DERR-2024-004896

Utah DEQ Underground Storage Tank
Installation Notification Form
www.deq.utah.gov
Facility lD 50OOO84 | ruew usr tnstallly'l I Upgrade/nepairp.
lnstallation Company: CSeSCO, lnC.
Contact Name: TraCy BOSWell Phone: [phone]
Address:830 West Northpointe Circle - NSLC, UT 84054
State Use
Permit Required?
Permit # t697-2024-7
Base Fee S SOO
lnspectionFeers2oo* z S 400
PST lnstall Fee 5200 x 2 S 4oo
Total
Date Approved & Paid
Certified lnstallers/Technicians on project fF) /i-\--!L"".1 i
Name Luke KelSo cert. # rL 041 6 exp. oatH ts
Name Zane Christensen Cert. # TL 0456 Exp. Date
Name Conner Christensen Cert. # rL 0457 Exp. Date
Tank Owner: JVP INC
Address: PO BOX 27 - Blufi, Utah 84512
Contact Name: VanCe NelSOn Phone# [phone]
Facility Name: K & C TRADING POST (SINCLAIR)
FacilityAddress: 161 East Main Street - Bluff, Utah 84512
tnstallation / Upgrade /Repair lnformation I Est. date work will commence: 0311312024
Tank #1 2
Capacity 10,000 5,000
Tank Material FRP DW FRP DW
Piping Material Flexible DW Flexible DW
Substance stored Unleaded Premium
Check if upgrade or repair only.Z (Describe details below)
Describe Details of lnstall/Upgrade/Repair in the box below (Submit a drawing/site map of work to be done!
lnsfall (1) new dorrhle wallfiherolass 2-Comnartment UST for a total of Ql new reoulated tanks. lnstall (2)
new fiberglass dispenser sumps with sump sensors. lnstall all new 1 112" OPW Flexworks double wall
ilextDle ptptng to tne (z) new otspenser sumps. rnstalr oouore wail spil DucKeIS wltn strargnt z+ orop
tlJlJgO. lllDLCrllllgYY Vg9\Igl l\rr,t',,l ll-g'l\rvrlLl-tnl\TYUltll\4/, lll-lqllNl lvvsgr\lrltlrvlsllllqlverlevlr\4/,
ma*a a.rar{ill al lno{all /C\ narrr I 11, UO Dad laalzal Qrrhmarcihla Drrmnc
with mechanical leak detectors. lnstall new sinole wall fiberolass vent lines underoround to new vent
risers. Reinstall (2 existing Gilbarco 3+0 Blender Dispensers.ri._L,,IVi-- D
Mailcompleted form to:
DEQ/DERR
Box 144840
Salt Lake City, Utah 84LL4-484O
195 N. 1950 W. 1't Floor
salt Lake City, Utah
Phone [phone]
Fax [phone]
UlAll lrEPrlRTl,lEu'f nl
ENVII1O f.lHf NTAL O rla i-lTY
ENVIRONI.IE NTAL R ESPONSE
& REMEDIATION
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