HomeMy WebLinkAboutDERR-2024-004892PST Owner Information
Facility ID#
PST Facility Information
Owner Name: Facility Name:
Address: Address:
City: State: Zip: City: State: UT Zip:
Contact: Phone: Contact: Phone:
DESCRIPTION OF PETROLEUM STORAGE TANKS
Tank #
UST or AST
Date Installed
Capacity
Substance Stored
TANK/LINE TIGHTNESS TEST Indicate Pass or Fail for each tank and product line tested. Include a copy of the test.
Tank #
Tank Test
Line Test
TYPE OF FACILITY
Marketing facility, or non-marketer with facility average monthly throughput greater than 10,000 gallons.
Non-marketer with facility average monthly throughput less than 10,000 gallons.
COMPLIANCE WITH PST REGULATIONS
All Petroleum Storage Tanks (PSTs) at this facility have been registered.
Registration fees and Petroleum Storage Tank Fund Fees have been paid.
Are your PSTs currently in compliance with all Federal, State, and Local PST regulations, including applicable Fire Code?
Yes No If "No" describe items of non-compliance:
PREVIOUS POLLUTION INCIDENTS
Complete the Previous Pollution Incidents form to indicate whether a pollution incident has occurred at the facility.
FINANCIAL RESPONSIBILITY MECHANISM DECLARATION (check one only)
* Non-regulated PSTs at the facility may be required to participate in the Environmental Assurance Program.
I choose another Financial Responsibility mechanism for the PSTs at this facility.
•Indicate the financial responsibility mechanism to be used:
•(For self-insurance or guarantee) Indicate your company’s fiscal year end date:
•(For Insurance) Indicate the date the policy is renewed each year:
The Certificate of Compliance cannot be issued until all documents have been submitted and the mechanism has been approved. If
the mechanism has already been approved, submit documentation of coverage for the new tanks.
I certify under penalty of law that the above representations made by me are true and correct.
CofCapp 1022
Utah Petroleum Storage Tank Program
Application for Certificate of Compliance
I choose to participate in the Environmental Assurance Program (PST Fund) *.
•Indicate the financial responsibility mechanism to be used for cleanup costs not covered by the Fund.
•Indicate the number of non-regulated petroleum storage tanks at the facility.
Owner/operator Signature Date Signed
Staker & Parson Companies
89 West 13490 South
Draper Utah 84020
Beck Street Pit
2080 North Beck Street
Salt Lake City 84116
Jason Hainey (801) 363-2492
BK#1
AST
2006
12,000 gal
Diesel
BK#2
AST
12,000 gal
2003
Diesel
BK#3
AST
2003
12,000 gal
Diesel
BK#4
AST
6,000 gal
2003
Gas
Nakeasha Scovill 801-871-6704
BK#1 BK#2 BK#3 BK#4
September 1st
4000621
3DVV 3DVV 3DVV 3DVV
Pending Annual Certified Inspection
06/29/2023
Utah Petroleum Storage Tank Program
Previous Pollution Incidents Facility ID#
This letter, or an equivalent, must be signed and submitted as a requirement for receiving a
Certificate of Compliance.
To: Mr. Brent H. Everett
Director
Division of Environmental Response and Remediation
Dear Mr. Everett:
As required by paragraph 19-6-413 of the Utah Underground Storage Tank Act, I have performed
a tank and line tightness test on each tank at my facility. Based on this test, there has not been a
release of petroleum. Additionally, based on "customary business inventory practices standards" I
am not aware of any release of petroleum from my tanks.
Signature of owner/operator
Or, if a release is known to have occurred at this facility:
I have had the following releases of petroleum (detailed below; also indicate the actions you have
taken to clean up the release):
Signature of owner/operator
Failure to report previous releases could invalidate your Certificate of Compliance.
ppiform 1022
4000621
EZY CHEK SYSTEMS TEST DATE
PRODUCT LINE TESTER Testing Company Information
DATA SHEET Name
Address
City
Test Location Information
Precision Testing Technologies, Inc.
2026 W. Elk Creek Crt.
Bluffdale, UT
Test Location Information Phone
Name
Address Technican Information
City Name
Phone Cert #
801-886-9224
Contact
Applied Pressure
#1 Product Type:#2 Product Type:
TIME DATA -/+GPL RES GPH TIME DATA -/+GPL RES GPH
0 0.0037 0.0000 0.0000 0 0.0037 0.0000 0.0000
0.0037 0.00370.0037 0.0037
0.0037 0.0037
0.0037 0.0037
0.0037 0.0037
0.0037 0.0037
FINAL RESULT:FINAL RESULT:
#3 Product Type:#4 Product Type:
TIME DATA -/+GPL RES GPH TIME DATA -/+GPL RES GPH
0 0.0037 0.0000 0.0000 0 0.0037 0.0000 0.0000
0.0037 0.0037
0.0037 0.0037
0.0037 0.0037
0.0037 0.00370.0037 0.0037
0.0037 0.0037
FINAL RESULT:FINAL RESULT:
#5 Product Type:#6 Product Type:
TIME DATA -/+GPL RES GPH TIME DATA -/+GPL RES GPH
0 0.0037 0.0000 0.0000 0 0.0037 0.0000 0.000000.0037 0.0000 0.0000 0 0.0037 0.0000 0.0000
0.0037 0.0037
0.0037 0.0037
0.0037 0.0037
0.0037 0.0037
0.0037 0.0037
FINAL RESULT:FINAL RESULT:
Facility ID#
:
10-11-22
4000621
Staker Parson North Salt Lake
1730 N. Beck St.
North Salt Lake, UT 84116 Max LaRou
UT-412
55 P.S.I.
REG
0 87
15 86.75 -.25 0.0009 0.0037
30 86.75 0 0 0
PASS
DSL, DSL Sats #4,5,6
0 83
15 82.75 -.25 0.0009 0.0037
30 82.75 0 0 0
PASS