlossi-q rt tL !1-'-1t. .rl
llrt\. lt ss " tLf.T ,l ur,lr tl fls.c 'ta I I SS Ir*Ft rrse
ofotrlircr
Aabrir otHrod(r)'
q.
r] rf'
, l[''t>
anl.. d
._ lL463 ta"[f-=.[e..trt#citri$tr*
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake Cify, Utah
841 l5
ANALYTICAL REPORT
Client: Haztec of America,Inc.
Collected: September l, 2005
Received: September 1, 2005
Analysis Requested: USC
Lab Sample lD: L67524-05A
Field Sample ID: #5 SW Corner Excavation
Site ID: Riverdale 4104
ResuIt
Contact: Gordon Wood
Analyzed: September 1, 2005
USC
Uniform Soil Classification MH - sandy elastic silt w/ gravel
(80r) 263-8686
rll Free [phone]
Fax [phone]
rail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Released by:
Supervisor ReportDate: september2,2005
Page I of9
Client: Haztec of America,Inc.
Collected: September 1, 2005
Received: September l, 2005
Analysis Requested: TPH by SW80I5B
ORGAMC ANIALYSIS REPORT
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake City, Utah
841 l5
Lab Sample ID: L67524-01B
Field Sample ID: #l NW Corner Excavation
Site ID: Riverdale 4104
Analytical Results
Contact: Gordon Wood
Analyzed: September 2, 2005
Extracted: September 1, 2005
TPH-DRO bv 80158/3545
Units: mg/kg-dry
Dilution Factor: I
Compound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofluorobenzene
Reporting
Limit
10- I 69
7o Moisture: 5.5
Analytical
Result
<212l
[phone]
rll Free [phone]
Fax [phone]
rail: [e-mail]
ll.2
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Oflicer
Report Date: September 2, 2005
Page 2 of9
with thr r&ertiomst hh6^ti^n ^r teb ^f .e hdhrl
^r mlt d in miurrian with lhr r*oilhlialbn of lhi3 reDort lor anv ouroola oth€r lhan tof lhe addlaSsee will be Ofanted only
lreleasedb
Client: Haztec of America,Inc
Collected: September 1, 2005
Received: September l, 2005
Analysis Requested: TPH by SW8015B
ORGANIC ANALYSIS REPORT
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake City, Utah
84115
Lab Sample ID: L67524-028
Fietd SamplelD: #2 NE Corner Excavation
Site ID: Riverdale 4104
Analytical Results
Contact: Gordon Wood
Analyzed: September 2, 2005
Extracted: September 1, 2005
TPH-DRO bv 8015B/3545
Units = mglkg-dry
Dilution Factor: I
Comoound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofl uorobenzene
Released
Reporting
Limit
2l
l0-169
Supervisor Report Date: SePtember 2, 2005
7o Moisture: 5.3
Analytical
Result
<21
12.3(801) 263-8686
rll Free [phone]
Fax [phone]
rail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Page 3 of9
Client: Haztec of America,Inc.
Collected: September 1, 2005
Received: September l, 2005
Analysis Requested: TPH by SW80I5B
ORGANIC ANAIiYSIS REPORT
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake City, Utah
841l5
Lab Sample lD: L67524-038
Field Sample ID: #3 SE Corner Excavation
Site ID: Riverdale 4104
Analytical Results
Contact: Gordon Wood
Analyzed: September 2, 2005
Extracted: September 1, 2005
TPII-DRO bv 8015813545
Units = mg/kg-dry
Dilution Factor: I
Comoound
Total Petroleum Hydrocarbon (DRO' Cl0-28)
Surr : 4-Bromofl uorobenzens
Reporting
Limit
7o Moisture: 4.5
Analytical
Result
<21
(8ot) 263-8686
,ll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
2t
l0-169
Supervisor RcportDate: Scptcmbcr 2,2005
20.s
Released by:
Page 4 of9
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake City, Utah
841 l5
Analytical Results
ORGANIC ANALYSIS REPORT
Client: Haztec of America,Inc
Collected: September 1, 2005
Received: September l, 2005
Analysis Requested: TPH by SW8015B
Lab Sample lD: L67524-O4B
Field Sample ID: #4 SW Corner Excavation
Site ID: Riverdale 4104
Contact: Gordon Wood
Analyzed: September 2, 2005
Extracted: September l, 2005
TPII-DRO bv 8015813545
Units: mg/kg-dry
Dilution Factor: 1
Compound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofl uorobenzene
Released by;
Reporting
Limit
l0-169
Supervisor Report Date: September 2'2005
24
7o Moisture: 15
Analytical
Result
<24
[phone]
rll Free [phone]
Fax [phone]
rail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Offrcer
10.8
Page 5 of9
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake City, Utah
841l5
Client: Haztec of America,Inc.
Collected: September 1, 2005
Received: September l, 2005
Analysis Requested: SW8260B/5030A
ORGANIC ANALYSIS REPORT
Contact: Gordon Wood
Analyzed: September l, 2005
8260-S-MBTEXN/GRO
Lab Sample lD L67524-0lA
Field Sample ID: #l NW Corner Excavation
Site ID: Riverdale 4104
Analytical Results
Units: mg/kg-dry
Dilution Factor: 2.51
Compound
Methyl tert'butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPH C6 to ClO (GRO)
Sun; 1,2-Dichloroethane-d4
Surr; 4-Bromofluorobenzene
Surr: Dibromofl uoromethane
Sun; Toluene-d8
Reporting
Limit
o/o Moisture: 5.5
Analytical
Result
[phone]
rll Free [phone]
Fax [phone]
rail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
0.0053 < 0.0053
0.0027 <0.0027
0.0053 < 0.0053
0.0053 < 0.0053
0.0053 < 0.0053
0.0053 < 0.0053
0.053 < 0.053
72-131
76-126
7s-119
84-l l9
103
94.5
94,2
96.8
Released by:o7/)4-
@ ReportDate: september 2,2005
Page 6 of9
ORGANIC ANALYSIS REPORT
Clienl Haztec of America,Inc.
Collected: September 1, 2005
Received: September l, 2005
Analysis Requested: SW8260B/5030A
Lab Sample lD: L67524-02A
Field SamplelD: #2 NE Corner Excavation
Site ID: Riverdale 4104
Analytical Results
Contact: Gordon Wood
Analyzed: September l, 2005
8260-S.MBTEXN/GRO
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake City, Utah
84115 Units: mg/kg-dry
Dilution Factor: 2.49
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPH C6 to C10 (GRO)
Surr: 1,2-Dichloroethane-d4
Surr: 4-Bromofl uorobenzene
Surr: Dibromofl uoromethane
Surr: Toluene-d8
Reporting
Limit
%o Moisture: 5.3
Analytical
Result
[phone]
,ll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
0.00s3 < 0,0053
0.0026 < 0.0026
0.0053 < 0.0053
0.0053 < 0.0053
0.00s3 < 0.0053
0.00s3 < 0.0053
0.053 < 0,053
72-131
84-l 19
ttz
76-126 94.E
75-l l9 95.2
96.6
Rereasedby: 92L1U
-1u[-o."aty Srp"*it-* Report Date: September 2,2005
Page 7 of 9
Client: Haztec of America,Inc.
Collected: September l, 2005
Received: September l, 2005
Analysis Requested: SW8260B/5030A
QITGANIC ANALYSIS REPORT
AMERICAN
WEST
ANALYTICAL
LABORATORIES
Lab Sample lD: L67524-034
Field Sample ID: #3 SE Corner Excavation
Site ID: Riverdale 4104
Analytical Results
Contact: Gordon Wood
Analyzed: September 1, 2005
8260.S-MBTEXN/GRO
Units: mg/kg-dry
Dilution Factor: 2.5
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPH C6 to ClO (GRO)
Sun: 1,2-Dichloroethane-d4
Surr: 4-Bromofl uorobenzene
Surr: Dibromofl uoromethane
Surr: Toluene-d8
Released
7o Moisture: 4.5
Reporting
Limit
Analytical
[phone]
rll Free [phone]
Fax [phone]
rail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Result
0.0052 < 0.0052
0.0026 < 0.0026
0.0052 < 0.0052
0.0052 < 0.0052
0.0052 < 0.0052
< 0.0052
< 0.052
111
94.2
99.7
97.9
0.0052
0.052
72-131
76-126
7s-tt9
84-l l9
Supewisor Report Date: September 2,2OOs
Page 8 of9
463 West 3600 South
Salt Lake City, Utah
841l5
\
Client: Haztec of America,Inc.
Collected: September 1, 2005
Received: September 1, 2005
Analysis Requested: SW8260B/5030A
ORGANIC ANALYSIS REPORT
AMERICAN
WEST
ANALYTICAL
LABORATORIES
463 West 3600 South
Salt Lake City, Utah
841 l5
Lab Sample ID: L67524-044
Field Sample ID: #4 SW Corner Excavation
Site ID: Riverdale 4104
Analytical Results
Contact: Gordon Wood
Analyzed: September l, 2005
826O.S.MBTEXN/GRO
[phone]
rll Free [phone]
Fax [phone]
rail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Offrcer
Units = mg/kg-dry
Dilution Factor: 2.5
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPH C6 to ClO (GRO)
Surr: 1,2-Dichtoroethane-d4
Surr: 4-Bromofl uorobenzene
Surr: Dibromofluoromethane
Sun: Toluene-d8
Released by:
Reporting
Limit
0.0059
0.0029
0.00s9
0.0059
0.0059
%o Moisture: 15
Result
< 0.0059
< 0.0029
< 0.0059
< 0.0059
< 0.0059
< 0.0059
< 0.059
93.3
92.9
Analytical
0.0059
0.059
72-t3t
76-126
75-l l9
84-1 l9
Laboratory Supewisor Report Date: SePtember 2,2005
t22
9E.E
Page 9 of 9
*friGeiorerriaernenr, pror*uon oraate of any proouaorprods,;i;;,ocd *ih thorepublicauon otdTis reportOr.:nv p.r,po."9flt""qlf,*1f-Y-yl5-9,P]f "'lv
Client
Address p
Crty A9
enone 1C;ltobZL rax qL7 )6) z-
*HS cHArN oF
AI{ALYTIcAL CUSTODYr"AEon!9!ry 6or)263-t6E6a53wca35iosorlt irrgi2r3+6So
sdt Irb cty, t hi rr* ('mri zcr-.aoglt{ll5 861i1;.*116rw!l-labs.com
Around nme Gide One)
2day 3 day 4 day sday Standard122+33+4
cL(
o Page of
Tum
@voc
€A"J
@ NSrj\o.- r.. f
Project Number/P.O.#
Sampler Name
f,.-oa AA\" 4ro.[Proiect Name
a
LABORATORY USE ONLYPlease indicat6 tests needed below
COMMENTS
.Uv,
J
(o
=
E
E!!t
b
2
\
{
\t
$
€
Eoo
-gooo
EF()
ooSample lD
3 Lllil,s lt'a\Auert E-(S afiit"r u*2(}E CoL*'r,( Etc+-
S J.telil^ tor.$arrrt[rB e E*rc"d'r"oJ
s a vEESee4 s ,Lr-,
r'IIIBA#s'-s- t ,F FJ(-Zt,e,A t
saxPr.rs wE!E. z-----\1 Shipped o(hand delivered
/Volos
z amuenr or(cnrrre)otrs. \--l
s tempraure fut-)-
I neceiveo eroreru- )ng
(tmEopedy Sey(,).
rvotesr Lf
5 PrrOGdy Pres€rved&\ ir
h,iods:
6 .BfceNed Withtn
/llQbim limes(Y\
\@les:
By:ffi:,&t.o-_,.L
frvoa.7\a.ad,I$iu"'ore oo{
Oate necervd6v: sbiritureRelinquished Br SEnatu.e
PRINT NAMETirEPRINT NATIE
COC Ttpe lvas:
Pres€ot on Oul€r
Pacl€ge Y
NA v
)
IA
1{A
t{A
1
pie
N
Sample
N
on Outr.
IIIIIIIIIII
IIIIITIIIIIITIIIIIIIIIIIIIII
IrIIIII
IIIIIIIIIIIIITTTIIITIIIIIIIIIIIIIIIIIIIIIIIIIIII
wtd
fl
IIIf,BilFilglgilE @
IIIIIIIIIIIIIIIIIIIIIIITIIIIIIII
Date Rec6ived 8y: Sigaafu/"Relinquished 8),: SEraaru/e
PRIT.'T NAMETifllePRINT MIIE
Receiv€d By: St nalureDaleRelinquished B),1 S,trratute
I lnstructions:Ef\ic RoSoLS lO
f[la.u*r.c K r@ \lApoct 60.CoUa'
Discre Between
Sample
Rooord?
PRII'IT NAME Time PRINT NAME
and "t
Labsampre ser# h15ry'
I
State
E-mail
I
Nolesr
ANALYTICAL REPORT
Contact: Gordon Wood
Analrzed: September 6,2005
AMERICAN
WEST
ANALYTICAL
LABORATORIES
Client Haaec of America,Inc.
Collected: September 1, 2005
Received: September 2,2005
AnalysisReguested: USC
Lab Sample ID: L67536-07A
Field Sample ID: #12 Dispenser Island
Site ID: 4104 Riverdale
Result USC463 West 3600 South
Salt Lake Ciry, Utah
841l5
Uniform Soil Classifi cation CL - sandy lean clay
[phone]
,ll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F. Gross
l"aboratory Director
Peggy McNicol
QA Ofticer
LaboratorySupervisor ReportDate: September7,2005 psge I of13
Releasedby: %_-75>-
AMERICAN
WEST
ANALYTICAL
LABORATORIES
ORGANIC ANALYSIS REPL .f
Client }Jaztec of Americ4Inc.
Collected: September 1, 2005
Received: September 2,2005
Analysis Reguested: TPH by SW80I5B
Lab Sample ID: L67536-0lB
Field Sample ID: #6 Product Piping Trench
Site ID: 41M Riverdale
Analytical Results
Contact: Gordon Wood
Analwed: September 7,2005
Extracted: September 6,2005
TPH-DRO bv 801s8/3545463 West 3600 South
Salt Lake City, Utah
841l5 Units = mg/kg-dry
Dilution Factor: I
Compound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofl uorobenzene
Reporting
Limit
l0-169
7o Moisture: 8.3
Analyhcal
Result
<22
16.4
22
[phone]
,ll Free [phone]
Fax [phone]'7
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Oflicer
Releasedby: %l:a
-/ira*atory Supervisor Report Date: September 7,2005 page 2 of 13
AMERICAN
WEST
ANALYTICAL
LABORATORIES
ORGANIC ANALYSIS REPu^.I
Client: Haztec of Americ4 krc.
Collected: September 1, 2005
Received: September 2, 2005
Analysis Reguested: TPH by SW80I5B
Lab Sample ID: L67536-028
Field Sample ID: #7 Product Piping Trench
Site ID: 4104 Riverdale
Analytical Results
Contact: Gordon Wood
Analrzed: September 7,2005
Extacted: September 6,2005
TPH-DRO bv 8015B/354s463 West 3600 South
Salt Lake City, Utah
841r5 Units = mglkg-dry
Dilution Factor: 1
Compound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofl uorobenzene
Repoting
Limit
1G169
7o Moisture: 9.0
Analyhcal
Result
<22
18.1
22
[phone]
,ll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Offrcer
Released by:
Laboratory Supervisor ReportDate: September7,2005 page 3 of 13
ORGANIC ANALYSIS REPu^J
AMERICAN
WEST
ANALYTICAL
LABORATORIES
Cte,nt Haz/'tr, of America,Inc.
Collected: September 1, 2005
Received: September 2, 2005
Analysis Requested: TPH by SW8015B
Lab Sample ID: L67536-038
Field Sample ID: #8 Dispenser Island
Site ID: 4lM Riverdale
Analytical Results
Contact: Gordon Wood
Analrzed: September 7,2005
Extacted: September 6, 2005
TPH-DRO bv 80158/3545463 West 3600 South
Salt Lake City, Utah
841l5 Units= mdkg-dry
Dilution Factor: I
Compound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofluorobenzene
Reporting
Umit
1G169
7o Moisture: 9.2
Analytical
Result
<2222
18.4(801) 263-8686
,ll Free [phone]
Fax [phone]'7
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Released by:
Report Date: September 7,2005
Page 4 of 13
Laboratory Supervisor
AMERICAN
WEST
ANALYTICAL
LABORATORIES
Client Haztw of Americ4Inc.
Collected: September l, 2005
Received: September 2, 2005
Analysis Reguested: TPH by SW80I5B
Lab Sample ID: L67536-048
Field Sample ID: #9 Dispenser Island
Site ID: 4lM Riverdale
Analytical Results
Contact: Gordon Wood
Anahzed: September 7,2005
Exhacted: September 6,20A5
TPH-DRO bv 80158/3545463 West 3600 South
Salt Lake city, utah
84115 Units = mg/kg-dry
DilutionFactor: I
Compound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofl uorobenzene
Reporting
Umit
1G169
7o Moisture: 14
Analyf,cal
Result
<23
33.9
23
[phone]
,ll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Released At, %1,3%,
a/Luborrtory Supervisor Report Date: September 7, 2005
Page 5 of 13
ORGANIC ANALYSIS REPL .T
ORGANIC ANALYSIS REPt-. T
AT1ERICAN
WEST
ANALYTICAL
LABORATORJES
Client Hamc of Americq lnc.
Collected: September l, 2005
Received: September 2,2005
Analysis Requested: TPH by SW80I5B
Lab Sample ID: L67536-05B
Field Sample ID: #10 Dispenser Island
Site ID: 4104 Riverdale
Analytical Results
Contact: Gordon Wood
Analrzed: September 7,2005
Exfiacted: September 6,2005
TPH-DRO bv 8015B/3545463 West 3600 South
Salt Lake City, Utah
841rs
[phone]
,ll Free [phone]
Fax [phone]
ail; [e-mail]
Units= mdkg-dry
DilutionFactor: I
Compound
Total Petroleum Hydrocarbon (DRO - Cl0-28)
Surr: 4-Bromofl uorobenzene
Reporting
r rnxit
lG.l69
7o Moisture: 12
Analytical
Result
<23
15.0
23
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Released by
Laboratory Supervisor Report Date: September 7,ZOOS page 6 of 13
ORGANIC ANALYSIS REF.,{{T
AMERICAN
WEST
ANALYTICAL
LABORATORIES
Client Haztac of Americ4Inc.
Collected: September 1, 2005
Received: September 2, 2005
Analysis Requested: TPH by SW80I5B
I^ab Sample ID: L67536-068
Field Sample ID: #11 Dispenser Island
Site ID: 4lM Riverdale
Analytical Results
Contact: Gordon Wood
Analrrzed: September 7, 2005
Extacted: September 6, 2045
TPH-DRO bv 80158/3545463 West 3600 South
Salt Lake City, Utah
84115
[phone]
,ll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Units= mdkg-dry
Dilution Factor: 1
Compound
Total Petroleum Hydrocarbon (DRO - C10-28)
Surr: 4-Bromofl uorobenzene
Reporting
Umit
rG169
7o Moisture: 9.7
Analyhcal
Result
<22
2s.7
22
Laboratory Supervisor Report Date: September 7,2005 page 7 of 13
Releasedav, @ ). gA
Client Hazlfi,of America, Inc.
Collected: September l, 20A5
Received: September 2, 2005
Analysis Requested: SW8260B/5030A
Lab Sample ID: L67536-01A
Field Sample ID: #6 Product Piping Trench
Site ID: 4lM Riverdale
Analytical Results
ORGANIC ANALYSIS REP.-^(T
Contact Gordon Wood
Analrzed: September 2,2005
AMERICAN
WEST
ANALYTICAL
LABORATORIES
8260-S-MBTEXN/GRO463 West 3600 South
Salt Lake City, Utah
841t5
(80r) 263-8686
ll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F, Gross
Laboratory Director
Peggy McNicol
QA Officer
Units = mdkg-dry
Dilution Factor: 2.49
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPHC6toClO(cRO)
Surr: 1,2-Dichloroethane-d4
Surr: 4-Bromofluorobenzene
Surr: Dibromofl uoromethane
Surr: Toluene-d8
Reporting
Umit
0.00s4
0.0027
0.0054
0.0054
0.0054
0.0054
0.054
72-t3l
7Gt26
75-tt9
84119
7o Moisture: 8.3
Analytical
Result
<0.0054
<0.m,27
< 0.0054
< 0.0054
< 0.0054
< 0.054
106
94.7
94.6
98.8
B - Toluene detected in MB VoC (run9/2/2005 8:49:00 AM) at an estimated value between the MDL & pel,
at 0.00076mg/kg.
Sample was received with headspace.
Released by:
Laboratory Supervisor Report Date:September 7, 2005
Page E of 13
Port b FoYk ed for he sxdudve u8€ of thE addrc$6. PriMhger of rubs€qucnt uss ot he name of lhia compa!ry or rny rnembcr of it! rbtr, $ reproduc{m gf |his r€porl ln connsdion
< 0.0054 B
ORGAMC ANALYSIS REPL^. T
Clie,nt llailecofAmerica, Inc.
Collected: September 1, 2005
Received: September 2, 2005
Analysis Requested: SW8260B/5030A
Lab Sample ID: L67536-02A
Field Sample ID: #7 Product Piping Trench
Site ID: 41M Riverdale
Analytical Results
Contact: Gordon Wood
Analyzed: September 2, 2005
AMERICAN
WEST
ANALYTICAL
LABORATORIES
8260.S-MBTEXN/GRO463 West 3600 South
Salt Lake City, Utah
84115
[phone]
rll Free [phone]
Fax [phone]
ail: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Units = mdkg-dry
DilutionFactor: 2.49
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPHC6toClO(cRO)
Sun: 1,2-Dichloroethane-d4
Surr: 4-Bromofl uorobenzene
Surr: Dibromofluoromethane
Surr: Toluened8
7o Moisture: 9.0
Reporting
Limit
Analyhcal
Result
0.0055 < 0.0055
0.005s 0.0071 B
0.0055 < 0.0055
0.0055 < 0.0055
0.00s5 < 0.0055
0.055 < 0.055
72-131 108
76t26 95.0
75-119 93.6
84119
0,00.27 <0.m.27
98.7
B - Toluene detected in MB VOC (run91212005 8:49:00 AM) at an estimated value between the MDL & PQL
at 0.00076mg/kg.
Sample was received with headspace.
Released by C)/7+
-/L^bor^tory Supervisor ReportDate: September 7,ZOO5
Page 9 of 13
ORGANIC ANALYSIS REPC^
AMERICAN
WEST
ANALYTICAL
LABORATORIES
Client Haztec of America,Inc.
Collected: September l, 2005
Received: September 2,2005
Analysis Requested: SW8260B/5030A
Lab Sample ID: L67536-03A
Field Sample ID: #8 Dispenser Island
Site ID: 4lM Riverdale
Analytical Results
Contact: Gordon Wood
Analwed: September 2,2005
8260-S.MBTEXN/GRO463 West 3600 South
Salt Lake City, Utah
841l5
[phone]
1l Free [phone]
Fax [phone]
lil: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Officer
Units = mg/kg-dry
Dilution Factor: 2.5
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPHC6toClO(cRO)
Surr: 1,2 -Dichloroethane-d4
Sun: 4-Bromofl uorobenzene
Surr: Dibromofl uoromethanc
Surr: Toluene-d8
Reporting
Umit
0,0055
0.0028
0.00s5
0.005s
0.005s
0.0055
0.055
72-131
76-126
7o Moisture: 9.2
Anal)rtrcal
Result
< 0.0055
< 0.0028
0.0069 B
< 0.0055
< 0.0055
< 0.0055
< 0.055
110
94.9
75-tt9 94.2
84-t 19 98.0
B - Toluene detected in MB VOC (run912/2005 8:49:00 AM) at an estimated value between the MDL & PQL
at 0.00076mg/kg.
Sample was received with headspace.
Released by:
Laboratory Supervisor Report Date: September 7 ,2005 page l0 of I 3
ORGAI.TIC ANALYSIS REPC^ -
AMERICAN
WEST
ANALYTICAL
LABORATORIES
Client Hadec of America,Inc.
Collected: September l, 2005
Received: September 2,2005
Analysis Reguested: SW8260B/5030A
Lab Sample ID: L67536-04A
Field Sample ID: #9 Dispenser Island
Site ID: 4104 Riverdale
Analytical Results
Contact: Gordon Wood
Anahzed: September 2,2005
8260.S-MBTEXN/GRO463 West 3500 South
Salt Lake City, Utah
841l5
[phone]
,lt Free [phone]
Fax [phone]
ail: [e-mail]
PeggyMcNicol
QA Officer
Units= mdkg-dry
Dilution Factor: 2.5
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
I?HC6toClO(cRO)
Surr: 1,2-Dichloroethane-d4
Surr; 4-Bromofl uorobenzene
Surr: Dibromofl uoromethane
Surr: Toluene-d8
Reporting
Limit
0.0058
0.0029
0.0058
0.0058
0.0058
0.0058
0.058
72-t3t
7G126
75-tt9
84119
7o Moisture: 14
Analytical
Result
< 0.0058
0.031B
< 0.0058
< 0.0058
< 0.058
111
95.9
97.3
98.2
B - Toluene detected in MB VOC (run 912/2005 8:49:00 AM) at an estimated value between the MDL & PQL
at 0.00076mg/kg.
Released by:2
Supervisor Report Date: Septembcr 7,2005
Page I I of 13
Kyle F. Gross
Laboratory Director
0.0038
0.022
Client Haztec of America,Inc.
Collected: September 1, 2005
Received: September 2,2005
Analysis Requested: SW8260B/5030A
Lab Sample ID: L67536-05A
Field Sample ID: #I0 Dispenser Island
Site ID: 4104 Riverdale
Analytical Results
ORGANIC ANALYSIS REPO^.f
Contact Gordon Wood
Analrzed; September 2, 2005
AMERICAI\I
WEST
ANALYTICAL
LABORATORIES
8260-S.MBTEXN/GRO463 West 3600 South
Salt Lake City, Utah
841 l5
[phone]
ll Free [phone]
Fax [phone]
lil: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Oflicer
Unib= mg/kg-dry
Dilution Factor: 2.5
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPHC6toclO(cRO)
Surr: 1,2-Dichloroethane-d4
Surr: 4-Bromofl uorobenzene
Surr: Dibromofl uoromethane
Surr: Toluene-d8
Reporting
Limit
0.0057
0.0028
0.0057
0.m57
0.0057
0.00s7
0.057
72-t3t
76-126
75-n9
8,tl l9
7o Moisture:
Analyhcal
Itesult
< 0.0057
< 0.0028
0.12 B
< 0.0057
0.12
0.0066
0.28
109
95.2
98.9
12
96.9
B - Toluene detected in MB VOC (nn9l2/2005 8:49:00 AM) at an estimated value between the MDL & PQL
at 0.00076mg/kg.
Sample was received with headspace.
Released by:
.-Z' uooratorySupervisor ReportDate: September 7,2oos
Page 12 of I3
ll analycis applicaue to tho CWA, SOWA and RCRA q,! pcrtormod ln accord.nca to NETAC potocob. Pcrtin€nt !.mpling inbmaton i! locrbd on th€ ettrdrod Ghelnof4ultody. Thi.
Client Hamc of America,lnc.
Collected: September 1, 2005
Received: September 2, 2005
Analysis Requested: SW8260B/5030A
Iab Sample ID: L67536-06A
Field Sample IDt #11 Dispenser Island
Site ID: 4104 Riverdale
Analytical Results
ORGANIC ANALYSIS REPL".f
Contact: Gordon Wood
Analwed: September 2,2005
AMERICAN
WEST
ANALYTICAL
LABORATORIES
8260-S.MBTEXN/GRO463 West 3600 South
Salt Lake City, Utah
841l5
[phone]
ll Free [phone]
Fax [phone]
lil: [e-mail]
Kyle F. Gross
Laboratory Director
Peggy McNicol
QA Ofiicer
Units= mg/kgdry
Dilution Factor: 2.49
Compound
Methyl tert-butyl ether
Benzene
Toluene
Ethylbenzene
Xylenes, Total
Naphthalene
TPHC6toClO(cRO)
Surr: 1,2-Dichloroethane-d4
Surr: 4-Bromofl uorobenzene
Surr: Dibromofluoromethane
Surr: Toluene-d8
Rereased ay:Q/ ) *-=r-
Repoting
Umit
0.0055
7o Moisture: 9.7
Analytical
R€sult
< 0.0055
0.0028 < 0.0028
0.005s 0.014 B
0.00ss < 0.0055
0.0055 0.02r
0.0055 < 0.0055
0.055 < 0.055
72-t3t 109
7G126
75-tt9 94.5
94.6
84119 98.7
B - Toluene detected in MB VOC (rw9/2/2005 8:49:00 AM) at an estimated value between the MDL & pQL
at 0.00076mg/kg.
4t{Auuro.y Sup"*ir* Report Date: September 7, 2005
Page 13 of 13
ll analyals applkebb b tho CWA, SDWA and RCRA ar! portofir€d ln accordanc. b NEI C protocol!. Pardnont tsmpling inlbrnaflon ir locabd on lhe .tbch€d Chalnolcusbdy. This
08/23/05 LL:20 FAX [phone] DEQ DERR @ oor
TRANSMISSION OK
0837
18013997170
t
I 0r
00lt
*8t***** 8**** *** rB ***:8
*** TX REP0RT s**
***ss*****s*8**s***s*
TXIRX NO
CONNECTION TEL
SI]BADDRESS
CONNECTION ID
ST. TIUE
USAGE T
PGS. SENT
RESULT
08/23 11: 18
02'27
7
OK
JON M. HTJNTSMAN, JR
Govennr
GARYHERBERT
bculenaat Gwernor
State of Uah
Departnent of
Environmental QualitY
Diannc R. Nielson, Ph'D-
Eficrttlrte Di,ector
DTVISION OF ENVIRONMENTAL
RESPONSE AND REMEDIATION
Brad T lohnson
Dlrcctor
Date:
To:
Agencyl-Firm:
FAX Number:
From:
Pages to FoIIowr
Comments:
6 -43 -e \
FAX CO
t-\ <-.-1*t'
to t -jqt- -+[? o
7h,a/q gurte t-(q
-*oq- Fm
{,
Loo
do
#^r-
l'{,ra
r#ff,1
_r,a
nt
State of Utah
Department of
Environmental Quality
Dianne R. Nielson, Ph.D.
Execalive Direclor
DIVISION OF ENVIRONMENTAL
RESPONSE AND REMEDIATION
Brad T Johnson
Director
Pages to Follow:
Comments:
[ -43 --o \>
JON M. HUNTSMAN, JR.
Governor
GARY HERBERT
Lieulenanl Governor
FAX COVER SHEET
z-\\
Date:
To:rlw l,l
Agency/Firm:
FAX Number:to t - jtt- -+[? o
il er-fl-x l'
From U e
P!r2,44 Tna /,{z gut/,Q- U qc ff"fuilh
h Zoa oq - /7a7
E,q./z #"8
/-fir4 C/o r-t w
'(r+lC,+Stzt Dlir<-A [xi,,Lr€ rvl oura
e*c ,A o T har({o ryl4a /*carrrz
Att% nta,W ar,"<! adoUu/4a 1 ^0?il/4 fD
eth
s
G t ,s U Q nnz Qrurq Nu /t//4
It 5 ?q Scw+w LAlt€ DRIUL.
flAN Dtego, CA Ql t31
X lLb tu 00 -O
dortg {A x-/A 80t "q 61 - 2632
I 68 North I 950 Wesr . PO Box 144840 . Salt Lake Ciry, UT 84 I I 4-4840 . phone lltnh!
T.D.D. (80 1 ) 53644 1 4 . u'ryv,.deq.utah. gov Whcre irteas connecr-
I
C.,
Tuesday, Augus' '3, 2OO5 9:22 AM
l.A{:n.,1'l:Y. lN}'oRMATtON
p.01
NDERGROUNI)SI'ORAGETANK CI,GURE PLAN {rev. f,/, 03)
LHDUSEONLY
'rte Rcceived
cvlcwcr
retc LHD
)alc rnailcd io Strlc
:losurc Plan al rhc of thc o (i&irtified
*^:,",?;y,rj Dg{hr1 (
t'
0
STATE USE
X->- -o
Date.Mdlcd prrp 3-23-o1=74 aidf7
Revictlcr/Dak Approved
Mgr. RrvicwDotc
,t
\ddrcss
Trrir Ogncr
s{rlc
Addrcss
Nem
Addrcss
Contncr
'I'rrtal numbcr of
T()hl rlbmber of
s--
\ Contractor rnay prcpaE lhis ck$u.c Plan ut thc (rtprr/(Dcrdork lgent- lo prcpffing.thc closurc.plan,lhc conltaclff must sct with
he owner/operater's kffrwlcdgc srtd itpproval.. 1.hc owner/opcraror m-usr Sgn itrc€losure plu.
.'his ClosurE Plail h sobmiltcd in compliarrcc wirh thc rcquircrnents co rincd in40 CFR 280.Subparr G ard R3Il-204 ru.A.C.)
L f-
lanks at lhi:s sitd
rxoks at lhir sitc.closed . -J
)
>tJ c-PhotE #
rilN zey.[tL ]6EFE-SCFffiE
"lrnnn Jot-t1g,ot+3
f] parrrership E corrxrration
ziti{cbft'i.r dcJr.)S,,,1"$*
zio 8tL 4o €t\A GitY.Alue\r&[.r srarU{-
ptrone.* to/- Y7 q-o'/t)
\r /
*\";./N.-/
\-N,4?t-\t\y'-z /-&sa3
tbAr"\oA'a l)tro.4i6G\A&\GAS
/\-F G<
\\cr,r,ro,,.r.I
NEIITrnl.I
FRP
I)arc lGrallcd
S$hslrrlc str'rcd'
lhtc li!.t
Rcnr)vcd/h Plac., (-'lrJntc in
Scrvt'c (C
th" ilhcific srt6rrrEc rr.ft{ iD.r.nri Enl to h. (t{cd lrrTrl.lr. lml..drd, (lk-scl. yrrlr; oil. clc.)
lbr F&slc oll lsnLs: llavc dcgrclsing (rt lylts rrf solvctlls lx]cn skrnxl or mircd wilh lhD s,astd (!il?
N"E Nu Krrrwn EYer (idcntify if.knewo)p
(lisrnrsal ficiliry.)
DERR
ENYIRONITET{TAL RES'01159 g 96;150' ITION
ENTEREO
nlaod
Ptw
t-o
orJeD
/*/x ow\ k,/,b #- 3* i g arLb\
Qt)/y1^)vD. "fkwb ttA I ? +Are 2 3 zot5
urLll -nof L4
ONLY
Drle Rticcivcd
Datc Rcceivcd F om LHD
l\,<-no/ tASSc,r^
Ae-t4OWd
Tuesday, August 23, 2005 9:22 AM 80't-967-2632 p02
TANK \ssREMOVERName
SOIUGROUNDW,
Address
Name
|efore'lhc closure'planis su-bmitled fon rpprov{ rbe hcal hcattb and tire dcpartrnonts where rhc frcility b .ocatcd must bcnntocltd' ffthitaeility is m lleavet,'carbon-fuuir, En rr1, oadield, Grod. lron, Kanc.,$alr t.alc. fuaJuon. wasarch, or washington coantv contact)ERR (I[ST)ot {80I}Sj64I@ instead.olrtu.tocal AaUn aiaii
Cert.#D46 lo'y' -a tt
C.
38
Ptonc fl
s'rvS&+ A#-,Smrctr ap 8*rlr
Cert. # Glsdt 2 lr{c Phorc* 8o(-z-
Stat UF Zilr.{t Ar
CONTACT LOCAL HEALT}I
Contact
CONT^CT.LOCAL FIR"E tlEPT. Name of
Contacl
Dts-tD()sAL.
be al: Facil
Addrcss
of Dist.
(J
vP
-<) )
Titlc 7-7todPhona# 3
Datc
Title
"'/ -'7 tAlPhone#
city \Ar-$- L\c{-t Srac Ul--7ip
Conla('t
Phonc#
Producl lincs will cirher he:removed ilr clcaned, securcd iri and
rem<lved or ord.sccuredVcnl Hnes will eilhcr be:
willtr
Addrcss cit State-
Contacl.(s/Ptrcxrer
will hc Phone#tfi/
\,will be.eleaned L u\al: F-aciwill be(irnlilnrinilted walcr in thc llnk/rinsare
J.[oContacl Phone#r
will bc:(lr inert thc
Re'sirluul will be it thc
A<klress .Cir State
Conlacl Phrtefl
FOI{ C]I-OSURE IN.PI-ACTi ONLY
has bcen I Fircftrrlhc
f ire Phone#Contact Date
closure has beenftrr Lt^-ul'
C'rrntact Datc
)
Tuesday, August 23, 2OO5 9:22 AM 801-967-2632 p.031
:ASSFJ.SSMENT
Anotyticet Metlrods for. Environmenlnt r9ampling at Underground.Storagc Tank Siks in Utah
irll,wing nrodilrcatir:n*to ll*sc cc'liticrl mclhrxls are t'on11<lurll lccr.pabtc hy thc.tixccurivc.sccre!ilry (rrs,r):f)ual colurnrr trnlirmarion rury n., tc ,cquiJ i,* Tpll anrl aTEit,,/Mfli'i aoaly.sis.
nrganics (Cto - Crlr).
Hcxaoc nray hc uscct as an ctlra(ion solvcnt. .rsilit: Gcl'l'rcat'Dcnl $(ir) nury'hc used inthc dcrcanin,ti.n.f rrrlat.Recrrvcrablc pcrrolaum l.ly4nrcartxrnx..
I: 'l'hc samplc prcpitralirin mcthid,rxl any mtxlilicati'n(s) r, a ccrtilicrJ meth(xt musr lrc rep(rrlcd by the lahrrar'ry
;Ttrilfitfiliff^ti*H.lHliy,il;:'iffi5'tr-,i#;:"#fit,Fn:TJlg,:Jx?:Lr#:,ffi;:::1,,ffi:,...1r
likclv to be prcscnt' If groundwar*;;;;;il.ed. a soii il;il;il cottecrcd, in ttre un*Lrabd zonc, io additioo ro cach
rdwater sample' soil and groundwater';;;i;rtr ue anatyzcd.i;;;;*.p"unds shorvn in it. rotrorring table, using approprjarc r'b
ods.
3
METIIODSI
Subslarrcc or
Product Type
Contarninant Comoounds to be Analyzed for Each Subslarceor Product Typc
.Soil, Groundwatcr
Gasoline
Erhyt benzene,Naphtholcnc.and.
Total Pctrcleum Hydrocarbons {scgetbls TPH as. gasoline
EPA 8Ol5B or EpA 82608
EPA 80218 s EpA 82608
f)ieseI
lllg+!-r-c_s:
Xylcncs,
Total Petnrlcum :Hydnrcorbons (ex{roctnble TpH as diescl
9rq:-9r-)---.__-
Benzenc. Tol ucnc: Ethyt bcnzenc.and Nsphthalene(B',t'tixN).EPA 8o2lB gEpA 82608
.EPA.8OI5B
EPA 8O2lB or EPA AZ6OB
EPA I6E4A or
EPA I(64A
Oil and Grcasc.(O&G) or.
(.MPIPctnrleum.ll,T0lal Rccoycruhh EPA 1664Aor
EPA (SGT*1
Other rtfTypc wilt:rnalyr:es te'bascd thculxtn substarrc ()r pmdrrct'andrilored the Ercculive Method will bc'bnscd uplln rhe
substancts or
'l'trto| Petrolcum. ltydrcx.artxtns (rrrrrrctblc TpI,t :rs dicscI range,nrgaoics ('1p - Cr*)
Benz.r:nc.'lfrluene,
(81'r!XN):benzcnc.Ethyl Naphthalcnc
C<rmlxrunds
'lirtal lrclrrrlcum t Iydnlc:artirns (purqcnblc 1'Pll as gaxrlinc
19_ngg-r_r1g;r-n-i.c_s_-t]c__-eLn)
Xylenes. andand llalogenared Volatilc ()rlranic
l;PA EOISB txIrPA 8Z(l0B
.GI.'A 8Ol.5B or.liPA B2(rOB
til'n 8O2lB g EPA 82(fB
.Benzenc.
Used OiI
New Oil
Unknown.
Tuesday, August 23,2005 9:22 AM 801-967-2632
1
ll materials getrcralcd from UST closures musl be managed and disposcd in a rnannerthaldoes not.place those mabrials in direct conloctith thecnvironmenl- On-sitc stockpiling of contaminated sOils may be-rcquircd prior to-any soil msrenvdialassistancca
Contaminatcd soils
Address
Conuct
nagerncntocti vtlies _ A n y pcrsonaetation arrd ovc r-etcLvdtiott otore'tlun 50 t tus/, be a
of removal are to be al lhe
Consubont.
)omplelc rhe Ftrility sirc.Plrl and slmplc lnformatbn Trblc on pages 4 and s to providc sit'e essessrrcnt informetiorr-
;ONT^ M INAIKIN INT10 RMATION
t contlrminal'on a( the fTillt is lgspc'c-'t:El or gQ4lEgd' thc information must be raported to thb Exccutivr secretrry (usr) at (gol) 536-'!fi)'within24'hours- Thc Division oiGIcr duritv m"sr bc ntxified oi tmrl53s;I46 itFrcc prcducr is cncountcred or,ifsurfaee warer
lhlffi;f*cld' lf contamination is confirmcd' *y p"r"on;ti.;;li; rhc iemediririon pnxes fora fec mrlsr bc a.ccrrincd trsr
Jornplete rabtc fr:r allsamples to be taken ,*
ciry State ?p
Phonc
Sample
s
Subslanoe .
stsred ln.
tank.
Sample
lypet'Depthl Compounds3 Analysls method(sf
,Gls 9S U\.IZW 6Lt:ilfi .-t bATJGASS>
.\4Lfi
LL ,l
5 GA>ss il tuor L(A
{-(64>.ss '4<vtrr l.tl ot t5GASs-s il-ruFa C(,6-hs €5 \-t tr Eots-h irl*A-l G.^S SJ a-u pr
_(t ll tl tt
2 eus 5'3-v fr ' r(L(t,l/I( lrq6asS5f,-yrr v{u tl c( t(t0 6As 5'3-{ Fr
L lt u L( tttl@fl'tr)h-( r--I Lr Lt 1ttaG){Ac s6 j-u#tr S.C
I l ltll.l_stt91lq4.walgr (6w).,rr Uhilicd Sriil Ctassification_(USC).
3 (onranrin*r.c'mp,unds ur lic qnaryzed roicacrr iiiiiiiiilii"-*rdG.I'.';:'ri:'4
^ppropnatc anatysls nrcllttds for contaminant conrpririul(i) in clch.sarirpic (frrrm rrhlc.on p -3).
4
p04
,r^l\L'tt
tl vl t,tL
4
l$*.B-ldA\l^Sa---ffi--
r(
LT
IrLl
Tuesday, August 23, 2005 9:22 AM 801 -967-2632 p05
^
e siE plat must be drawn to ao appropriatc
'cr rel:yanl information. T"rk al;;rnd'xure PIan.
:r _!'ad[fySiteplaa (Closurr plerr)ucntiliod scate- Ir musr'.si;;;;;ncj-slmpring rocarions, subsranc* ilorEd in ranks, andtdcniifigsliorlnurnbers musr be'consisrcnt Gur-itre information givcn on p, r and 4 of the
North
fi
Scali: I Fcct
pping run
(estimated)
TG"^k-* l = t0 Y- Cttl,ll tovno-l
Toa"t*3 . lI K_ iirnlec..leA L*o &IornouTon(#{ = L( (- Nrar{ C,r:,ll rgme_l/\ )'tanfl 5-- G K, ^( rc) ir{ il.,r-l )
trSFs
rc bcLtma0
oelcrrrhrQ]v\
R,U$Nql N
fl^!r,crL/-
WfiNED
rnrusrrI l,r"
l{r,tov
K*
J,
,]J
dirpenrr islands
F
*b
^rN
a
,j
iemplp laarioas (SS-d. WS _{, USC-# )lonilrring, lVells (MW-fl .lioil txrriog (.Stt-0). or (irxrprobs BorinE.(Cp-#)
Watcr
_Wdll.,i (rJorrc.stic. tiyest,rk, etc.i "
r I .5 u rfirr'lhprgrapt ry : f N, f.r W ; iV S fir. S.S li I :.. N E rJst' tu Sitc: _Rcsiuenrial _C"-ro"r.iai:-;;;;#irxiingtand:_Rcsidcnrhf C,rrr*i.irr--iill#;,
Sit'c l,lat Murl tndfu.:rle Approrimatc l.ocetinrs (X:y'.(turrc-nt & firnrrcr raik.*. pipine t;;#r;rr--''y'- l-ocatkm of atl sanplcs ro hc.rikcn .rz llrriklinps..l'cnccs. & propefly hrundoricsv t,lrltly conduits (.sr.wcrs. l!&\, wulcr. stornr rlruins,.elcc-tracaj. rlc.)
Tuesday, August 23,2005 9:22 AM 801-967-2632 p06
flow direction:
to bc'used:
in lhe of the tanks:2+.r.
OLr-"5f S>
a'$y2 a-f.ate Certifiad
ddress
onlact Person tt
'ctrv St r*,l
Stat Ld-%e6*tLc
Phone L+Z - &8 t
lcase unusual or circunrslanccs the site asscssment ot closure:
:crtify.under ptnally of luw tbtl I ent the owmr/operulor of the brrk(s) rcfctueed above nnd lhlt I ru famillrr with the
firrmotion on thb form lnd &sf il is lruc, accurole end comphte, and'further; thrl lhcproeedurosdemribed hercin will bc followr{
rring tanl cbsune.
Si of tank
Full Name of rank owner.b""S/Fo{
(r
1
Friday, August 19, 2005 3:56 PM 801 -967-2632 p.011
Date: gltgl2OOs
m%v,
bcN-
q
Attention: Victor Scherer
Company: Utah DERR Number of Pages: 4
Fax Number: 359-8853
Voice Number: 536-4100
From:
ComPany: Haztecof America, Inc.,l
Fax Number: 801-967-26A2
Voice Number:801-968-6632 e 0
g,T 3'
Subject
Eii"i R0NMENTAI RESP0NSE &l;REiil[DI,X,TION!:i:sn
DIRR
EI,IT
, 9 2005
Comments:
Y to'n lp- 3t { '( ' l'4 {'2zr'"
t*h 4 4rl /-/^/e,tu*'J-
,fu / € Cfr/n dt4-t-, O{/
ilury
o"'f
I
Friday, August 19, 2005 3:56 PM 801 -967-2632
rrNpElRcRouND'SroR/lcE TAIIK CLOSURE NOTTCE
TEMFORERY CI,(}SURE
p.02
^
(Reviscd/fln@.Facilily
TcmpmryClorue or,ne/opcrator{belov):by G^a&",rf C--La-qsod
of \q)# ( 8!t-Tt"N44.a3 z
Address zip 9+tg
UST vuoneerfcf I *7?,a*iG
t I solc {l { I corporaficrn
(]c,)S.c*s rl $qil"\rt-.- ap 3*@
Fedtsty
a
CmlaEr p€i6on Phorrc#'
N&rrbcr of rcgulatcd f&i af frc fucitity to be tcnpomrily clowd:
Number of rcguhtEd .terl<s d dre frcilit',:*
Ce,tl &{"') e.l-G2eo
TETfi'ORARY CIIIS.UNE REGULATIOT{S .
I &r UST syctern emprarily ctosod lcrr thal 3 moilh$ must: .O continrn qpgariorr and rnrintcnance of comosior protection (if any) on tanls ad lim$ .19 continuc opqration ard rmintcrrsnce of relcase deiection or ernpty tftc.thc UST sptern to lcsa thao. I " of product.
.]t fui UST slrsfffii enpotarily cloecd 3 months or morc must:e conthuc ope*rliotr ana ruintrrance of coriooioa protection (if ily) orr tar*s and tincae ' continue op*ation and rminbnarrce of reltasc dct;ion or cnglr ttrc thc UST sfistcrn to loss tlrarr l. of product-o ' leaw vcntlire ry and finctionitg
"rd -p -d ;;ai orrrer lincc. punrpg, ramuaJ6 urd msilhrye$ipnurr.o ' scod a poperlv einplct a rcr@ora; Cloeui f"rar,oG oeRRruST section.
1/ USTs (urb'and lines) withort propcr corrosiqr Fo&c6or rnay rrnain urder tcnryorary dosrc alrhr5 for up to I2 mords.Beforb tte eod of t+ic clcrrc ocrioa,O ' ths tadcs'nnrst Ue perninemly ctciscd, orCI a sib asq 'qrrerrt rinrst be pe#orrnod ririd an crusioh of ilrb c-nrporary clocure strfrE rEquesilDd from the DERR andap,pmad.
t/ An-UST syem ternporarity cloeed for more thur I 2 monlhs must be upguded wi& errosion protection on tanks rad tinps. andspill and ovcrfirr prcventioo befqr' the tanke can bc brought into use.'
I J Fui{ was aoptied- [ J C-orrosioo proloc,tior is oncrating [ ] Relcase detectbn equipmg t is oporating;. ,
,"-t00t?
Friday, August 19,2005 3:56 PM 801 -967-2632 p03A
Br6ndon
,\.
80 1 48757S5Rug l7 05 O2:37p P.1
TAN KE TBilPOBANILY CL.[,6ED
. baLah ar Ftt!<ralrrrtrlr-tr c.l lltt!r do,ca(rqdrrtslrr&a ailrL rnlSr[rlri
r ttrr:rgrrtll1.cl
Fa Tungonry Ctollra gf 3 rtronth, at mor!:
B:lorr ll aonlbrthc Ufir)rltlbe [ ] Pcnruco$ctced I I Ncr/Upgndod I l E*Gn loa
WTtr
lfancrrllrlonolrlrc t2nrnilrronpontyclon rc italqucicdrcotnpldcrhcsltoArrouranlprlbnrofdicUrdirg ourd Stong.Trn\
PcrDrrnGnl Cloturc ttotlc (rvaltablc upon ,lquctl),
I cartily urdcr palrlgr of!.e lhil t .D tho Otr.. Dl.tD. 3t!t((a, dlrcrlH rtirG .trd llll I ro hnlllrr rth llc lafororrlo,\
hlbrcd durlng'acGul!lc rrd corpho rrd llrllen tld ah Drooldlr!! d+tctlDod brcb rcrl
tml:lornra
f1eie""t *usr
ftrll rlrmcolOrnrr
I(crutaco'nDbqiTcEDonry Cloqn Naicc hrr tc:
Strtc of Uoh DGAL of Envlrmrmd Aorny
DMrion of Errvircrreofrl lcrponlc rnd Rcn*dirrien UST llccdoa
l6t Non r l95Olfotl l|l Floor
Sttrtrk el.:r, lrr.t} LtE
D.t.
TrDkf t 3-_^I +s
Drll lnssllcd tsE( e ffi"'tffi':wkll u#{'s t
Crporlqy tolooo loztru,h';n &t-d /rb
Sutrlrne riortd!GsS GEs 4s Ar..aSeL 6hs
D.lc lrtt oDd.t d
ttrlLr of produat
nnreininrh rtdtt ffi1',ffirA t-€.s-
+d{rl i a
L-?65
lgaN,'l I"FSS+th! l't
Trnlt I :.ts L
Crpped/Sccund (Y/N)
liacs
DumDt
rfnu'.lni
YU
=
+Y\.r+_a+L
Vcnt Uncr ooen (Y/N)v v v Y Y
t/t'd 9080'olt sllllvdvi09 )toil'{vH t{d{0: I q00z'tr'enY
I
Friday, August 19, 2005 3:56 PM 801-967-2632
,\
HAZTEG (tF
AN/|EFIIGA; INC.
PROVIDING COMPLIANCE SOLUTIONS SINCE 1989
Certffied Tester:. Gordon G.Wmd
Ceilification Numbor: .UT 0280
Explratlon Date:
Test Date: August 15, 20(E 1:57 PM MDT Tester Signatura:
Test Rsason: ! .3, year f! e nmntr [1. retest afier repair sio Oay
GP System'lYpe E Galvanic EI tmpresseO Cunent
p04
t
I
t
TE
I
GITIIOBIG PNOIEIIII0il
Itsr n[$11T8
LocaUon: . FomerTri"Mart Chevron
4104 Rived* Rd
Ogden, Utah E4405 .
Test Rdsult:
ffi Pass ! ra
fl 'lnconclusive
Test Crtterla (vs. Cu/GuSO4):
[J -aso mv'ori n -eso mv off
fl toO mV polarizatiron
SchemaUc of UST System lncludlng Test Point Locaffons
anrl Readlngs Ys. GuiGuSO4:
fail
Recffier M*e/!bdel: C*odall FSAYSA 4G5 N
Rated Outprt 40V/5A Serial No: 94FiI231-
Found Sathg:ofi Me.asuled OulPUt.
Leftsetting: 30. Measurd Otpuk.S.MV/4.36A
Hourlrleten nla
Anode Shunt readirqsin DCAmps ff4flituble):.1: 2:, 3: 4:. 5: 6: '
7: 8: 9: 10: '11: 'lZ
13: 14: 15: 16: 17: 18:
.Test point\A\*su4t\-.#o
Vts
Resulb
-0.885.
-1"065
-1.'44
4.877
-0.888
-1.761
-0.995
-1.020
-1.759 *..r-1.050''-'/.
*3" *(
REGI.IIR
SUPRET'E
REGIXIR PLI'S
<d,lL
(u+
{-'il"
+j #rt
OIESEL
#8
*11
#14
-0.945
-1.166
-1.122
-1.089 .
-1.280
1
NoGs:.Tno severed arode leads and'one sfructure lead were repaircdpiorto system'reaclvation and testilg;
No ins{ant off potenfels uere measurcd at this time. .
At time of cathodb.probotbn.system repairand testing, the dbpensers wera beilg pmoved from the
istands atttis locatbn.Ihe hrieadenrinoslanks are-sdreduhd to.be rcmored..Sub putndpBttg
measrrcnenb nete not.Eken asthe fralirgsystem isgohg to be repi@ fullowirg demolilbn and
IffiI ffil8itffiil*,"f"'S,HXllkffiH tr
il10
#11
#12
fl3
fl4
*15
iffil ffi
ffi
#1 {:2 *3
07 /20/05 15: 09 FAX [phone] DEQ DERR @ oor
v\o \3'17
unc^
*
u
****8*****+***8******
r#* TX REPORT ***
**************a******
0730
N g^^I fi&In4,\
'fif q()B
Ld\
itsgq
U\ kE be
qn Drego r Cc.
aar3l
State of Utah
Department of
Environrnental Qual ity
Di$noR. Niclso4 Ph.D,
E*allvc Dlnctot
DIV]SION OF ENVIRONMENTAL
RESPONSE AND R.ETIEDIANON
BndTJohrsflt
Dirvrq
Date:
To:
Agencylt'irm:
FAX Number:
From:
Plges to Follow:
Comments:
TRANSMISSION OK
TXIRX NO
CONNECTION TEL
SUBADDRESS
CONMCTION ID
ST. TIME
USAGE T
PGS. SENT
RESULT
')\A
IA, I A $l\{a -oq bq l*€ b '.
Nor. [*rr
TTwp Ulos,,rr JU"r.
Kcvnse&\tt6i:
18585781295 c-D t-c,a,tr^- bAf
F*,^"\ Y\ P O [tcJ ',n
Ou*rn r"-,r. l[br.-o. pw&tr n
o.t\ Sl-'.ko lrY\+-rn^,,$ol07/20 15:04
@ ?*{otm in1 g$ [6-+rn \
Q?o^.uor A tc,"/^tc&1r0 \ac,n
t\
State Utatr
rNi
ot i
i
,l
I
I
I
)
,ot.IM. HUI{NI(AN,JR
Govcttw
OARYHEIREERT
LhucrriilOowlrtat
DEPAXIIIR{T OF B{VIRONMENTAL QUAUTT
DIVISTON OF EIITIIRONMENXAL RESPONSB
AI{DRET,IBDIATIoN
le Nonh 1e5O Weer - tC Fbor
P.O- Bor ,l44{l,to
$n rrks ct Ltbh a.lta{tlo
F
*
Yictor Schcrur, pG.
EavLuacud SOiardr8 / Gobtid
DR
\>s
r.AX CO1IER SHEET
a-
f oFr,,.*. .\ .--.p[ t o.,,"t
1- )-ct - ('S-
tc Dtto,rr.r 4,w-**rJ:
0-0 {\y
ur q{
I -rl
/'!I,.
(,
{
nlL AN
a
&u
L-- . -. 0- ,t. r l- -L, .-'-I
E
L
,**
LlL
*a l" n dJrd k
oldn
t_
,l-
tl
owner Name if I z <Llr.rz. t h,4,I L,Lt, Au,^o^^,Name
Address
State UT
Contact Phone Contact
Tank lnstallation Date i/24 ltz tlzq I tt t /?c l9l rlrqlTJ
Capacity of Tank (in gallons)/ nrZ /D l<i2-1<Nt (
lndicate if tank is siphoned or compartmented. Show related tanks.
Substance Stored GA5 qA5 Ltwt- t (\, r..-/
Tank is in use.Yes ffi';i". .lID Yes @--ves e-
date last used and in tank.tn of
tank Yes .t(a Yes .@ Yes {@
----.s-^l-l--
Yes @
Material of construction of tanks 9*eel-9\'ceL-L) cei-a lr:e C
Material of construction of piping fQa P-Q.P ? rzo Dp o
Pipinq type rP D 0 p
Type of Spill Prevention device. Note on form if tank is filled by transfers
of less than 25 gallons. lf so, no spill prevention is required.C qac 5g au lqa t-eqn L
Spill containment bucket is clean, drv, and free of oroduct. water. debris.Yes No Yes No Yes No Yes No
Type 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 So 5o sc)sa
lf an overfill alarm is the primary overfill
Corrosion Protection method
marked
-tc
No
t-L
--@-,g-
Ee
--r@-- ruo-
Ec.-
Corrosion Protection method used on pipinq k) 'l,t A) lu ,rl)Wl il tll
Corrosion Protection method used on flex connectors, swing ioints, etc.At tanks:At
Enclosed containment sumps are present at tanks and dispensers At tanks:Yes A{A At disp6nsers:
v Yes {O
Containment sumps are sealed, free from water, product, etc.No
The results of the last two cathodic protection tests are available (within six
months of installation and every three years thereafter).Yes {&)
rrATank Tester UT Date volls volts volts volts
DatePipinq Tester NJdl "- X-/' ur volts volts volts volts
volts volts volts voltsFlex Connectors/ Swing Joints
Tester
v At tank
At disDenserUTDate volts volts volts volts
For lmpressed Current Systems: The results of the last three equipment
operation checks are available (required every 60 days).Yes @ r t ^/kLL lvtu Po{
]!qme of owner/operator representative
Signature:
R g(o/LPJ Slte Drawing North I
Urtt &1, kfG, CP lo,rtc +
RECEIVED
JUL - 6 2005
DEQ
Environmental Response & Remedialion
,WL o
t-?--*-.-E_
L0 k**W len"P€
I a6DNe6
N
I
r/2/oz
fc-
,uo
LaO \
{+6{-
C)
qrt
c
,0A
(m
L
generator tanks only; leak detection deferred.
tr USTs temporarily closed and empty; leak detection not required.
tr USTs temporarily closed, locked and secured.
Distribution: White- DERR, Yellow- lnsp€ctor, Pink- Facility/Owner Ldchecko8o4.doc
Utah UST Program
Release Detection I Checklist of
B-)lrrl,.,()
Phone
v has more than fdur tanks- comnle ,rm-
Number of tar Tahk 1.EAK2 -T'tfrd)
Answer the fo
.-R No
*t-nJ -J *rrr'-r/
ection Testino. Show
s
LEAK N
Method used for tanks Automatic Tank Shutdown Continuous lnterstitial Mon
Tvoe of Secondarv Containment used:Tvoe of lM documentation used:
Yes
NoManulacturername and model of
perlormance claims (third party
the
lnCircleNo for
Records on site document that the system is properly installed, calibrated,
maintenanceand tankand maintainedIM
is available Yes
Yes @dft rrr,t Device documentation is available on site (owner's manual, etc.)
6D ru
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational.Yes @
ffirv Documentation of valid testing or monitoring is available for the last l2
months. Show results in table below.Yes &
lf not in center, show tilt
lactors from the setup reDorl.
#4#2 #3Tilt: #1tffiNo@The probe is located at the
center of the tank.
v". (@_Minimum Level:/6\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
Yes NoIMSystem is capable of detecting a release ol regulated substances from any
portion of the primary tanUpiping within one month of release
IM lf observation wells are part ol the system, wells are clearly marked and
secured to avoid unauthorized access and tamperinq.Yes No nla
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).
Show resul
hiohest or,_--r
Mo/Yr
I
tank ror
#
#A\-\--A rlAr t vth .[ .P
#v)
PIPING LEAK DETECTION
Method(s) Used (Automatic line leak detector and one other method are required for Pressurized Piping):
hflquiohatic Line Leak Detector todt-ine Tightness Testing I j lnterstitial Monitoring [-
[ ] Statistical lnventory Reconciliation [ ]]apor Monitoring [ ] Groundwater Monitoring I
I .2 GPH Monthly Testing
lOther
Safe Suction Piping: Documentation is available and veriliable to show that piping operates at less than atmospheric pressure, has only one check
valve (under pump), and has proper slope of pipinq. Yes No
Line Tightness Testing, Line Leak Detector Testing:Tank 1 Tank 2 Tank 3 Tank 4
Results of last line tightness test are available: Y N Results
Test Date rh", n"." and cert. number: n r url Test Method:
Automatic Line Leak f\tor.f r noicqlq type\manuf acturer,ffi oopr pr y\
eachleakdetector /tvt-l[tecirdnicalp E-.flectronic IS-SLmpYens6r LI VY >se MES MES
Results of last leak detector performance test are available: Y N Results
Test date:Tester name and cert. number:UT Test Method:
for the
Mo/Yr
#
#
#
#
t- (((1
u)
Distributioni White-
041&gsg -882 onb 7 13,
Automatic Tank
Utah -ST Program
lnterstitial
v bv tank anv exceotions to the answers oiven in the first column.
c\
\
(
.\
)
Location Name i v u,Qzn
Address Address 4 / ., 4 -C-- ,{, , ou -/n/, lZ /
State ./,,^Citv n State UT Zio Q
Phone
Number of tanks at facility:
Contact Location Contact Phone
Tank
Tank lnstallation Date
Capacity of tank (in gallons)/ z/(/h/Q /o/(Atl 4K
L^^Substance stored *tltt I lr <b- itula*t\ tr
Tank is in use (Y) or, if not in use, give date last used tr I I Y v
ll not in use, depth of product in tank (in inches)
Current year tank tags are in place t/
I
Material of construction of tanks <]r, L raf vEl v tr,IJ
Material of construction of piping
.EbP
Nnv t b ,nn)
Piping type (,, , ^{..-,'.Type of Spill Prevention Device. Note if tank is filled by transfers of less
than 25 oallons. lf so. no soill prevention is reouired.Elllkonmtntat Response & fieIllsdiation
utsu
Type of Overfill Prevention Device. Note if tank is filled by transfers ol
less than 25 gallons. lf so, no overfill prevention is required.
lf an overfill alarm is the primary overfill device: Alarm is located where
Method used on tanks
it can be seen and and alarm is marked
r(-.
@*"
gePlglti'i! lhq,hst
Method used on piping ti/
Method used on flex connectors A
Enclosed containment sumps at tanks (subpump) and dispensers Yes @-
lndicate dates of upgrades- lining, tank or piping cathodic protection.
Cathodic Protection Testing. Show test results for each tank, line, or
The results of the last two cathodic protection tests are available (within
6 months of installation and every 3 vears thereafter).Yes No
Tank Tester l( *.-l-.. {n Date,..tt 7a Tdflt voltsI r /r\volts volts volts
Pipinq Tester Date
V v
votts volts volts volts
volts volts volts voltsFlex Connectors
Tesler
Sub pump
Date Dispenser
volts volts volts volts
For impressed current system: The results of the last three equipment
operation checks are available. (required every 60 days.)Yes No
Comments
.t Page of
l(name)//t
of Owner or Owner's d
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner
Utah UST Program
Release Detection lnspection Checklist tD
Ownership of Tanks Location of Tanks /r-
lxr- fl4xptOwner Name
//,
Complete for each tank. lf facility has more than 4 tanks, complete information for additional tanks on separate form.
.Gnrl dwv.h f{"nkS
Answer the following for all tanks. Note any exceplions in the last column.
tFt l-/Ar r- lL ,|.- t\
\
Utah UST Program
Tank and Piping Leak Detectiona flrc Method(s) used for pipingMethod used for tanks
3'o cert. available Yes NoManufacturer.name and model n
to the answer inand 'st column,
@*oATG IM Records on site document that the system is propedy installed, calibrated, and
maintained (system and tank setup reports, mainlenance records).
ATG IM Device documentation is available on-site (owner's manual, etc.).(e?- No
@*oALLEquipment used to acquire data, take readings, perform test is adequate, accessible and
functional. lnclude ATG console, dipstick, etc.
@*oDocumentation of valid testing or monitoring is available for the last 12 months. Show
testino or monitorinq results in orid below.
The probe is located at the center of the tank, or, if not in the center, show the tilt factor
for each tank from the tank setuo reoort.
Center Tilt Factors: #l #2 #3 #4
IM
ALL
ATG
ATG
The tank was filled to at least the minimum level required by the manufacturer's
equipmenl protocol to ensure a valid leak test, and the tank size is within the allowed
uDoer and lower size limits.@*o
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, and is not in the 25-yr flood plain (per site assessment).
Yes No /tI
Yes No
vtIC SIR
MTG
lnventory readings for product inputs and withdrawals are properly obtained and
recorded. Readings are properly reconciled.
Records include the proper number of water readings, and water readings are used to
adiust inventorv balances as necessarv.Yes NoIC SIR
IC SIR
MTG
An appropriate tank calibration chart is used and is available for review,Yes No
IC SIR Dispensers have current calibration stickers or proper calibraiion documentation.Yes No
or lnconclusive
are
No lnvalid
IR tu and extend to within foot of
Show results of mon for each tank for the last 12 months. lndicate
Mol/r r-rltl /)t fl-flrn-J t,/t'tAI t-i,//'*n irt{fllm lr.u 4----
#I /I p p p 0 P D p p P I0
#,2 p p P )P P p )D D a
)a p 0 p 0 P#)
#
I p p p p p
II )0 p 0 p ?p )!?))ffi-1#'r r khnra
Date of last test for tanks:Test results
Date of last test for Test results
m
Name and certilication number of tester: I '1 n , t "'LGi#Kuro h7 ?o resrMethod: f,h.=.r )t .
Date ol leak detector rmance test:
show that piping operates at less than atmospheric p
M S M M E S
le Yes Nore,
S of
MES ESE
\u
has on one check valve
Comments
Safe Suction piping: Documentation is available and
and hasr
Automatic Line Leak Detectors. lndicate type and
model number for each leak detector.
Paoe of
Distribution: White-DERR, Yellow-lnspector, Pink-Facilily/Owner
ID
tank
Yes No
,f., /r.
falRano utftdrigntn&ss Testing,rLine ueat 6etector T#ting: P rjank 2
Test lt/ethod:UT
I Itt 0 ()n
1,,1,. /) 7r,;.i7- Tesrresurts /)D p