DERR-2024-012462

lnspector observed collection of samples:lnspector collected and submitted duplicate samples:D
Contaminated soil was over-excavated: Yes No @lE) ttyes, confirmation samples were collected: Yes No
Rcsid commercial Buildinos 2O' A/Prooertv Line Al A Active Water Well
Surface Water Sewer Line Water Line Natural Gas Line
Telephone Line Electrical Line Storm Drain 2O' 5 Other:
on(date): ll-2O-4{n
Cert.#: T 7|;
ClosureinspogoS.doc
Utah Department of Environmental Quality
UST Facility Site PIat
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lnter. Probe I
Vapor Rec. V
Capped C
locations ol all buildings, streets,in each tank. Show locations of tank manways and identify each:
V, USC), location, and depth of each sample collected by the certifiedsubmersible pump, fill, ATG probe, vapor recovery, etc. For closures: lndicate the type (soil,
lndicate the locations of any reported PID or FID