HomeMy WebLinkAboutDERR-2024-004793State Use Only
Permit Required?
Permit# _____________________
Base Fee $ __500
Inspection Fee* $200 x ___ $_ ___
PST Install Fee $200 x ___ $_ ___
Total $_____
Date Approved & Paid ___________
*Applies in non-LHD contract areas
Utah DEQ Underground Storage Tank
Installation Notification Form
www.undergroundtanks.utah.gov
Facility ID 4002251
New UST Install
Upgrade/Repair
Installation Company:Csesco, Inc.
Contact Name:Tracy Boswell
Phone:(801) 292-4404
Address:830 West Northpointe Circle, North Salt Lake, Utah 84054
Certified Installers/Technicians on project
NameLuke A. Kelso
Cert. # TL 0416
Exp. DateFebruary 1, 2026
NameConner Christensen
Cert. # TL0457
Exp. DateFebruary 1, 2026
NameZane Christensen
Cert. # TL0456
Exp. DateFebruary 1, 2026
Tank Owner:Holiday Oil Company
Address:3115 West 2100 South - West Valley City, UT 84119
Contact Name:Jay Cahoon
Phone#(801) 973-7002
Facility Name:Holiday Oil# 39
Facility Address:3894 South Highland Drive - Salt Lake City, UT 84124
Installation / Upgrade /Repair Information
Est. Date work will commence: 2/27/2024
Tank #
1
Capacity
15,000
Tank Material
FRP DW
Piping Material
DWFlexible
Substance stored
Unleaded
Check if upgradeor repair only.(Describe details below)
Describe Details of Install/Upgrade/Repair in the box below (Submit a drawing/site map of work to be done)
DEMO OF PORTION OF EXISTING CONCRETE AND UNCOVER EXISTING UNLEADED PRODUCT LINE BETWEEN THE UNLEADED UST AND DISPENSER #1/#2. PROVIDE AND INSTALL (1) NEW DOUBLE WALL FLEXIBLE UNLEADED
LINE BETWEEN UNLEADED UST AND DISPENSER #1/#2. BACKFILL TRENCH AND POUR CONCRETE THAT WAS REMOVED TO MAKE THIS REPAIR.
Mail completed form to:
DEQ/DERR
Box 144840
Salt Lake City, Utah 84114-4840
195 N. 1950 W. 1st Floor
Salt Lake City, Utah
Phone (801) 536-4100
Fax (801) 359-8853
Ver. 8/1/2016