HomeMy WebLinkAboutDERR-2024-011354State 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 4001169
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
NameZane Christensen
Cert. # TL0456
Exp. DateFebruary 1, 2026
NameMitch Hull
Cert. # TL0557
Exp. DateMarch 11, 2026
Tank Owner:Premium Oil Inc / Jackson Food Stores
Address:3450 E Commercial Ct - Meridian, ID 83642
Contact Name:AndrewMarvin
Phone#(208) 888-6061
Facility Name:Jacksons Food Stores #150
Facility Address:1704 WestNorth Temple - Salt Lake City, UT 84116
Installation / Upgrade /Repair Information
Est. Date work will commence: 10/14/2024
Tank #
9
10
11
12
Capacity
12,000
12,000
12,000
12,000
Tank Material
FRP
FRP
FRP
FRP
Piping Material
Flexible DW
Flexible DW
Flexible DW
Flexible DW
Substance stored
Premium
Unleaded
Unleaded
Diesel
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)
Install (4) new double wall fill spill buckets with straight drop tubes with fill adapters and caps. Install (4) new double wall vapor spill buckets with new adapters and caps. Test
new spill buckets and submit results. Install all new top of tank manholes.
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