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Home My WebLink AboutDERR-2024-0048092024 UST CERTIFICATE OF COMPLIANCE ISSUED TO:LOCATION OF TANKS: CHRISTIAN BOUDREAU STAKER PARSON REDMOND # F480978 STAKER PARSON MATERIALS AND CONSTRUCTION 408 W 100 S 89 WEST 13490 SOUTH, SUITE 100 REDMOND UT 84652 DRAPER, UT 84020 Facility ID: 2000742 Tank #Capacity Substance Desc Compliance Financial Assurance Mechanism 2 20000 Diesel Yes Insurance This certificate will automatically lapse if any of the required fees are not paid. It may also be revoked for failure to comply with state and federal UST regulations. Possession of this certificate does not signify coverage under the Utah PST Fund. Cleanup requirements may be obtained from the Division of Environmental Response and Remediation. UTAH DEPARTMENT OF ENVIRONMENTAL QUALITY Page 1 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ Utah Notification for AbovegroundWĞƚƌŽůĞƵŵ Storage Tanks Division of Environmental Response and Remediation Underground Storage Tank Section P.O. Box 144840 Salt Lake City, Utah 84114-4840 Phone #(801) 536-4100 Fax #(801) 359-8853 Email:TankCompliance@utah.gov Web site:deq.utah.gov STATE USE ONLY Facility ID #: _____________ Date Received: ___________ Data Entry Clerk Initials: ____ This form must be completed for each location containing aboveground ƉĞƚƌŽůĞƵŵstorage tanks (AWSTs) that are regulated by the State of Utah. I. Ownership of tank(s)II. Location of tank(s) Owner Name _________________________________________ Mailing Address _______________________________________ City ____________________ State ___________ Zip _________ Contact______________________________________________ Phone # ____________________ Cell # ____________________ E-mail _______________________________________________ Facility ID # (unless new location) ____________________________ Facility Name _________________________________________ Street Address ________________________________________ County ________________City ________________ Zip _______ Facility Phone #______________ Latitude: ________________ Longitude: ________________ III. Type of Notification IV. Other New Notification Amended Notification Located on land within an Indian reservation or on other Indian trust lands. Name of Tribe:_____________________________________ Federally regulated underground storage tanks are at this location. If so, please enter the Facility ID assigned in the space above under Section II. V. Type of Owner VI. Type of Facility VII. Exempt Commercial Private Federal Government State Government Local Government Tribal Government Auto Dealership Contractor Federal – Non-military Federal – Military Gas Station Industrial Railroad Residential Trucking or Transport Utilities Other (explain) _________________________ Commercial Airport(fueling) Farm/Agriculture Petroleum Distributor/Refiner (SIC Code 2911 or 5171) Oil or Gas Production and Gathering Heating Oil used on premises Less than 501 gallons VIII. Contact Person in Charge of Tanks Name: Job Title: E-mail: Address: Phone Number (Include Area Code): IX. Financial Responsibility I plan to meet the financial responsibility requirements by using the following mechanism(s):(check all that apply) Bond Rating Test Commercial Insurance Guarantee Letter of Credit Local Government Financial Test Risk Retention Group Self-insurance (Financial Test) State Fund (Petroleum Storage Tank Fund) Surety Bond Trust Fund Other Method (explain) __________________________________ X. Certification (Read and sign after completing ALL SECTIONS of this notification form) I certify under penalty of law that I have personally examined and am familiar with the information submitted in Sections I through XI of this notification form and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, believe that the submitted information is true, accurate, and complete. __________________________________________________________________________________________________________ Name and official title of owner or owner’s Signature Date Signed Authorized representative (Print) _______________________ Signature Staker Parson Materials and Construction 89 West 13490 South, Suite 100 Draper Utah 84020 Nakeasha Scovill 801-871-6704 385-266-2060 nakeasha.scovill@stakerparson.com Redmond Pit 408 West 100 South Redmond 84652 39.004483 -111.871364 ✔ ✔ ✔ Mike Dearden Shop Manager mike.dearden@halessg.com 408w 100s Redmond, UT 84652 435-668-8309 ✔ Mike Dearden 6-24-22 2000742 6/27/2022 SDW Page 2 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ XI. Description of Aboveground WĞƚƌŽůĞƵŵStorage Tanks (complete for each tank at this location) Tank Identification Number (use additional pages if more than 5 AWSTs) Tank # Tank # Tank # Tank # Tank # 1.Tank system description (check all that apply) (if either of these apply, the AƉST is regulated) Rests directly on soil (including gravel) Any portion of piping buried or touches soil (including gravel) 2. Status of Tank (check only one) Currently in Use Temporarily Closed 3. Date of Installation 4. Capacity (501 gallons and greater) 5. Tank Attributes (check all that apply) Asphalt Coated or Bare Steel Cathodically Protected Steel (impressed current) Cathodically Protected Steel (sacrificial anodes) Composite (steel clad with non-corrodible material) Concrete Double Walled Manifolded Compartmentalized Field – constructed Steel Secondary Containment Concrete Secondary Containment Earthen Secondary Containment Tank rests on cradles UL Listed AWST Connected to an Emergency Generator Other, Specify Here ____________ ___________ ___________ ___________ ___________ 6. Overfill Protection (check all that apply) Automatic Shutoff High-level Alarm 7. Spill Prevention Single Walled Dry Connect Fitting Other, Specify Here ____________ ___________ ___________ ___________ ___________ 90-190 1 ✔ 2009 20K ✔ ✔ ✔ ✔ ✔ x Page 3 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ 8. Vapor Recovery Attributes (check all that apply) Pressure Vent Valve on Vent Pipe Coaxial Drop Tube at Tank Two Point Vapor Recovery at Tank Emergency Venting 9. Piping Attributes (check all that apply) Bare Steel Galvanized Steel Fiberglass Reinforced Plastic Flexible Plastic Copper Cathodically Protected (impressed current) Cathodically Protected (sacrificial anodes) Double Walled Secondary Containment Airport Hydrant Piping Unknown Other, specify Here ____________ ___________ ___________ ___________ ___________ 10. Piping Flexible Connectors (tank end) Containment sump Booted Not in contact with soil Cathodically Protected (impressed current) Cathodically Protected (sacrificial anodes) 11. Piping Flexible Connectors (dispenser end) Containment sump Booted Not in contact with soil Cathodically Protected (impressed current) Cathodically Protected (sacrificial anodes) 12. Piping Delivery Type Safe Suction (no valve at tank) U.S. Suction (valve at tank) Pressure Gravity Feed ✔ ✔ ✔ ✔ ✔ ✔ Page 4 Version ϭϬ.1Ϯ.2021V1 13. Substance Gasoline - Regular (up to 10% ethanol) Gasoline - Midgrade (up to 10% ethanol) Gasoline - Premium (up to 10% ethanol) Gasoline – Ethanol Free Gasoline Containing > 10% ethanol (specify amount of ethanol and grade of product) Diesel Off Road Diesel Biodiesel Diesel Containing > 20% biodiesel (specify amount of biodiesel) Kerosene Avgas Jet Fuel New Oil Used Oil Other, specify here ____________ ____________ ____________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ 14. Release Detection (check all that apply)Tank Pipe Tank Pipe Tank Pipe Tank Pipe Tank Pipe Tank Tightness Testing Automatic Tank Gauging Interstitial Monitoring Statistical Inventory Reconciliation Automatic Line Leak Detectors Line Tightness Testing ŽŵŵĞŶƚƐ ✔ ✔ ✔ ✔ ✔ Annual testing on dispense pipes Tank ID: 90.1901 (F480978) Tank ID: 90.1901 (F480978) PST Owner Information Facility ID# PST Facility Information Owner Name: Facility Name: Address: Address: City: State: Zip: City: State: UT Zip: Contact: Phone: Contact: Phone: DESCRIPTION OF PETROLEUM STORAGE TANKS Tank # UST or AST Date Installed Capacity Substance Stored TANK/LINE TIGHTNESS TEST Indicate Pass or Fail for each tank and product line tested. Include a copy of the test. Tank # Tank Test Line Test TYPE OF FACILITY Marketing facility, or non-marketer with facility average monthly throughput greater than 10,000 gallons. Non-marketer with facility average monthly throughput less than 10,000 gallons. COMPLIANCE WITH PST REGULATIONS All Petroleum Storage Tanks (PSTs) at this facility have been registered. Registration fees and Petroleum Storage Tank Fund Fees have been paid. Are your PSTs currently in compliance with all Federal, State, and Local PST regulations, including applicable Fire Code? Yes No If "No" describe items of non-compliance: PREVIOUS POLLUTION INCIDENTS Complete the Previous Pollution Incidents form to indicate whether a pollution incident has occurred at the facility. FINANCIAL RESPONSIBILITY MECHANISM DECLARATION (check one only) * Non-regulated PSTs at the facility may be required to participate in the Environmental Assurance Program. I choose another Financial Responsibility mechanism for the PSTs at this facility. • Indicate the financial responsibility mechanism to be used: • (For self-insurance or guarantee) Indicate your company’s fiscal year end date: • (For Insurance) Indicate the date the policy is renewed each year: The Certificate of Compliance cannot be issued until all documents have been submitted and the mechanism has been approved. If the mechanism has already been approved, submit documentation of coverage for the new tanks. I certify under penalty of law that the above representations made by me are true and correct. CofCapp 1022 Utah Petroleum Storage Tank Program Application for Certificate of Compliance I choose to participate in the Environmental Assurance Program (PST Fund) *. • Indicate the financial responsibility mechanism to be used for cleanup costs not covered by the Fund. • Indicate the number of non-regulated petroleum storage tanks at the facility. Owner/operator Signature Date Signed Staker & Parson Companies 89 West 13490 South Draper Utah 84020 Nakeasha Scovill 801-871-6704 Mike Dearden Redmond 408 West 100 South 84652Redmond 435-668-8309 AST 2009 20,000 gal Diesel 2000742 September 1st 90-1901 (F480978) 90-1901 (F480978) 06/29/2023 Pending Pending Annual Certified Inspection Utah Petroleum Storage Tank Program Previous Pollution Incidents Facility ID# This letter, or an equivalent, must be signed and submitted as a requirement for receiving a Certificate of Compliance. To: Mr. Brent H. Everett Director Division of Environmental Response and Remediation Dear Mr. Everett: As required by paragraph 19-6-413 of the Utah Underground Storage Tank Act, I have performed a tank and line tightness test on each tank at my facility. Based on this test, there has not been a release of petroleum. Additionally, based on "customary business inventory practices standards" I am not aware of any release of petroleum from my tanks. Signature of owner/operator Or, if a release is known to have occurred at this facility: I have had the following releases of petroleum (detailed below; also indicate the actions you have taken to clean up the release): Signature of owner/operator Failure to report previous releases could invalidate your Certificate of Compliance. ppiform 1022 200742 408 W 100 S