DERR-2024-006338

Facirity p oo)oqtE,@ Utah Department of Environmental Quality
UST Facility Site Plat Page of
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UTM Northing:Easting:
Vacant
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Show locations of all buildings, streels, tanks, piping, and dispenser islands. lndicate the product in each tank. Show locations of tank manways and identlfy each:
submersible pump, fill, ATG probe, vapor remvery, etc. For closures: lndicate the type (soil, GW, USC), location, and depth of each sample collected by the certified
sampler or the inspector. lndicate the locations of any reported PID or FID readings. Qlow locations of potential receptors.
Comments
Product Contalnmont ht grltti nreort
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owner Name CALDER BROS CO INC Location Name CALDER'S GAS-N-GO .t4
45E300NAddress Address'1010 EAST MAIN
cityPROVO stateUT Zip 84605 citv wELLTNGTON State UT 2ip84542
[phone]
Number oI tanks at the facil
Contaot BBUCE BILLINGS Contact BBUCE BILLINGS Phone
Tank lnstallation Date 9/30/1994 9/30/1 994
Capacitv of Tank (in qallons)1 2000 1 2000 12000
Tank siphoned or comparlmented
Substance Stored North
l'Ltuj
Center South
Tank is in use.@No fds-") No <6O No Yes No Yes No Yes No
Date last used/depth of product
Current vear tank taos are in place.Yes fD Yes S;)Yes /ff)Yes No Yes No Yes No
Material of construction of tanks Fiberglass Reinlorce Fiberglass Reinlorce Fiberglass Beinforce
Flexible Plastic Flexible Plastic Flexible PlasticMaterial of construction of piping
Pressurized PressurizedPipinq tvpe Pressurized
-
>\Tvpe of Spill Prevention device t?i'// ArA
=T?5
rNo Yes No Yes No Yes NoSpill bucket is clean, intact etc.No r4.D No
Type of Overfill Prevention device L
-(fio N/AOverfill alarm (audible or visible) is properly located so delivery driver can hear or see it, and is clearly identified.
lree from water,etc. u) r .+#are seal t Yss (\to__r N/A
Yes No .zN/A rThe results of the last two cathodic protection tests are available (within six months of installation and every three years thereafter)
Tester
-<-
UTCathodic Protection Testing. Date of last test:
Yes No N/A Dates of last three checks:lmpressed Current System is checked for proper operation at least every
60 days and the results of the last three checks are available.
Corr. Protect.
Method
Sacrificial
Anode
1 ,/n
2 n/n
J ,fA
4
5
Tanks
b
'1
2 tl/v1
3 /trr
4
5
Lines
b
1
lnstant Off
Current Site Drawing North
2 ar
I corr"nts*l-r,t u fL ./-.+ Lo^k 7E .A3L>
{JcrtI4
5
Tank
Flex
t,
I L<
.1
I I I rnMethod: PfT-F-n) Method oK? .& N by: Df(,-- '
u I I tfio"r'1, l,/ttlo ' inspectedthisfacilitvon lD-14{z
,I T ZOl)
Disp.
Flex
b L I I orosionature: ?Y7,tt *- OJltrT
lndicate below the corrosion protection method place-for com ponent.ldentify each dispenser by pump n umbe(s).Show read ings
for the most recent test.zl/c n
^Uta,, UST Program
Release Detection I Checklist
Facilitv lD 5000435
Pase i ot Z
of Tanks t75/67 i'a:E neRR use
ComDlete for each tank. lf the fac v has more than le the inlormation a ,rm.
I I J J
9/30/1 994
A1 ,t I talt c Tar lnt
TANK LEAK DETECTION AIG
MonitoriTank method used:
Man
ATG Shutdown
Veeder Rootmodel of TLS-350 CSLD No Manitold
ATG Continuous
IM Containment used of lM Documentation used:of
@J ruo
ATG IM
Records on site document that the system is properly installed, calibrated,
operated, and mainlained (system and tank setup reports, maintenance
records). Written documentation of calibration, maintenance, and repair is
kept tor at least one year after work is completed.
ATG IM
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational.No@
ATG IM
Documentation ol valid testing or monitoring is available lor the last 12
months. Show results in table below.@*o
ATG Yescenter of the tank.
probe is located at the ll not in center, show tilt factors Tilt:
from the setup report.tSbrb #4 #5 #6
@ t'toATG
The tank was lilled 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.Third Party Minimum t-evet: ) -l)
System is capable of detecting a release of regulated substances from any
oortion ol the orimarv tanUpipinq within one month ol release Yes NoIM
4ta?6/o gto .)9lo 2 'totoMol/r 2t27 3to 2
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PIPING LEAK DETECTION SUCf,ON LTTD Piping qualifies as Safe Suction. Documentation is available and verifiable to show that piping operates at less than atmospheric pressure,
has only one check valve (under pump), and has proper slope of piping. lf all these criteria are met, no leak detection is required on the piping.
@>e
/o-*-cd
s1 3.2.1 s1 3.2 1
Cert. Number UT Test Method:
o M o MEO
s1 3.2.1 s1 3.2.1
Automatic Line Leak Detector one other form ol leak detection.
EO ME
s1 3.2.1
Manufacturer and model of each leak detector:
Results:Otl/
sL3.2.1
Tank 6Tank 3 Tank 4 Tank 5Tank 1 Tank2
Pe o
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lndicate type of test: Simulated Leak, 3 gph, .2 gph, .1 gph
(3, .2, .1- electronic LLD only)
Tester name:
Date of last leak detector
performance test:
@e o
Piping method(s) used. Pressurized piping must have an
XAutomatic Line Leak Detector.
Type(Mechanical, Electronic, Other) :
Cert. Number UT Test Method:
Results:
Q Line tightness testing.
/bate ol last line tightness wt lo-zai
E Same as above . Tester name
tr Monthly monitoring. tr .2 GPH Monthly Testing E lnterstitial Monitoring. Type of lM Documentation:
lndicate the method used: il SIR tr GW Monitoring tr Vapor Monitoring
Show results of monthly monitoring for piping for the last 12 months. lndicate Pass, Fail, lnvalid, or No Results lor each month.
1l a 3l 4t 5l 6l 7l 8l 9l 10t 111 121Mol/r
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Tro hCOMMENTS L
Ldargiro307.d@
Utah UST Program lD 5000435
of
Circle Yes or No for each ouestion. ln the last column. exolain and identifu bv tank anv exceotlons to the answers oiven in the first cohrmn
Show results of monitoring for each tank for the last 12 months. lndicate Pass, Fail, Invalid, or No Results tor each month. For ATG tests, show the
hiohest Droduct level tested for each month.
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Underground Storage Tank lnspection Verification Form Facility lD: 5000435
Owner Name:
Owner Address:
CALDER BROS CO INC
45E300N
PROVO
Facility Name: CALDER'S GAS-N-GO
Street Address: 1010 EAST MAIN
Last lnspd: 10/16/2006 WELLINGTON UT 84542uT 84605
BRUCE BILLINGSOwner Contact:
UTM Coordinates 524,436.00
Comments:
(801 374-0269
4,376,984.00 orrhoquad 1 meter lrnage
BRUCE BILLINGS
ln LD compliance Yes ln Operation Compliance: Yes
/a J Lr/rttof
Tank lD/Alt lD:
Tank Status:
Date lnstalled/Capacity/Loc:
Tank Material:
Tank Modifications:
Pipe Material:
Pipe Modifications:
Pipe Flex Connectors:
Pipe Type:
1 1 E-Gen: No
Cunently in Use Manifold: No
9/30/1994 12,000 North
Fibsrglass Beinf orced Plastic
None
Flexible Plastic
Double-Walled
Steel Flex in Sump
Pressurize Perm RD by: 9l29l2OO4
Tank lD/Alt lD:
Tank Status:
Date lnstalled/Capacity/Loc:
Tank Material:
Tank Modifications:
Pipe Material:
Pipe Modifications:
Pipe Flex Connectors:
Pipe Type:
Substance Stored:
Spill/Overf ill Description
Tank C P MeVLast TesVPassed?
Last Line CP TesVPassed?:
Tank Release Detection:
Last TTT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Min. Vol./Max. Cap.:
Max. Monthly Thruput:
Pipe Release Detection:
Date ALDT/Type/Passed?
Date LTT/Method/ Passed?
PSTFund: Yes Other:
3 3 E-Gen: No
Currently in Use Manifold: No
9/30/1994 12,000 South
Fiberglass Reinlorced Plastic
None
Flexible Plastic
Doubla-Walled
Steel Flex in Sump
Pressurize Perm RD by: 912912004
Diesel
5 gal. Spill Bucke Automatic shutofl
YES
ATG
1012511994 Homer EZY lll Yes
Veeder Root TLS-350 CSLD N
10%old5%new 45K
227,559 gtmo
1. LTT 2. NONE
1019/2006 Mechanical Yes
1Ol9l2AOO EZY 3 Locat Yes
No OtherType:
Substance Stored: Gasoline
Spill/Overfill Description 5 gal. Spill Bucke
Tank C P MeVLast TesVPassed? YES
Last Line CP TesUPassed?:
Tank Release Detection: ATG
Last TTT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Min. Vol./Max. Cap.:
Max. Monthly Thruput:
Pipe Release Detection:
Date ALDT/Type/Passed?
oate t-Ffofuod/ Passed?
PSTFund: Yes Other:
1012511994 Horner EZY lll Yes
Veeder Root TLS-350 CSLD N
10% old 5% new 4i;K
227,559 glmo
1. LTT 2. NONE
10/912006 Mechanical Yes
1011612006 EZY 3 Locat Yes
No OtheiType:
61,^2,*1
utoff
Tank lD/Alt lD:
Tank Status:
Date lnstalled/Capacity/Loc:
Tank Material:
Tank Modifications:
Pipe Material:
Pipe Modifications:
Pipe Flex Connectors:
Pipe Type:
Substance Stored:
Spill/Overf ill Description
Tank C P MeVLast TesVPassed?
Last Line CP TesVPassed?:
Tank Release Detection:
Last TTT/Method/Passed?:
SIR Vendor
ATG Vendor/Model
Min. Vol./Max. Cap.:
Max. Monthly Thruput:
Pipe Release Detection:
Date ALDT/Type/Passed?
Date LTT/Method/ Passed?
PSTFund: Yes Other:
2 2 E-Gen: No
Currently in Use Manifold: No
9/30/1994 12,000 Center
Fiberglass Reinf orced Plastic
None
Flefble Plastic
Oouble-Walled
Steel Flex in Sump
Pressurize Perm RD by: 9l29l2OO4
Gasoline ------*\
--\5 gal. Spill Buck6 Automatic shutofl i
YES
ATG
10125fi994 Homer EZY lll Yes
Veeder Root TLS-350 CSLD N
10%old5%new 45K
227,559 glmo
1. LTT 2, NONE
10/9/2006 Mechanical Yes
10/9/2006 EZY 3 Locat Yes
No OtherType:
A/ednesday, September 26, 2001 Page 1 of 1
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Utah UST P
Release Detection lns Checklist
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lndicate below the corrosion protection methods in place for all UST system components. ldentify each dispenser by pump numbe(s). Show readings
for the most recent cathodic
Site North
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nro,Jitt* vht ?T_7
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Ownership of Tanks Location of Tanks tr DERR Use onty
Address 115 E 3OO il
Location Name o
Address
Citv Proto state uT zip 644d city t,,te-/l)na toh State UT ,,, 84A*
Contact Phone Contact Phone
lor each tank. It the form.
Number of tanks at the facility: 3 Uanf r--z (fank 2)<Tank 3-7 Tank 4
Tank lnstallation Date 4-7-4+-
Capacitv of Tank (in qallons)t 2lc t2K t2k
lndicate if tank is siphoned or compartmented. Show related tanks.
Substance Stored ba5 6q5 O,'e ki
Tank is in use"(A No 6No (a No Yes No
lf not in use, give date last used and depth of product in tank.
Current year tank tags are in place.d;.)No da No 6I No Yes No
Material of construction of tanks {rep
Material of construction of pipinq fiut trKP^
Piping type P.rC;55ule -->Type of Spill Prevention device R x(l<2 L
Spill containment bucket is intact, Clean, and free of pro 6, No @No G) No Yes No
Type of Overfill Prevention device $l',uL a,4€\
overfillalarm(audibleorvisible)isproperlylocatedsodelivqd Yes No N/A
containment sumps are sealed, free frordfudrpafu!..Yes ,t(0 N/A
The results of the last two cathodic protection tests are available (within six months of installation and every three years thereafter).Yes ruo 6rD
Cathodic Protection Testing. Date of last test:Tester UT
lmpressed Current System is checked for proper operation at least every
60 davs and the results of the last three checks are available.Yes No N/A Dates of last three checks:
lmpressed CurrentCorr. Protect.
Method
Sacrificial
Anode lnstant Off Depolarized
1 Al /vl
2 1l
J tr
Tanks
4
1 At tu
2 1l
J tl
4
Lines
1 rvt
2 \l
rl
Tank
Flex
4
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f,lf
1 lr
4 Ir
9 fl
,b L
Disp.
Flex
t <P.an l^hrf nfutinspectedthisfacilitv on lO- t/r-OL
Signature:$zst,u, /h/alz.,ln--
Name of owner/operator represerrt-a'tiVii:
Distribution:RR, Yellow- lnsp@tor, Pink- Facility/Owner Ldcheckl 205.doc
ID
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Utah L-rT Program
Automatic Tank Gau lnterstitial Monitorin
LEAK DETECTION
PIPING LEAK DETECTION
! Piping qualifies as Safe Suction. Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, has
only one check valve (under pump), and has proper slope of piping. lf all these criteria are met, no leak detection is required on the piping.
Piping method(s) used. Pressurized piping must have an Automatic Line Leak Detector and one other form of leak detection
Tank 1 fank 2 Tank 3 Tank 4
@e o @Eo @e o MEO
Lr #t , tt/
Pas s-
-Ss1 3.2.1 s1 3.2.1 s1 3.2.1 s1 3.2.1
Tester name Cert. Number UT 0aq4 Test Method:
M Automatic Line Leak Detector. Type (Mechanical, Electronic, Other):
Manufacturer and model of each leak detector:
Date of last leak detector performance lesl: lO -q.o6 Results:
lndicate type of test: Simulated Leak, Qph, .2 gph, .1 gph (3, .2, .1- electronic LLD only)
d Un" tightness testing. Date of last line taghtness test:
fr"r" as above Tester name:
Results:
Cert. Number UT Test Method
Facility,D 5oort 43E
Paqe 2 of 2
Tank method used:ATG Shutdown Testi ATG Continuous T
Manufacturer, name and model of system e tLt- ks
Circle yes 6p 11e 1or each question. ln the last column, explain and identify by tank ?ny exceptions to the answers given in the first column.
Type of lM Documentation usedIMType of Secondary Containment used:
No@
Records on site document that the system is properly installed, calibrated,
operated, and maintained (system and tank setup reports, maintenance
records). Written documentation of calibration, maintenance, and repair is
kept for at least one year after work is completed.ATG IM
No@ATG IM
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational.
@*oATG IM
Documentation of valid testrng or monitoring is available for the last 12
months. Show results in table below
Noc?The probe is located at the
center of the tank.
lf not in center, show tilt
factors from the setup report.
Tilt: #1 #2 #3 #4
ATG
@NoATG
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.Third Party Minimum Level: 3Dolo
Yes NoIIV
System is capable ofdetecting a release of regulated substances from any
portion of the primary tank/piping withl@
Show results of monitoring for each tank for the last 1 2 months. lndicate Pass, Fail, lnvalid, or No Results for each month. For ATG tests, show the
hiqhest product level tested for each month.
5to6 6taA Ttod 8ta t eto A1l d-2taC 3t06 4t06 10tn6 11lO\12t63Mof/r
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tr Monthly monitoring. lndicate the
method used
Show results of
COMMENTS
tr .2 GPH Monthly Testing E lnterstitial Monitoring
tr SIR E GW Monitoring
for for the last 12 months. lndicate Fai lnval or
Type of lM Documentation
E Vapor Monitoring
Mol/r 1l 2t 4l 5l 6t 7t BI 9l 101 111 12t
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Distribution: White- DERR, Yellow-lnspector, Pink' Facility/Owner Ldatgim 1 205.doc
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Product Containment lntegrity Report
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petroEnviro sreveLyons
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788 E. 180 N, UT4064 T.rtruNpadorm.dwtrhErtdr(ool(rEzychoktaoN-volum.gl.T.nkfeft.r
Salcm, UT &4653 UT7-'t038
Ph.801.7s84716 64.1834
Fir 801.798.1868
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Utah u rT Program I
Location Name C.a Her'< Lde^ /{- 6 cowner Name Ca lrl.p.f B roS, (r. TnC.
Address Lo lo EaSl, fiainAddress ll5 E. 300 il
city Velllaa *.oYl state ur 4R45+2city Ptav,e srate uT zip &1605
U
PhoneContactContactPhone
rm.
Gan[,CankP Tank 4
-fiik-F-Number of tanks q1e -?q'Tank lnstallation Date t,-K )2kt2ECapacitv of Tank (in gallons)
lndicate if tank is siphoned or compartmented. Show related tanks.
6as O )c)e"lGasSubstance Stored
Yes NorYeA No 2/6\ No//D NoTank is in use
in tank.date last used andlf not
,fe\ No6Notr@ Noare rntankCurrent
-€Roof tanksMaterial of Lro;i pr p -Material of of LPtOSStl/2
Botr,be',
-\-
of Spill Prevention
redtfno
on form if tank is
IS25of less Yes NoYes ({6)Yes 4!to-O Yes @)bucket is clean of water
--\,4 lo, ^'
device. Note on form
no overfill
is filled by
ts
Type of Overfill
of less than 25
/6) No Yes NoG)No6) Nocanseen and heard and marked
Alarm is located wherelf an overfill the primary overfill
^\,Nan. lleon tanksProtection method JN/n
-method used onCorrosion
t-/A/o - 4nr',1,'LlAt tanks:on flexProtection method etc.
At disp€nse6:6|b ruoAt tanks:No\(0tanks andmentareEnclosed
Nodafree from waternment sum are
Yes No
months of installation and
stxarelast two cathodicThe results
three
voltsvoltsvoltsvoltsUTTank
volts voltsvoltsvolts
Tester UT Date
voltsvoltsvoltsvolts
volts voltsvoltsvolts
Flex Connectors/ Swing Joints
Tester
At tank
AtUT
Yes Noequipmentresults of the last
60
Current
are available
tr Emergency generator tanks only;deferred
tr USTs temporarily closed and empty; leak detection not required.
tr USTs temporarily closed, locked and secured.
COMMENTS
h t L
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Slte Drawlng North I
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Name of
re:
Distribution: Whitg- DERR, Yellow- lnspector, Pink- Facility/Ownor LdcheckoSo4 doc
Release Detection Checklist
State Use
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ol
Aritomatic Tank
TANK LEAK DETECTION tb[\ilethod used tanks:
PIPING LEAK DETECTION
Method(s) Used (Automatic line leak detector and one other method are required for Pressurized Piping):
I Automatic Line Leak Detector [ ] Line Tightness Testing [ ] lnterstitial Monitoring Type of lM Documentation
Automatic Tank Shutdown Testi Automatic T Continuous Mon
certification) for
No- 250 is available.
claimsVtheManufacturername and model of
or No
Type of lM Documentation used:IM Type of Secondary Containment used
No@ATG IM
Records on site document that the system is properly installed, calibrated,
and maintained (system and tank setup reports, maintenance records).
4r) noDevice documentation is available on site (owner's manual, etc.)ATG IM
No@ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational.ATG IM
l@*oATG IM
Documentation of valid testing or monitoring is available for the last 12
months. Show results in table below.
lf not in center, show tilt
factors from the setup report.
Tilt: #1 #2 #3 #4
ATG No(@The probe is located at the
center of the tank.
@*o Third Party Minimum Level
,o-lo /oATG
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 uppel?lq lgwe
Yes NoIMSystem is capable of detecting a release of regulated substances from any
portion of the primary tanupiping lryrthin one month o
Yes No nlalf observation wells are part of the system, wells are clearly
secured to avoid unauthorized access and tampering
marked andIM
Yes No nla
Secondary barrier is properly placed and
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 lite g!!9!:tng!!I-
constructed, designed forIM
(Bladder or
excavation
liner)
rth. For ATG tests, show the
8/cs 4/rs l0/oq'/"s 4/os 5/rs 4cst/cs 2/oeMol/r t%o +
--\
o#I
-Er-a#-J:4.#3 0
#
Safe
valve
than has on checkoneshowtothatlesslyatSaavailableverifiableoperatesatmosphericpressure,ndDocumentation pi pingonSuctiPiping
Noofhasandnde
test are available: Y NResults of Resultsline
Test Date
MES MESMESMESType (M- Mechanical E- Electronic S- Sump Sensor):
Manufacturer and model of each leak detector:
Automatic Line Leak
Detectors
Results of last leak detector nce test are available: Y N Results
nd cert. number:Test Tester UT Test
Mo/Yr
#
#
#
#
Statistical
COMMENTS
iation Groundwater Mon ,2 GPH Testi
P le-a <.- +o f hla f) *e<'*<
ffioaPink- Facility/owner Ldatgim0804.doc
Facilitv lD .5nna\zK
Paqe 2 of 3
tank tn
hiohest oroduct level tested for each month'
7/oc,t /ort
l
lank2 Tank 3 Tank 4Tank 1Line Tiqhtness Testing, Line Leak Detector Testino:
Tester name and cert. number: UT
Show results of monitoring for piping for the last 12 months. lndicate Pass, Fail, lnvalid, or No Results for each month.
Utah .,ST Program
Release Detection ln
generator
tr USTs temporarily closed and empty; leak detection not required
tr USTs temporarily closed, locked and secured.
COMMENTS
1o,' ll hatV el < rle Zd Lct beW
Facilitv lD 4oart 4ZS
1
of trOwnership of Tanks
!rPeulr(Jr
Owner Name atlder 9,ros.Location Name (.nl)or'< Las- r(- Lo
Address qq E too t!Address lO lA k<4. tlloin
Contact Phone
I
Contact Phone
each tank. lf has four orm,
Number of tanks at the facilitv:\Tank 1 ./<Ianr z ;>iTank 3)Tank 4
Tank lnstallation Date q-3iAc \\
Capacity of Tank (in gallons)itt i2K t2k
lndicate if tank is siphoned or compartmented. Show related tanks.
Substance Stored ba<ba<Dle sa/
Tank is in use.#6i No 6":)No 6\ No Yes No
lf not in use. qive date last used and deoth of oroduct in tank.
Current year tank taqs are in place Yes 6-)Yes 6;)Yes 6)Yes No
Material of construction of tanks t€v _5
Material of construction oJ pipinq C€€\\
Pioinq tvpe
Type of Spill Prevention device- Note on form if tank is filled by lransfers
of less than 25 qallons. lf so, no spill prevention is required.A" tkel -l
'Soill containment bucket is clean, drv, and free of product, water, debris.Yes 60 Yes 6j Yes $q Yes No
Type of Overfill Prevention device. Note on form if tank is filled by
transfers of less than 25 qallons. lf so, no overlill prevention is required.cu al )f t{l
d"? No /fe3 No /6) No Yes No
lf an overfill alarm is the primary overfill device: Alarm is located where it
can be seen and heard, and alarm is clearly marked.
Corrosion Protection. Answer the followinq lor all tanks.
Corrosion Protection method used on tanks N/u
Corrosion Protection method used on pipinq t1/ /n
Corrosion Protection method used on flex connectors, swinq ioints, etc.At tanks:Al t-At dispensers:rtL
Enclosed containment sumDs at tanks and disoensers At tanks:No At dispensers:(6 No
Containment sumps are sealed, free from water, product, etc.e"b No
lndicate dates of upqrades- lininq. tank or pipino cathodic protection
Cathodic Protection Testing. Show the results of the most recent test'
The results of the last two cathodic protection tests are available (within six
months of installation and everv three vears thereafter).Yes No
DateTank Tester r t/\volts volts volts volts
DatePipinq Tester lt / t)volts volts volts volts
volts volts volts voltsFlex Connectorsr/
Tester '*J{y/"n At tank
At dispenserDate volts volts volts volts
For lmpressed Current The results of the last three equipment Yes No
I this on
ature:
Site Drawing (North {i )
rf,
rf
CI
11IV
()
5 Ia
Distribution: White- DERR, Yellow- lnspector, Pink- Facility/Owner Ldchecko7o3.doc
Checklist
civ pfo,/,o state tlT zip A4605
e the information (s on a seDarate
-
Siqnature:K^o. /1,t/nn.M,o -
owner/onerato, nlJ,,
-rYn,,-/^ fn, //, >
Autornatic Tank
T LEAK DETECTION
al
Method for tanks:Automatic Tank Continuous testi lnterstitial MonitoriSh
Type ol lM documentation used:Tvpe of Secondary Containment used
Documentation of perlormance claims (third party certification) for
the svstem is available. Yes NoManufacturer, name and model of system: Ve q'le/'foo* Tlgl=g
nswers qiven in the firsil column.
@*oRecords on site document that the system is properly installed, calibrated,
and maintained (system and tank setup reports, maintenance records).ATG IM
1@ ruoATG IM Device documentation is available on site (owner's manual, etc.I
@*oATG console or other equipment used to take readings and perlorm tests is
adequate, accessible, and operational.ATG IM
Y@ ,oDocumentation of valid testing or monitoring is available for the last 12
months. Show results in table below.ATG IM
lf not in center, show tilt
factors from the setup report.
Tilt: #1 #2 #3 #4
No6)The probe is located at the
center of the tank.ATG
No@ Minimum tevet: Sakztank 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
The
ATG
Yes NoIMSystem is capable of detecting a release of regulated substances from any
portion of the primary tank/pipinq within one month ol release
Yes No nlaIMlf observation wells are part of the system, wells are clearly marked and
secured to avoid unauthorized access and tampering.
nlaYes No
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).
of each tank for the Pass, Fail,
Mo/Yr 'oloq t,/rt tz/"tl t/ru
^/ru 3/, u */du g/
/Or+b/uo 7/o*E/o+1/o+
#l P 7w6 0 6tLl P qst /,P l,kqa P sas P L$I)P sts't Q qq4a Q (aDs P uN/,P zstq I tSoq
#',P guza 0 ?ta P ailz P iluz P xqt ) tiTt 0 tntT P ssa+P 62ta I qtsu P 8b3;'P loko
#1 P tsas P)ttb P ast P \ABq P twt ? uso P13n Q itol PNn P tt*t 'P atq,,P t\tt
#
P]PING LEAK DETECTION
Method(s) Used (Automatic line leak detector and one other method are required for Pressurized Piping):
[ ]AutomaticLineLeakDetector [ ]LineTightnessTesting [ ]lnterstitial Monitoring [ ].2GPHMonthlyTesting
[ ]Statistical lnventoryReconciliation[ ]VaporMonitoring [ ]GroundwaterMonitoring[ ]Other
Sale Suction Piping: Documentation ts available an
valve (under pump), and has proper slope of piping.
d veriliable to show that piping operates at less than atmospheric pressure, has only one check
Yes No
Results of last line tightness test are available: O N Results fa# *
Test Date Tester name and cen.m UT Test Method
Automatic Line Leak Detectors: lndicate type, manufacturer, and model for ES S ES ME
each leak detector M- Mechanical E- Electronic S- Sump Sensor
Results of last leak detector perlormance test are available: O N Results Pa ss
Test date:Tester name and cert. number:Method
the Fail,
Mo/Yr
#
#
#
#
COMMENTS
Distribution: White- DEBB, Yellow-lnspector, Pink- Facility/Owner ldatgim0703.doc
Utah u.;T Program
i Paoe i- of )
ln the
hiohest Droduct level tested lor each month.
Line Tightness Testing, Line Leak Detector Testing:Tank 1 Tank 2 Tank 3 Tank 4
Show results of for
Oct O1 O4 O4r45p BDI 801-3?4-O30S p.3
PRoDUcr CoHTAIN'E*T SysrEr,t lxteenllv Ever_uerlox DATA CHART
Loclrron Gtr.r-/- 6z /d//lj //-
OwreR
Re,rsox FoR TEST
PERsofl
REoUESTIilG TEST
E, P. A. RE6ULATIO'{S
zA
Texr(s) rnvoLvEn
.Ceptcrrv GRADE TESTED AT AcE HerERtai
4
5
Locerror CovER Ftlt-s/vexrs punps Sypnoxr
?
3
4
I
5
L
1
srR ULT RATE DATE
,o2
1
4
H
l132.EAK DETECToR TEST 1 q
ll
i:
'xpenaaouxo HeteR
RESULTs
AccoRDI'{G To AVAILABLE soURcEs, HoRE THAil
ID
1".--_
-
FEET.
DATEResuutsRATE
2z
4
5HoRxER EZy 3Nou VouuuernicIAI{X I IGHTHESS
Te s rrR
STE
32t|
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0113
0001
YOfiS
52
uT-0054
ID--9114029
UTT-IO'8
PETROENVIRO
P.O. Box.5l365
hovo ut t4605
Ph.80l 798 5715
Fax..80l ?98 I t68
I
r--t
*A-
Jan Og 04 O4:18p BDI 80 1 - 37 +- 0309 p.5
Scos+3s
PRoDUcT CoxreiflHENT SVSreu Irreantrv EvelUertox Dere CxaRr
Loclrlot - 6t /dil
ta at
OWHER
REesoX FOR TEST
PrRsottRrourstl16 TEsr
Taxr(s ) INvoLvED
E. P. A. REGULATIoI{s
Fu,,a
Clprctrv GRADS Tesreo er
a
a
a
t
,
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a
ta
aI
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Aee HAteRtai
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Locettott CovEn Ftut-s/VExTs Put.tps Sypxoxe
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5 4
Pu o"P.*tt &'ry:
AccoRptxe ro AVAILABLE souRCES, t{oRE rxntt _ FEET.
ID Resuurs Rere Dnre
L
1
2
3
.EAK Derecton TEsr 1
.NDERGROUXD HATER
Rgsuurs
52
1
2
,q
5
Sre
,2q
i{onxeR EZY 1Nox Vor-urterR I cTnxx Ttentxess
TesreR
0
Co-0001
uT-o054
Io-9114029
UTT-10'B
YOflS
52
PETRO ENVIRO
P.O. Box.51365
Provo W. E4605
Ph-801 79867t5
Fax.-801 798 1868
,
r------jt
o
a
*a
Lltnhl-
Michael O. Leavitt
Governor
Dianne R. Nielson, Ph.D.
Executive Director
Brad T Johnson
Dircctor
Where ideas connect
Department of Environmental Quality
Division of Environmental Response and Remediation
168 North 1950 West
P.O. Box 1214840
Salt [:ke City, Utah 84114-4840
(80r) 536-4100
[phone] Fax
(80r) 536-4414 T.D.D.
www.deq.utah.gov
October 21,2003
ATTN. Bruce Billings
Calder Bros. Inc.
45 East 300 North
Provo, UT 84603
Re:Non-compliance of underground storage tanks at Gas N Go # 17 in Wellington
Facility Identification No. 5000435
At the request of the Executive Secretary (UST), the Division of Environmental Response and
Remediation (DERR) performed a compliance review for the underground storage tanks (USTs) at
the above facility. The compliance review, performed on 10-6-2003, indicates you have not satisfied
the requirements of the Act and are out of compliance. To achieve compliance, you must do the
following:
1. Submit a copy of a current (performed in the last 12 months) precision line tightness test for the
product lines associated with USTs #I,2,3.
2. Submit a copy of a current (performed in the last 12 months) test for proper operation of the
automatic line leak detectors on the pressurized product lines associated with USTs #I,2,3.
The above information must be submitted to this office by 12-21-2003. If you fail to submit the
required documentation as requested, you will be charged $70.00 per hour for time and
travel as allowed by statute, for every follow up inspection necessary to document
compliance. If you have questions concerning this matter or need any assistance, please contact
Sean Warner at [phone].
Sincerelygr*r-M
Sean Warner
Utah UST P ram
Release Detection I
tr Emergency.generator tanks only; leak detection deferred.
tr USTs temporarily closed and empty; leak detection not required
tr USTs temporarily closed, locked and secured.
COMMENTS
Site Drawing (North ,ft )
Y1
E
o
a I
a
Checklist
ID
L.Location Name La trle/S 6 aS - fl- Go
Address 4-6 L 3OO N Address lo ld e a 3L
State 4 t4
Contact Phone
State UT
Contact Phone
Complete for each tank. lf the facility has more than four tanks, complete thej*lomrf,tion for additieneUanks on a slparate form.
Number of tanks at the facility:Tank 4
Tank lnstallation Date q -:5o 44
---
Capacitv of Tank (in qallons)
- tzk'
Indicate it tank is siphoned or compartmented. Show related tanks.
Substance Stored Lal
Tank is in use {"1 No 6J No f6! No Yes No
lf not in use. oive date last used and deoth of oroduct in tank.
Current vear tank taqs are in place.Yes iG)Yes fi)Yes d;l Yes No
Material of construction of tanks €2P -\
Material of construction of pipinq FP'P \\
Pipinq tvpe nv,f ->Type of Spill Prevention device. Note on form if tank is tilled by transfers
of less than 25 qallons. lf so, no spill prevention is required.BtrkeL
Spill containment bucket is clean, dry, and tree of product, water, debris @No €s) No S) No Yes No
Type of Overfill Prevention device. Note on form il tank is tilled by
transfers of less than 25 qallons. lf so, no overfill prevention is required Al- lrtt '-5ll an overfill alarm is the primary overfill device: Alarm is located where it
can be seen and heard, and alarm is clearly marked.6} No {A No <6$ No Yes No
Corrosion Protection method used on tanks /f",1r4t
Corrosion Protection method used on piping Alm ->
Corrosion Protection method used on tlex connectors, swinq ioints, etc.At tanks:Atc-At disDensers:alc
Enclosed containment sumps at tanks and dispensers At tanks;No At dispensers:6A No
Containment sumps are sealed, free from water, product, etc.Yes 6)
lndicate dates ol upqrades- lininq, tank or piping cathodic protection
Protection Show the results of the most
The results of the last two cathodic protection tests are available (within six
months of installation and every three years thereafter).Yes No
Tank Tester ,/ l/\ Date volts volts volts volts
Piping Tester // r)Date volts volts volts volts
;::Ji"""*"
rsr suy'ns'V:^," /- |At tank
At dispenser
volts volts volts volts
volts volts volts volts
For lmpressed Current Systems: The results o, the last three equipment
operation checks are available (required every 60 days).Yes No
this facilIi on
re:
Oistribution: White-lnspector,Facility/Owner Ldch4k0703.de
Paqel of ?
Ownershio of Tanks
Owner Name La lr
14ankL/(-f rnk2 -,/f-Tank3)
Automatic Tank
TANK LEAK DETECTION
Method ks:Automatic Tank Shutdown Co
Tvpe of lM documentation used:Tvpe of Secondary Containment used
certilication) for
No
{ffiartvDocumentation of performance claims
the system is available.Manutacturer, name and modet of system: Vedef *fOoL TLS&I
for ln the tank
@NoATG IM
Records on site document that the system is properly installed, calibrated,
and maintained (system and tank setup reports, maintenance records).
NoG)ATG IM Device documentation is available on site (owner's manual, etc.)
No@)ATG IM
ATG console or other equipment used to take readings and perform tests is
adequate, accessible, and operational.
Yes NoATG IM
Documentation of valid testing or monitoring is available for the last 12
months. Show results in table below.
Yes NoThe probe is located at the
center of the tank.
lf not in center, show tilt
factors from the setup report
Tilt: #lO.a #4f2#3
d{b et.ol)ATG
Yes No Minimum LevelATG
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 of regulated substances from any
portion of the primary tanupipinq within one month of release
Yes No nlaIMlf observation wells are part of the system, wells are clearly marked and
secured to avoid unauthorized access and tampering.
Yes No nla
Secondary banier 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).
IM
(Bladder or
excavation
liner)
Show results of monitoring for
hiqhest product level tested
tank for the last 12 months. lndicate Pass, Fail, lnvalid, or No Besults for each month. For ATG tests, show the
tor each month,
lvlo/Yr 4/"A t\/u2 t/a z 4az 7/os 1/nz 5/o<4l*7Ae 8/=ze iluz lo.
#l P \
#A {)_-s_
#3 P
#
PIPING LEAK DETECTION
Method(s) Used (Automatic line leak detector and one other method are required tor Pressurized Piping):
[ ] Automatic Line Leak Detector [ ] Line Tightness Testing [ ] lnterstitial Monitoring t
[ ] Statistical lnventory Reconciliation [ ] Vapor Monitoring [ ] Groundwater Monitoring I
I .2 GPH Monthly Testing
lOther
Sale Suaion Pping: Documentation is available and verifiable to show that piping operates at less than atmospheric pressure, has only one check
valve (under pump), and has proper slope of piping.Yes No
Line Tightness Testing, Line Leak Detector Testing:Tank 1 Tank 2 Tank 3
-
'Results of last line tightness test are available: Y N Results
Test Date Tester name and cert. number:Test Method
Automatic Line Leak Detectors: lndicate type, manufacturer, and model for
each leak detector M- Mechanical E- Eleckonic S- Sump Sensor
MES MES MES MES
Results of last leak detector perlormance test are available: Y N Results
Test date Tester name and cert. number:UT Test Method
ior 2 Fail,
Mof/r
#
#
#
#
Distributron: White- DERR, Yellow-lnspeclor, Pink- Facility/Own€r ldatgim0703.doc
COMMENTS
Utah u-lT Program
lnterstitial
Facilitv ID
Paqe of
Tank 4
I
I I
f?<1 ,-( it e i^r] ll -brrunr)l/<
lltnh I
a
Michael O. Leavitt
Govemor
Dianne R. Nielson, Ph.D.
Executive Director
Brad T Johnson
Director
Where ideas connect
Department of Environmental Quality
Division of Environmental Response and Remediation
168 North 1950 West
P.O. Box 1214840
salt Lake city, utah 84114-4840
(80r) s36-4100
[phone] Fax
[phone] T.D.D.
www.deq.utah.gov
October 21,2003
ATTN. Bruce Billings
Calder Bros. Inc.
45 East 300 North
Provo, UT 84603
Re Non-compliance of underground storage tanks at Gas N Go # 10
Facility Identification No. 5000397
At the request of the Executive Secretary (UST), the Division of Environmental Response and
Remediation (DERR) performed a compliance review for the underground storage tanks (USTs) at
the above facility. The compliance review, performed on 10-6-2003, indicates you have not satisfied
the requirements of the Act and are out of compliance. To achieve compliance, you must do the
following:
1. Submit a copy of a current (performed in the last 12 months) precision line tightness test for the
product lines associated with USTs #1,2,3.
2. Submit a copy of a current (performed in the last 12 months) test for proper operation of the
automatic line leak detectors on the pressurized product lines associated with USTs #1,2,3.
The above information must be submitted to this office by L2-2I-2003. If you fail to submit the
required documentation as requested, you will be charged $70,00 per hour for time and
travel as allowed by statute, for every follow up inspection necessary to document
compliance. If you have questions concerning this matter or need any assistance, please contact
Sean Warner at [phone].
Sincerelyg** A/a,'zo,m
Sean Warner
pnooucr ConreiHlrEHT SvsrEx IxresRrrv Evnuuertox Dern Cxenr
Locetlox /6a
aa aa aa aa aa
€rlrtAOwxen
ReesoX FOR TEST
PeRsox
REougsriilc rEsr
Texr(s) IilvorvED
a
a
a
a
I
a
a
a
a
a
a
at
a
a
a
t
a
t
a
a
a
a
a
a
a
t
a
E. P. A. REGULATIoI{S
6;a'e.a
CrptcrrY Gaeoe Tesreo et Aee Hnten r ei
*)
Locertox CovEn F tut-s/VENTs Puups Svpxoxe
I TRE ULT Rlrr DarE 7
2 3 4 5frrrfur
AccoRotxe ro AVAILABLE souRcEs, l'{oRE rxel _ FEET.
ID Rgsuurs Rrre Dare
?-
L
1
2
3
.EAK Derecron TEsr 1
'r{DERGRouxo Haren
Resuuts
1
2
3
4
5
Sr EvE LvoxsHonxER EZY 3
Nox VouuuelntcTaxr TrentxEss
TesrEn
32t1011352
Co-O001
uT-0054
Io-9114029
UTT-10t8
PETRO EI\IVIRO
P.O. Box.51365
Provo LJt. E4605
Ph.80r 7986715
Fax..80l 798 1868t
-ea
frrr
a
a
a
a
Location Name C a tdarY Ga{^,tr- AoOwner Name 0,rn//er Brn<. (o.
Address LO t o €a €{ rl(-,'nAddressa( Fa s A 3 oo rl/ar* h
Location Contaci
State UT46ra
I
Contact B
State
Phone
/6
Tank 4
iormation for additic
-*-{7ank1 )!d- s
nalrtanks on,sepafi--c-,k;>-@-Number of tanks at facility:
4^ a.-qa-j>Tank lnstallation Date
\D-kCapacity of tank (in gallons)
ba-1 6as b,\e-<o-lSubstance stored
Y L/Tank is in use (Y) or, if not in use, give date last used V
li not in use, depth of product in tank (in inches)
Current year tank tags are in place
Material of construction of tanks FTZ Pr8pMaterial of construction of piping
Piping type
50,'tl R,-rt kdType of Spill Prevention Device. Note if tank is filled by transfers of less
than 25 qallons. lf so, no spill prevention is required.
Type of OverJill Prevention Device. Note if tank is filled by transfers of
less than 25 qallons. lf so, no overfill prevention is required.boit duL
is located where
Method used on tanks
markedit can be seen and
rm
and alarm is
maryan ove
^!t\A
ceptions in the last
Yes No
,t/ Ar4.Method used on piping
Method used on flex connectors
Enclosed containment sumps at tan G>No
Yes No
lndicate dates of upgrades- lining, tank cathodic protection.
6 months of installation and
arep
J
DateTank Tester volts volts volts volts
PiDino Tester I I IW Date volls volts volts volts
volts volts volts volts
/Flex Connectors
Tester
Sub pump
volts volts volts volts
Yes Noeve
s
current systerh:
ration checks are available.
the last three equipment
60
Ln
Page of
S -uthat II
I lo^-O2
of Owner or Owner's
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner Ldcheck.wpd rev0302
Utah UST Program
Release Detection lnspection Checktist ID
Location of TanksOwnership of Tanks
Citv t^lP- I l,^,, o kn
Complete for each tank. lf
Answer the following for all tanks, Note any exceptions in tho last colurnn.
Cathodic Protection Testing. Show test results for each tank, line, or flex connector.
/\
I
E
J
rte
Utah UST Program
Tank and Piping Leak Detection to Sooo
ATo Method(s) used for piping:Method used for tanks:
Manufacturer, name and model number of system; Veed ef-IO gL S ' 3,q, System 3'd party cert. available €D'lo
theln the
@*oATG IIV Records on site document that the system is properly installed, calibrated, and
maintained (svstem and tank setup reports, maintenance records).
6J r'roATG IM Device documentation is available on-site (owner's manual, etc.).
No@ALLEquipment used to acquire data, take readings, perform test is adequate, accessible and
functional. lnclude ATG console, dipstick, etc.
@@ALLDocumentation of valid testing or monitoring is available for the last 12 months. Show
testino or monitorino results in orid below.
@e)Tilt Factors: #1 f2 f3 #4The 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 setup report.
ATG
(O *"ATG The tank was filled to at least the minimum level required by the manufacturer's
equipment protocol to ensure a valid leak test, and the tank size is within the allowed
uoper and lower size limits.
Yes No
IM 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 NoIC SIR
MTG
lnventory readings for product inputs and withdrawals are properly obtaaned and
recorded. Readinqs are properly reconciled.
Yes NoIC SIR Records include the proper number of water readings, and water readings are used to
adiust inventory balances as necessary.
Yes NoIC SIR
MTG
An appropriate tank calibration chart is used and is available for review,
Yes NoDispensers have current calibration stickers or proper calibration documentation.IC SIR
Yes Norc srR Drop tubes are present and extend to within one foot of the tank bottom.
Show results of monitorinq lor each tank for the last 12 months, lndicate Pass, Fail, No Results, lnvalid (ATG) or lnconclusive (SlR).
Vo)4/a.t s/oa 6/o2 ?/oL 3/o)Q/o-t lo/rsMol/r llat 'UnJ '/o)
f)P f 'N(p J#i p p NA--s,
0 tp t/ {?P#1 p p N0-.\f
s.P 0 P /v {<P :#3 P Al A.
#
Tank 1 Tank 2 Tank 3 Tank 4Tank and Line Tightness Testing, Line Leak Detector Testing:
Date ol last tightness test for tanks:Test results
Test Method:Name and certification number of tester:UT
Date of last tiqhtness test for piping Test results
Test Method:Name and certification number of tester:UT
EM S M E SAutomatic Line Leak Detectors. lndicate type and
model number for each leak detector.
MES MES
Date of last leak detector performance test:Test results
Yes NoSafe Suction piping: Documentation is available and verifiable to show that piping operates at less than atmospheric pressure,
has onlv one check valve (under pump), and has proper slope of pipinq.
Comments
Paqe of
White-DERB, Yellow-lnspector, Pink-Facility/Owner
2/at
Utah P
ID
Location of TanksOwnership of Tanks
Location Name CatderS 6a< -/t- /.,aOwner Name /aldzr Brvs (fr. Tytc.
Address loto &aSt /talnAddress 1S Ea f I 3oo tt, f Lh
WOll;^^i-t^state uT zip N4g a jlCityCityPat-state lzt-T zip 8*6o3
Location Contact
J
PhonePhoneContact
Crnilatolotslch II than
Tank 4aw)@""Y>>({.rytNumber of tanks at facility:(4 '3o -q4-Tank lnstallation Date >l2 kCapacity of tank (in gallons)
D i'eselLd 3Substance stored JVTank is in use (Y) or, if not in use, give date last used
lf not in use, depth of product in tank (in inches)
Current year tank tags are in place
'€fpMaterial of construction of tanks (steel, FRP, composite, etc.)
t-?pMaterial of construction of piping (steel, FRP, flex plastic, etc.)
9ias<ur€Piping type (pressure, safe/US suction, SrgyA, etc.)
{{ gl cont. sump, etc,) Note if
,. ll-so. nn soill required.
Type of Spill PreVention Device (<5 gal,
filled by transfers of less than 25 gallons
Tpe of6verfill Prevention Device (shutoftf4lllJ@alarm, etc.) Note
if filled by transfers of less than 25 gallons. lf so, no ovlrfllllgqqllqd.
Yes NoFor oved-i[alarm-larm is located where it can be seen and heard, and
alarm is clearly marked
the following lor all tanks. Note any exceptions in the last column.Corrosion Protection. Answer
/,/,tlMethod used on tanks (NM, CS, lL, lC, SA, NP)
Method used on piping (NM, CS, lC, SA, NP)
lndicate dates of upgrades- lining, tank or piping cathodic protection
Enclosed containment sumps at tanks
A//nn/c
,€v.' No
Cathodic Protection Testing Complete for each tank.
The results of the last two cathodic protection tests are available (within
6 months of installation and everv 3 vears thereaftei.Yes No
Tank Tester / lre*Pipinq Tester /
volts volts volts volts
volts volts volts volts
Flex Connectors
Tester
tv I Sub pumpI
Date Dispenser
the last three equipment
checks are available.
Comments
results
60
I
Yes No
Page of
Se-,nn ila fne{certify that I inspected the above-named facility on (date) lC - t L - O Il(name)
,4rra ,4JozA-?z Date ( C^-/ L., - ollnsoector's sionature ltl--
nature of Owner or Owner's durin
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner Ldcheck.wpd rev0701
Answerthelollowingloralltanks.Noteanyexcept1onsinthelastcolu
vP<
Method used on flex connectors (8, CS, NILCP, NM, NP, N/AI
Methodusedfortanks: A T b Method used for pipino: LT-T
Manufacturer, name and model number of system:Veer{e/- rco *- 3 &2 System 3'd party cert. available Yes No
Yes No any excepl column.
Records on site document that the system is properly installed, calibrated, and
maintained (svstem and tank setup reports, maintenance records).No@
ATG IM Device documentation is available on-site (owner's manual, etc.),6) No
Ail Equipment used to acquire data, take readings, perform test is adequate, accessible and
functional. lncl. ATG console, dipstick, etc.@uo
Ail Documentation of valid testing or monitoring is available for the last 12 months. Show
testino or monitorino results in orid below.@)*"
ATG The probe is located at the center ol the tank. lf not, the tilt correction factor for each
tank is shown on the tank setup report.
f6.)r..ro
ATG The tank was filled to at least the minimum level required by the manufacturer's
equipment protocol to ensure a valid leak test and the tank size is within the allowed
upper and lower size limits.@uo
IM Secondary banier is properly placed and constructed, designed for gw considerations,
has an acceptable permeation rate, is compatible with the substance stored, is non-
corrodible, and is not in the 25-yr floodplain (per site assessment).
Yes No
IC MTG
SIR
lnventory readings for product inputs and withdrawals are properly obtained and
recorded. Readings are properly reconciled.Yes No
IC SIR Records include the proper number of water readings, and water readings are used to
adjust inventory balances as necessary.Yes No
IC MTG
SIR
An appropriate tank calibration chart is used and is available for review Yes No
IC SIR Dispensers have current calibration stickers or proper calibration documentation.Yes No
IC SIR Drop tubes are present and extend to within one foot of the tank bottom Yes No
Show results of monitoring for each tank for the last 12 months. lndicate pass, fail, no results, or inconclusive.
Mol/r LVo o t4oo t/ai 4o,"/(ct a/ci 5/ot 4tr 7/cr T/oi 9/o;
*1 Pe$3
#1 f.e ss --s-
#3 Pa 3s
#
Tank and Line Tightness Testing, Line Leak O"t""to, i"Jingt Tank 1 Tank 2 Tank 3 Tank 4
Qelg CI lqst tightness test for tanks:Test results:
Test Method:Name and certification n umber of tester:
Date of last tlghtness test for piping: l& - / + - a t Test results:Fa<s Pa <<Po<s
Name and certification number of tester: 5 X Test Method:?;,? Lv a;11I
Date of last leak detector performance test: I A - ( 4 -O I Test results Pa s</a< s Pc <<
Sale Suction piping: Documentation is available and verifiable to show that piping operates at less than atmospheric pressure,
has only one check valve (under pump), has proper slope olplping
Yes No
Comments
Paae nf
Distribution: White-DEBR, Yellow-lnspector Ldall rev0201 .wpd
Utah UST Program
Tank and Piping Leak Detection
Alt
lo/n,
Release
UTAH UST PROGRAM
onl tat
of
Street Address
""t Pbvo +1.
Phone NumberArea Code
Zip
form.
I
OwnerName t t ,.-,Le lrler bfos LO (-as-/1,- c,oAddresso, E, 3oo il )n )D L.t s t t?tdn
tl.
County
State
lll. Tank lnformation
Person At UST Phone #
each tank. lf tacility has more than 4 for additional
Zio Code9+t o3 CityStateuT
Certificate of Compliance on site? Yes No Certificate Year:
Number of tanks at facility:V^"x-D @))Tank 4
Current year tag is displayed No)@No No,@ Yes No
Tank presently in use No FO No NoC'o Yes No
lf not in use, date last used
lf not in use, depth of product in tank (in inches)
Month and year tank installed 4 -3a -4+,-\.Capacity of tank (in gallons)t2Y -.\Substance stored /-a.s 6o1 D,eSZ)
Material of construction ol tank (steel, FRP, etc.)
Material of construction of piping (steel, FRP, etc.)Fep
Piping type (pressure, suction, gravity, etc.)
Method used (enter method used and complete appropriate form)
IV TanksDetectionFor thelndicale used forRelease
Emergency Generator tank (leak detection deferred)
Method used (complete separate form where applicable)L
V. Release Detection lndicate used and tankmethod(s)complete appropriale checklists whereFor Piping
Automatic Line Leak Detector type and model .kc.*
Date of last Leak Detector performance test l)-14 - cc--:\
Test result (pass/fail)Pqs;-l
Date ot last Line Tightness Test A-14- co
Test result (pass/fail)fasi
Name and company of certified tester e Cert. No. UT
No leak detection required (must answer "yes" to all questioris netowj
Operates at less than atmospheric pressure Yes No
Slope ol piping allows ALL product to drain into tank when suction is released Yes No
Has only ONE check valve, located directly under pump Yes No
Above information is verifiable; use comments section below to document how it is verifiable
Comments:Ll 4-
Yes No
t5 2--5-ol
(m6h, day. yee. tm)
certify that I have inspected the above-named facillty on
Signature of Owner or Owner's Flepresentative Present During lnspection
lnspector's Signature Date: Z- S -Ol
Distribution: White-DERR, Yellow-lnspector LDchecklist.wpd 2/99
Facility lD
Checklist
l. Ownership of Tank(s)
Facility Name
{ranxy'
tr{eQ
PfP--sgdra
pal-
\
8o rl Lot
--
each tank.
(ank1..r Wank2)(rank3)Tank 4
ls the UST system is filled by transfers of 25 gallons or less? ll yes, spill
and overfill prevention is not required.@Yes Yes €A Yes @ Yes No
ls there a spill containment
the environment? lndicate
Containment sump at tank fill.
bucket <5
release of product inlo
, Spill bucket >5 gal.,
Now No@ Yes No
ls there an overfill prevention device installed on the
Ball lloal (in vent line), Automatic shutoff (in fill pipe)
(specify)Kry:effr"
No(g ft", No No(9 Yes No
For overfill alarm only: ls the alarm located where it can be easily seen
and heard by the delivery driver?No@ No@ No@ Yes No
For overfill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?Nor@ No@ No@ Yes No
Tank'l Tank 2 Tank 3 Tank 4
TankTank
AilT\
Tank Tank
Piping
lndicate the type ol corrosion protection: Non-metallic (NM), Composite
steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacrificial Anode
(SA). or Not protected (NP),/vin -Piping\Piping
Sub"PumpTLSub-Pump Sub-Pump_A Sub-Pump
0ispenser
lndicate the type of corrosion protection on Flex eonnectors and/or Swing
ioints: Booted (B), Total containment (TC), Not in contact with soil or
water (NC), Cathodically protected (CP), Non-metallic (NM) and Not
Protected (NP)
DispenserTL:0ispenser\-
lf tank or piping has been
upgraded, indicate date
upgrades were performed:
Tank lining
Tank cathodic protection
Piping cathodic protection
The results of the last two cathodic protection tests are available. (within
6 months of inslallation and every 3 years thereafter).Yes No Yes No Yes No Yes No
Date LTank. Tester volts volts volts volts
Piping. Tester 1 volts volts volts volts
Sub-Pump
volts
Sub-Pump
volts
Sub-Pump
volts
Sub-Pump
volls
Flex. Tester )It I
Date
I
I
\.
Dispenser
volts
Oispenser
volts
Oispenser
volts
Dispenser
volls
For impressed current system: The results of the last three equipment
operation checks are available. (Equip. check required every 60 days.)Yes No Yes No Yes No Yes No
ol
Comments:
Signature o{ Owner or Owner's Representative Present During
lnspeclor's S
Distribution: White-DEFlB, Yellow-lnspector, Pink-Facility/Owner Ldspillover.wpd 2/99
UTAH UST PROGRAM Facitity tD No._
Overfill, and Corrosion Protection lnspection Checklist
SPILUOVERFILL PREVENTII ,N
a9 No
CORROSION PROTECTION
Dispenser
CATHODIC PROTECTION TESTS Record results of the most recent cathodic protection test. Record the lowest reading for each tanffpipino/flex set.
/ D^fl
Manulacturer, name and model number of system:
,or each tank. Use
*
Please each 6E 6-"J Tank 4
Device documentation is qyq!!e!!gpl-s!!e (e.9., owner's manual).d,"ft-A No 6)No Yes No
Records on site document that the system was properly installed and calibrated
, reportL(system and tank
No@ No@ No@ Yes No
System is maintained in accordance with manufacturer's instructions (records are
available on site).
NoG)No{a No@ Yes No
The probe is located at the center of the tank. lf no, indicate tilt correction factor from
the tank setup report.
Noa
Titr:
No6)
Titt:
No{a
TIIt:
Yes No
Tilr:
Device can measure the hrlght of the product to the nearest 1/8 ol an inch dD No de No 6a No Yes No
Device monitors the in-tank liquid levels over the full ranqe ol the tank's internal heiqht 6 No ,,{e No -(G No Yes No
A monitoring box is present and there is evidence that the device is working (i.e., the
device is equipped with roll of paper tor results documentation)
No@ No@ No@ Yes No
Documentation is available demonstrating that the Automatic Tank Gauge performed a
valid leak test at least once a month for the last 12 months
No@ No@ NocQ Yes No
lf no, for which months was a valid test not performed? (specity months and year, use
space below if necessary)
The tank was filled to at least the minimum level required by the manufacturer's
equipment protocol to ensure a valid leak test
No@ No(?No6)Yes No
The tank capacity is within the upper and lower size limits required by the
manufacturer's equipment protocol to ensure a valid leak test
No{s Nofa No@ Yes No
Have any of the leak test reports indicated a failed test? It yes, specify in the space
below the month, year, and what follow-up actions have been taken.
Yes @ Yes @ Yes (o Yes No
Documentation of performance claims lor the automatic leak test feature is available
and shows the ability to detect leaks of 0.2 gph with 95% or greater probability of
detection and 5olo or less probability of false alarm (3rd partv certification).
No@ No@ No(a Yes No
lndicate month(s) of invalid or missing test:
Comments:
Signature of Owner or Owner's Representative Present During lnspection
Signature:_
-5-
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner LDatg.wpd 2/99
UTAH UST PROGRAM Facility lD No._
,
Automatic
6m)
lndicate month(s) of any failed test:
,r.'t
P.O. Box 1903
Provo, Utah 84603
( 801 )37s- I 41 2 . (801,)322-t4t4
FAX (801)37s-1646
T-- !t:tr t,?_ _.--1U- Eirl ivluufts
Ta,T:ft- -.rr-T:?tTtIJ.E\J.JL'I.ILT\
{-Ff,a? :a 4frrAtittod il$fln tY-}U WesI
c,Y/a Tl.Fil,t{{, ,t.'idJL'*", Ut 6+1l.t-+fr+U
lJar.E_ JIrlY rrj-- JUUU
*_!a'
I .a r.rlla- .iJl IJLG iilllluE-Ll
ENVI RONMENIAL RESPONSE & REIiJED!
^TIOi,IENTERED
JUL 2 0 20oo
HE- Iitx-c*rnpiiance *iru{futg5+uliri str:rage tarik; at iias-i.i-tio #il iilifi East irlairi
trV;iliryton- UT; Faciiiiv iD #-1000+:1i.
Ga -Trm* 1:1. i000. a i3." s,$a"e sigr r,s.as in;qtaii*ri +n ;ire (ia-s-]{-Grr store in 1l.'*iiinr:trrn UT irr a
i*caiian that is vi;ibie ii'+m {re i:n&r.groriod str.:rage tanlis. Tire }v,trdi*g *ir ihe *ign reads "'iillierr
aiam ";*uuls UST's at* firii. Push b*ttrur ru:ride t* ieset alarm.""
Timtk yi,u tirr Ir-ruf assisiartce 'ntd;tail*.nce h {his urafir,r'
Sirtr:s.rgi!'.
Eruct
DTAR
BY
,:,,'l
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
Michael O. Leavitt
Governor
Dianne R. Nielson, Ph.D.
Executive Director
Kent P. Gray
Director
168 North 1950 West
P.O. Box 144840
Salt Lake City, Utah 84114-4840
(801) 536-41ffi Voice
[phone] Fax
[phone] T.D.D.
TO:
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE TANKS AT CALDERS GAS.N.GO,
1010 EAST MAIN, WELLINGTON, UTAH; FACILITY ID# 5000435.
Tocontinue to maintain avalidCerlificateof Compliance, thefacility mustbe in compliance withFederal and
StateRulesandRegulations. AninspectionofyourfacilityonFebruary29,2000,andareviewofourrecords
on June 22,2000, has shown that the following information is STILL lacking:
tll Submitproper documentation verifying the installation of a Sign, identifying to the delivery driver what
is meant by the overfill alarm, when the alarm sounds. If must be able to be seen from the location
of the Tank portion of the USTs, since the driver must remain with the truck until the delivery is
complete.
To date. DERR has not received documentation of compliance with this item.
The above information must be submitted to this office by 712212000. If it is not received by the date
specified, we will commence the revocation process of your Certificate of Compliance. Continued
non-compliance will result in the fees on your Certified USTs to be increased from $75 per tank
to $150 per tank and failure to pay the additional fee can result inlapsing of your UST Certificate
of Compliance. If you have questions concerning this matter or need any assistance, please contact William
Moore at [phone].
Bruce Billings
Calder Bros Co., Inc
P.O. Box 1903
Provo, Utah 84603
DATE: 612212000
FROM: William Moore
^
:,
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
Michael O. Leavitt
Govemor
Dianne R. Nielson, Ph.D.
Executive Dircctor
Kent P. Gray
Director
TO
168 North 1950 West
P.O. Box 144840
Salt Lake City, Utah 84114-4840
(801) 536-41ffi Voice
[phone] Fax
[phone] r.D.D.
Bruce Billings
Calder Bros Co., Inc.
P.O. Box 1903
Provo, Utah 84603
DATE: 311012000
FROM: William Moore
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE TANKS AT CALDERS GAS.N.GO,
1010 EAST MAIN, WELLINGTON, UTAH; FACILITY ID# 5000435.
Tocontinueto maintainavalidCertificateof Compliance, thefacility mustbe in compliancewithFederal and
StateRulesandRegulations. AninspectionofyourfacilityonFebruary29,2000,andareviewofourrecords
has shown that the following information is lacking:
tl l Submitproperdocumentationverifying the installation of a Sign, identiffingto the delivery driverwhat
is meant by the overfill alarm, when the alarm sounds. If must be able to be seen from the location
of the Tank portion of the USTs, since the driver must remain with the truck until the delivery is
complete.
The above information must be submitted to this office by 511012000. If it is not received by the date
specified, we will commence the revocation process of your Certificate of Compliance. Continued non-
compliance will result in the fees on your Certified USTs to be increased from $75 per tank to $ 150 per tank
and failure to pay the additional fee can result in lapsing of your UST Certificate of Compliance. If you have
questions concerning this matter orneed any assistance, please contactWilliam Moore at [phone].
UTAH UST PROGRAM
Release Detection I
3
ecklist
l. Ownership of Tank(s)ll. Location of
llt. Tank lnfOrmatiOn Complete for each tank. lt facitity has more than 4lanks,
c"d?4sqz
Certificate Year:
Address
^/
Facilitv Name u^' """"' """*(z6ls - A/ - GrooY)|lT"e r<*o 6.r*
-Lor-.-
CodeState
Phone NumberCode
Contact Person
State
for additional
Certilicate of Compliance on site? Yes NoLocationPhone #
Number of tanks at facility:Tank 1 Tank 2 Tank 3 Tank 4
Current year tag is displayed No Nof"\Yes No
Tank presently in use No NoifE )c No Yes No
lf not in use, date last used
ll not in use, depth of product in tank (in inches)
Month and year tank installed
Capacity of tank (in gallons)lzll-LLIL-2L
Substance stored UrvL Qre"-^,D
>Material of construction of tank (steel, FRP, etc.)ruP
Piping type (pressure, suction, gravity, etc.)fr.vf9f
lV. Release ks
Method used (enter method used and complete appropriate form)
V. ReleaSe DeteCtiOn FOf Piping lndicate method(s) used and complete appropriate tank checklists where
Emergency Generator tank (leak detection detened)
Method used (complete separale form where applicable)L
Automatic Line Leak Detector type and model
co-Date oJ last Leak Detector performance test lEttut \.
Test result (pass/fail)__-__.->
Date of last Line Tightness Test tqq*\-
Test result (pass/fail)\\.-
Name and company of certified tester Cert. No. UT
No leak detection required (must answer "yes" to all questions belo{v)
Operates at less than atmospheric pressure Yes No
Slope of piping allows ALL product to drain into tank when suction is released Yes No
Has only ONE check valve, located directly under pump Yes No
Above information is verifiable; use comments section below to document how it is verifiable Yes No
the above-named facility on
Signature oJ Owner or Owner's Representative Present During
?,^t*
(print name)
lnspector's Signature
Distribution: White-DERB,LDchecklist.wpd 2/99
Facility lD
rt€^ No
D,r/-fru,1,1,Material of construction of piping (steel, FRP, etc.)
al(--
---+
p'-:-
P----:-
UTAH UST PROGRAM
Automatic Tank Gauging
Facirity rD No.soco{ 3>
Manufacturer, name and model number ol system
Please circle Yes or No for each question lor each tank I lacility has more than 4 tanks, complete inlormation lor additional tanks on
sepqr4lelq!!.
Tank 1 Tank 2 Tank 3 Tank 4
Device documentation is available on-site (e.9., owner's manual).G) No {"O No fr.A No Yes No
Records on site document that the system was properly installed and calibrated (system
and tank setup report).6 No @ No 6 No Yes No
System is maintained in accordance with manufacturer's instructions(records are
available on site).
@ No @t",6 No Yes No
The probe is located at the center of the tank. ll no, indicate tiltporrpftion factolpm
the tank setuD reDort. L el#t-. O4il.p R@ @@Tilt: /A ffip Yes No
Tilt
Device can measure the heiqht ol the product to the nearest 1/8 of an inch A No (dd T
No G No Yes No
Device monitors the in-tank liquid levels over the full range of the tank's internal height 6 No a No cl No Yes No
A monitoring box is present and there is evidence that the device is working (i.e., the
device is equipped with roll of paper for results documentation)@""No No Yes No
Documentation is available demonstrating that the Automatic Tank Gauge performed a
valid leak test at least once a month for the last 12 months @ No @'"@ No Yes No
ll no, for which months was a valid test not performed? (specify months and year, use
space below if necessary)
The tank was filled to at least the minimum level required by the manufacturer's
equipment protocol to ensure a valid leak test @*@*,@'"Yes No
The tank capacity is within the upper and lower size limits required by the
manulaclurer's equipment protocol to ensure a valid leak test
(9 No @ No No Yes No
Have any of the leak test reports indicated a lailed test? lf yes, specily in the space
below the month. vear. and what lollow-uD actions have been taken.
Yes ) Yes o Yes No
Documentation ol perlormance claims for the automatic leak test feature is available and
shows the ability to detect leaks ol 0.2 gph with 95% or greater probability of detection
and 5"/" or less probability ol false alarm (3rd party certification).
'D'"@"@ No Yes No
lndicate month(s) of invalid or missing test:
lndicate month(s) of any failed test:
s6 0
comments: I L/ ,/t/ / ,-/ (-/ -/ L/
Z.'t/'-/ l-/D/ ,/ t/ . t-a' ,/
lnspector's Signature
Signature of Owner or Owner's Representative Presenl During
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner Revised 12\95
o o
@
v"s@
-__
n
UTAH UST PROGRAM
Overfill and
Facility lD
Checklist
EOOO
inlormation for k. UsePlease has more than 4 tanks.
Tank 1 Tank 2 Tank 3 Tank 4
The UST system is filled by transters of 25 gallons or less. lf yes, spill
and overfili prevention is not required.Yes @-^Yes @ Yes @ Yes No
NoC9
,)-
(9*'No Yes No
No No(9
ls there a spill containment device that will prevent release of product into
the environment? lndicate type: Spill bucket <5 gal., Spill bucket >5 gal.,
ls there an over ention device installed on the
Ball lloat (in venr e), Automatic shutoff (in fill
(specify)
Containment sump at tank fill.
No Yes No
No(B Yes NoFor overfill alarm only: ls the alarm located where it can be easily seen
and heard by the delivery driver?Yes No Yes No
For overlill alarm only: ls the alarm clearly marked to indicate
meant when the alarm sounds?
-'g(-Yes @ Yes No Yes No Yes No
Tank 1 Tank 2 Tank 3 Tank 4
/Nilk
-
Tank
Prorno Pipino \
lndicate the type of corrosion protection: Non-metallic (NM), Composite
steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacrificial Anode
(SA). or Not protected (NP).ty't;i'"--7 Piping
Sub-Pumo'\Sub-Pump
TC-
Sub-Pump Sub-Pump
DispenserrCOispenser
lndicate the type of corrosion protection on Flex conneclors and/or Swing
joints: Booted (B), Total containment (TC), Not in contact with soil or
water (NC), Calhodically protected (CP), Non-metallic (NM) and Not
Protected (NP)
Dispenser
ll tank or piping has been
upgraded, indicate date upgrades
were performed:
Tank lining
Tank cathodic protection
Piping cathodic protection
CATHODIC TESTS of the most the each
Yes {Yes NoThe results of the last two cathodic protection tests are available. (within
6 months ot installation and every 3 years therealter).Yes No Yes No
DateTank. Tester volts volts :y volts
Piping. Tester Date volts \=volts volts
Sub-Pump
,o:>
g+,{ump
volts x"'o volts
Sub-Pump
volts
DateFlex. T volts-y Dispenser
volts
,"*\Dispenser
volts
For impressed current system: The results of the last three equipment z'
operation checks are available. (Equip. check required every 60 days.)Yes No Yes No Yes No No
co^^"nt", <tY n ont riveaz'{, I L,( (ro vq:-7
Sionature of Owner or Owner's Representative Present During ln
lnspector's Signature
Distributioni White-DERFl. Yellow lnspector,Revised 2/4/99
(9
e o
CORROSION PROTECTION
4
Drspenser \
-
ity/Owner
C^LDER'S GAS'N'GO
101O EAST MAIN
WELLINGTON UT L bFacility lD:
Owner Name:
Owner Address:
Facility Name:
Street Address:
5000435
CALDER BBOS CO INC
45E300N
PBOVO UT 84603
44542
UTM Coordinates
524,480.79 4,376,8'14.86 Hand Held GPS No Corrections
Iank lD:
Federally Regulated Tank:
Tank Status:
Date lnstalled:
Date Closed:
Tank Capacity:
Tank Material:
Tank Material:
Pipe Materialr
Pipe Material:
Pipe Flex Connector's:
Pipe Type:
Substance Stored:
Overlill lnstalled:
Spill lnstalled:
Cathodic Protection l,ret:
ln Compliance:
On PST Fund:
Other Financial Mechanism
Tank Release Detection:
ATG
1
Yes
Currently in Use
9/30/1994
12000
Fiberglass Reinforced Plastjc
None
Flexible Plastic
Double-Walled
Steel Flex in Sump
Prgssurized
Gasollne
Yes
Yes
Yes
Yes
Y€s
No
ATG
LTT
SIB
2
Yes
Currently in Use
9/30/1994
'12000
Fiberglass Reinforced Plaslic
None
Flsxlble Plaslic
Double-Walled
Steel Flex in Sump
Pressuriz€d
Gasoline
Y9s
Yes
Yes
Yes
Yes
No
ATG
Tank lD:
Federally Regulated Tank:
Tank Status:
Date lnstalled:
Date Closed:
Tank Capacity:
Tank Material:
Tank Material:
Pipe Material:
Pipe Material:
Pipe Flex C,onnectofs:
Pipe Type:
Substance Stored:
Overfill lnstalled:
Spill lnstalled:
Cathodic Protection iret:
ln Compliance:
On PST Fund:
Other Financial Mechanism:
Tank Belease Detection:
ATG
3
Yes
Currently in Use
9/30/1994
12000
Fiberglass Reinlorced Plastic
None
Flexible Plastic
DoublE-Walled
Steel Flex in Sump
Pressurized
Dies€l
Yes
Yes
Yes
Yes
Yes
No
ATG
LTTPipe Release Detection
LTT SIR
Pipe Release Detection
LTT
Tank lD:
Federally Regulated Tank:
Tank Status:
Date lnstalled:
Date Clos€d:
Tank Capacity:
Tank Male.ial:
Tank Material:
Pjpe Material:
Pipe Material:
Pipe Flex Connecto/s:
Pipe Type:
Substance Stored:
Overfill lnstalled:
Spill lnstalled:
Cathodic Protection Met:
ln Compliance:
On PST Fund:
Other Financial Mechanism
Tank Release Delection:
ATG
Wednesday, February 09, 2000
LTT
Page 1 of 1
Pipe Release Detection:
LTT
.,
-\ I*,,,.,,,:,,,
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
Michael O. Leavitt
Governor
Dianne R. Nielson, Ph.D.
Executive Dircctor
Kent P. Gray
Director
168 North 1950 West
P.O. Box 144840
Salt Lake City, Utah 84114-4840
[phone] Voice
[phone] Fax
[phone] T.D.D.
TO:
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE TANKS AT CALDERS GAS.N.GO,
1010 EAST MAIN, WELLINGTON, UTAH; FACILITY ID# 5000435.
Tocontinuetomaintain avalidCertificateof Compliance, thefacility mustbe incompliance withFederal and
StateRulesandRegulations. Aninspectionof yourfacilityonMarch lO,1999,andareviewofourrecords
has shown that the following information is lacking:
tll Submit evidence that you are properly using your Veeder Root TLS-350 CSLD Automatic Tank
Gauging (ATG) System, by:
(A) Documenting that you have "Enabled" the Periodic and Gross Test Fail Alarms.
(B) Documenting that you have had the "Tank Tilt" calculated and entered in each Tanks setup.
LZ) Document you have had the water problem in the Diesel sump identified and corrected.
The above information mustbe submitted to this office by 5116199.If it is notreceived by the date specified,
we will commence the revocation process of your Certificate of Compliance. Continued non-compliance will
result in the fees on your Certified USTs to be increased from $75 per tank to $150 per tank and failure to
pay the additional fee can result in lapsing of your UST Certificate of Compliance. If you have questions
concerning this matter or need any assistance, please contact William Moore at [phone].
EN"l\R0tli'l\ENi;'
.
Bruce Billings
Calder Bros Co., Inc.
P.O. Box 1903
Provo, Utah 84603
DATE: 3116199
FROM: William Moore
JJ 0
._)
1
RocKY RDGE
TO: William Moore
DEQ/DERR
P.O. Box 144840
sLC, UT 84114-4840
RE: Gas-N-Go # 17 WelingtorL Utah Facility ID# 5000435. Tank tilt status, water in diesel
sump, enabling periodic and gross test fail alarms.
To Whom it I\day Concern:
The underground storage tanks at the above referenced facility were installed with no
distinguishable tilt to them.
On lvIay 29, 1999 the diosel sump in question w:N pumped out and inspected. No obvious water
infiInation was noticed but I will check this sump periodically to ensure there is no problem. Also
on lvlay 29, t999I enabled the TLS 350 to do the Periodic and Gross Test Fail Alarms.
Respecffirl$,
la
Stevo fyon6
\gs
\N 1$
,{
'1i!. 'li ,,t ii ii ,-l/t :, tl' ,l' 'ri: ,'1r :: ::
Michael O. Leavitt
Govemor
Dianne R. Nielson, Ph.D.
Executive Dircctor
Kent P" Gray
Director
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
168 North 1950 West
P.O. Box 144840
Salt Lake City, Utah 84114-4840
[phone] Voice
[phone] Fax
[phone] T.D.D.
TO DATE: 3/16199
FROM: William Moore
RE: NON.COMPLIANCE OF UNDERGROUND STORAGE TANKS AT CALDERS GAS.N-GO,
1010 EAST MAIN, WELLINGTON, UTAH; FACILITY ID# 5000435.
To continue to maintain a valid Certificate of Compliance, the facility must be in compliance with Federal and
StateRulesandRegulations. AninspectionofyourfacilityonMarchl0,1999,andareviewofourrecords
has shown that the following information is lacking:
tll Submitevidence thatyou areproperly using yourVeeder RootTLS-350 CSLD Automatic Tank
Gauging (ATG) System, by:
tzl
(A) Documenting that you have "Enabled" the Periodic and Gross Test Fail Alarms.
(B) Documenting that you have had the "Tank Tilt" calculated and entered in each Tanks setup.
Document you have had the water problem in the Diesel sump identified and corrected.
The above information must be submitted to this office by 5116199 .If it is not received by the date specified,
we will commence therevocationprocess of yourCertificate of Compliance. Continued non-compliance will
result in the fees on your Certified USTs to be increased from $75 per tank to $150 per tank and failure to
pay the additional fee can result in lapsing of your UST Certificate of Compliance. If you have questions
concerning this matter or need any assistance, please contact William Moore at [phone].
Bruce Billings
Calder Bros Co., Inc.
P.O. Box 1903
Provo, Urah 84603
Tank(s)
Addressr tg n"ib?8" E-aoh
Area Code Phone.Number
Phone #Certiticate of Compliance on site?Certificate Year:
Owner
State
Person
for
No No No
,^"rrrtryf.,l
"'w<
{ tanks,lank.hag thanmoreeachlorfaeility complete
,("o
Tank 4Number of tanks at facility:
Current is dis Yes No
No6")No6A Yes NoTank presently in use No
ll nol in use, date last used
lf nol in use, depth ol product in tank (in inches)
Month and year tank installed
c---I >k_t24Capacity ol tank (in gallons)
f)ui/1,^-D<r/\-Substance stored 4Material of conslruction of tank (steel, FRP, etc.)
Fp_P -4Material of conslruction of piping (steel, FRP, etc.)\-Piping type (pressure, suclion, gravity, etc.)//"e4 -
tank.thefor
Emergency Generator tank (leak detection defened)
lnventory Control/Tank Tightness Testing
l,-(/Automatic Tank Gauging
Manual Tank Gauging
Vapor Monitoring
Groundwaler Monitoring
lnterstilial Monitoring
Statistical lnventory Reconciliation (SlR)
checkllst and approprlate tank
(-/Automatic Line Leak Detector
name of method)Other approved method
For Piping compteto
Line Tightness Testing /
Vapor Monitoring
Groundwater Monitoring
lnterstitial Monitoring
Statistical lnventory Reconciliation (SlR)
Other approved method (indicate name of method)
above-named facility on
{pinl n6he)day, y.ar, lim)
Comments
ld
I
Ie ol o',v!'ef S! 9!CLqLC Ee?resentative Present Duri
lnspector's
Distribution: \ryhite-DERR, Yellow-lnsp@tor,Revised O8/O&97
UTAH UST PROGRAM Facility lD
!1. Location of Tank($l
Release Detection lnspection Checklist
Colaty(. a,
q/(
t>
eheckllst lor each rnethod used.
I
lll. Tank separate rorm.
ner
T.r* I fnt 2S6t 1 Tl!* 3 T.nt 4
Automatic Flow Eostrictor (it y6s, indic6to modol in comm.nta 66ctionl
Automrtic Shut-off Dovico (iI y6s, indicoto modgl in commontE roction) )
Continuou6 Alsrm Sy6t6m (it yo!, indiclto modol in commonts soctionl
No6,,1(?y-1 xoRocord! of last Lins Lsrk Detocto, performsnco tost !.e lvlilablo on-aito No,{*)Y6s No
Dlto of last Lino L6sk Detoctor pedormlncg tost
\1, \
Ra6ult ot last Lin6 Leak Dotoctor pedormlnco lgst Fail{,e F.iltr)Fail6)
Sot 2
Rscord6 of la.t Lin6 Tightnoss Tost aro .vsilablo on-sit6 No
a^
O/'ca )No6i ,€No Yer No
Dlto ot lEst Lino Tightn6s6 T6Et I
Rorult of last Lin€ Tightncss T€8t Fail{a Feil6,,Foil6-"]Psss Fail
Utah Tostor Cartification Numbor: UT
Vrpo, Monitoring lit yo6, u6o Vapor Monito,ing chocklistl
Groundwato. Monito,ing (if yo6, u6o G,oundwltor Menitoring chocklist)
lntorstiti.l Monitoring (it yos, uso Into,stitial Monitoring checklist)
Ststistical lnvontory Roconcili.tion ISIRI (if y€s, use SIR chocklist)
Other 6pprov6d mothod lit y6s, u66 olher mothod chocklistl
Rocords of la6t Lin6 Tighlnoss Tast aro svailsbls on-sit6 YoE No
,.,!!ffiiEtr
Ys8 No Yos NoY6sNo
Date ot last Line Tightness TeEt
Rssuh of last Line Tightnoss Test Pass Fail P6s6 F.il Pa6s Fail Pass F.il
Vapor Monitoring (if y6$, us6 Vapor Monitoring chocklistl
Groundwator Monitoring lif yes, use Groundwatar Monitoring checklist)
lntsrstitial Monitoring lif y€6, u66 lnto.Btitial Monitoring chocklist)
Statlstlcal lnvsntory B€conciliation ISIRI (if yos, u6e SIR chscklist)
Olh6r .pprovod method lil yss, u6e othsr mothod chocklistl
Opsral6s at l66s than atmosphoric prss6uro
"l$toiia},lr!,,,,,,,, . ::':
Yo6 No
iii:i::::iii:iiiiiiiciiiiiiiilii
Yor No Y66 No
Slopo of piping will allow ALL product to drain ihto tank wh6n suction is
a6l6ra6d
Y66 No Yos No Yas No Y6s No
Ho8 only ONE chock valve, locatod diroctly und6r pump Yos No Ys8 No Yg8 No
All abov6 intormation on 6uction piping is VEBIFIABLE, us€ comments
soction bslow to document how it i6 vorifiable.
Yoa No Yes No Y6s No
Comments
Date:7
Signaturo ot Own6r or Ownor's Reprossntative Prosont During lnspocti
lnsp6ctor's Signatur€
rfivffiRE
EZER I
Diitribution: Whir6-DERR, Y6llow-lnsp6ctor, Hnk-
iffi
Pa6b Fril
N.mo .nd comp.ny of c6nifi6d t6st6.:
Yos No
Yos No
UTAH UST PROGRAM
Automatic Tank Gau
Facility wn.9ffi4l{
Manufaclurer, name and model number ol C''-D
Please circle Yes or No for each question for each tank ff lacility has more than 4 tanks, complete inlormation for additional tanks on
lorm.
Tank 1 Tank 2 Tank 4
Device docu owner's manual No No Yes No
Records on site document that the system was properly installed and calibrated (system
and tank setup report).@ No @ No @ No Yes No
System is maintained in accordance with manufacturer's instructions(records are
available on site).
(_9 No G No G No Yes No
The probe is located at the center of the tank. lf no, indicate tilt correctiorl/actor frprDthetanksetupreport. r atw<-oY *r-I'ff,p ,H:.nD Yes
Titt:,{2 Yes No
Titt:
Device can measure the heiqht of the product to the nearest 1/8 ol an inch
I/f"l No
T
m&No (itl No Yes No
Device monitors the in-tank liquid levels over the full range of the tank's internal height R No a No d"No Yes No
A monitoring box is present and there is evidence that the device is working (i.e., the
device is equipped with roll ol paper for results documentation)e No @ No @ No Yes No
Documentation is available demonstrating that the Automatic Tank Gauge pertormed a
valid leak test at least once a month for the last 12 months
No @*"@ No Yes No
lI no, lor which months was a valid test not performed? (specify months and year, use
space below if necessarv)
The tank was filled to at least the minimum level required by the manufacturer's
eouioment Drotocol to ensure a valid leak test 6 No @*"@ No Yes No
The tank capacity is within the upper and lower size limits required by the
manufacturer's equipment protocol to ensure a valid leak test
No @ No 6 No Yes No
Have any of the leak test reports indicated a lailed test? lf yes, specify in the space
below the month. vear, and what follow-up actions have been taken.
Yes o ves @\Yes No
Documentation of performance claims for the automatic leak test feature is available and
shows the ability to detect leaks of 0.2 gph with 95% or greater probability of detection
and 5% or less probability of lalse alarm (3rd party certification).
f9*@ No e No Yes No
lndicate month(s) of invalid or missing test:
lndicate month(s) of any failed test:
-l/
I
lnspector's Sig
Signature of Owner or Owner's Representative Present During
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner Revised l2\95
Tank 3
Ll /'.1),G;)No
@
(9
v"" cill
t:
Tank 1 Tank 2 Tank 3 Tank 4
The UST system is filled by transfers of 25 gallons or less. lf yes, spill
and overfill prevention is not required.Yes @ Yes G)Yes @ Yes No
ls there a spill containment bucket or another device that will prevent
release of product into the environment?No@ No@ No Yes No
ls there an overfill prevention device installed on the tank? lf yes,
indicate the type of device: Ball float (in vent line), Automatic shutoff (in
fill pipe), Alarm, or Other (specify)
NoI No@ No(y Yes No
For overfill alarm only: ls the alarm located where it can be easily
seen and heard by the delivery driver?Yes No Yes No Yes No Yes No
For overfill alarm only: ls the alarm clearly marked to indicate what is
meant when the alarm sounds?Yes No Yes No Yes No Yes No
Tank 1 Tank 2 Tank 3 Tank 4
TankrFr-J>fmt \Tank
Piping
lndicate the type of corrosion protection: Non-metallic (NM), Composite
steel (CS), lnternal lining (lL), lmpressed Current (lC), Sacrificial Anode
(,a"+P(SA), or Not protected (NP).rqryt rPFins
-
Piping
Sub-PumpSub-PumT-q-suuPume>Sub-Pump
Disp€Eer'FL-I
lndicate the type of corrosion protection on Flex connectors and/or Swing
joints: Booted (B), Total containment (TC), Not in contact with soil or
water (NC), Cathodically protected (CP), Non-metallic (NM) and Not
Protected (NP)
DispeNer
Ybs rd No Yes r"nk No Yes rd No Yes r"* Nolf the UST is not protected, was the tanUpiping installed before May 7,
1985? ll yes, corrosion protection is not required until Dec.22,
1998; do not complete the remainder of this section.Yes Pldne No Yes Prsrc No Ygs PiP'"! No Yes PiPry No
The results ol the last two cathodic protection tests are available (within
6 months of installation and every 3 years thereafter).Yes No Yes No Yes No Yes No
volts volts volts volts
volts volts volts volts
Results of the most recent cathodic protection test.
Test Date:
Tank
Piping
Flex
Name of
volts volts volts volts
Yes No Yes No Yes No
For impressed curtent system: The results of the last three equipment
operation checks are available. (Eguip. check required every 60 days.)Yes No
lf the tank has been retrofit (lined or cathodically protected), indicate the
date the retrofit was completed.
lnspector's S
Comments
forU
understand that the following marked items must be completed by
tr Facility meets 1998 upgrade requirements.
tr Overfill prevention lor tank
Siqnature of Owner or Owner's Representative Present During I
tr Corrosion protection for piping/flex assoc. with tank(s) #
tr Spill prevention lor tank(s)#
D Corrosion protection for tank(s) #
(prlnt nam)
December 22, 1998 in order to meet the 1998 upgrade requirements:
Dislribution: White-OERFl, Yellow-lnspeclor,R€vised 5/98
UTAH UST PROGRAM
Overfill and Corrosion Protection
Facility lD
Checklist
Please complete all inlormation for each tank. Use addltional lorms as necessary ll the facllity has more than { tanks.
@
CORROSION PROTECTION
,
,1
CALDER BROS CO INC
45E300N
PROVO UT 84603
Facility lD:
Facility Name:
Street Address
5u-.435
CALDER'S GAS.N.GO
101O EAST MAIN
WELLINGTON UT
Owner Name:
Owner Address:
84542
Tank lD:
Federally Regulated Tank:
Tank Status:
Date Installed:
Date Closed:
Tank Capacity:
Tank Material:
Tank Material:
Pipe Material:
Pipe Material:
Pipe Flex Connector's:
Pipe Type:
Substance Stored:
Overfill lnstalled:
Spill lnstalled:
Cathodic Protection Met:
ln Compliance:
On PST Fund:
Other Finaricial Mechanism:
Tank Release Detection:
Pipe Release Detection
Tank lD:
Federally Regulated Tank:
Tank Status:
Date lnstalled:
Date Closed:
Tank Capacity:
Tank Material:
Tank Material:
Pipe Material:
Pipe Material:
Pipe Flex Connector's:
Pipe Type:
Substance Stored:
Overfill lnstalled:
Spill lnstalled:
Cathodic Protection Met:
ln Compliance:
On PST Fund:
Other Financial Mechanism
Tank Release Detection:
4;y' fio"rOlass Reinforced Plastic
I
prl rioergtass Reiniorced Plastic
1
Yes
Cunently in Use
913011994
1 2000
Pressurized
Gasoline
Yes
Yes
Yes
Yes
Yes
No
ATG
2
Yes
Currently in Use
913011994
1 2000
Fiberglass Reinforced Plastic
Fiberglass Reinforced Plastic
Pressurized
LTT
lnterstitial
Tank lD:
Federally Regulated Tank:
Tank Status:
Date lnstalled:
Date Closed:
Tank Capacity:
Tank Material:
Tank Material:
Pipe Material:
Pipe Material:
Pipe Flex Connector's:
Pipe Type:
Substance Stored:
Overfill lnstalled:
Spill lnstalled:
Cathodic Protection Met:
ln Compliance: r
On PST Fund:
Other Financial Mechanism: '
Tank Release Detection:
3
YeS
Cunently in Use
9/30/t 994
1 2000
Fiberglass Reinforced Plastic
Fiberglass Reinforced Plastic
Pressurized
ATG
Diesel
Yes
Yes
Yes
Yes
Yes
No
Pipe Release Detection LTT
lnterstitial
6
lneGasol
Yes
Yes
Yes
Yes
Yes
No
{o 5"{-
tP11
4"- 7 Ito
Pipe Release Detection
Wednesday, February 24, 1999
ATG
Page 1 of 1
a
LTT
lnterstitial
*"^ffi,u glY i'11'L
Phone #Contact Person At
Number of tanks at facilitu:
q.s E- . ZOo
City
U , ? .o, Boc tqnrAddress
Owner Facilitu Name . .' A^Lcl z*
State zip
\^
City I
cs - V'6n
.t-E-4 (l
County
Street Address
I Rl^,
(Ae=) No (G) No .ff;) No Yes NoTank listed on Certificate of Comoliance
.nEE Jrlo z,6NoTank oresentlv in use {:]]G No Yes No
lf not in use. date last usod
lf not in use. deoth of oroduct in tank (in inches)
$ lqq 4 lctq s/q4Month and vear tank installed
Caoacitv of tank (in oallons)rLL ILV-t2K
6-.--i^^,tts>{(*u,l*;^t'd9Substance stored
troP zvt 4Material of construction ol tank (steel. FRP. etc.)
Itrtatcrial of construction of oioino (steel. FRP. etc.)FRP Ey' r,il,il
#$ffiftI#-
rc$.fE ..l ia
Emeroencv Generator tank (leak detection deferred)
ffiHfie aForobitaie, i
lnventorv Control/Tank Tiohtness Testino
L-ldAutomatic Tank Gauoino
Manual Tank Gauoino
Vaoor Monitorino
Groundwater Monitorino
lnterstitial Monitorino
Statistical lnvsntorv Reconciliation (SlR)
Automatic Line Leak Delector l/
Line Tiohtness Testino t/l-./
Vanor JUonilorino
Groundwater Monitorino
lnterstitial Monitorino
Statistical lnventorv Reconciliation (SlR)
Signature of Owner or Owne/s Representative Present During I
lnspector's Signature:
I have inspected the above-named tacility on
day, )er, tm)
la-.
bl,tllc?d
Distribution: White-DERR,
;tilrBi+ . _nla{ UTAH UST PROGRAM Fadtiry lo no._5?3(79&5,
'-?Ftt tJffielease Detection lnspection Ghecklist, r
L Ownership of Tank(s)ll. Location of Tank(s)
l2ntcz,
UST Locationg.\t(ha r Certificate of Compliance'on site@No Expiration date:I lt,lqL
ar*h fr"a at ln Tqak A
-->-pi^i^^ hrha /nraqcrrra sr rntinn nravifu aln I 4
Othar ennrnvad mathrrl findinata nama aI malhndl
V- Ralease DeiAcilon For Pinlno Crrnntata nlnlnn r.jrankllst nnd annranrlete tenk nhe..klis{/*\ far annh mathd ltfl#ul
Other annroveri mathorl (indicate nama oI mathod)
nh z--( faalr) )G Tank 4
The UST system is filled by transters of no more than 25 gallons at one
time. lf yes, spill and overfill prevention is not required.
\->E=-
Yes e Yes /fi[o\v Yes Yes No
ls there a spill containment bucket or another device that will prevsnt
release of product into the environment?
No Yes No No Yes No
No No@ Yes No Yes NoAn overfill prevention device is installed on tho tank. lf yes, indicate
the type of device in the space below.
Ball float valv€ (in vent line)
Automatic Shutoff valve (in fill oioe)L-Ovarfill Alarm <-/
Other Svstem /snecifu fuoa)
No No.@>No@For overlill alarm only: ls the alarm located whers it can be easily
seen and heard by the delivery driver?
Yes No
For overfill alarm only: ls the alarm cleady marked to indicate what is
meant when the alarm sounds?
Tenk I
No'eP
Aenk 2
No@
Tank 3
No
Tank 4
Yes No
Tank
NoG Ter*
No@ Tan*
NoC".)
Tank
Yes No
UE
NoG Um
NoG)LIF
/C) No t
Tanks and/or lines are made of a noncorrodible material (such as
fiberglass) or are made of steel clad with a noncorrodible material. lf
yes, cathodic protection is not required.Um
Yes No
Trr* /
Yes rt Tar*
Yes .r/
Tar*
Yes "/
Td*
Yes No
Tanks and/or lines are made of unprotected bare steel and were
installed prior to May 7, '1985. ll yes, cathodic protection is required
on or by December 22, 1998.
No
rt-/
v"" f Yes
Lrb /
^"
/*oYes
Um
Yes No
lndicate type of cathodic protecdon: lmpressed Current (lC) or
Sacrificial Anode (SA)I I /
The results ot the last two cathodic protection tests are available.
(Tests are required within six months o, installation and every three
years thereafler).
No'1"'*l No No,t Yes No
volts
Ter*T.*
volts
Te*
volts
Td
volts
Results (in volts) of most recent cathodic protection test.
Name of person who performed laet'
Test
Llm
voltsI
Um
volts
Llm
L volts
UE
volts
NoYes No Yes No Yes No
Signature of Owner or Owner's Representative Present During
lnspector's Signatu
For impressed current system: The results of the last three
equipment operation checks are available. (Equip. check required every
Distribution: White-DERR
SPILUOVERFILT PREVENTION
@
@
@
@
CORROSION ...PHOfEeilON
I la.
UTAIIUST PHOGRAM FaallltY:Itr
Spill, Overfill; and Cdrrosion Protection lnspection Ghecklist
(
,$
Tank 4Set 1
lJ/D-Ll
Yes No
Automatic Flow Restrictor (if yes, indicate model in comments sert'o! l9!9r).1
Automatic Shut-off Device (if yes, indicate model in comments section below)
Continuous Alarm System (if yes, indicate model in comments section below)
1fi\ No @No NoG)Records of last Line Leak Detector performance test available on-site
iil zsl++Date of last Line Leak Detoctor perlormance test
1d@ rait aPgFD Fait ,@qG)r rait Pass FailResult of last Line Leak Detoctor performance test
Set 2
NofYD Yes NoNo@No(@Records ol last Line Tightness Test available on-site
hlrylqq -Date of last Line Tightness Test
f@ Fait (,FES) Fail Pass FailFail6DResult of last Line Test
-Monitoring (if yes, use Monitoring
Groundwater Monitoring (if , use Groundwater
lnterstitial Monitoring (it yes, use lnterstitial Monitoring
Statistical lnventory Reconciliation use SIR checklist)
Yes NoYes No Yes NoYes No
method (it yes, use other method checklist)
Records of last Line Tightness Test available on-site
Other
Date of last Line Test
Pass Fail Pass FailPass Fail Pass FailBesult of last Line Test
use Vapor checklist)Vapor
use Groundwater Monitoring checklist)Groundwater
use lnterstitiallnterstitial checklist)
Statistical lnventory Reconciliation tslRl (if yes, use SIR checklist)
Yes No Yes No Yes NoYes NoOperates at less than atmospheric pressure
use other methodOthermethod (if
Yes No Yes NoYes No Yes Nowill allow ALL product to drain into tank when suction releasedSlope of piping
Yes No Yes NoYes No Yes No
is VERIFIABLE, use comments section
Has ONE check valve, located di
All above information on suction
under pump
Yes No Yes NoYes No Yes No
F*
Signature of Owner or Owner's Representiative Present During
lnspector's Signature:
Distribution: White-DERB
:iti a! I i !::,:ii:i : :: ,,,,: la ,::: r.::::::
iiitliiiii:liiiiiu,ilA.H UST PHOGRAM
:::,Hilense Detbclion For:: Fipi.hg::r
Faillity iE
]jiiifi:: i]iiiffiiffiiit i ,:$ffi11 r,rFiffia;1circ*eYesoil.to. wheieae$l C,ii ] . iitaCititypil$iUiiruu ri$irg.,
S fi iioh ahdll,GiAnj$,, Fl6w
ha+a.L-t
- CLSDManulacturer, name and model number of T
Tank 1 Tank 2 Tank 3 Tank 4
No@ @No @No Yes NoDevice documentation is available on-site (e.9., manufacturer's brochures, owne/s manual) (
No No4Es:NoRecords on site document that the system was installed, calibrated, and maintained
according to the manufacture/s instructions (if no explain below)
Yes No
A probe is present in the tank (checked by inspection)(@No No-@ NoI Yes No
1$) No @No @No Yes NoDevice can measure the height of the product to the nearest 1/8 of an inch
(
Not{a 3D Nor @No Yes NoDevice monitors the in-tank liquid levels over the full range of the tank's intemal height
No@ No@A monitoring box is present and there is evidence that the device is working (i.e., the device
is equipped with roll of paper lor results documentation)
NoG Yes No
Yes @ Yes @ Yes G Yes NoDocumentation is available demonstrating that the Automatic Tank Gauge was in leak t6st a-
mode at least once a month for the last 12 months ?
lf no, which months are missing? (specify months and year)/au
No@The tank was filled to at least the minimum level required by the manufacture/s equipment
protocol to ensure a valid lsak test
No@ dd$\ No Yes No
No@ No@ @No Yes NoThe tank capacity is within the upper and lower size limits required by the manufacture/s
equipment protocol to ensure a valid leak test
Have any of the leak test reports indicated a failed test. lf fail, specify in comments section
what actions have been taken to correct the problem. Has DERR been notitisd?
Yes @ Yes @ Yes @ Yes No
NoMNDocumentation of performance claims for the automatic leak test feafure is available and
shows the ability to detect leaks of 0.2 gph with 95o/o or greater probability of detection and
5% or less probability of false alarm (3rd party certification)
No(No Yes No
6/t,t/{
J
Date
Signature of Owner or Owner's Representative Present During lnspection
lnspector's Signature:
Distribution: White-DERR, Yellow-lnspector, Pink-Facility/Owner
UTAH UST PROGBAM
Automatic Tank
Faillity,,lS
Please circle Yas or No lor eath gusstion lor uch tank .ll,t . . ,ffii#.
on s€parat€ iDm. ,',1 :,::,f,r.r"
f;;\
0Zil
\
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44
J3?
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ft
i{*
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+
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-
-
\-, TANK DATA \/
OWNER: CALDER BROS. CO., INC.
LOCATION: CALDERIS GAS-N-GO
FACII.,,]TY ]D NUMBER:
OWNER ID NUMBER :
TANK ID NUMBER :
DATE C].,OSED :
HOW CT-,OSED :
SITE ASSESSMENT:
].,EAKAGE EVIDENCE ;
5000435
350
1
In Use
0
12,000 Gallons
FRPFiber Reinforced Plastic
Pressure
Gasol ine
Applicable
Appl i cabl e
Appli-cab1e
App 1i cabl e
s000435
360
In Use
0
12,000 Gallons
FRPFiber Reinforced Plastic
Pressure
Gasol ine
Applicable
Appl i c able
Applicable
Applicable
Auto. Gauging
Inter. Mon. /Double WalledTi
Not
Not
Not
Not
E DET, :
E DET. :
OVERF I ].,L PROT . :
SPILL PROT. :
Yes
Yes
TANK RE
PIPE RE
FACII.ITY ID NUMBER:
OWNER ID NUMBER:
TANK ID NUMBER:
STATUS:
AGE:
CAPACTTY:
TANK MATER]AI,;
PIPE MATERIAL:
PIPE TYPE:
SUB " STORED:
DATE CI,OSED :
HOW CLOSED:
SITE ASSESSMENT :
LEAKAGE EV]DENCE :
TANK RE],EASE DET. :
PIPE RELEASE DET. :
OVERFILL PROT. :
SPILL PROT . :
Auto. caugingInter. Mon. /Double WalledTi
LEAS
SLEA
Not
Not
Not
Not
5000435
350
3
Yes
Yes
In Use
0
12, 000 Gallons
FRPFiber Reinforced Plast.ic
Pressure
Diesel
App 1i cabl e
Applicable
Appl i cabl e
Appl i cabl e
Not
Not
Not
NoE
Auto.Inter.cauging
Mon. /Double WalledTi
Yes
Yes
STATUS:
AGE:
CAPACITY:
TANK MATERIAL:
PIPE MATERIAL:
PIPE TYPE:
SUB. STORED:
!r. _'- ^ '- '-.,:
v-i*tV1U
DEPARTMENT OF ENVIRONMENTAL QUALITY
DTVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION
Michael O. lravitt
Govcfnor
Dianne R. Nielson. Ph.D.
Exeutivc Dircctor
Kent P. Gray
Direttr
168 Nonh 1950 West
P.O. Box lzl48z10
salt llke city, urah 841l4-484O
[phone] Voice
[phone] Fax
(801) 536-44r4 T.D.D.
FIL E COPY
ERRU-175-95
Apil 27, 1995
CERTIFIED MAIL
RETURN RECEIPT REOUESTED
Milo D. Calder, Registered Agent for
Calder Bros. Co.
45 East 300 North
Provo, Utah 84606
NOTICE OF AGENCY ACTION AND ORDER
Deliveries to Facility ID No. 5000435, Calder's Gas-N-Go
Located at 1010 East Main, Wellington, Utah
Dear Mr. Calder:
Please find enclosed a Notice of Agency Action and Order for deliveries at the above-referenced
site. If you have any questions regarding this matter, please contact William Moore at [phone].
Sincerely,
Kent Gray,(usr)
Utah Solid and Hazardous Waste Control Board
KPGAVEIWacc
Enclosure
Sandra K. Allen, DERR Attorney
EPA Region VItr
Fred Nelson, Attorney General's Office
Gary Angott, M.S.P.H., Director, Southeastern Utah District Health Department
RE:
cc
Printed on recycred oaper
\, \/
TIIE EXECUTIVE SECRETARY (UST) OF TIIE
UTAH SOLD AND HAZARDOUS WASTE CONTROL BOARD
In The Matter Of:
Calder Bros. Co NOTICE OF AGENCY ACTION
ORDERING PAYMENT OF PEN ^LTIES
RE: ILLEGAL DELIVERIES
at Facility ID No. 5000435
CASE NO.: UST-D-5000435'1
As the Executive Secretary (UST) of the utah solid and Hazardous waste control Board, I am initiating an
agency action and order for the purpose of assessing administrative delivery penalties to Calder Bros' Co', due
to cerrain violations of the Utah Underground Storage Tank Act ("Act"), Utah Code Ann., $$ 19-6-401 et seq' and
utah Admin. code R3l1-200 et seq., at facility ID number 5000435. The agency action is based on the following
facts and violations of the Act:
FACTS
i Calder Bros., Co., herein referred to as ("Calders") is a Utah corporation doing business in the
2.
State of Utah.
The Division of Environmental Response and Remediation records show that on
September 6,1994, through January l7' lgg5, Calders made at least five (5) deliveries of
petroleum to the underground storage tanks ("USTs") at a Calders facility known as the Calders
Gas-N-Go, 1010 East Main, Wellington, Utah, while those USTs were not covered by a Certificate
of Compliance.
The USTs have been registered with the DERR at the above site and have been assigned facility
identification number 5000435
Records maintained by the DERR disclose that the facility failed to obtain a Certificate of
Compliance. The facility was without a Certificate of Compliance until issued on
January 17,1995.
4.
1
3.
5
6.
7
The records maintained for the facility disclose that employees of Calders made the five (5)
deliveries to the USTs that did not have a Certificate of Compliance.
Utah Code Ann., Section 19-6-416(l) states that "no person may deliver petroleum to a petroleum
storage tank if the owner or operator of the tank does not have a valid Certificate of Compliance."
VIOLATIONS
As shown in paragraphs #2, #4, #5. and #6, Calders committed five (5) violations of Utah Code
Ann. Section 19-6-416, for which the statutory penalty is $50O.00 per violation.
ORDER
The Executive Secretary (UST) hereby orders Calders to pay the statutory administrative penalty for violations
of Utah Code Ann. Section 19-6-416, of $500.00 per violation, for the five (5) violations, totalling $2,500.00.
Pursuant to l9-6-4M(3) and 63-46b-12, you may contest this Notice of Agency Action Ordering payment of
penalties regarding illegal deliveries, by filing a Request for Agency Action to contest the Notice of Agency
Action for it within 30 days after issuance. The Request for Agency Action should be filed with The Utah Solid
and Hazardous Waste Control Board, P.O. Box 144840, Salt Lake City, Utah 84114-4840. A copy must also be
mailed to Kent P. Gray, Executive Secretary (UST), P.O. Box 144840, Salt Lake Ciry, Utah 84114-4840. If you
do not contest this Notice of Agency Action Ordering Payment of penalties regarding illegal deliveries, as
described above, the facts specified herein will be deemed true and not subject to contest in future administrative
or judicial proceedings, and you will forfeit any right to proceed with an administrative or judicial appeal.
You may contact William Moore at [phone]or mail a response to the Division of Environmental Response
and Remediation, P.O. Box 144840, Salt Lake City, Utah 84114-4840, to discuss this matter.
Dated this day of 1995
Kent P., Executi (usT)
Utah Solid and Hazardous Waste Control Board
2
KPG/WEIWacc
)7il
MAILING CERTIFICATE
IcertifythatlmailedtrueandcorrectcopiesofforegoingNoticeofAgencyActionorcc
Payment of Penalties addressed as follows by depositing the same in the U S' Mail' p )ge
prepaid this -D- auy ot ,l 1995.
(Also sent by certified mail, retum receipt requested)
Milo D. Calder, Registered Agent for
Calder Bros. Co.
45 East 300 North
Provo, Utah 84606
Sandra K. Allen, DERR attomey
Fred Nelson, Attomey General's Office
EPA Region VItr
Gary enlott, M.S.P.H., Director, Southeastem Utah District Health Department
3
FACTLIT'Y rD. ,ooC Y 15-
PST PROCESSING CBECKTJIST
^.Year I5
Unacceptable AccepE.able
Not.
Appl i cabl e
Non-Marketer Discount.
-_*.
Previous PolluEion Incidents
- LUST Fii.e
- Form Included
v& t -''
@u-
i ttlt{
TTT
- Verify tank/ l j"nes
vs registered
- DocumenE.acion ok?
- Rate ok?
Fund Paid t lt+lq{FY 91
FY 92
FY 93
FY 94
Q1_Q2_Q3_Q4_Q1_Q2_Q3_Q4_Q1_Q2_Q3_Q4_Q1_Q2_Q3_Q4_
F\ q<
! 2eu / t"*,t-3 B 7 5-()
I ees Paro Y/N /
r''{ 1e tl rt lr{
-FY88
-FY89-FY90-FY91
-FY92-FY93-FY94
t \x,{/h*E *3 =-!'ltt{
Comp 1i ance
- Compliance OuE.standingr?
- Leak det.ecE.ion required?
- Spi11/overfi1l required?
- Corrosion protect.ion required?
- NoE.if icat.ion up to dat.e & compleE.e?- application submiEEed?
N-r)J rn<? sc.,zip\< sut .ilt.i@
%
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@
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Review corp.Letsed and certificat.e issued \r
rlt+/q{
prrproc. frri Ol129197
o/<
DaEe QualifiedDaEe Issued
v
-*tz/zt/17
\ tlt'+lcl(
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;. ' t:'
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it Calder Bros.:Tyans
Billing and Disparg[ Olfice
'll.e"
j,
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;, CatOcr Brcs. C.o., [nc.'r..i'' P.O. Box l9O3
I Provo, Utah
:1 . rcc Mc239i36,'i'i Pscu 2610
s6doo.t6q
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Co.tatrtb lJ.UdtIl ttLFllaAuaEl
DYED DIESEL R,,8" NONTAXABLE USE ONLY. PENALTY FOR TAHELE USE
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Llcense No.
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Label data for
License No.
Slata f.r I,
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utad ,e ,htiaria, ch4ila
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,tdtier Bros. Travq'
and DisPatch OF".
1085 Ovcrland Road
North Salt lakc, UT
801-29&7115
Fuel
45 oooqs{
323'tcaldcr Bros. co', !nc'
P.O. Box 19o3
Provo, Utah
tccMC 219r$
PSCU 2610
)
lnvoice
15 dryr. I dtitF,cGoatsiJ.ta lilrnotm!&Paymd dintt 15dayPo'iod,caflie, shal ass€ss r r6Drc6 cnrt!c
For Accountlng Urc OnlY
Oato
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Ptrllg
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llprebY was received bY me.
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FOR CHEMICAL EiTEBGENCY
Spill, Leak, Fire, Exposur€ or Accident
Call CHEMTREC - Day or Night
8{10-424.93@ (Toil Free)
Washlngton, O.C. 483.7616
outsic,€ continenrat u.s.A. [phone]
4
Bill ol Ladtng or
State TarJ
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I
comfrodxy lsdad
Snippsl Carler
Racrivad ,o,
Heallh and Physical Hazard Label data for producl described is providect on back ot form.
Complelecl form must be retained 3 years
mt-
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1r-rsax6,2-90
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UNDE^.dROUND STORAGE TANK PRC ltAM
tment Form
Acontant
?,0, &a r{03
h, flfl7(3-Q"ro
Date: | /
ut tt6o3
ADDRESS: {S E. loo U,
OWNER:
(circle one or more)
REFUND DELETE CHARGESReason f,AD fl@>Yes-No
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CERTIFTCATE NO. 46167-3
UST CERTIFICATE
OF
COIVI PLIANCE
ISSUED TO:LOCATION OF TANKS:
THIS CERTIFIES THAT THE FOLLOWING TANKS ARE IN COMPLIANCE
WITH THE UNDERGROUND STORAGE TANK ACT.
JAN 01 L996
DATE OF EXPIRATION
UTAH STATE DEPARTMENT OF ENVIRON
S
CALDER BROS. CO.,
45 E. 300 N.
P.O. BOX 1903
PROVO, UT 84503 !
,S GAS-N-GO
T MATN
WELLI UT 84542
ID: 5000435
TANK#CAPACIW SUBSTANCE TANK#CAPACITY SUBSTANCE \
'1L 12, OOO GASOLINE
z 12, 000 cASoLr
3 12,000 DrES********************
{
Terms ol Coverage: The o
This certificate will automatically i,
revoked for failure to comply with
closed tanks is specified in Utah Admin.
be made in accordance with Utah Admin. Cr
it ',
l"l
r this
"of th
fedeii
e'F131
,de Rl
fxq
'!
administrative purposes only.
ui are not paid. lt may also be
ulations. The coverage period for
7. Claims against the PST Fund must
t11-207.
NTAL OUALIW
-..*."-.-,r1..j
INC. ii' " '',.: ':"""" - "
I
\ilr 1''r. Yr Iilritr{, o{'LItah
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDTATION
168 Nonh 1950 West lst Floor
Salt take City, Utah 84116
(801) s36-4100
[phone] Fax
(80r) 536-4414 T.D.D.
TO Calder Bros. C any Inc.
Michael O. Leavitt
Covernor
Dianne R. Nielson, Ph.D.
Exccutive Director
Kent P. Gray
Diret0r
At tn: Brrrr--e Bi l l incrs
Dat.e: Dec. 30, 1994
From: PauI Hardinq
FACILITY I.D. #5000435
P-O Box 19 0 3
Prowo. IItah n46 03
Dear Mr. Billings:
According to t.he provisions of the Utah Underground Storage Tank
Act (ACT) , utah Code Annot.ated (ucA) , section L9-6-41,2, ef fective
July 1, 1991-, arr owners and operators of petroleum underground
storage tanks must have a Certificate of Compliance. Any petroleum
distributor who delivers to a tank that does not have a Certificate
of compliance will be subject to a civir penalty of 9500 per
occurrence (19-6-4L6, UCA) .
The tank tightness tests you submitted indicate that. aIl three
tanks contained product on october 25, 1994. The delivery of
product to these t.anks was made without a Certificate of Compliance
or permission for a one-time drop having been issued to this
facility and is therefore in violation of Lg-6-416 (UCA) .
A Certificate of Compliance cannot be issued unless a facility is
in substantial compliance with state and federal statutes.
Delivery receipts for all del,iveries to this facilit.y should be
submitted to demonst.rate compliance. untir a certificate of
Compliance is issued to the facility no product can be delivered
without the delivery being in violation of L9-6-41,6 (ucA).
La-'In order to receive a Certificate of Compliance you must file a pST
apprication and previous 5'otrrtio., incident.s form. you must also
pay registfftion and PST fuffa fees. For new t,anks the registration
fee is s135 per tank and the pST Fund fee is 9250 per tank (totar
of $1155 for three tanks for the first fiscal year) .
Pr fleo on recVcled parler
In addition you will need to submit a not.if icat.ion includi.ng page 5
properly completed and signed by the installer. I have included
these forms and a copy of the notification form that. you have
already submitted. Please indicate an exact. dat.e of insE.allation
by providi-ng the date that construction began, E.he date the tanks
were installed in t.he ground, and the date Ehat product. was first
delivered to the tanks.
If you have any questions, please contacc me at (801-) 536-4121 .
Sincerely,
Paul Harding
ieAr&
fur"t
UST lnstallation/Upgrade Notificarun vtLrl\vl
The utah undorground storase Tank (usr) rules (utah Administrativo codo R31 1-203-3) require lhat usr lnstaltets norrtyths Executive secr€tary, utah solid ina nararolr. w"ite i:ihrot eoaro, eo oavs u6roriiinslaling or upg*ding anyregulated usr svstom' This ,orm has been prcp"i"o io ir.Li you in provkiing ins nrormition. Borors tnstaling orupgrading an usr system, please complete tnis torm ana retm t lo'the Division of Environmentat Rssponse andRemediatlon al the address below_._|, any tanrs or tines .ir i"pl.Lo, a closure plan must bo .ro*ttuo ar,6 approv.d lorthe tanks or lines to be replaced and a ste assessment mrsii" performed al closure.
[ (l New lnstatlation [ ] Upgrade
Tank Owner Col&* %,', -Y,'rc
Phone#(8or )1-75-r.rra
Address Q.o.%o^\q cil ?l-or..>State:\_ zt €t-t Coo r
Contad Ferson in charge of tanks e\
Faclllty Name
Address \Q\C,
(> - c'.\ -L)o \--l
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ceniled Tank tn$alter Nan" S'TEVE oN5
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Phone # ( y'-6u7 Z r74
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Tank #
lnstalYuNrado
C+acity (gallons)
Type (FHP, Stael, etc.)
Substance to be stored
Tank Leak Detection melhod
Une leak detection melhod
Form ol Conosion Frotection
Spill devices ro be i;stalled (y/N)
Piping Typo (Press., Suction, Gravity) e.,r.,s
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Overlill device to bE installed (y/N) u a(_q
unusuar or extanuafl ng crrcumstan"""G-*
Mall compl€ted lgm to: \ utah Department o,Environmedal Ouality
Division of Enviro nmental Response and Remediation
150 Nonh 1950 West, 2nd Floor
Cily, Utah 84116
Rec'd BY- Notbs senr To o/oStale Uso Only: oaie Rec,d
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Date work will commence f{\ o..r t eq.l
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E. P. A. REGULATIoNS
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STEVE LYONS & ASSOC.,INTERMOUNTAIN LEAK,,P.0. Box 50076
Iu-9114029
UTT-10'8
PROVO, UTAH 846054.7
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CALDERS GAS-N-GO
P.O. BOX r 903
Piovo, UTAH 84603
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This letter, or an equivalent, must be signed and included with your application and fees.
PREVIOUS POLLUTION INCIDENTS
To:Mr. Kent P. Gray
Executive Secretary (UST)
Utah Solid & Hazardous Waste Control Board
Dear Mr. Gray:
As required by paragraph 19-6-413 ol the Utah Underground Storage Tank Act, I have performed a tank and
line tightness test on each underground storage tank at my
a release oI petroleum. Additionally, based on "customary
aware of any release ol petroleum from my tanks.
SI of ope
I have had the following releases oi petroleum (detailed below; also mention any action you took to clean up
the release).
signature of owner/oPerator
Failure to repoft previous releases could void your coverage under the Petroleum Storage Tank Fund.
facility, and based on this test, there has not been
business inventory *f,Wi,;fl;:rds. r am 41
."t:;llf'rn
"'oiYla*_{yr?,6r
p3lEpp.lrm 07/1294
^ FacilitytD*-&u>:12-
OR
) ra"r k 5 (^eat',/ ,,1^ z l- z"l9 a+*
Underground storage tank owners and operators must submit their faciliry throughput information for calendar year 2017,in order toreceive the proper PST Fund assessment rate. If the throughput informatiron is nJt ieceived by April 30, 201g, you will automaticallybe assessed at the higher rate. Documentation verifying the clairns made on this form must be made available or submitted for audit,when requested by DERR.
Please retum the completed form to:
OWNER FACILITY
Please indicate any changes or corrections to the owner/facility information in the space above.
Division of Environmental Response and Remediation
Underground Storage Tank Section
P.O. Box 144840
Salt Lake Ciry, Utah 84114-4940
If you know your 2017 calendar year throughput simply enter it on line 5 below.
Otherwise use the five step formula to calculate it.
I. BECINNING INVENTORY
(TOTAL AMOLTNT IN ALL REGULATED TANKS ONt/t/20t7)) RECEIVED
2. PURCHASES DURING THE YEAR
3. PETROLELM AVAILABLE FOR USE APR I 2 2(lIE
(ADD LINES I AND 2) Environmental Response &
4. LESS: ENDING INVENT.R' Remediation
(TOTAL IN ALL REGULATED TANKS ON 12l3Il2OI 1)Gallons
5. TOTAL ANNUAL FACILIry TI{ROUGHPUT ,fi .6tfy7'/ffvl@"u,,o,,"(:){l i llls-rs LINE 4.--,{LL+EGUL-#rED rANKS)
I certify under penaby oflaw that the above representations made by me are true and correct. I understand that byfalsifying this
document, I could beJined $10,000 per day of violation.
PETROLEAM STORAGE TA]YK FUND
F acility Thro ughp ut Declaration
Fiscal Year 2019 Qaly l,20IB- June 30,2019)
E -' ,''%116
S i gnature of o*ryf{erator T{ite
Email Address
* SEND NO PAYMENT AT THIS TIME *
An invoice will follow approximately May l5th.
Faciltty ID 5000435
Gallons
Gallons
ER BROS CO INC CALD ER'S GAS-N-GO CONOCO
BOX 50344 1O1O EAST MAIN
PROVO, UT 84605 GTON, UT 84542
Gallons
,,^' o D7 7
^Facility lD *
PETROLEUM STORAGE TANK FUND APPLICATION
5q6t2-,5
OWNER OF TANKS LOCATION OF TANKS
Owner Name C^u..B.Cc,8.. <.Facility Name
AddroSS rt) u5
(: -... - N-(>o
Address P.o. e)o(\QoB 661t fl..lq. n
City Q"o\ro City \Nq"\\,^o ton
County County C,r-.. \c, tl.'t
State Zip Code B.rGdl State L.ltcr^
Phone o l- j'75- rq I ?
Contact Person
Zp Code Bq6q a
Phone
Contact Person
5- r.u2
\\.
TYPE OF OWNER
[ ( ] Marketer, or non-markete
[ ] Non-marketer with facility
r with facility average monthly throughput greater than 10,000 gallons.
average monthly throughput less than 10,000 gallons (must verity).
Tank #
Age
Capacity
Substance
Tank #
Pass/Fail
TI TE
N Q\,J
,z,o6o
I 3
t2'12, ooo
qo!" qo5
oi
d 7
Qo.>5 Ro<'<r ?o''ag
N
Tanks (USTs) at this facility have been registered.
have been paid.
,r
/)
I r ] -All Underground Storage
t X l All tank registration fees
EGU oNscoMPLIANCITH U
ls the applicant currently in compliance with all Federal, State, and Local UST regulations?
I X ] Yes [ ] No ll "No" Please d escribe item(s) of non-compliance:
ENTS-PREV IOUS POL LUTION
Has a pollution incident
I I Yes lf "Yes" P
ever occurred at your facility?
lease provide LUST (Leaking Underground Storage Tank) information:
lxlNo lf ,No,, please attach a leter stating that under customary business inventory practicesstandards
you are not aware of any release lrom any tank(s) at this facility. The PREVIOUS POLLUTION
/NC/DENIS torm maY be used.
NO N
t(1
F A
I have met the financial responsibility requ
method:
[ ] Guarantee
irement for the first $25,000
[ ] Commercial lnsurance
per release bY the following
[ ] Surety Bond
I X] Self lnsurance
[ ] Risk Retention Group [ ] Letter of Credit [ ] Other
I ceftifl under PenaltY of w that the above representations made by me are true and correct.
Owner/Operator signatur Date signed 06 a
u+-\.
PETR'' EUM STORAGE TANK FUND CHECI'UST'
\/ --TION,|BTIFICATE OF REG
t,(l All Underground Storage Tanks (USTs) have been registered-EPA form 7530-1 (Revised 292).
d Tank registration f€es havs been paid- Fiscal lears 1988-89=$2Sltanlc/yr.,Fiscal years 1990-92=
$45/tanUyr., Subsequent fiscal years= $60 or $1Ss/tanldyr.
lrltl
R
I am in compliance with release
I am in compliance with all othe
detection requirements.
r Federal, State, and Local UST regulations.
3.P OLEUM RAGE TAN O FUND FEE s
PST Fund tees have been Paid.
t 1 Fiscal years 1991-93= g2s0/tanuyr. or $12s/tanuyr. (with non-marketer discount') plus applicable
process fees.
t 1 Fiscal year 1994= $1sO/tanuyr. or $7sltanUyr. (with non-marketer discount') plus applicable
process tees.
t I Subsequent fiscal years= Based on facility throughput $50, $150 or $17s/tanldyr plus applicable
process fees.
' For non-marketer dlscount
t I I am a non-marketer with facility average monthly throughput less than 10,000 gallons.
t j I have completed the APPLICATION FOR NON-MARKETER D/SCOUNrform(s).
4. TAN K AND LINE TIG HTNESS TE
trltrl - All systems pass the tank
I am submitting the results
and line tightness tests.
of the tank and line tightness tests and a copy of the field report.
All tanks do not meet the requirements set by rule regarding tank tightness testing.
I have contacted the state UST office and will submit evidence of a plan for review.
5. PRE VIOUS POLL N INCID
14 I have completed the
business inventory P
PREVIOUS POLLUTION INCIDENIS form, which states whether under customary
ractices standards I am aware of any release from the tank.
6. IND PENDENT CIAL NCE
I x] I have met the tinancial responsibi
method:
I y] Self lnsurance
[ ] Risk Retention Group
lity requirement for the first $25,000 per release by the following
[ ]Guarantee [ ]Commercial lnsurance []SuretyBond
[ ] Letter of Credit [ ] Other
).WITH UST
"See explanations under'How do I get started?'