DERR-2024-011738

&EPA
United States
Environmental Protection Agency
Washington, DC 20460
Approval expires 04/30/24
0MB No.2050-0068
Notification of Ownership Change for Underground Storage Tanks
Implementing Agency Name And Address: IMPLEMENTING AGENCY USE ONL y
INSTRUCTIONS AND GENERAL INFORMATION
Please type or print In ink. Also, be sure you have signatures in ink.
The primary purpose of this notification form is to inform implementing
agencies of ownership changes for underground storage tank (UST)
systems that store or have stored petroleum or hazardous
substances.
Federal regulation requires UST owners to notify the
implementing agency of any ownership change for USTs storing
regulated substances after October 13, 2015.
Who Must Notify? 40 CFR part 280, as amended, requires owners
of USTs that store regulated substances (unless exempted) to notify
implementing agencies of any ownership changes. Owner is defined
ID NUMBER: '20000 G~
DATE RECEIVED:
DATE ENTERED INTO COMF'UT'ER:
DATA ENTRY CLERK INITIALS:
OWNER WAS CONTACTED TO CLARIFY RESPONSES, COMMENTS:
What Tanks Are Excluded From Notification (see§ 280.10 and§ 280.12)?
• Tanks removed from the ground before May 8, 1986;
• Farm or residential tanks of 1,100 gallons or less capacity storing motor fuel for
noncommercial purposes;
• Tanks storing heating oil for use on the premises where stored;
• Septic tanks;
• Certain pipeline facilities regulated under chapters 601 and 603 of Trtle 49;
• Surface impoundments, pits, ponds, or lagoons;
• Storm water or wastewater collection systems;
• Flow-through process tanks;
• Liquid traps or associated gathering lines directly related to oil or gas production
and gathering operations;
• Tanks on or above the floor of underground areas, such as basements 91"
tunnels;
as:
•
. • Tanks with a capacity of 110 gallons or less;
In the ce,e of an UST in use on November 8 1984 or brought intb use· • Wastewater treatment tank systems;
after1hat date, any person who owns an UST used 'tor storage,. use, ot , • : UST systems containing radioactive material that are regulated under the Atcmic
dispensing of regulated substances; or Energy Act of 1954; .. . _____ .
I the of a UST· bei N mb 8 1984 .b t no 1 • UST sy~~s that are P.art-of an emergeqc:y ~~rator system at nuclear power
• ;~ use =at d~te, an;~~ ;:,-~~ UST imtri~tet~~ hi: n 9 e f:} §enhr•~ faciliN$1ri/gulale<I by tti,!Nudeat ~latory Commission under 10
before its discontinuation. • CFR part 50. • • • ---• ---
What USTs Are Included? An UST system is defined as any one or
combination of tanks that is used to contain an accumulation of
regulated substances, and whose volume (including connected
underground piping) is 10 percent or more beneath the ground.
Regulated USTs store petroleum or hazardous substances (see What
Substances Are Covered to the right). This includes UST systems
with.~ tanks and ajrport.bY~raa! f~J djstdtJ4,l!9!J ,~-: __._.... -~ . . ,..[~ ..,.
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When·And Who To Notify? Arty ownettor-operator who assumes " 1
ownership of a regulated UST system must submit this notification
fonn to the implementing agency within 30 days of assuming such
ownership.
'
, • ' • • , • ' ' • J ;-~ ~\; i \ /
What Substances Are Covered? The notification requirements ~pply to
USTs containing petroleum or certain hazardous substances. Petroleum
Includes gasoline, used oil, diesel fuel, crude oil or any fraction thereof which is
liquid at standard conditions of temperature and pressure (60 degrees
Fahrenheit and 14.7 pounds per square inch absolute). Hazardous
substances are those found in Section 101 (14) of the Comprehensive
EnvironmentaJ,Response, Compensation and Liability Act of 1980, with the
exception of those substances regulated as hazardou$ waste under Subtitle C
of the Resource Conservation and Recovery Act. • • • • • •
Penalties: Any owner who knowingly fails to notify or submits false information
shall be subject to a civil penalty not to exceed $16,000 for each tank for which
notification is not given or for which false information is given.
OWNERSHIP OF USTs :
C • I d. ·d I p bl" A Or Other Ent,·ty ' FACILITY NAME AND LOCATION OF USTs
orporat,on, n ,v, ua , u 1c gency,
Current Owner Name Previous Owner Name
fY\O\r \.\IY" D 'oo-J> Maro e t\.l l) )'YJ e. 1>
current Owner Address I Previous owner Address
\ 2-<.. '1 > ~"' \V)ea~$'1 • l
~oGN fV\Ou.vt-> -
Current Owner Phone
~\ 1-\ '7? 7 3-" Previous owner Phone
3, 6,-2-1;:,~-I b ~2-
SI nature Of Current Owner:
Paperwork Reduction Act Notice
Facility Name Ftl 1"1\f\12.... LLL
gJ Check here If name changed after ownership
Check this box if the physical address of the USTs is the same as the cuOllnt owner.
address. If address Is different, enter address below:
If required by lmplementi~ agency, give ,the geographic location of USTs either in decimal
degrees, or degrees, minutes, and seoonds. Example: L-11.tude: 36.1234& (or 36° r
24.4"), Longitude: -106.549876 (or-106° 32' 59.6")
I.
Latltu I , , , I' I' ' ' ' 0 ff1' I ' . '" I ' 1)
Date Of ew,;ership
1 Change
W!, ,t • .. i1, .t~ ',( ,'i,-,;u_~ I q I 1, II'",'\ I , , t . i :p, I ! .
Date: J l'J .Z'\ 2 y
The publlc reporting and recordkeepln9 burden for this collection of Information Is estimated to average 30 minutes per response. Responses to this oo11ection of lnfonnatk>n
are mandatory {40 CFR 280.22). An agency may not conduct or sponsbr, and a person is not required to respond to, a collection of lnfonnatlon unleea'lt clspla~ a currently
valld 0MB control number. This collection of information is approved by 0MB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (0MB Control No. 2050-
0068). s'end ~ants~ lhe Agency'$ need for this infeln'natlon, • the ·ecairacy of the provided burden estimates, and any suggested methods for minimizing respondent ..
burden, Including through the use of automated coflectlon techniques to the Director/ Collection Strategies Division, U.S. Environmental PrOtection Agency (282211).f 12QO!l!r. •
Penns anla Ave., NW, Washl ton O.C. 20460. Include the 0MB control number In an corres ndence. Do ,not send the com leted form to this acknle.' · • ' , ·' ·1
10/29/2024 10/29/2024
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Utah DEQ DERR 195 North 1950 West,
Salt Lake City, UT 84116