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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. DE F T A N K L A Y O U T ATS UT-4902 AS NOTED 5/10/2024 ES T E S T R U C K I N G F A C I L I T Y 12 3 4 S 3 2 0 0 W SA L T L A K E C I T Y , U T 8 4 1 0 4 1 IN I T I A L I S S U E AT S 5/ 1 0 / 2 0 2 4 2 3 4 5 6 8' - 6 " 3' 10 ' 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