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Home My WebLink AboutDERR-2024-0107351 UNDERGROUND STORAGE TANK PERMANENT CLOSURE NOTICE (rev. 2/1/15) FACILITY ID# . … State Use Only Date Processed by Date Mailed to LHD LUST ID# Date to LUST Review Closure Notice prepared at the request of the owner/operator (identified below) by of (company name) Phone # Address City State Zip TANKS CLOSED Piping Only Tank # Please complete for each tank Type (Steel,FRP,etc.) Date Installed Capacity (Gallons) Substance stored* Date last operated Date Closed Removed/In Place/ Change in Service (CIS)? *Indicate the specific substance stored in each tank to be closed (regular, unleaded, diesel, waste oil, etc.) CLOSURE INFORMATION Fuel was emptied Sludge was removed Tank was cleaned Tank was: Purged Inerted Method Used: Location of Closure Records: For In-Place Closure:tanks filled with: For Change-In-Service: Substance to be stored: FACILITY INFORMATION Tank Owner Phone # Address City State Zip Facility Name Address City State Zip Contact person Phone # Total number of regulated underground tanks at this site before closure Total number of regulated underground tanks at this site after closure TANK REMOVER Name Cert. # TR Exp. Date Company Phone # Address City State Zip SOIL/GROUNDWATER SAMPLER Name Cert. # GS Exp. Date Company Phone # Address City State Zip Aaron Spackman Spackman Enterprises 801-598-7928 Po BOX 1276 Centerville UT 84014 State Fuel Network 385-602-4872 4315 S 2700 W Taylorsville UT 84129 Aaron Spackman 0436 04/15/25 Spackman Enterprises 801-598-7928 Po BOX 1276 Centerville UT 84014 Aaron Spackman 1738 2/15/25 Spackman Enterprises 801-598-7928 Po BOX 1276 Centerville UT 84014 1200360 Weber County Roads Department 2222 S 1900 W Ogden UT 84401 Brett Gurney 385-602-4872 2 0 8 DWFRP 12/11/1996 12000 06/09/24 06/10/24 Removed 9 DWFRP 12/11/1996 12000 DieselGas 06/10/24 06/09/24 Removed 8-28-2024 2 DISPOSAL SITES USED Location Name Contact Name Phone # Date Amount Tank(s)Tank # Product From Tank(s) Contaminated Water From Tank Cleaning Sludge Contaminated Water From Excavation Contaminated Soil SITE ASSESSMENT Complete the Facility Site Plat (Closure Notice) and Sample Information Table (Closure Notice) on pages 3 and 4 to show the locations, depths, and other information on all soil/groundwater samples taken for closure. The samples must be consistently identified by sample ID # on the site plat, table, and lab analysis report. Completed Facility Site Plat (Closure Notice) is attached. The following must be included (enter the distance, and direction (N,S,E,W) from the area of contamination or, where applicable, use OH for overhead, NP for not present): Water Line Sewer Line Natural Gas Storm Drain Telephone Electrical Property Line Buildings Completed Sample Information Table (Closure Notice) is attached. Certified lab analytical environmental sample results are attached. Unified Soil Classification (USC) sample results are attached. Chain of Custody form is attached. Samples were properly: Collected Labeled Packaged Transported Samples were in sight of the person in custody at all times or in a secured locked place. I certify under penalty of law that the closure site assessment at this facility was conducted in accordance with 40 CFR 280.52, 40 CFR 280.72, and R311-205 U.A.C., and that any additional samples required by 40 CFR 280.52, 40 CFR 280.72 and R311-205-2(a)(1) were properly collected. Signature of Certified Groundwater/Soil Sampler Full name of Certified Sampler Date If contamination at the facility is confirmed, any person providing remedial assistance for a fee must be a Certified UST Consultant. The Certified UST Consultant providing assistance is: CERTIFIED UST CONSULTANT Name Cert. #CC Exp. Date Company Address City State Zip Phone # Please explain any unusual circumstances that occurred during the site assessment or closure: Sump and Trap Cleaning Shane 801-595-8151 Same Same Mouldings and Sons Landfill Scale 801-399-9994 06/10/24 2 06/10/24 218 N/A N/A NP NP NP NP NP NP NP NP Aaron Spackman 08/23/24 3 Facility Site Plat (Closure Notice) The site plat must be drawn to an appropriate identified scale. It must show planned sampling locations, substances stored in tanks, and other relevant information. Tank and sample identification numbers must be consistent with the information given on p. 1 and 4 of the Closure Notice. Facility ID: Drawn By: Date: X = Sample locations (SS-#, WS-#, USC-#)Site Plat Must Indicate Actual Locations Of: 0 = Monitoring Wells (MW-#) Current & former tanks, piping & dispensers = Soil boring (SB-#), or Geoprobe Boring (GP-#) = Water Wells (domestic, livestock, etc.)boundaries Slope of Surface Topography: (N,NW,W,SW,S,SE,E,NE) Land Use At Site: Residential Commercial Industrial Surrounding Land: Residential Commercial Excavations, GW monitoring wells & soil stockpiles North Scale: 1”= Feet 1200360 Aaron Spackman 08/23/24 4 SAMPLE INFORMATION TABLE (Closure Notice) Complete table for all samples that were taken for closure. Sample ID numbers on the table must be consistent with the sample ID numbers given on the site plat and in the lab analysis report. 1 Soil (SS), Groundwater (GW), or Unified Soil Classification (USC).2 Final depth (in feet) below grade at which samples were taken.3 Contaminant compound(s) analyzed for each sample (TPH, BTEXN, O&G, etc). 4 Appropriate analysis methods for contaminant compound(s) in each sample State Certified Laboratory used Address City State Zip Contact Person Phone # I certify under penalty of law that I am the Owner of the tank(s) described above and that I am familiar with the information on this form and that it is true, accurate and complete and further, that the procedures described herein were followed during tank closure. Signature of UST owner Full Name of owner Date Return completed Closure Notice form, Facility Site Plat and Sample Information Table, Soil/Groundwater sample lab analysis results, USC sample results, and Chain of Custody form within 90 days of UST Closure to: Mailing Address State of Utah Dept. of Environmental QualityDERR / UST SectionP.O. Box 144840 Salt Lake City, Utah 84114-4840 Sample # Substance stored in tank Sample type1 Depth2 Compounds3 Analysis method(s)4 Street AddressMulti Agency State Office Building 195 North 1950 West (First Floor)Salt Lake City, Utah 84116 Chemtech Ford 9632 S 500 W Sandy UT 84070 Office 801-262-7299 SS-1 GAS/DSL SOIL 10'MBTEXN TPH DRO GRO 8015,8260 SS-2 GAS/DSL SOIL 10'MBTEXN TPH DRO GRO 8015,8260 SS-3 GAS/DSL SOIL 3 MBTEXN TPH DRO GRO 8015,8260 SS-4 GAS/DSL SOIL 4 MBTEXN TPH DRO GRO 8015,8260 USC-1 USC USC 10 USC USC USC-2 USC USC 3 USC USC GW-1 GAS/DSL WATER 10'MBTEXN TPH DRO GRO 8015,8260 GW-2 GAS/DSL WATER 10'MBTEXN TPH DRO GRO 8015,8260