DERR-2024-011514

r._- . United stales
-
trnvrronmental prot
washington, r."rflSr, Ag e n cy OMB Conrrot ruo:Oiffinoapproval Expires or /st/i9-
tttotiti"ution fo''f::::i'iglnu,.r*#
iJ!.iffi r;H,;,i[i"n, n".p"n="
",a Remedration IMPLEMENTING AGEN;' UGrc}NLV
.-
LJ A, NEW FACILITY
OR ONE.TIME
NOTIFICATION
(previously deferred
onre erurEneo rGoi6ililil*tr"iG;GIil DATA ENTRY CLEN* ,,,,,OG
OWNERWAS.O,,O",.h
CLARIFY RESPO'"U',
"O"ilil
L{ *rrou-**li,iitv
Number of continuation sheoF- ..-ts attached
I Liquio trapJ oi assoilil
I and,galhering op"rrtion"l
gathering lines directly related to oil or gas production
I . I anKs on or above the fl, : I:*: yl.l , .Jo*t;"Ji%J,1ffi,"JtJ:[:d.areas, such as basemenrs or tunners:. vv_astewater treatment tank sy;stems;. qsT systems containino
Energy Act oF 1g54; - radioactive material that are regulated under the Atomic. US I systems that are Da;#J#i;:il,?:"Tf,1l :: t ?ff i,l"J:I,'fi :;,?"il;,3liflfli,::lXTff 1",,
yJfi :J.i:lfi
'l!1"f J,
"ffi',::"^9
3 - Ih," n ot i f i car i o n req u i re m e n rs a p p r y to
Ull;:,m::lx.:',",1#[*iit1!i3,1T3?Yi"?fiTff"",t?,,"y,."J;i*n,.n,,Fanrenheit and 14.7 rornd" :t-t-"Iperature. and pressure.(60 o"gi"i!
substanceslil_,r,[,Ji,i j"?#"J"'"1iiT?il,"i,,;i:?,T:,.#;ilfl
Si];.trnvrronmenrat Response. compensation
"io iiJliliii XJt ot r sso, with theexceprion of rhose substances iegylated
"; ;r;;;j;il";asre under Subtile Cot the Resource Conservation
"nE nu"or"-ry i
fi !FH:f ,Y# jIfl ili!ll+,?#iq,:.Ty:,iJH,i,,?l;:;ffi Eff :f ,#f,
,X'c,days of brinqinq rhe UST jnro,use. rr trr" imj",r!"ii;; ;0"""y requiresnotifrcation of arrv anrendm"nts to the racirii;,;;;;'i;;:#rrron ro rhermplementing agency immediately,
Penalties: Any owner who knowingly fails to notrfy or submits falserntormation shall be subtect to a crvil penalty a"t i","*""A $16.000 for eachj3,I]]!,1"' r!]!h "",,ri""16 . ""t gi"",j "i r.;*i]lh"r][""'i;rormarion is qjven.
What USTs Are lncluded? a. rr"rF
r;r*::::ljrlfil:d;f!x',:i]iisini'"x"Jff t,:;#'x,",::?:
[tnlrtHt[*o#H*1**']ddru#],{ffi "'
What-Ianks Are Excluded I: l;]ii""#'ffitn{fJifii=?ji"""1,11ry,,,x s 280 10 and g 280 ,2)?
- noDcommerciar pu.po"e"s;"' I ' I uu gallons or less capacity storing motor fuel for. I anks storing heatino oil ic. Septic tanksl --.,., -', 'ur use on the premises where stored;o Cerlain pipeline facilities re. surrace impo,;.;;il:fi3'l'"',rt ::|il;fffJ:" 601 and 603 or rile 4e;. brorm water or wastewaier. Frow-th roushH;;:"r,i;;?.:",recti on s ysrems :
1 ownedat tlris locition.;;'; "'" tdlrAs lrmorethan 5tanksare
i tnun, tor. ul6l1t"",i!i',"Jrirll' mav photocopy pages 3 ilrroush o and use
The pnmary purpose of this
iffi []i x*ffii ntsliij*"ltl$T ,:t :ll nr{:; "ffi:::'be based ., ,";;;"";btr:;:slarrces. The informarion vc
re c o rd s, yo u r k n ow r e d sL
",,
l[?i,,",
"';:"";:
; ;;:; fi :l'itx:: JJ""]' : : #"',
*[*t,u:**l.'l'*tn**,*r{hffi
Ht".y.,i^r"t|3,tj[r,"1o,,3i"TL?I"iu"knl,ended,requiresowners
rmptementing agencies of tioe,ned as: L*lftH{:ffis,i"}1t"0,,",",0,
' ln the case of an UST inarter tnat olie 1n;il,1;1.;n"J$".::lii,.? l3:x ,:i 3ff:r# l::5:orspensing of regulated suosrances; or'
]ilh:^c1s.9 of an UST in ::: pg.fore November 8, 1984, but no lonoer in;;.H,,jt;tj,.#: any person wrro owneo irrJ"usi i,i"m*eo1"t"ry o"ro," tr.
Also,, owners of previously deferred UST systems with field-consrructed tanks and airoorl hydrant rr"r-ii".tiio,lti,lii syltums in ttreground as of January 1 , i0t Tmust submit a onilflril" "noi,ti""tion
otexrstence by october 13. 2018. O*r,i.
"f u"siJyrfrt *i,r, ri"fa_constructed tanks and aiioo( hydrant fuel distribution systems
:ltflTlli,p, :::, f, I":*l gry_i, z o r / "i" l"i,.j;#i?:; ra ci r i ti e sili #::. rolow rh e samJ notinclt,= Jr'r*i r i ["#iilt", ;: ;;HX? iJSi
PIease type or print in ink.
I?,.::,,^1,_",i, vrrr.anJ ii ,c:",i]:i;
!: ffi:Jr"J,r,:ye srsratures in rnk
; il;,Sf I y, ; : HB ii"yi
0,".,,"f g,: l, "
r.. -ii,
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r,, r o r e a c h J oc a r i o n
Owner Name (Corporation, lndividual, ,rOU" Onliliffi
5J;,H:"..:IJl,3:l]:lii]'."i']]"y'giVelhegeographic,o"u.,o,ffili
24.4,,). Lonoirrrrip. _inA A/oo7e ]9"":"^?lq"; !11mnte: Latiructe: 36.123480 1or 36,):",,,,",24.4"), Lonstude, toojfazo i", _ri,ffi i6lij
- ttl.53,t\rOstreet Address \ SLtLl Facility Name Or Company Site ldentifier, As Applicable
"*'Ko.\"nU
Phone Number (lnclude Area Co '")13s-GLt
EPA.Form 7530-1 (Rev. 6-2015) Etectrnnin anrr ^o^^"..^previous editions .ry o" r# ?^i:":|ffi ii"Sijr?aper verslons acceptabre.
Page 1 of 6
l. OWNERSHIp OF USTs ll. LOCATTON OF USTs
600015910/21/2024
10/21/2024
KV
E n vi ro n rn e r r'j,ilr:iG-
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5 f#:"',:tEA:*7,Ti,*
Government
fi commerciat
Government
E .,u,"
Governmenf
E lo.ar
Government
E priuat"
flt;;jii"Hf#,{""il,j:;#ffir D ,lederaltyrecog;;;;m
l-l Commer.ial Airport orAirlinel-l contractor
D .u,',
E F.d.rrt - Non-mititary
Er"o"'rffi
E[ Gas stalon
E trucking orTransport
D ,,,,,,,u.
E o,r'ur" (Exptain)
Wr.BG Job rifle:pcer\bec.! o
\!t\Anl 6 , (*n .r", O1+n.r
eooress:fl,GO G Phone Number (lnclude Area Code):
'130-611-5G7?i
n ,nruu
(check a, that appry)
responsibility requirements (in accordance with 40 cFR pafi.2Sosubpart H) by using the foilowing mechanjsms:
n to.ut Government Financial Test
E *,.u Retention Group
n Su,r-,n=urrnce (Financial Test)
n st"t" Fund
n Surety aono
D Trust Fund
E o,n"r" Merhod (describe here)
r-1I I I do not have to meet financial responsibility requirements because 40 cFR part 2go subpart H is not applicable to me (e.g., if you are a state orfederal owner).
ffi|;:Hfl i5'rr"J;iiffYl;H al*,t :l:;i*$l inquirv or tnose rnaiuiJuars iimeoiaterv r"sponsft,re roiJituinrng the in-fo*ation, r beiieve that
t.qloqD-viJerwr.t,r
Name and official tifle of owner or owner's
authorized representative (print)
Paperwork Reduction Act Notice
The public reporting and recordkeeping burden for this collection of information is estimated to average 30 minutes per response. send comithis information' the accuracv of th" ploy]dg9 urto"n ".lirli".i,'and any suggusi"J;;til";.;;inimrzing respondenr buiden, incruoing thrlcollection techniques to the Director, coltection strategies oiri"iJ", u.s. Enuir"nr"nt"r'pi"t"ciion ngency lzoz 2T), l2oopennsyrvania Ave.,lnclude the oMB control number in
"ny "otr".p*d"n3".-J"'""ia""0 the completed form to this address.
on the Agency's need for
the use of automated
, Washington, D.C. 20460.
EPA Form 7530-1 (Rev. 6-201S).Electronic and paper versions acceptable.Previous editions m'ay be used r;nil" iirppi[.'f "'.
Page 2 of 6
^EPA
ttt.n,r. oF;wNER-
l.coNrAcrPE@
n eonO Raring Test
p comr"rcial lnsurance
n Guarantee
fl ,-u,,ur. of credit
ffi
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