DERR-2024-011847

Utah DEQ Underground Storage Tank
Installation Notification Form
www.undergroundtanks.utah.gov
Facility ID 6000188 New UST Install Upgrade/Repair
Installation Company: Csesco, Inc.
Contact Name: LUKE KELSO Phone: [phone]
Address: 830 West Northpointe Circle, North Salt Lake, Utah 84054

Tank Owner: MAVERIK INC,
Address: 185 SOUTH STATE STREET #800 SALT LAKE CITY UT
Contact Name: JUSTIN WOOD Phone# [phone]
Facility Name: MAVERIK #245 CEDAR CITY
Facility Address: 209 South main street CEDAR CITY UT, 84720

Installation / Upgrade /Repair Information Est. Date work will commence: 10/29/2024
Tank # 1 2 3
Capacity 10000 10000 10000
Tank Material STEEL STEEL STEEL
Piping Material FLEX DOUBLE
WALL
FLEX DOUBLE
WALL
FLEX DOUBLE
WALL

Substance stored UNLEADED UNLEADED PREMIUM
Check if upgrade or 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)
REPLACE ALL SPILL BUCKETS WITH NEW OPW DOUBLE WALL SPILL BUCKETS AND ADD 2 POINT FILL / VAPOR
RECOVERY TO ALL BUCKETS, NEW PROBE RISERS WITH NEW CAPS AND ADAPTERS .NEW DROP TUBES WITHOUT
FLAPPERS USE OVERFILL ALARM AS OVERFILL PROTECTION.
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 [phone]
Fax [phone]
State 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
Certified Installers/Technicians on project
Name Zane Christensen Cert. # TL 0456 Exp. Date February 1, 2026
Name Mitch Hull Cert. # TL0557 Exp. Date March 11, 2026
Name Luke Kelso Cert. # TL0416 Exp. Date February 1, 2026
Ver. 8/1/2016