DERR-2024-006895

Underground Storage Tank Inspection Verification Form
Facility ID:9000397
Owner Name:D & A MCRAE INC.Facility Name:Roosevelt Terminal
Owner Address:PO BOX 570238 Street Address:2690 W 2000 S
SIGURD, UT 84657 ROOSEVELT, UT 84066
Operator A:No Data / No Data / Operator B:No Data / No Data /
Owner Email:[e-mail] UTM Coordinates X/Y:581455 / 4458536
Disp ID/Alt
ID
Substance UDC Pipe Flex Loc Install Date UDC Install Date Fire
Valve
Sat
Present
UDC Test Disp Flex CP
Test
1 - 1/2 Diesel No No Yes
Tank ID/Alt ID:1 / 1 EGen/AST/Stat
e:
No / Yes /
Yes
Pipe Material-Mod: -
Siphon/Compart:No / No PVV/StageI:Pipe Type/STP Cont: / No
Tank Status:Currently In Use STP Flex Connectors:
Installed/Cap/Loc:1/1/1910 / 10000 / Single LLD Model:
Substance Stored:Diesel / Spill/Overfill/Sm deliv:Dry Connect Fitting / Automatic shutoff / No
Tank Material-Mod:Asphalt Coated or Bare Steel - PST Fund/Other Type:No / Insurance
ATG: / Tank/Pipe Rel Det:OTHER / OTHER / NONE
ATG Specs: / / STP Sump Test:Spill Bk Test:06/13/2023
ATG Test:Overfill Test:
LTT Test:LLD Test:CP Tank Test:CP Pipe Test:
5/7/2024 Page 1 of 1