DERR-2024-012536

UTAH PST PROGRAM
TEMPORARY CLOSURE NOTICE t0l2
OWNER AND FACILITY INFORMATION
TANKS TBMPORARILY CLOSED
* Indicate the specific substance stored in each tank to be closed (regular, unleaded, diesel, waste oil, etc.)
I Vent lines open and functioning I Product lines capped/secured
I Fuel was emptied to less than 1" ! Corrosion protection is operating
When a PST system is temporarily closed for 3 months or more, the owner/operator must also
o leave vent lines open and functioning
o cap and secure all other lines, pumps, manways, and ancillary equipment
o send a properly-completed Temporary Closure Notice form to the DERR/PST Section.
State of Utah Dept. of Environmental Qualiry
DERR PST Section
PO Box 144840
Salt Lake ciry, Utah 84114-4840
FACILITY ID#
State Use Only
Date Received
Date Processed by
I Pumps, manways secured
! Release detection equipment is operating
R,trGtr[\/tr
No\/ 1 5 102(
Environmental llesponse & Remediation
195 North 1950 West
Salt Lake City, Utah 84116
Temporary closure requirements:
When a PST system is temporarily closed, the owner/operator must:
o continue operation and maintenance ofcorrosion protection on tanks, lines, flex connectors, and other metallic system components.
o continue operation and nraintenance ofrelease detection OR empty the PST system to less than I inch ofproduct.
I certifiz under penalty of law that I am the Owner of the tank(s) described above and that I am familiar with the information on this
form and that it is true, accurate and complete and further, that the procedures described herein were followed during tank closure.
Full Name of pST Owner: [Marc Westfall
Signarure of PST Owner:Date: 11113124
Return completed Temporary Closure Notice form to Street Address
Temporary Closure Notice prepared at the request of the owner/operator (identified below) by [/afC WeStfall
of (conpany !ame) 7-Eleven lnc Phone # [phone]
Address PO Box 711 City Dallas State TexaS 2ip75221
Tank ownerT-Eleven lnc phone # @01)782-8522
AddressPO Box 711 citv Dallas 9131s Texas 2ip75221
Facility Nam. 7-Eleven #32807
Address 1829 West 2700 North City Farr West State Utah 4ip84404
Contact person Marc Westfall Phone # [phone]
Number of regulated PSTs at this facility: 2 Number of regulated PSTs to be temporarily closed: 2
Tank #1 2
Type (Steel,FRP,etc.)FRP FRP
Date Installed 10t14t1999 1011411999
Capacity (Gallons)10,000 10,000
Substance stored*Regular Premium
Date last operated 11 1612024 11 1612024
Inches of Product remaining in
tank (to the nearest 1/8 inch)<1"<1"
Closnoticetemp I 205.doc
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11/15/202411/19/2024 M.O.