DERR-2024-004464

UTAH DEPARTMENT OF ENVIRONMENTAL QUALITY (FOR STATE USE ONLY)
DIVISION OF ENVIRONMENTAL RESPONSE AND REMEDIATION Date Received:
PETROLEUM STORAGE TANK PROGRAM Facility ID:1100388
Pay Online at:Fiscal Year:2024
DERRpay.utah.gov Invoice No:57387
Fee Pmt Amount:$
Invoice Date: 1/19/2024 Fund Pmt Amt:$
Owner Location Other Pmt Amt:$
SARA GALLIEN
WALMART INC.WALMART SUPERCENTER FUELING STATION #4696
2101 SE SIMPLE SAVINGS DR 1274 SOUTH US HIGHWAY 189
BENTONVILLE, AR 72716 HEBER CITY, UT 84032
Type of Assessment Description of Account Activity Numbers of
Tanks
Charges Credits
Current Charges
1 2024 PST fund Fee Assessment 4 $600.00
Sub Total:$600.00
2 2024 UST Reg Fee Assessment 4 $440.00
Sub Total:$440.00
PAYMENT DUE BY 5:00 P.M. ON 02/18/2024 PAYMENT DUE: $1,040.00
PENALTIES & INTEREST WILL BE ASSESSED ON BALANCES PAST DUE ACCORDING TO UTAH CODE ANN. 19-6-401 et seq.
IF FEES ARE NOT PAID, 60 DAYS AFTER DUE DATE, YOUR CERTIFICATE OF COMPLIANCE LAPSES WITHOUT FURTHER NOTICE.
PAYMENTS ARE APPLIED AS FOLLOWS: (1) PAST DUE BALANCES (2) CURRENT BALANCE (3) PROCESS CHARGES, (4) PENALTIES (5) INTEREST
PAYMENT MUST BE RECEIVED BY 5:00 P.M., IN OUR OFFICE, ON THE DUE DATE TO AVOID PENALTIES & INTEREST.
DIRECT QUESTIONS TO: 801-536-4100 - Accounts Receivable
REMIT PAYMENT WITH INVOICE TO:
ENVIRONMENTAL RESPONSE & REMEDIATION
195 NORTH 1950 WEST - 1ST FLOOR
P.O. BOX 144840
SALT LAKE CITY, UT 84114-4840
NOTE: Please write your facility number on your check stub to insure proper posting to your account.
Please enclose invoice with payment and this invoice will be returned to you as your receipt of payment.