DERR-2024-004915

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
9000221
I know of one release. It is the EFDL. I have attached a copy of my most recent report.