HomeMy WebLinkAboutDERR-2024-012346ALL RIGHTS RESERVED. THIS DRAWING IS THE PROPERTY
OF DIAMOND Z ENGINEERING, INC. & IS LOANED WITH
THAT UNDERSTANDING & SHALL NOT BE COPIED,
REPRODUCED OR OTHERWISE DISPOSED OF DIRECTLY
OR INDIRECTLY WITHOUT PRIOR PERMISSION.
DIAMOND Z ENGINEERING, INC.
5670 STATE ROAD
CLEVELAND, OH 44134
PHONE: 440-842-6501
SCALE:DATE:
DRAWN BY:PROJECT NO.:
REVISIONS
DRAWING NO.
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AS NOTED 5/10/2024
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30'
3'-1"3'-1"
23'-10"
Utah DEQ Underground Storage Tank
Installation Notification Form
www.undergroundtanks.utah.gov
Facility ID New UST Install [ ] Upgrade/Repair [ ]
Installation Company:
Contact Name: Phone:
Address:
Tank Owner:
Address:
Contact Name: Phone#
Facility Name:
Facility Address:
Installation / Upgrade /Repair Information Est. Date work will commence:
Tank #
Capacity
Tank Material
Piping Material
Substance stored
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)
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
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 Cert. # TL Exp. Date
Name Cert. # TL Exp. Date
Name Cert. # TL Exp. Date