Attachment_-_Company_Experience.pdf

Attachment 10 – Experience and Capacity Response (Continued)

2.1 Provide at least one example per UST Inspection type that exhibits your experience for clients relevant to the Scope of Work for UST Inspections. Provide supporting documentation as a separate attachment and title the document: “Attachment - Company Experience”.

Williams & Company Consulting, Inc. (now providing as Energy & Environmental Advisors, Inc.)

currently holds ADEQ18-00008257 UST Inspections contract for ADEQ and has been performing each type of inspection, relevant to the scope of work, since August of 2018. We provided inspection reports to demonstrate these examples in Attachment – Company Experience.

EXAMPLE 1:

ROUTINE INSPECTION REPORT

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 1

UST Field Inspection Report Facility Name : CARIOCA #35 Facility ID: 0-000945

Inspection ID: 421620 Inspection Date: April 25, 2023

Physical Location:

Mailing Address: 2623 W DUNLAP AVE, PHOENIX, AZ 85021 County: MARICOPA

Inspector(s): Randy Jaquez Patrick Baty Inspector Email and Phone:

jaquez.randy@azdeq.gov (602) 826-8789 Site Arrival Time: 1110 Site Departure Time: 1230

Responsible Party Contact: Magee, Howard Phone: (602) 741-3532 Email: HOWARD@CARIOCACO.COM Tank Owner:

Owner Address:

Operator:

Operator Address:

Reason for Inspection:

☑ Routine Inspection ☐ Compliance Assistance ☐ Follow-Up ☐ Complaint ☐ Other:

Date Started: April 25, 2023 Date Completed: April 25, 2023

On-Site Representative Name and Title: Sam Lee, Manager Email:

Phone: (602) 943-1175

DRO:

DRO Email:

Facility Initial:

Inspection Report Issued: Email from ADEQ Office

ADEQ Initial:

Results of Inspection:

☑ This Facility is in compliance with Arizona Revised Statues A.R.S. §49-1001 through 49-1021 and associated Administrative Rules ☐ This Facility is not in compliance with Arizona Revised Statues A.R.S. §49-1001 through 49-1021 and associated Administrative Rules. Follow-up action is needed; please submit the requested documentation, which is detailed on the Due within 30 calendar days from this notice .

☐ Potential deficiencies were noted during the course of the inspection. Within one business day of this notice, submit compliance documentation to the compliance officer listed on this report.

Attachments: Notice of Inspection Rights, Small Business Bill of Rights, Photograph Log, Inspection Checklist, Small Business Bill of Rights, Inspection Checklist Comments:

Intent to Prohibit Delivery (Notice of Stop Use Order):

In accordance with A.R.S. § 49-1023.B.1, ADEQ may immediately issue a stop use order and affix a stop use tag on the non-compliant UST system(s) for the violation(s) identified below:

1. ☐ Section § 49-1003: Release Detection

2. ☐ Section § 49-1009: Tank Performance Standards

In accordance with A.R.S. § 49-1023.B.2, ADEQ will issue a stop use order on the non-compliant UST system(s) if the violation(s) identified below are not corrected within 30 days of the date of this notice.

3. ☐ Section § 49-1006: Financial Responsibility requirements

4. ☐ Section § 49-1020: Payment of Annual Tank Fees

5. ☐ Section § 49-1031: Payment of Fuel Tax

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 2

ARIZONA DEPARTMENT OF ENVIRONMENTAL QUALITY

NOTICE OF INSPECTION RIGHTS

FACILITY INFORMATION ADEQ INFORMATION

Facility Name : CARIOCA #35 Facility ID: 0-000945 Physical Location:

Mailing Address: 2623 W DUNLAP AVE, PHOENIX, AZ 85021 County: MARICOPA

Date/Time of Inspection: April 25, 2023 Inspector: Randy Jaquez Patrick Baty Inspector Email and Phone: jaquez.randy@azdeq.gov

(602) 826-8789

Responsible Party Contact: Magee, Howard Phone: (602) 741-3532 Email: HOWARD@CARIOCACO.COM Tank Owner:

Owner Address:

Operator:

Operator Address:

On-Site Representative Name and Title: Sam Lee, Manager Email:

Phone: (602) 943-1175

DRO:

DRO Email:

ADEQ Follow-up Contact: FCB, Chris Brown -brown.chris@azdeq.gov - 602-771-

The ADEQ representative(s) identified above were present at the above address on the above listed date and time. Upon entry to the premises, the ADEQ representative(s) met with me, presented photo identification indicating that they are ADEQ employees and explained:

That the purpose of the inspection is to determine:

☑ Compliance with Title 49 of the Arizona Revised Statutes, Title 18 of the Arizona Administrative Code* and/or:

Arizona Revised Statutes: Title 49, Chapter 6.

Arizona Administrative Code: Title 18, Chapter 12.

Permit/Agreement Number: N/A.

☐ Qualification for a license issued pursuant to:

ARS: Title __, Chapter __, Article ___. AAC: Title __, Chapter __, Article ___.

☑ That this inspection is conducted pursuant to the authority granted in Arizona Revised Statutes § 49-104(B)(8) and/or:

Arizona Revised Statutes: § 49-1009.

Arizona Administrative Code: Title 18, Chapter 12.

Permit/Agreement Number: N/A.

☑ That the state shall not be barred by the statutes of limitations of actions, according to A.R.S. § 12-510, except as provided in A.R.S. § 12-529 concerning certain claims based on navigability of watercourses. According to 28 U.S.C. § 2462, the U.S. government must commence an action within 5 years after the date the claim first accrued.

☐ The applicability of the Small Business Bill of Rights pursuant to Arizona Revised Statutes § 41-1001(21).

☐ That the fee for this inspection is: $0.

*The Arizona Revised Statutes (A.R.S.) can be found on the internet: www.azleg.state.az.us/ArizonaRevisedStatutes.asp while the Arizona Administrative Code (A.A.C.) can be found at www.azsosaz.gov/public_services/Table_of_Contents.htm.

While I have the right to refuse to sign this form, the ADEQ representatives may still proceed with the inspection.

☑ I have read this notice and discussed any questions or concerns with the ADEQ representatives and I have received the Small Business Bill of Rights.

Signature of Regulated Person or Authorized On-Site Representative Sam Lee Name of Regulated Person or Authorized On-Site Representative

Date: April 25, 2023 Title: Manager

Signature of ADEQ Representative

Date: April 25, 2023

☐ The regulated person or authorized on-site representative refused to sign.

☐ The regulated person or authorized on-site representative was not present at the facility.

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 3

Inspection Rights

☑ I understand that I can accompany the ADEQ representative(s) on the premises, except during confidential interview.

☑ I understand that I have right to, on request:

• Copies of any original documents taken during the inspection, and that ADEQ will provide copies of those documents at

ADEQ’s expense;

• A split of any samples taken during the inspection, if the split of the samples would not prohibit an analysis from being conducted or render an analysis inconclusive;

• Copies of any analysis performed on samples taken during the inspection and that ADEQ would provide copies of this analysis at ADEQ’s expense;

• Copies of any documents to be relied on to determine compliance with licensure or regulatory requirements if the agency is otherwise permitted by law to do so.

☑ I also understand that:

• Each person who is interviewed by an ADEQ inspector during the inspection must be informed that:

1) Participation in an interview is voluntary, unless legally compelled to participate;

2) They have the right to have an attorney or other experts in their field present during the interview to represent or advise the regulated person;

3) The ADEQ inspector may not take any adverse action or treat less favorably or draw any inference as a result of the regulated person’s decision to be represented by an attorney or advised by any other experts in their field;

4) Statements made by the person may be included in the inspection report; and

5) They have the right to 24 hours to review and revise any written witness statement drafted by the ADEQ inspector on which the ADEQ inspector requests that person’s signature.

• If the information and documents provided to the ADEQ inspector become a public record, trade secrets and proprietary and confidential information may be redacted, unless the information and documents are not confidential pursuant to statute.

• Each person interviewed during the inspection must be informed that statements made by the person may be included in the inspection report;

• Each person whose conversation is tape recorded during the inspection must be informed that the conversation is being tape recorded;

• If an administrative order is issued or a permit decision is made based on the results of the inspection, I have the right to appeal that administrative order or permit decision. I understand that my administrative hearing rights are set forth in Arizona Revised Statutes § 41-1092 et seq. and my rights relating to an appeal of a final agency decision are found in Arizona Revised Statutes § 12-901 et seq;

• If I have any questions or concerns about this inspection, I may contact the person listed as the ADEQ Follow-up Contact on the front of this form; ADEQ’s Ombudsman at (602) 771-4322 (toll free inside Arizona at (800) 2345677, extension, 771-4322); or the Arizona Ombudsman-Citizens’ Aid office at (602) 277-7292 (toll free at

(800) 872-2879);

• If I have any questions concerning my rights to appeal an administrative order or permit decision, I may contact ADEQ’s Office of Administrative Counsel at (602) 771-2212 (toll free inside Arizona at (800) 234-5677, extension 771-2212).

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 4

Arizona Revised Statutes: Small Business Bill of Rights

41-1001.01. Regulatory bill of rights; small businesses A. To ensure fair and open regulation by state agencies, a person:

1. Is eligible for reimbursement of fees and other expenses if the person prevails by adjudication on the merits against an agency in a court proceeding regarding an agency decision as provided in section 12-348.

2. Is eligible for reimbursement of the person's costs and fees if the person prevails against any agency in an administrative hearing as provided in section 41- 1007.

3. Is entitled to have an agency not charge the person a fee unless the fee for the specific activity is expressly authorized as provided in section 41-1008.

4. Is entitled to receive the information and notice regarding inspections and audits prescribed in section 41-1009.

5. May review the full text or summary of all rulemaking activity, the summary of substantive policy statements and the full text of executive orders in the register as provided in article 2 of this chapter.

6. May participate in the rulemaking process as provided in articles 3, 4, 4.1 and 5 of this chapter, including:

(a) Providing written comments or testimony on proposed rules to an agency as provided in section 41-1023 and having the agency adequately address those comments as provided in section 41-1052, subsection D, including comments or testimony concerning the information contained in the economic, small business and consumer impact statement.

(b) Filing an early review petition with the governor's regulatory review council as provided in article 5 of this chapter.

(c) Providing written comments or testimony on rules to the governor's regulatory review council during the mandatory sixty-day comment period as provided in article 5 of this chapter.

7. Is entitled to have an agency not base a licensing decision in whole or in part on licensing conditions or requirements that are not specifically authorized by statute, rule or state tribal gaming compact as provided in section 41-1030, subsection B.

8. Is entitled to have an agency not make a rule under a specific grant of rulemaking authority that exceeds the subject matter areas listed in the specific statute or not make a rule under a general grant of rulemaking authority to supplement a more specific grant of rulemaking authority as provided in section 41- 1030, subsection C.

9. May allege that an existing agency practice or substantive policy statement constitutes a rule and have that agency practice or substantive policy statement declared void because the practice or substantive policy statement constitutes a rule as provided in section 41-1033.

10. May file a complaint with the administrative rules oversight committee concerning:

(a) A rule's, practice's or substantive policy statement's lack of conformity with statute or legislative intent as provided in section 41-1047.

(b) An existing statute, rule, practice alleged to constitute a rule or substantive policy statement that is alleged to be duplicative or onerous as provided in section 41-1048.

11. May have the person's administrative hearing on contested cases and appealable agency actions heard by an independent administrative law judge as provided in articles 6 and 10 of this chapter.

12. May have administrative hearings governed by uniform administrative appeal procedures as provided in articles 6 and 10 of this chapter and may appeal a final administrative decision by filing a notice of appeal pursuant to title 12, chapter 7, article 6.

13. May have an agency approve or deny the person's license application within a predetermined period of time as provided in article 7.1 of this chapter.

14. Is entitled to receive written notice from an agency on denial of a license application:

(a) That justifies the denial with references to the statutes or rules on which the denial is based as provided in section 41-1076.

(b) That explains the applicant's right to appeal the denial as provided in section 41-1076.

15. Is entitled to receive information regarding the license application process before or at the time the person obtains an application for a license as provided in sections 41-1001.02 and 41-1079.

16. May receive public notice and participate in the adoption or amendment of agreements to delegate agency functions, powers or duties to political subdivisions as provided in section 41-1026.01 and article 8 of this chapter.

17. May inspect all rules and substantive policy statements of an agency, including a directory of documents, in the office of the agency director as provided in section 41-1091.

18. May file a complaint with the office of the ombudsman-citizens aide to investigate administrative acts of agencies as provided in chapter 8, article 5 of this title.

19. Unless specifically authorized by statute, may expect state agencies to avoid duplication of other laws that do not enhance regulatory clarity and to avoid dual permitting to the extent practicable as prescribed in section 41-1002.

20. May have the person's administrative hearing on contested cases pursuant to title 23, chapter 2 or 4 heard by an independent administrative law judge as prescribed by title 23, chapter 2 or 4.

B. The enumeration of the rights listed in subsection A of this section does not grant any additional rights that are not prescribed in the sections referenced in subsection A of this section.

C. Each state agency that conducts audits, inspections or other regulatory enforcement actions pursuant to section 41-1009 shall create and clearly post on the agency's website a small business bill of rights. The agency shall create the small business bill of rights by selecting the applicable rights prescribed in this section and section 41-1009 and any other agency-specific statutes and rules. At the request of an authorized on-site representative of the regulated small business, the agency shall provide a written document of the small business bill of rights. In addition to the rights listed in this section and section 41-1009, the agency notice of the small business bill of rights shall include the process by which a small business may file a complaint with the agency employees who are designated to assist members of the public or regulated community pursuant to section 41-1006. The notice must provide the contact information of the agency's designated employees. The agency notice must also state that if the regulated person has already made a reasonable effort with the agency to resolve the problem and still has not been successful, the regulated person may contact the office of ombudsman-citizens aide.

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 5

UST Inspection Checklist

R18-12- Fill/Overfill Pass/Fail/N/A 220D(1) Spill bucket is free of cracks, bulges, holes, or other defects Pass

Comment:

220(A) Spill bucket is free of Product or PCW Pass

Comment:

220(A) Spill bucket lid is free of cracks and gasket is intact Pass

Comment:

220(A) Fill lid cap is functional and gasket is intact Pass

Comment:

220(A) Fill pipe is free of any obstructions and flapper valve is not disabled Pass

Comment:

220(A) DW SB: interstice port accessible and interstice free of liquid N/A

Comment:

220(A) DW SB: interstice gauge shows no liquid in the interstice Pass

Comment:

220(A) DW SB: interstice gauges are operational and readable Pass

Comment:

235(A)(1)(b) Triennial spill bucket integrity test conducted and passing Pass Comment: Test Date: 03/01/2023 235(A)(1)(b) Triennial sump and UDC integrity tests conducted and passing Pass Comment: Test Date: 02/16/2023

235(A)(2) Triennial Overfill Prevention Equipment test conducted and found operational and set to operate at the correct level

Comment: Test Date: 03/01/2023

R18-12- Pre-Inspection File Review Pass/Fail/N/A 240(A)(3) ATG Operability testing conducted and passing Pass

Comment: Test Date: 11/29/2022 237(G)(1) A and B operator certificates are present and current Pass

Comment: Samuel Lee on site Exp. Date: 07/19/2025 237(G)(1) C operator certificates (or signage, if unmanned facility) are present and current) N/A

Comment: N/A Exp. Date:

301(A) Financial Responsibility is current with the agency Pass

Comment: Exp. Date: 02/25/2024 222(B) Notification forms are submitted and accurately reflect all USTs present at the facility Pass

Comment:

222(B) Installation of new (after 12/22/88) UST(s) are properly certified on a notification form Pass

Comment:

233(E) Testing after any installation, modification, or repair conducted and present and within 30 days Pass

Comment:

222(D) Any new equipment installed/tested since last inspection N/A

Comment:

234(B)(1)-

(7) Records, repair, and testing and release detection available for inspection Pass

Comment:

CHECK Violations addressed and closed from previous inspections N/A

Comment:

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 6

R18-12- Fill/Overfill Pass/Fail/N/A 235(A)(2) Audible alarm test conducted and operational Pass

R18-12- Sumps Pass/Fail/N/A Has there been a precipitation event that may have contibuted to water in the sumps? No

220(A) Sump is free of product and/or Petroleum Contact Water (PCW) Pass Comment:

220(A) Sump is free of trash and other debris Pass Comment:

220(A) Sump is free of cracks, bulges or other defects Pass Comment:

220(A) RD Sensor is at the bottom of the sump Pass Comment:

220(A) STP or piping shows no significant signs of corrosion Pass Comment:

220(A) Line leak detectors (LLDs) are present and in good condition Pass

R18-12- Piping Pass/Fail/N/A 220(A) No cracks or breaks present in the piping Pass

Comment:

240(A)(1) DW Piping: Test boot is not pulled over piping and clamped or valve stem removed Pass

Comment:

220(A) Piping Penetrations are not cracked or coming off of sump wall Pass

Comment:

220(A) Piping flex connectors or metal components are not corroded Pass

R18-12- Dispensers and Under-Dispenser Containment (UDC) Sumps Pass/Fail/N/A 220(E) Shear Valve is properly anchored and all bolts are intact Pass

Comment:

220(A) Shear Valve switch has not been tampered with or held open Pass

Comment:

220(A) Shear Valve and connections are not leaking Pass

Comment:

220(A) UDC is free of product and/or Petroleum Contact Water (PCW) Pass

Comment:

220(A) UDC is free of trash, fuel filters or other debris Pass

Comment:

220(A) UDC is free of cracks, bulges, holes or other defects Pass

Comment:

220(A) Piping near or below the shear valve is free of leaks Pass

Comment:

220(A) Piping penetrations are not cracked, disintegrating, or coming off of UDC wall Pass

240(A)(1) DW Piping: Valve test stems removed or capped Pass

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 7

R18-12- Dispensers and Under-Dispenser Containment (UDC) Sumps Pass/Fail/N/A

240(A)(2) RD sensor is at the bottom of the UDC Pass

R18-12- Periodic Operation and Maintenance Walkthrough Inspections Pass/Fail/N/A

236(A)(1) Monthly Walkthroughs conducted every 30 days except where deliveries > 30 days Pass Comment:

236(A)(1)(a) Last 12 months of monthly walkthroughs are present Pass Comment:

236(A)(1)(b) Most recent annual walkthrough present Pass Comment:

236(A)(2);

236(A)(3) Monthly walkthroughs are conducted to a standard code of practice Pass

Comment:

236(A)(2);

236(A)(3) Annual Walkthroughs are conducted to a standard code of practice Pass

R18-12- ATG Operability Pass/Fail/N/A CHECKED ATG: Overview and Tank Inventory Overview is printed off the ATG Pass

Comment:

CHECKED ATG: RD Reports/Tapes are normal and alarms were investigated for unusual operating conditions or suspected releases Pass

Comment:

CHECKED ATG model is listed and confirmed for accuracy Pass

Comment: ATG Model: Veeder Root TLS 350 240(A) ATG is on and operational Pass

Comment:

245(C) ATG has paper and can print tank reports Pass

Comment:

240(A) ATG alarms acknowledged upon arrival N/A

Comment:

243(D)(1) ATG was in test mode a minimum of once a month for the last 12 months and documentation is present to verify Pass

Comment:

245(A) ATG installation documentation verified Pass

Comment:

240(A) Water in the bottom of the tank is checked and displayed to the nearest 1/8th of an inch Pass

Comment:

240(A) Device documentation is available on site (owner’s manual, manufacturer’s brochure) Pass

Comment:

245(A) ATG was installed, calibrated and maintained in accordance with manufacturer's specifications. Pass

Comment:

245(A)(2) ATG maintenance records maintained and available Pass

Comment:

240(A)(3) All parts of the UST system that use the ATG are programmed and being actively monitored Pass

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 8

R18-12- ATG Operability Pass/Fail/N/A

240(A)(4)

The following ATG minimum performance standards are met: 0.20 gph with probability of detection of 95% and probability of false alarm of 5% for ATG (e.g., third-party result sheet under EPA’s “Standard Test Procedures for Evaluating Leak Detection Methods”)?

Will declare a leak on the basis of inventory reconciliation if discrepancy exceeds 1% of flow-through, plus 130 gallons on a monthly basis Detects water and product to the nearest 1/8th of an inch

Pass

R18-12- Release Detection – General Pass/Fail/N/A 240(A) A method, or combination of methods, of release detection is in use Pass

Comment:

234(B)(7);

245(C) Last 12 months of release detection records are present Pass

R18-12- Release Detection – Site Specific

Method of Release Detection: Annual or Triennial Line Tightness test conducted and passing (Record Test Date)

Test Date (if applicable): 11/29/2022

Method of Release Detection: Annual Line Leak Detector test conducted and passing (Record Test Date)

Test Date (if applicable): 11/29/2022

Method of Release Detection: Interstitial monitoring conducted at least monthly

Test Date (if applicable): 04/25/2023

R18-12- Corrosion Protection Systems Pass/Fail/N/A

231(B)(1) Cathodic protection systems tested within 6 months of install and every 3 years thereafter N/A

Comment: Test Date:

233(C) Cathodic protection systems tested within six months of a repair N/A

Comment:

231(D) Records of sacrificial anode system tests indicate system is functioning properly N/A

Comment:

231(C) Records of cathodic protection systems being inspected every 60 days (Impressed Current Only) N/A

Comment:

220(B)(2)(c) Impressed current system is turned on and operating upon arrival N/A Comment: Amps/Volts/Hours:

R18-12- Safe Suction Piping Pass/Fail/N/A

241(C)(2)(a) Piping operates at less that atmospheric pressure N/A

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 9

R18-12- Safe Suction Piping Pass/Fail/N/A 241(C)(2)(d) Piping has one operational check valve located directly under the pump N/A Comment:

241(C)(2)(b) Slope of piping allow product to drain back into tank when suction is released N/A Comment:

241(C)(2) All information regarding suction piping has been verified with documentation N/A

R18-12- Suspected Releases Pass/Fail/N/A

251(A) Any suspected releases between inspection periods were reported within 24 hours of discovery N/A

Comment:

251(C) Suspected Releases were investigated within 60 days and the result reported to the agency N/A

Comment:

251(E) 14 day follow up of confirmed releases were filed with the agency N/A

Comment:

251(A) ATG alarms notifying of product in STP sumps or UDCs were investigated N/A

Comment:

230(B) No evidence of a spill or overfill present associated with a UST system Pass

R18-12- USTs Temporarily Closed For More Than 3 Months Pass/Fail/N/A 270(B) Corrosion protection has been maintained during closure N/A

Comment:

270(B) Release detection has been maintained during closure N/A

Comment:

270(B) USTs have been emptied to no more than 2.5 centimeters (1 inch) of residue or 0.3% by weight of the total capacity of the UST system N/A

Comment:

270(C)(1) Vent lines left open and functional N/A

Comment:

270(C)(2) All other lines, pumps, manways, and ancillary equipment are capped N/A

R18-12- Upgrades and Compatibility Pass/Fail/N/A 221(A) The UST system meets upgrade requirements as per A.A.C R18-12-221 Pass

Comment:

211(A)(3);

232(A) UST system components are compatible with the substances stored Pass

Comment:

232(B) Records demonstrating compatibility of UST system and components are present Pass

R18-12- Expired Exemptions Pass/Fail/N/A 210 (A) Emergency Generator UST has been upgraded to meet requirements N/A

Comment:

210 (A) Field Constructed Tanks (FCTs) have been upgraded to meet requirements N/A

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 10

R18-12- Expired Exemptions Pass/Fail/N/A 210 (A) Airport Hydrant Systems (AHSs) have been upgraded to meet requirements N/A

R18-12- For USTs Temporarily Closed For More Than 12 Months Pass/Fail/N/A 271(A) USTs have been upgraded, permanently closed, or had a change in service N/A

Comment:

270(A) Notification form for closure has been submitted N/A

Comment:

271(D)(5) Site assessment was conducted for tank closure N/A

Comment:

270(E) Permanently closed a UST system that does not meet either the performance standards for new UST systems or the upgrade standards and has been in temporary closure for more than 12 months

N/A

Piping Information Piping Number Pipe Wall Double Type of Construction Fiberglass Reinforced Plastic Leak Detection Method(s) Interstitial Monitoring (Double Walled) Type of Delivery System PRESSURE Location of Check Valves Comment Piping Count 9

Pipe Wall Double Type of Construction Fiberglass Reinforced Plastic Leak Detection Method(s) Interstitial Monitoring (Double Walled) Type of Delivery System PRESSURE Location of Check Valves

Piping Count 10a

Pipe Wall Double Type of Construction Fiberglass Reinforced Plastic Leak Detection Method(s) Interstitial Monitoring (Double Walled) Type of Delivery System PRESSURE Location of Check Valves

Piping Count 10b

Tank Information Tank Number 0-000945 Tank 9 COMPARTMENT A Date Installed 2020-11-20 Capacity(gallons) 12,000 Tank Wall Double Type of Construction Fiberglass Reinforced Plastic Contents Unleaded Gasoline Leak Detection Method(s) Interstitial Monitoring (Double Walled) Overfill Protection Flapper

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 11

Spill Protection Yes

Tank Count 1

Tank Number 0-000945 Tank 10 COMPARTMENT A Date Installed 2020-11-20 Capacity(gallons) 6,000 Tank Wall Double Type of Construction Fiberglass Reinforced Plastic Contents Premium Unleaded Gasoline Leak Detection Method(s) Interstitial Monitoring (Double Walled) Overfill Protection Flapper Spill Protection Yes

Tank Count 2

Tank Number 0-000945 Tank 10 COMPARTMENT B Date Installed 2020-11-20 Capacity(gallons) 6,000 Tank Wall Double Type of Construction Fiberglass Reinforced Plastic Contents Diesel Leak Detection Method(s) Interstitial Monitoring (Double Walled) Overfill Protection Flapper Spill Protection Yes

Tank Count 3

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 12

Photo Log

Facility Name: CARIOCA #35 Facility ID: 0-000945

Photo Number: 1 Inspector: Randy Jaquez

Photo Date: April 25, 2023

Photo Description: Veeder Root TLS 350

Photo Number: 2 Inspector: Randy Jaquez

Photo Description: Tank inventory

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 13

Photo Number: 3 Inspector: Randy Jaquez

Photo Description: Liquid status all normal

Photo Number: 4 Inspector: Randy Jaquez

Photo Description: Store front

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 14

Facility ID: 0-000945

Photo Number: 5 Inspector: Randy Jaquez

Photo Description: Dispensers

Photo Number: 6 Inspector: Randy Jaquez

Photo Description: Dispensers

Photo Number: 7 Inspector: Randy Jaquez

Photo Description: Tank pad

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 15

Photo Number: 8 Inspector: Randy Jaquez

Photo Description: Tank 1 unleaded 87 overview

Photo Number: 9 Inspector: Randy Jaquez

Photo Description: Tank 1 unleaded 87 Spill bucket overview

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 16

Facility ID: 0-000945

Photo Number: 10 Inspector: Randy Jaquez

Photo Description: Tank 1 unleaded 87 Spill bucket and Interstice gauge

Photo Number: 11 Inspector: Randy Jaquez

Photo Description: Tank 1 unleaded 87 Fill tube and flapper valve

Photo Number: 12 Inspector: Randy Jaquez

Photo Description: Tank 1 unleaded 87 STP sump

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 17

Photo Number: 13 Inspector: Randy Jaquez

Photo Description: Tank 1 unleaded 87 Piping penetration

Photo Number: 14 Inspector: Randy Jaquez

Photo Description: Tank 1 unleaded 87 Interstitial probe

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 18

Facility ID: 0-000945

Photo Number: 15 Inspector: Randy Jaquez

Photo Description: Tank 2a premium 91 overview

Photo Number: 16 Inspector: Randy Jaquez

Photo Description: Tank 2a premium 91 Spill bucket overview

Photo Number: 17 Inspector: Randy Jaquez

Photo Description: Tank 2a premium 91 Spill bucket and Interstice gauge

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 19

Photo Number: 18 Inspector: Randy Jaquez

Photo Description: Tank 2a premium 91 Fill tube and flapper valve

Photo Number: 19 Inspector: Randy Jaquez

Photo Description: Tank 2a premium 91 STP sump

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 20

Facility ID: 0-000945

Photo Number: 20 Inspector: Randy Jaquez

Photo Description: Tank 2a premium 91 Piping penetration

Photo Number: 21 Inspector: Randy Jaquez

Photo Description: Tank 2 b diesel overview

Photo Number: 22 Inspector: Randy Jaquez

Photo Description: Tank 2 b diesel Spill bucket overview

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 21

Photo Number: 23 Inspector: Randy Jaquez

Photo Description: Tank 2 b diesel Spill bucket

Photo Number: 24 Inspector: Randy Jaquez

Photo Description: Tank 2 b diesel Fill tube and flapper valve

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 22

Facility ID: 0-000945

Photo Number: 25 Inspector: Randy Jaquez

Photo Description: Tank 2 b diesel STP sump

Photo Number: 26 Inspector: Randy Jaquez

Photo Description: Tank 2 b diesel Piping penetration

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 23

Photo Number: 27 Inspector: Randy Jaquez

Photo Description: Fuel types

Photo Number: 28 Inspector: Randy Jaquez

Photo Description: UDC

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 24

Photo Number: 29 Inspector: Randy Jaquez

Photo Description: UDC piping penetration

Photo Number: 30 Inspector: Randy Jaquez

Photo Description: Vent lines and alarm

Revised April 2021 Facility ID: 0-000945 Inspection ID: 421620 Page 25

Facility ID: 0-000945

Photo Number: 31 Inspector: Randy Jaquez

Photo Description: Vent lines and alarm

EXAMPLE 2:

ROUTINE EXIT DEBRIEF REPORT

UST FIELD INSPECTION EXIT DEBRIEFING

Facility Name : CIRCLE K #2703463 Facility ID: 0-010530 Inspection ID: 421036

Physical Location:

Mailing Address: 2737 S ELLSWORTH RD, MESA, AZ 85209 County: MARICOPA

Inspector(s): Randy Jaquez (602) 826-8789 Inspector Email: jaquez.randy@azdeq.gov Compliance Officer: Chris Brown -brown.chris@azdeq.gov - 602-771-4270 Inspection Date: April 7, 2023 Responsible Party Contact: Kwiatkowski, Kim K.

Phone: (602) 728-8000 Email: AZLICENSE@CIRCLEK.COM Tank Owner: CIRCLE K STORES INC Owner Address: PO BOX 52085, PHOENIX, AZ 85072 Operator: CIRCLE K STORES INC Operator Address: PO BOX 52085, PHOENIX, AZ 85072

DRO: DOVIE MARIE SNYDER

DRO Email: DSNYDER@CIRCLEK.COM

On-Site Representative Name and Title: Angela Howe , CSR Email:

Phone:

You have just received an inspection conducted to evaluate compliance with the Arizona Revised Statutes, Title 49; the Arizona Administrative Code; and applicable permits/licenses. The following is intended to summarize potential deficiencies noted during the inspection, items you should consider for follow up action, or additional information requested by the inspector that is necessary to make a compliance determination. Be advised that additional reports and correspondence may be forthcoming from ADEQ.

Any omissions in this exit debriefing shall not be construed as a determination of compliance with applicable laws and rules.

Results of Inspection:

☐ This Facility is in compliance with Arizona Revised Statues A.R.S. §49-1001 through 49-1021 and associated Administrative Rules.

☑ This Facility is not in compliance with Arizona Revised Statues A.R.S. §49-1001 through 49- 1021 and associated Administrative Rules. Follow Up Action due within 30 days of this notice (May 7, 2023): Notice of Opportunity to Correct Deficiencies ☐ Potential deficiencies were noted during the course of the inspection. Within one business day of this notice, (), submit compliance documentation to the compliance officer listed on this report.

Additional deficiencies were noted during the inspection, and will be provided in the final inspection report.

Documentation:

Please submit documentation to the ADEQ contact above demonstrating that no violation has occurred or documentation that the alleged deficiency has been corrected. Acceptable documentation includes, but is not limited to photographs, receipts, standard operating procedures, and/or relevant logs.

Documents confirming the following items were not available at the time of the inspection. This documentation can be submitted to the inspector Randy Jaquez (602) 826-8789 within one business day of this notice to meet the compliance standards of Arizona Revised Statutes A.R.S. §49-1001 through 49-2021. If documentation is not received within 1 business day a NOC/NOV will be issued.

Subsequent correspondence will be handled via a compliance officer Chris Brown -brown.chris@azdeq.gov - 602-771-4270.

Is there a one-day delay for paperwork?

Yes

Field Inspection Comments:

Was compliance assistance provided?

No

Compliance Assistance Comments:

Violations List 1 Violations Code: A.A.C. R18-12-240 - 245: Previous 12 months of monthly release detection results.

Notes:

Violations List 2

Violations Code: A.A.C. R18-12-236(A)(1)(a): Monthly walkthrough inspections (every 30 days) of spill prevention equipment and release detection equipment Notes:

Please submit your response to your inspector’s attention at the Arizona Department of Environmental Quality, 1110 West Washington Street, Phoenix, Arizona 85007 or via email. Once ADEQ has received the requested documentation, the case will be closed and a letter will be issued stating that the agency will take no further action as a result of this inspection.

EXAMPLE 3:

NEW INSTALLATION INSPECTION REPORT

Installation Report version 2021.08.11

UST INSTALLATION INSPECTION REPORT

1110 West Washington Street, Phoenix, Arizona 85007

ADEQ Help Line (In-State Only) 1-800-234-5677

INSPECTION

INFORMATION

ADEQ Plan # NT5260.001 State Program None

Pre-Burial Tank Date 08/24/2022 Arrival

Time 7:00am

Departure Time

10:00am

Pre-Burial Piping Date 09/26/2022 Arrival

Time 9:10am

Departure Time

1:25pm

Final Inspection Date 04/24/2023 Arrival

Time 12:35pm

Departure Time

1:40pm

FACILITY INFORMATION

Facility Name Fry’s Fuel Center 104 ADEQ Facility ID 0-005260

Facility Address 1322 E. Route 66

City & ZIP Flagstaff 86001 Facility County Coconino

Tank Usage Retail Fuel Sale Facility Status Always Staffed

OWNER INFORMATION

UST Owner Name Fry’s Food Stores of Arizona

Mailing Address 500 S. 99th Avenue, Tolleson, AZ 85353

Owner Contact Name Dave Hill Contact Title Project Manager

Owner Contact Email Dave.Hill@frysfood.com Contact Phone # (623) 907-1990

Owner Type Private or Corporation

INSTALLER INFORMATION

Service Provider Company Eaton Sales and Services

Service Provider Address 3420 W. Whitton Avenue, Phoenix, AZ 85017

Primary Contact Loren Hodges Position Construction Mgr

Email Address LorenH@eatonmetal.com Primary Phone # (602) 415-3394

INSTALLATION INFORMATION

Backfill Material Crushed Rock Sieve Analysis meets tank manufacturer’s requirements

Bedding Depth 12+ inches Bedding Depth meets tank manufacturer’s requirements

Top of Tank Depth 80” Bottom of Tank Depth 200”

Excavation Liner Filter/Geotextile Fabric Will Excavation Cover be Subject to Traffic Yes

Cover Concrete Cover Thickness 8”

Tank Pit Monitoring Wells Yes Number of Wells 2 Well Location(s) SW and NE corners mailto:Dave.Hill@frysfood.com mailto:LorenH@eatonmetal.com

TANK INSTALLATION INFORMATION

Complete One Column for Each Compartment

Tank ID # 8 9A 9B

Tank Gallon Capacity 20,000 18,000

Compartmentalized Tank No Yes

If yes, compartment sizes 8,000 10,000

PRODUCT

Regular Unleaded

/ 87 Premium

Unleaded / 91 Diesel

Tank Compatible with Product

Yes Yes Yes

Manifolded Tank No No No

Manifolded with (T#) N/A N/A N/A

Method of Manifold

☒ Vent lines

☐ Product Lines

☐ Siphon Line

☐ Vent lines

☐ Product Lines

☐ Siphon Line

☐ Vent lines

☐ Product Lines

☐ Siphon Line

Location of Manifold N/A N/A N/A

TANK MANUFACTURER Xerxes Xerxes

Tank Model 622-057 632-108

Tank Diameter 10’ 10’

Tank Length 37’ – 8 ¾” 35’ – 2 ¼”

Serial # 91005507 91005508

UL # F-44612134 F-44612136

Tank Wall Type Double Double

Tank Material Construction Fiberglass

Reinforced Plastic Fiberglass Reinforced Plastic

Tank Corrosion Protection n/a n/a

ANNULAR SPACE Wet Annular Wet Annular

Vacuum Gauge Reading N/A N/A

Vacuum Gauge Reading after 1-hour wait period (if applicable)

N/A N/A

Does the Vacuum Gauge Reading meet tank the manufacturer’s requirements for installation?

N/A N/A N/A

Vacuum Application Date

N/A N/A N/A

Does the Vacuum Application Date meet the tank manufacturer’s requirements for installation?

N/A N/A N/A

Is MONITORING FLUID visible on the tank’s

EXTERIOR?

No No

Is monitoring fluid visible on the tank’s INTERIOR?

No No No

Monitoring Fluid level 6-1/2” 0-3/4”

Pressure Test Result (PSI) 2.2 psi 2.0 psi 2.2 psi

Soap Bubble Test Date 09/26/2022 09/26/2022 09/26/2022

TANK INSTALLATION INFORMATION - continued

Tank ID # 8 9A 9B

Product Regular Unleaded

/ 87 Premium

Unleaded / 91 Diesel

ANCHORAGE Method Overburden Overburden Overburden

1st vertical measurement (UST on bedding material)

123-1/2” 123-1/2” 123-1/2”

Vertical measurement after anchoring UST

N/A N/A N/A

Vertical measurement after backfilling to tank top

123-1/2” 123-1/2” 123-1/2”

Is deflection within tank manufacturer’s range?

Yes Yes Yes

Space Between USTs 24+ inches

Space from USTs to basin walls

24+ inches

GENERAL COMMENTS

about UST installation

USTs were delivered on 8/17/2022 and staged on bedding / backfill material until 08/24/2022 when they were installed in the basin.

ANCILLARY EQUIPMENT INFORMATION

Tank ID # 8 9A 9B

Product Regular Unleaded

/ 87 Premium

Unleaded / 91 Diesel

SPILL CONTAINMENT

Manufacturer & Model

OPW

1C-31320

OPW

1C-31320

OPW

1C-31320

Spill Containment Type Double Double Double

If Double Wall, type of gauge

Site Glass Site Glass Site Glass

Spill Containment Size (Gallons)

5 5 5

Reference: PEI/RP100-17, Section 7.2: SPILL CONTAINMENT

Spill Containment Integrity Test Date

09/26/2022 09/26/2022 09/26/2022

Spill Containment Integrity Test Method

Hydrostatic Test Hydrostatic Test Hydrostatic Test

Spill Containment was tested according to

Industry Standards Industry Standards Industry Standards

Is water within 1.5 inches of the top of the spill bucket?

Yes Yes Yes

PRE-test Height 11-2/16 inches 10 inches 9-12/16 inches

POST-test Height 11-2/16 inches 10 inches 9-12/16 inches

Did the water level drop

1/8” OR MORE?

No No No

Was a 30-inch water column of vacuum attained to start the test?

N/A N/A N/A

Is the ending vacuum level 26 inches water column or greater?

N/A N/A N/A

Spill Containment Integrity Test Result

Pass Pass Pass

FILL CAP Manufacturer &

Model

OPW / 634TT

Fill Adapter Manufacturer & Model

OPW / 61SALP

OVERFILL

PREVENTION Device

Flapper Valve

Flapper Manufacturer OPW

Flapper Model # 71S0-410C

VAPOR RECOVERY CAP

Manufacturer & Model

OPW

Vapor Recovery Adapter Manufacturer & Model

OPW

GENERAL COMMENTS

about Spill Containment

Vapor recovery buckets for UNLEADED and PREMIUM were also tested hydrostatically and passed.

ANCILLARY EQUIPMENT INFORMATION

Tank ID # 8 9A 9B

Product Regular Unleaded

/ 87 Premium

Unleaded / 91 Diesel

STP CONTAINMENT Mfgr Bravo Bravo Bravo

STP Containment Model B427x33-3BT-222-

B-PP-SL-K

B427x33-3BT-222-

B-PP-SL-K

B427x33-3BT-222-

B-PP-SL-K

STP Sump Wall Type Single Single Single

STP Containment Material Fiberglass Fiberglass Fiberglass

STP Containment DEPTH (from grade to lowest point sump)

80” 78” 79”

Reference: PEI/RP100-17, Section 8.5.4: CONTAINMENT SUMP TESTING.

STP Containment Hydrostatic Test Date

09/26/2022 09/26/2022 09/26/2022

Is the water a minimum of 4 inches above the highest wall penetration?

Yes Yes Yes

PRE-test Height 29-1/2 inches 30-14/16 inches 31-13/16 inches

POST-test Height 29-1/2 inches 30-14/16 inches 31-13/16 inches

Did the water level drop

1/8” OR MORE?

No No No

STP Containment Hydrostatic Test Result

Pass Pass Pass

GENERAL COMMENTS

about STP Containment Sump Hydrostatic Testing

Quantity of STPs 2 1 1

STP Turbine Manufacturer FE Petro FE Petro FE Petro

STP Turbine Model(s)

STPKMVS4-VL2-

STPKMRVS4-VL2-

STPKR150-VL2-24

STP Turbine Serial #

South:22E5005015 06S

North:

22E5005015055

22D501403120S 22G502201113S

Line Leak Detector Type Electronic Electronic Electronic

Line Leak Detector Mfgr FE Petro FE Petro FE Petro

Line Leak Detector Model TS-LSU500 TS-LSU500 TS-LSU500

Line Leak Detector Serial #

South:

22G501300040G

North:

22G501300039G

22G501300038G 22G501300037G

STP Piping Connector Flex Flex Flex

STP Corrosion Protection STP Sump STP Sump STP Sump

STP Equipment Compatible with Product

Yes Yes Yes

GENERAL COMMENTS

about Ancillary Equipment

PIPING INFORMATION

Tank ID # 8 9A 9B

Product Regular Unleaded

/ 87 Premium

Unleaded / 91 Diesel

New Piping Yes Yes Yes

Repair or Replacement Pipe

No No No

Total Piping Length ~340 feet ~340 feet ~340 feet

Piping System Type Pressurized Pressurized Pressurized

Piping Type Underground Underground Underground

Piping Wall Type Double Double Double

Piping Material Fiberglass

Reinforced Plastic Fiberglass

Reinforced Plastic Fiberglass

Reinforced Plastic

Piping Manufacturer Ameron Ameron Ameron

Piping Model Information Dualoy 3000LCX-A Dualoy 3000LCX-A Dualoy 3000LCX-A

Adhesive (Glue) Brand NOV NOV NOV

Is Adhesive (Glue) Compatible with Product

Yes Yes Yes

Is Piping Compatible with Product

Yes Yes Yes

Pressure Test Date 09/26/2022 09/26/2022 09/26/2022

PRIMARY

Test Pressure at START of Pressure Test

South: 56 psi @ D1/2

North: 57 psi @ D7/8

57 psi @ D7/8

57 psi @ D7/8

PRIMARY

Test Pressure at END of Pressure Test

South: 56 psi @ D1/2

North: 57 psi @ D7/8

57 psi @ D7/8

57 psi

PRIMARY

Pressure Test Results

Pass Pass Pass

SECONDARY

Test Pressure at START of Pressure Test

South: 6 psi @ D1/2

North: 5.0 psi @ D7/8

5.8 psi @ D7/8

6.0 psi

SECONDARY

Test Pressure at END of Pressure Test

South: 6.2 psi @ D1/2

North: 5.0 psi @ D7/8

6.0 psi @ D7/8

6.0 psi

SECONDARY

Pressure Test Results

Pass Pass Pass about Piping

UNLEADED has two STPs. One feeds the (3) south dispensers and (1) feeds the north (6) dispensers.

DISPENSER INFORMATION

Dispenser Description Gasoline only Gasoline & Diesel

Number of Dispensers

D3/4, D9/10, D15/16

All others

Dispenser Manufacturer (if available)

Wayne

Dispenser Model (if available)

B12/322XD6G B23/422XD6G+D

Dispenser Condition New New

Product at Dispenser Regular Unleaded

/ 87 Regular Unleaded

/ 87

Product at Dispenser Premium

Unleaded / 91 Premium

Unleaded / 91

Product at Dispenser Choose an item. Diesel

Product at Dispenser Choose an item. Choose an item.

Product at Dispenser Choose an item. Choose an item.

UDC Sump Manufacturer Bravo Bravo

UDC Sump Model B1250-E30 B1250-E30

UDC Sump Wall Type Single Single

UDC Sump Constr Material Fiberglass Resin Fiberglass Resin

Reference: PEI/RP100-17, Section 8.5.4: CONTAINMENT SUMP TESTING.

UDC Hydro Test Date 09/26/2022 09/26/2022

Is the water a minimum of 4 inches above the highest wall penetration?

Yes Yes

PRE-test Height D1/2, 13-15/16; D3/4, 14-7/16; D5/6, 14-0; D7/8, 22-2/16; D9/10, 14-5/16, D11/12, 14-13/16; D13/14, 14- 7/16; D15/16, 13-0; D17/18, 13-0

POST-test Height D1/2, 13-15/16; D3/4, 14-5/16; D5/6, 14-0; D7/8, 22-2/16; D9/10, 14-5/16, D11/12, 14-13/16; D13/14, 14- 7/16; D15/16, 13-0; D17/18, 13-0

Did the water level drop

1/8” OR MORE?

No No

UDC Hydro Test Result Pass Pass

GENERAL COMMENTS

about UDC Sump Hydrostatic Testing

D3/4 failed the first hydrostatic test. D3/4 was tested hydrostatically a second time and maintained the water level at 14-5/16 inches.

Piping Connector in UDC Flex Flex

Piping Connector Mfgr DoubleTrac DoubleTrac

Piping Connector Model Not provided about Dispensers

SHEAR VALVE INFORMATION

PRODUCT

Regular Unleaded

/ 87 Premium

Unleaded / 91 Diesel

Shear Valve Manufacturer OPW OPW OPW

Shear Valve Model 10P 10P 10P

Quantity of Shear Valves per dispenser

1 in each dispenser

1 in each dispenser

1 but only 6 dispensers

Checked functionality of at least one shear valve per product

No (see comment below)

No (see comment below)

No (see comment below)

Provide reason if shear valves were not checked

No metal test can onsite

Dispenser(s) where shear valves were checked

N/A

Functionality Test Results N/A

Shear Valves were securely anchored

Yes Yes Yes about Shear Valves

RELEASE DETECTION INFORMATION

Per R18-12-220. Performance Standards for New UST Systems (A)

Owners and operators of a new UST system shall meet the requirements described in this Section in order to prevent releases due to structural failure, corrosion, or spills and overfills for as long as the UST system is used to store regulated substances. In addition, except for suction piping that meets the requirements of R18-12-241(C)(2)(a) through (e), tanks and piping installed or replaced after January 1, 2009 shall be secondarily contained and use interstitial monitoring in accordance with R18-12-243(G). Secondary containment shall be able to contain regulated substances leaked from the primary containment until they are detected and removed and prevent the release of regulated substances to the environment at any time during the operational life of the UST system. For cases where the piping to be replaced exceeds the percentage in A.R.S. § 49-1009(C), the entire piping run shall be secondarily contained.

Tank ID # 8 9A 9B

Product Regular

Unleaded / 87 Premium

Unleaded / 91 Diesel

Automatic Tank Gauge (ATG) Yes

ATG Console condition New

ATG Manufacturer Franklin Fueling

ATG Model TS-550EVO

ATG Serial Number M402219405

If using existing ATG console, list console upgrades

N/A

Tank Annular Space Wet Annular

Tank Interstitial Monitoring

(IM)

Yes

TANK IM SENSOR Model TS-3WSNS

ATG Probe Condition New

ATG Probe Model FMP-LL3-131-I

ATG Probe Serial Number M4-7117553 M4-7117358 M4-7117362

Line Leak Detector Info Information listed in ANCILLARY EQUIPMENT INFORMATION

Piping Leak Detection Method Double-wall & Sumps w/Sensor

PIPING Interstitial Monitoring Yes

PIPING IM SENSORS used in All Sumps Manufacturer Franklin Fueling Model FMP-ULS

Quantity 12 Type Connected to ATG

PIPING IM SENSORS used in Choose an item.

Manufacturer Model

Quantity Type Choose an item.

PIPING IM SENSORS used in Choose an item.

Manufacturer Model

Quantity Type Choose an item.

PIPING IM SENSORS used in Choose an item.

Manufacturer Model

Quantity Type Choose an item.

PIPING IM SENSORS used in Choose an item.

Manufacturer Model

Quantity Type Choose an item.

Do all IM sensors rest on the base of the sump?

Yes Are all IM sensors at the lowest point of the sump?

Yes

Are all IM sensors mounted in a true vertical position?

Yes

Are jumpers used to connect sections of secondary containment of the piping

Yes

The secondary containment of the piping is open in

STP sump

Method used to open the secondary containment of the piping stems removed from schrader valves

FINAL INSPECTION SYSTEM TESTING INFORMATION

Tank ID # 8 9A 9B

Product Regular

Unleaded / 87 Premium

Unleaded / 91 Diesel

TANK TIGHTNESS Test

Date 04/20/2023

Tank Tightness Test Results Pass Pass Pass

LINE TIGHTNESS Test Date 04/20/2023

Line Tightness Test Result Pass Pass Pass

LINE LEAK DETECTOR

Test Date 04/20/2023

Line Leak Detector Test Results

Pass Pass Pass

OVERFILL PREVENTION

Device Test Date 04/20/2023

Overfill Prevention Device Test Result

Pass Pass Pass

LEAK DETECTION SYSTEM Test Date 04/20/2023

Leak Detection System Test Result Pass

MONITORING CERTIFICATION Date 04/20/2023

Monitoring Certification Result Pass

TESTING COMPANY Fuller Petroleum Services Inc.

Items Tested Tanks, lines, ATG, overfill.

Testing Company Address 2210 E Rose Garden Loop, Phoenix, AZ 85024

Testing Technician Steve Scoma ADEQ Testing Certification # T00113

Technician’s Email dbenham@fullerpetro.com Primary Phone # (602) 923-1500

TESTING COMPANY

Items Tested

Testing Company Address

Testing Technician ADEQ Testing Certification #

Technician’s Email Primary Phone # about system testing

OWNER / OPERATOR REPRESENTATIVE

During the final inspection, the Inspector explained the UST system, testing, and release detection requirements to the Owner/Operator’s representative.

Owner Contact Name Contact Title

Owner Contact Email Contact Phone #

Signature Date

GENERAL COMMENTS

about release detection and IM sensors

PRE-BURIAL TANK GENERAL COMMENTS

Dave…