DERR-2024-012045

Utah DEQ Underground Storage Tank
Installation Notification Form
www.undergroundtanks.utah.gov
Facility ID 0100181 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: KIMBUR HYER,
Address: P.O BOX 8 LEWISTON UT 84320
Contact Name: KIMBUR HYER Phone# [phone]
Facility Name: K & B SERVICE
Facility Address: 4 NORTH MAIN LEWISTON UT 84320

Installation / Upgrade /Repair Information Est. Date work will commence: 11-5-24
Tank # 1 3
Capacity 6000 3000
Tank Material FIBERGLASS FIBERGLASS
Piping Material FLEX DOUBLE
WALL
FLEX DOUBLE
WALL

Substance stored UNLEADED DIESEL
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 UNLEADED AND DIESEL SINGLE WALL SPILL BUCKET DUE TO RECENT FAILURE ON A HYDROSTATIC TEST
NEW DROP TUBES WILL BE STRAIGHT NO FLAPPER OWNER HAS OVER FILL ALARM
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