DERR-2024-012932

-l
Form Approvod. OllB No. 205o{O6E-
Notification for Underground Storage Tanks
oare necerrreo l. 0
T\IPE OF I.ICITIFIGATION A Dde Entered lnto Corptrter
B. Dda E'rry Oerk hitials
C. Orrner Was Codacfed b
Ozfi Responses. Conmens
fl e. r.rew rAclLny fl s. euanoeo fl_c. clqsule
-
tto-ot tarks ar ladlity
-
No. d conlirudion sheds afre.fi€d
INSTRUCNONS
Please @-OqEriglifioI, a! lterrs ere9t'Cgndre'h seclin V. Thb iorm
nrst Oe @ qiatirhg ind..gtqnd cbfage tat*s. lf
nre than fvb (q tanls areowned dtHs lGiirr, pttobcopyGebflouhg
she€ts, and staCe contirr.ration she€ts !o lhe bmt
frJccrgiar A fi etlnn rOllrO - lrar E mf $illb C
nCaf i ru i afr ermrrn. rl- cruC ol c ny tdt lh..ld i$r -
ic- rrrl ao crrdur ol rnprrur rr FE tt (6c qtr Frlrt-
rd ta.7 pouc f aqtt iur airIrD}
ttrre Iot{ff Smdsr!p..o.d hitt b:
IMO'Dffi
r88 IOETH t9s0 WEgr. t H9on
sAurlfiGctrY.tmfl gtt3
tldcdat b trqdd t, ffild hllot dltta.tt[urld r"t tllr
hrw b.il rnd to rirr r.gdr.d rutafpt .h- &.rrr, 1. t,q 0lt
f. h thr Srulrd r d Lr-a. t3aa, cth lr trongt l5-tD +f &r''
iIC ir lfcnrba rqririrf f -rrct*td
by E do.t tc d rtr Hranru
Corrrvdo nd nroorrY fa' (f,Cnl|. r d
Tle prinrry grrpce d nL ndcrin P.ogtrtt b D bcrD lrd ''-ra'rrnd.qpirrd Enirr ira an or tur anrr plohm or tE rlh' arEr'
It b s-F(,.d lhd th. hlqlr.in F, FYir. d b. bG.d on tE lly -evrfio ,tcol6. c h th..E r; oisrgr rcor*' you lsalder. bld. or
lrcoldinl
Wb tl.d }.dr? Sect<n ItGl ol BCRA s ]rtrldr4 trqrir lrd. udc
srrnpre4 cnrra'urlr.goJttd EtE t lsa t gtttd!+Ern.-'tlr,lr
rrcrify'@nrd Sto ot lirl qricis of ,rr siilE ol tni d. Ofrt
m-r!-
{ h thr crr. d u urc.!,ot d gI. rrrlth rr. qr l{o,."b t. l90r. a
tror{m iro rr. lr tl O. sry prst rtr al. rt undrEltu d l,re.
ml-rsea U the oqr,.r-. d d+...ip ol qrd lEtr. ad
b) h t,r. cr.. d lV ud.otqnd gte. rrk hlr. b*.t t{6T t6t &
lSer. Urr m tor,3- t tir cr drtOo. rny-prar rtr d a'dl E'*
inri.d.Dl, b.bl ria (Ecslturt o rf is cr
c) i, th. srr.e..rc, ro lt(pa. .t, H, ,ia l-oad4ar rly futgr
o t&V AUtmfoi a ir* orirrn aoi tquy urrd ltttt hbanrtitn '"6b b. irdud.dl
Wfra Trnfr An hcrdrd? t trr.lltqrd toq. Ed( b d'ffi G rlry ql'
accntinirr ol EE ta(l) b u3..rb Ganrh .r ecannSon o' i'ed'd
.Ala.' a ta rtr idfrno fna*re Gsm..rd tri4lulf qiing) ;ior; ;oll b..iih trr oora- Sinr Gltrd-.tt uldr1lotrld ltb'Eit:
L GEh.. rd d. 6dcd fJ.( rtd 2. id.Eil d,..ri gdcil-r
Hicibctrt(|m.
. Ita T.rrl. At! Erd.t-d? T.rla rrrud tcn ir erqttd il nq3'ti'cl
r mtlkaln olhr rrtl ccrld to.tt luitclin lr:
1. hnn c ldtmld rrl(3o{ f J(D eab.la bt.t'fv lId h gif
mo.lll b.tEErmEgrpc
. --Z iiJur-h Eite ta.IE or-hr crnglr rr cr ir ilt-
dta.!ttrtd:
t -f,arnaq( d*r. tufd- (ncffre ert*t fbJ rAuf.d tr!(f fi. ltrnd GEpiCir'g*r eaoa rg. o. n lts 6l. UqrU Pfp.lto S.h, AcC tgrg. o.
rra. !r nlo rir irdY 16oo.rr Slr r5
3.irir, mFrEElE. E FdE a.gEE
6. 6.ttt fi a r- fr Gdlch.]-.r:
7.now-{r!rgh Fait{r.:
!- f*U rnf a eseird eohcrin lir erdy rrLr.d D ol 6 gas
Bqralqt ano g.Errrrg orltlDlE;' 9. ortr rr{n lurrrO lr ]l urlrglqnid .lI ($dr .s. bcrtrlr. cd5.
miurttrg. dit rfidr q urrd) I hr otto rr* b dlra uFr d &' t'
ru{rrof ir ior.
SLrl &iaa lr. Co{tttd? Ihc mlficein rqirtrur.gCy D l'rd.t
duno sD.ro Etus DE GarrrEn rcgse arrx. fh.b -ua rrr
IAtr oiftl s tradosc h taim tol (r4) d lr. Ccrgtt.,af,
gn*ormnc nryr+ Cqrrrion rd Lut f.ro( lfo @ir}.rq
ttm To llaly? l. Ornrt d unrlrglqrrd Erg|.-Eila l5c. o. rh tm
Ucri-ir.n crra rirum du&nrrry i. rszr. hrrrl h 6r'gund. turttdt
U UrV E r ga z ifnrt rtp Uin u*bryqrd tDlrer lE io rr Ar ffry
(re6, n stay*d*t $ <hFd nir*tg 6. rrb ir ur. 3. It $!
&itr rdffi.i o( rny rrrrrifo*ro Ey :rnd htrmrin D Srr IlE,
imrany.
Fadr: &rt owrlro fnchgl, l& b rd, r ri* t&
Ei*rr'b r{r.t r r Gtt{ pdn*7 u r rana-.l0loo lr.dt
rrrlir*,m aAcar;n b na gtni cbrrt&ft t-o lJc-bt b'
rEIGE-
flrrsrabrl.-!-tr. E I
EPA Form 753G1 (Rcv. 2-92)
@ erirrw on Rxyded Paer
,-\
III.TIPEOFOTYiER tv.ND|AN LAt{DS
tr FrdGomr:r tr OocrncA
tr SElrGovrruri ! nf,ra"
tr tocdGovqnngrt
Trr*s gr locded qr H ri[itt r hdmBrrvdhccndrtl,.tffi.tr I
I
I
I
Tltoqt{dor:
Tg{s rc onrd !y nehte Anricgt trnalln.tbe,c
V.TY?EOFFACLITY
_FrloleimtltlrE
-AtTdGrh.l
-tbdtOtr
-AnDeCrntip
-R*od_Fffi-ttm,tnry
-Ffrd-1ffr,_fdsUd
-CotErE
-Trudirsffztsport
-t[!or_HdrUd
-Frnt_6r(Fahh)
Vt @NTACT PERSCIN N CTIARGE OF TAI{I(S
tilgrr
fiul K0,l(rtl
Jotmb Adret
llA0 Sd,{fitt\raut
Hur }lmir (hdd.ArnCcb]
4[l bk'btrtrr fti'r uf tr4ozz 801 '['stl -0 lsl
Ut HMNCUL RESPdiFAI.ITY U
t trrur rmttr Ardd nryosbBy ttqiuttrnE h
sdanorilrzOCFHSngdH
Cft.ctlIGrApCy
r-1 srhrrm
l-1 EctRacndcreirp
I
I I---1
I I-t
I r-'l
I
I
I
Grabr
grtyBqld
l-d.rdCrrd
It_
I I ls& nnas
il-lrr.nrrrna
I l-t otror ltdrodllorrcdsp.cry
I
I
YIIL CCFfFX}AIPI'| tr d rd dgn eofld{ a rretr)
lafff .r* prrdyof htral lhm perrcrelyannirodrd rnrtrnter$rttr Hcm&t stttild hfhb rd ddrd
Oannltll' rrd GC bcrl qr my hqty d fu- hdrfirb llrrndebly rcponrDb b ohf&g Gc trtndon, I brbte lI lrrafiEirEfler irtu.ert, ardcEdn .
tldrldffi{lrdaraoilrt effird qnraelr (P tl)gnan D.bSltd
Prp.rtort Roductlon Act lldlcr
EPA ecfinala pr.6lcr?ormtg hldmlbrthElormE arr4e3O rlrubc pe regoosc irdndttg drm br rcviewlrg hstrrcJocf
gfierhg ammfrffitgthedataneededandcorrplstrg andrevleuthgtteranrl Sgrdcomrrrtsregadngttb hdenedhrbb
Cl{e[, lrilonndoo Folk, Brandr 7l*l%, U.S. Emionmmtal Prctecton Agency. 4O1 M Sre4 Waslrtrgltsr O.C. A).160. rn rld
'Albalion DeC( Omcer b EPA"'Thb bnn anrnds the Friorrs ndficdm lorm as ptrtd in 40 CFR Prt 280. Appendr t Prrbs
rdlms ol tl{s nfficdim 6m may be used ufdc e4plc lart.
EPA Foru 75llG1 lF.a.2-g2l 4.2
DC DESCRImON OF UNDERGROT ND STORAGE TAtsG (Cocflaa ior edr tak at fib leilo")
Tar* ldentfcafon Nunter Tarr(hb. f Ter*r*,.2 Trr(tb. ? Trr(ib. q Ttr(t*r-
f . StsnsolTank(tnrtalyar) Arectyinusa
Terporadty OddUso
Fr..a--!
Pernanenty O,tt ol Use
li-r-ta--tl|
Aflr.ndm'qrt c,f lnbrmation
rrtrI Erl
ttl
Z Dded kldon (rp.ryear)
3. E!fimaLdTotel Capdty (galons)lo,Df)0 l2,OoO lo,0oo I 2,OOO
.1. i/labrbl ol Constndion
(lulark sll0rd apply)
Asphalt Coaed or Bare Steel
Cdrotf,caf Protecled $ed
Epqycodedsteel
CompGiie (Se€l with Fberglass)
Fbeqlass Rtfttbrced Haslb
Lh€d Interix
Dq.tleWalled
Polyelhylete Tank Jacket
Ccsete
Ercavdln Une I
Urf,r.rr,t I
odrr. Plcase
"p"dfy I
Has tank been ,r**r l
{x Y-,1
5. Piping (tvldedal)
(tt/ld( ar fid apdy)Barl Steel
G.lnnizedSt6el
Fberglass Rdn{orcad Phsfic
CoPPer
CdrodcdlyProtecled
Dq.tleWatred
Sondary Cmtahrnent' ur{rnorn
OOpr. Please speify
s.HprE Gypel(llrt 8l ttdappty)
9rclirn: no vdve dtank
Sudion:valve dtard(
ftsssua
GrrYity Fe€d
Has ptprE been repaired?
tl
EPA Forn 753G1 (Ra. 2€2)P.gr3
Tara( ldentificdion l$rrtr Tarf( ib. I Tsrf(ib.-4.Tarf(ib.i,T.rl(tib. L TarI( ttb._
7. Srtstre Armty or Laa SbrdhGtleidCfsdtybyVolur:
Gasolhe
DiEd
Geohol
Kquene
Hed*poil
Us€d Ol
Otnr, Ptasesp€cily
17 I
Flazardous Stbstarp
CEHClJnarp andor,
CASrunber
fvhm ol Subslances
Plese specify
)CTATIII(S OUT OF USE OR CMNGE IN SERVICE
1. Clc&rg of Tank
A. Esl[naed dde last us€d
(tro./dayfear)
B. Eslimde dde tank dosed
(notdrt|aarl
C. Talt w.as renwed lrom gumd
D. Tad< was deod h grunrd
e Ted(fi[odwih hgt mdedd
Decribe
F. Ctungeh s-rrice
2 Sile Assssrnent Cqnplsted
BiJerud aleekdebcfcd
EPA Forll 753G1 (Rov. 2€:l)Prgra
x cEHnHcATlc,N oF coMPLtANCE (COMPLETE FOR AtL NEW AND UFGRADED TANKS ATTHTS LOCATKIr|)
Tar* ldenlifcadoo Nucter Tarr(No. I Td*,j*.4 TatI(No. 3 Tart(No.q Tar*lib.
l.lnstdlalion
A" hstall€rcertified by tant( ard
pillitg rnanulacnrres
B. lnstaller cgrlified or lbensed by the
imflernerlirq qr€ncy
C. hstallalio irmpectetl by a
rqistandengher
D. lnstaldkn lnspecleO and
apgoveO Uy inptermoting ag€ncy
E llandaare/s installalicn
choddsB han befi coflpleted
F. Andrer mdrott allorcd by State
aSmcy. Please spetify.
2 Release D€tectim (ftiark all thd apply)
A Marualtankgauging
8. Tar* tigtrtness tosting
C. lnvmtorycofltols
D. Arbmdictankgausins
E VaporrmiEirp
F. Grumdrderrrrtbrirlg
G- lntrstitial nuritodng double walled
tad/piflrB
H. lntesfidd mdnitoring/secondary
@otaiilrEnt
l. Arbrndic fine leakdeteors
J. UnetigfthessrsdirE
K Ottermsfiodsllotredby
lmflementing Agoncy. Please
sP€dty.
TAI.IK
EEEEEEE
E
E
fl
PIPING
E
t_lE
E
Etlt:]
TAl.lK
EEtlEt-lEE
E
E
E
PIPING
tltltl
E
EEtl
TAT{K
tItlEfltlEt_l
Lf
fl
tl
PIPING
EEE
-Efltl
TAI.IK
EtlEE
t_lEE
tI
E
E
PIPING
Eflfl
E
tlEE
TAITIK
EEEflEEE
E
E
E
PIPING
EEfl
E
EtlE
3.Sdl ard olrsrfl Proiedion
A- Ovsflderricahstafl€d
B. Splldevioehdalled
EPA Fotur ?$o.l le.a.2-*4 hFs
4
OtlB No. 2050+'e... ApP?ovtl .ltl'!. f/tt/ltsForm AeProvrc.
r----
Notificatlon for Underground Storage Tanks STATE USE ONLY
IO NUMAEF lea
oatc Entereo lnto Cofipurer
Daa Enry Cledr hitdc
Gmr WarConrsdodto
Clanty R e spottsrr. Cdrnments
TYPE OF M'TIFICATION
. I A NEw FAcLnY ! a. euenoeo ! c. cLosfJFlE
i--
i N6 6l trnra n laatrtt No. ol Gpn!ruaEoar sl'taltt SnaCnXti -
_ I'lo. ol tanx! d laqrtv
INSlSIJCTIONS
A.
8.
c-
Pleasc ULglgq4.E5!, rI ltrnr.rc sl'lgnr!n'ln ren V. Thir lorm
rnrsl b. conrgcrrO for rgr fstsr glrntng unOrrgrctrtd 3brrgo tr'Jtr ll
rs. nan five (5) lsnl(l rt. owlt.d d ri3 lcilon. Photogy rl. bllomng
sneets. and saplr contrullon shatu to lha brln.
xdff..e! b .r{lstta' *.a,a E d u'r"tru,' Err' th'l
h.ra t .r c..a lo llctr ttlItal.a a!-LEa.E JarErlt t. t f,.' t,r"
.n an tlr. l,qna r c Iq- l. lll t tll rr iullnl lt.....ll, 15 a'
rrf. Ilr i;crruEr in;-tr.if-tEraEC rirfu-r
Co.t .rrrEr ra nrcrVfa.tnce l r d
llrr qrruo ruoor d aaaofur E li 3 D E''r' -nlt
.ioQrculE arta lrataEr o,nG! ag]I !.au]o ct,rilrlrDaa3rc!l,Er'
: 6 rr-Grao tlat oa la,qillEt tq, gtrrl E oa Eat oal t-SrLlIY
avtl{ 'to!a!. d n Ea atEtEa ca tI'! ,EC, fu, lJElqa. fL' -,a<D.-llral
wlio u.rr tacuv? S..lal gItr ol RCRA rgnru. ,EJ.rr aal s'5
.rarnltlt. fiitatd utEa!,E rE rrl nuartrtTLtsartl!,E-au,I
.€!,v (EgllE sUr c Ul 4rrr ol !I 3EE c ars 3E o.lr'
tnrI,lF
d ar tr .rI c rn llr.tu!.rtl aE lil. ua tr lq.'ir a' t93'. d
lrqan tr! t- art tr (la. rrt garr iE E tt o.I5tlu,r, lDlta
rrr ira Arrr clr, lr. tlErr ! Ctf-eana rl!
Dl h !r crra C anT urLvlt! .rru n i lr ftl lSvrnr a.
t 9fa. tJr l! Elll r tr. !! artln arlT Frrr! ilrl arct''t
6m.d.|' !.tso na atadtfrarn C ia l.r
c, i, lll Sta ag.rEf E arrIa rrv :tI' n t tr t f!.'r. r,l' clr{.
o tany aban.Elt, Irt al$ Ca |ollt at-E tnr alt ti.El nr6
ro r rr6uo{L
Wta Tratr lr Hr..lt ij,O.gur!.D,a. fr - drfu: ny cr
c, (ltnoiaEt ol laE aa tt t a lI E GE-.r ar aaEril-lst C '!'9trE
.rrrra,' afit la iul illr (.radl orrE l'rrtlurtd otErC, r
'r ot atEr Erlt aa t urrl ScL.l;ran raruurrt rrrr IGQ:
1. a--G urrod. 6d-a Lrt a ill-r Err E
l.ruort,r[ar.
fira f..r. .rn Ercrta? Ir,*r rtqc lli at Frr, at tE 3+a
a irrcfu.L Orr! anra raf,r 16 i&EllG
r. lntr r rraraa SrIrC t.tE gllrrr rarlel ir- E t[rl
aosttrauioEilna-t El8
2. rrlr ur- ts aEr! l-rt ca brqrrE,sr.r i! E]l=
-ra,taD.IE
!.laclrE:i. c*l roitr arurrc c.G.r.t ir-l rQrla6.rr ar r'r,l G'
Ad'r S.h{t Aar C I g. c. rr.-}'btrrE lrua Pirl,rt 5.L" L C t e 'l' 'rtrcr a !!.raE DEt fft lTl.- rtr SIa lt
3. ifr nrErEnirr' tr!. EE rrFr:
a Etrrrlt trt ir orEl at!f,rr:
7.tb'arll{nrEf3:
t. t(lra alr, aEt- Carl,t! lrla CGlt t'{'rt' E o' t g..
trarctti tr galrtnc el,llt !:
t. Erca lrE 3ra5 rr f! s!!avur! arr' lsidr 'l ' Etrl Grr'
,nn .UE!. gri altdt, rrtral a,t' 3q'''r' "'i'r r,tEl c aa'!' n'
sfr.rol!rb.
EPA
.5 ra.t lE rrlartra.lra.!l'!ErT I
trt5! r' t'dr' s'r'Gtlrqrg tst: D:
DEPARTMENT OF EIMRONIT{R{TAL QUAUTY
DMSTON OF ETMRONMENTAL RESX)NSE
16l NoRTtl lgto tlrEsT tsT Ft-oon'
SALT IJKE OTY. UTA}I t.II6
St- f.l.ftv? t. O.5 C utl,l'.!fi!'Etot-r5-h '-ttrtiih.r .rl cll c oo,c, rrJitiii i. r rrr' ur ir ir an 0mrrl nr' rult
ur lilrla ri ior:ur trl ;iaAd'mt rrr rDr-'r rrt
1 toa rl.-.r6trurr, r cr J i-o'i rr nr io rr' r t n' 6D
,Eil rEGrEl a ur rr:rirnrr i iryrtr aLrgl o 5lr r6c7
iilErrr
...:=r.1I';E.IeffiI$:#:ffifi.drrt,tri-i -H r J JfriiE'*i t'r EtrI b
ift--.
t.oWNEFSHIPOFT rK(S)
--=Et-.)--t--
-+n .'- aaa.:>n * 4o
-.-aE-t-J-a_/o ts Elv -=r"nt+,tb&" ,'-er X4Fe-
Form 7530.t (Rd.2.C21
,$ e,;,nurecctadPo,r
P.L7
lii,i 09 'gG L4t48 KRR KNrK 86"noasg
CERTIFICATE NO.41354*2
USTCEffIFICATEOF
WPLNCE
tssuED ro: LocArtol ot,Il'*t;
IG*"r<wrr f5 +eo
1015 12Tlr sT '
ocoBu, I/I 84403
KAR KIIIK INC. .iE ze ur st. *38
66oBrl. IJT 84401-1s01
t^t* crPACrr SLET NCE
c P crrv sL€sr^l€€
12,000 GAsolIIg
iz, ooo ce-so!ffi Ii ';;;;; dase!!u+;,,?:[[i frV;;;;|"'4 5, Oo0 DLEaas.u 1''
I***** * *i * * *tir* * * ;l'i.y *,
i4.\ ;\ r, r'!,1.,'l7'-r,,
Tcrnu of Covcnge: The exPir.aton d
.*rtitiot will automaticalty lafrie.i! any oJ
lor lailure to cornply wilh state and tedert
is specilied in Utah Admin. Cgoe.n]l]
accordance with Utah Admrn' Code H311
ffi THE FotrowNc rAt'lKS ARE lN coMPuANcE
wft rHE i^bAcBouND groRAGErA!'lK Acr'
\
l
i
I
ALOUALITY
Plcg lvac or orinr ln lnk rll ltrrrl.roEt trgnaun. h rain V. Thb to.nt
mugl b. comBd.d ra..dl bOn silrnurg unOrryOund stor{n EnIr r
nEr. drrn llve (g tu*r en ffi t thb lapn. plrOoqy Or lobwr4thrt!, rnd stlpb omthurucn srtratoo. fom.
- t.Alfrh b trrf lFtU IrE- utri'rla rr5illIf, b.r r- fc rcr ltfir:E lltsr tE llrry I, lJla. Erf
!llln!. Fud.r C 5a, rI. cr,rr rt.rutt nca- d*I. atL.thrrrrcrlrtEr mlf f lanrf Iaala mCttr Aainr--!.-rran rlr iely ea. rilCRll r ru.
Ttr cnarV lrgr ct tt rprilcur EE !n ! D Er. -r, FtErrlarullr! lltr llr aEttt trruD aErE Eilarrt E naarga tEr.I !.E6tnn
'lr nEilaEnFuEuraI!t Erit.rrtroEvlrrlla nEtt3. s n !!, &tto d .lEr rE!|. iq, rrrrq.. tfd. trE@t.
tlrlD ll.r tadtfy? S.(!or e@ol RCRA..r.,Drr,.d. nltlrti arl ut-ararnDEo, olr!.t_o, rrErllottE Enll ltr al!,t rrguaEt a.oaE Era n JttEtrfy tr!{iltrr StrD d roaal t rE- ot nr ournircr or glr teru" furrrl1M-
rl h tnr crr. ol tr ur-Ctur! E ea rr n rr. or lbrnar l. llry. qtrurgt! nE lla drr
'lE
60. arrf FDi rtD Er t, t t6-?urts EI,Euurtts b 6r aqa, lD. t 6lrIr! c rE at ltlrrEtt. rrt
-_!) h rh. c. ol -, uurilurt rq. Er n Lr ti.t ltbrnr a.t54. bu[rDErl.?o lI dtthrtalD.rv'rrur;rcn o arrn trilrilrEDt bbt t rl..-olF-qn C ti ur.
_ .-.!lt-Lq!. Srq to nnirr rrt Err rE,! ur,lol ry dlrfD rEtV nbfireo E lrt tyrrr .tt!.r lqr, rnrrrr lrrr ;tstilin ,r;D!.ndra.0.
thl trrE A,t Lgr-C, th.rglrl! tE' It t .tlrd ! 17 ort oEnEn Er ol EIl ftr (1, L urt D otrur !t Ert lr.Et d.ttCuit.taEr.'r,I (a rnr El,r lrErdrt cErE llrcvurl, cirrt r
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W.Irt t.nf. A,t Erdlg? Tt*r rnw tqn Ar gturri -t ,E llJq-o acfrec OArr l,ur a!$& tEtilEslcrDt ar:
l. rrrtr r lta(tr0a tlta o, t.t OO grur 0, na EfqI, rra E aErlllDE i.a b rursrnrud ErE!-:
2. ErE ua- br aErE ,rar! qt !, cqrrrD!f, lI. qr th, Drtrtll-rittaE!d:
NoUflcgilon ,or Unclerground Storage Tanks
NSTFI CTIOT{S
L OWNERSHTP OFTANK(S)
--,EaE-raD--Da-a-
STATE USE O}ILY
OATE RECETVED
A. 08. Enl.trd |il, Comgrrtr
B. DnrEnry Clcrt lntlrb
C. furrr t{rr Conud b
euly n Fn r" Comm.iltr
t rrEdl
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C rrE ntE rtrrB. ga!. ErL g, tat:
a. tEtrr rE t rr rlE EtEr ttrtrr:7.t*rru.grgE-rrr:
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L rup rrf rf h .tt utt !lur! a'a (rEt r a hir!. Grlr,.nuxrra. o{t fraL t urrf I tha q. ail b tlD tEr r tofit tr.ulECrtE
llil luEun fr Ccrrd? Tb nalEn rnurrrrrr @E y D lrugrcrxt rqr rrrr Dltcotrtrtn raguerrt auBrJEa. Tlir rr.u rryI.BID ofrra ! lrE Er n Eqr rot (f al ot !t CnnrrrrrEru,qrrrri nEI CarmrEl rI lXlaft, A! d rI0 (CEftLll. rttr Er d lE]arEr rteuat r llEtrEr rr tlu &b@ CERI t ll rUn Erurm. aa- on.lr C, t? h-{t GrrirnEn t
lqaC I srt oEEtrr d rtrrE . .rE FrEr Cl, 6ryt . F.,trrUrtlrt ta.7 E rLrErrtlIh alot af.
fh't lc tElt? Srrc cErlfid bilt u
UDEO'OERH
t68 NORtrH 1950 WESr. t.t FLOOB
SALT I.AKE crrY, ur&t 84il0
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hrfE &y arJD Hrc, aI tc trlft cllr.! tr trEr>
tEr fl b .ra|t b. clrl F.r.nr rE te E d JIA.OE tr Er trrt ts
rlrtsr nClltaEt S rEr tfrt r Erhbh trt htsrEr I r.6rd,
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tI E tIIttE Eat ItI rrEL.iL ar Er.EriIlr.t Lr:Ir5I:LLtrt
Ldludc tongitudr
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T\PE OF }IOTFICATE'iI
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Addrrs
VII. FINANCTAL RESPONSIBILITY
-Trua<n/frer_t dl!L.
-Rrritrnth!
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(EPlrin)
Plrnr Nunlbcr (ltdt d. Arlr Code)
ErructFutd
t hnr md tlrr linerriel rrrnriblllly rcquircmcno in f-lr-nrp wiur 40 CFR SubPen H
Vnt CgfnflcATI)N (B.td std rign dtrrcomPrtne eX raonrt
I c..!ty undc, p.nelty o{ lrw tha I hm porronrlry oreminod rnd em lemiliu rrnh thr ffiormdn lubmittrd ln thb ]i d ddl'd
d-rmril. !16 rhd brsrd on nrr iqurry or o,i: il-hfilE-fillid;il;fiiloa t ifiuung t. inlormairn I bliv' $i tro
.,rUnara idrnrabn blru..E raa' rnd compStr'
Signom o3r srynrd
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;.o;;; thi.
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torm mry br urrd wtrilo lupCirs legr
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llrrtr .nd stlbid liUr ol rmr
;-iln ,t audrorizrd rprE mdrrr (Ptht)
x DESCnPnC'N OFIJ!:DEFGFIOI ND STORAGE TAttllG (Comlrlt{.dr uru !c tni ldrl)
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2 Rrlcrsr Detectn (Malt dltha pry)
A Manuat tanx glrrgrng
B. Tank trghtncas t6ing
C. lnvcnory conrob
D. Anomactmxgnt gittg
E Vrpormomodng
F. Grcundwater rrnitoring
G. lntcrnitial mnitaing.doublc rrllcd
tsnktrrprng
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contSnmam
L Auomablnr lrdrdrtott
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fis locATl$0
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A{J, /, o* o / I;4" *v' /'oo t" App frJ- i/- /a ; fd illG|l.c.srillEffiGrrtrtsrffilt -
tloflltcrtloo for Undergrctrnd Stotsp Tanlo
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.rh pdryr greo d fir '!l[uhri l.!ilrlr b E bit ft, |{ll|n
t4!.rUE tr!-llflrllr aEt u lH tE .d li'laqlll E hErrhur gfi*r*rril[Ei Ar h arlullrin ltu t 6rfi II !l bE donillloilts,rtrfiI. rE rta. a h tlr ogti ot-rrxtr lsrri lrr-tr*trd0.,Eila, orrlf,lGbr
tIto tLir lt.l,llr? 8rr6on E00E ol EtrBr. |' fltEnrtr4 rq4|| ti. uU|,rlurDH.ilnen 0t uruooroud Entr nat rtsrmrlrtrd tr$rrrur dxatt5lily drEEnred gbl0 tr bcfl ggene!! slnor*ndra.t otOai.H,*r. Orxa.,
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toicr iur t$arh m_Coru.Sdmc .{het . ut urros,grdna E [i lE*,r$L Grrdr, UIC-C. U fiot a td, frH ? ilrdali., ratucrrifr$ritrrhilddlrrtdtril.aE.
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gofu Con rt{ldrlhr clr.ntirlr* fUu d*rrltil hrn rrrtrafitl,ltr lr.dt rr r Esrurl calll.
fifil$Hrffi.ttd[ a tlla{ fr m-cno tr*ir'rlur nm c rbve ftt
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gaud rtaar rnlc tr! co6dn fiiulaDd t$ileffrl, tilr rndeaar srU
ru!ilErE .UIrd rrlrz*Sur h iclar l0l tlal 6l'dtr CafltfltfirlE
Erriomrntsl nn*nr. &arn.llrn rnd Utlfrr Ar C r*0 toEnctAl. Hur
m ramrd tdr tmrdr murrf r hodthr ilI uilffr $brth C
ftBel. n E Hrudr !ru*am. rd, aulr ol r rr IIsIr lrnolt|ffn s
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f,tmto lldy? Eu, sttililrd furr u
UTAI{ DEPARTT1ENT OF }igBL[II
l,rt r*$rffi
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firarno{ry
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EfuT#ffi F-ilffi P*1rffi HHHffi ffi "1ilS BUREAU 08 ENVIBCNMENTAII RB$PONSE E REII{ED'
t0g N. t460 l{.r P.o. Eox 16690
$AL0 tlllE crTY, UTAH 8{116-.0690
tlhlt aE &r trrxlrrll thdrrgoud r.crgc nnlrllrl rxE ltl Elrrc, Ltsr[.Euiri tEl|l0 Etrt rrdoltxl H m cntI cfltlirlcn cf utr nd {0 L Urtd s c*ruin ra'lumrtului oitiiniiui-asbruur.' rta l2l rilfra i&rt ligr.dro urrrad urdrrtrrd lEtar lrl$-qfrl ft H tq! ie4l tiirudrr-eilacaIirffind effi h
{gO Nr l.|PU llrl f .IJ. 9t.r ,997v I
$AL0 tlllE crTY, UTAH 8{116-.0690 I
tura?ollxllr? t.Ortlro atruont{.rahHr h irr ff t* rts}t Ilrn lrlil alaliirndmdrr&mtri, rgr..ta&natfi lauil, firllr no{t Ilrn lrlil aI al (l[*rmn drr&fitu, i. l0r.;
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dl b. orytq[rd tu cufi leaion comrfrrtrBEndfqmund Smc trr{tr. InulOreffiEffi'Eiartiicol Endggoundlutagcrrliltr. I
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FOR I RETURN Kenneth Alkema
iffi I
"""'*EB LEi'fl*t#;ffi::H*
STATEUSEONLYr'D'Number
I zu) zB 4
Notilicrlion is rcquircd by Fcdcnl hw for ell undc4round trnLs thrt hryc bcst
us.d to !!ore rciulrtcd subatrnccs sincc Jrnury I, 1974, tht rc ln thc arourd u of
Mey t. 1986, or thrl rrc-btor4ht into rsc rftcr Mry t, 19t6. Thc furformrdon rcqucrd
b required by Section 9002 of thc Rcsourtc Comervttion rrd Rccovcry Act,(RtRAI
rs rmended.
The primarl, purpose of this norification program is to locate and evaluate under-ground tanks that storc or have stored pctroleum or hazardous substances. lt is
expected rhat the information you provide will be based on reasonably arailable
records. or. in the absence of such rccords. your knowledge. belief. or recoilecrion.
Who Must Notify? Section 9(X)2 of RCRA. as amended. requires rhat. unless
exempted. owners of underground tanks that store rcgulated subsiances must notify
designated State or local agencies of the existence of their tanks. Owner means-
(a) in the case of an underground storage lank in use on November 8. 1984. or
brought into usc after that date. any personwho owns an underground storage tank
used for the slorage. use. or dispensing of regulated substances. and
( ir) in the case of any underground storage tank in use before November 8. 1984.
but no longer in use on that dare. any person who owned such tank immediately beforc
the discontinuation of its use-
tYht Tlnts Art lnchdcd? Underground storage tank is defined as any onc or
combination of tanks thar ( I ) is used to conrain an accumularion of'regulited sub-
stances." and (2) whose volume (including connected underground piping) is 1076 or
more beneath lhe ground. Some examples arc underground thnks storihg: l. gasoline.
used oil. or diesel fuel. and 2. industrial solvents. peiricides, herbicides or fuhigants.
Wh.t Trnls Are Exctudcd? Tanks removed from the ground are nor subject to
noiification. Other tanks excluded from notification are:
l. farm or residential tanks of l.100 gallons or less capacity used for storing motor fuel
for noncommercial purposes:
2. tanks used for storing heating oil forconsumptive use on the premises where stored:
3. septic tanks:
4. pipeline facilities (including gathering lines) regulated under rhe Natural Gas
Pipeline Safety Act of l1)6E. or_rhe.Hazardous Liquiil Pipeline Saferr.Acr ot 1979. or
which is an intrastare pipeline facility regulared unier Stite laws:
5. surface impoundments. pirs. ponds. oi lagoons:
6. slorm llater or wasle waler collection systems:
7. flow-through proess tanks:
t.liquid traps orassociared garhering lines dircoly rclated to oil or gas production and
galhering opcrations:
9.. storage tanks situated in an underground area (such as a basement. cellar.
mineworking. drift. shaft. or runnel) if thi srorage tank is siruated upon or above rhe
surface of the floor.
Whri $$dlrcl Arc Covccd? The norification requiremenrs apply ro under-
gro_und storage unks that contain regulated;ubstanctr. Thit includeiiny substance
defined as hazardous in section l0l (14) bf the Comprehensil,e Eniironmental
Responsc. Compensation and Liability Acr of 1980 (CE RCLA). wirh the exception of
thosc substancrs rcgulated as hazardous waste under Subrirle C of RCRA. lt also
includa; pctr,olcum. e.g.. crude oil or any fracrion rhercof which is liquid ar srandard
conditions of tempcraturc and pre;surel60 dcgrees Fahrenheit and i4.7 pounds per
quarc inch absolute).
Wharc lio Notily? Completed notification forms should be scnt ro the address
giren at the top of this page.
Whcn To Notify? l. Owners of underground storage ra nks in use or that har e been
taken out of oDeration after Januan l . 1974. bur still in the sround. musr nor ifr bl
May 8. 1986. 2. Owners who bring rinderground storage tanl-t into ust afrer Mdt t.
1986. must notify within 30 days oI bringing the ranks iiro use.
Ptoddr.: Any owncr who lnowln3ly frib to nodfy or submits frbc informrtirm$.ll bc x&lccl io r civll Fndty mt to cxcccd 310,0fl) fc cedr trnt for which
notflkrthr b not jvcn or for whhh fibc infonnrtion b submilfcd.
Please type or print in ink all items except *signature'in Section V. Thbfmnmuilbyocnplctcdfor
erch locetion contrining undergrolmd storrge tsnks. lf more than 5 tanks arc owned at this location.
photocopy the reverse srde. and staple continuation sheets to this form.
lndicate numhr of
continuation sheets
attachd
Public Agency, or Other Entity)
Type of Owner (lto* ell ttpt apP{ylfi )
E "rr"n, E stateort-ocarcovt ts BtYBt?S{"'El Fo,,", tr t68fffiflIf,.o. no. tr g#?"#l;,
lndicate
number ol
tanks at this
locetion
Mark box here if tank(s)
are located on land within
an lndian rerrervation or
on other lndian trust lands
(lf same as Section 1 , mark Oox nere E )
Name or Company Site ldentilier, as ap
Name (lf same as Section l, mark box here lxl )
t] Mark box here only if this is an amended or subsequent notitication for this location.
submitted information is true, accurate, and complete.
I certily under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
documents, and that based on my inquiry ol those individuals immediately responsible for obtaining the inlormation, I believe that the
Name and offici4l title ol owner or owner's authorized representative
Tank ldentlllcallon No. (e.9., ABC-1Z!), or
Arbitrarlly Assigned Sequentlal Number (e.9., 133...)
TankNo.Tank No.)TankNo.TankNo.
L/
Tank No.
1. Status ol Tank
(Ma*attttr,tapptya) r"rr":H""3tJIXlU=
Permanently Out of Use
Brought into Use atter 5/8/86 rl-l
Ivl
E
r-{-l
rF
rrt
m
2. Estlmated Aoe (Years)n o r)o
3. Estlmated Totral Capadty (Gallonr)l).nrn ,/ 2 nAh C.nm la firt(\
4. Materlal ol Constructlon Steel(Ma*oneB.) concrete
Fiberglass Reinlorced Plastic
Unknown
Other, Please Specify
rr-l rrl
5.lnlemal Protectlon(Markattthataryryg) CathodicProtection
- ' - Tilterior Lining (e.9., epoxy iesins)
None
Unknown
Other, Please Specify
Errl
rrt
rl-l
H
rrt
rrl
rF
6. Extemal Protectlon
(Ittartcailthatapptyta) ^ c.lTfoProtection' Painted (e.g., asphaltic)
Fiberglass Reinforced Plastic Coated
None
Unknown
Other, Please Specify
-xr fR
7' PlPlng Bare steet(Ma*allthatapplya)
Gatvanizeo steet
Fiberglass Reinforced Plastic
Cathodically Protected
Unknown
Other, Please Specify
ryI
tt
rn tTl rn
8. Substance Curenlly orLmt Storcd atnGreatesteuantttyd;ffifi;'* - ^t-
E'ptv
(Ma*arthatapily1; b' Petrcbum
Diesel
Kerosene
Gasoline (including alcohol blends)
Used Oil
Other, Please Specify
c. HazardouoSubctance
Please lndicate Name of Principal CERCLA Substance
OR
Chemical Abstract Service (CAS) No.
Mark box E if tank stores a mixture of substances
d. Unknown
rrl rT
l_rt E
9. Addltlonal lnlormatlon (lor tanks permanently
taken out ol servlce)
a. Estimated date last used (mo/yr)
b. Estimated quantity of substance remaining (gal.)
c. Mark box E if tank was filled with inert material
(e.9., sand, concrete)
owner1ame(tromSectont,
/il" il"t -' Locaton(trom s*vourty/LtS )Y S# PageNo.-ol-c-Paser
EPA Form 7530-1 (11-85) Reverse t u.a. Oorrnmrnl
''lntlnt
Ottlo.t ltaHla-rl3 Page 2