DERR-2025-000415

Petroleum Storage Tank Trust Fund
Claim Information Packet
Department of Environmental Quality
Division of Environmental Response and Remediation
195 North 1950 West, 1st Floor
P.O. Box 144840
Salt Lake City, Utah 84114-4840
Telephone: [phone]
Fax: [phone]

TABLE OF CONTENTS

Introduction ......................................................................................................................................1

PST Trust Fund Eligibility ...............................................................................................................1

PST Trust Fund Deductible and Coverage ......................................................................................1

Environmental Consultants and Subcontractors ..............................................................................2

Work Plans and Budgets ..................................................................................................................2

PST Trust Fund Reimbursement Documentation ............................................................................3

Third Party Claims ...........................................................................................................................3

Other Information

Eligibility Application

Work Plan Approval Application and Agreement

Standardized Invoice

Request for Payment Voucher

Proof of Payment

Introduction
The Division of Environmental Response and Remediation (DERR) established the Petroleum
Storage Tank Trust Fund (PST Fund) to help underground storage tank (UST) owners/operators
meet U.S. Environmental Protection Agency financial assurance requirements and to help pay
the costs of abatement, investigation, and remediation of releases from leaking underground
storage tanks (LUSTs).

This claim information packet summarizes the procedures and requirements for obtaining PST
Fund assistance for the investigation and remediation of releases from PST Fund-covered
LUSTs. This claim information packet is not all-inclusive, therefore, one should review the
Underground Storage Tank Act 19-6-401 and the Underground Storage Tank Rules R311 for
more detailed information.

PST Fund Eligibility
Known or suspected releases (leaks) from petroleum UST systems (USTs, associated piping, and
dispensers) must be reported to the DERR within 24 hours of occurrence.

To be eligible for reimbursement from the PST Fund, the UST system must have a valid UST
Certificate of Compliance and must be covered by the PST Fund at the time of the release.

A ³PST Trust Fund Eligibility ApplicaWion´ oU claim mXVW be UeceiYed b\ Whe DERR dXUing Whe
period under which the UST system was covered by the PST Fund, or within one year after the
UST system was properly closed, or within six months after the end of the period under which
the UST was covered by the PST Fund. Following a review of your PST Fund Eligibility
Application, the DERR will provide written notification regarding eligibility for reimbursement
from the PST Fund. There are time constraints provided by law that may cause an otherwise
eligible release to become ineligible. Therefore, it is important to file a PST Trust Fund
Eligibility Application promptly.

PST Fund Deductible and Coverage
Deductible: Releases that occurred and were reported before July 1, 1994 have a $25,000
deductible. Releases that occurred and were reported after July 1, 1994 have a $10,000
deductible.

Coverage: For releases reported before May 11, 2010, the PST Fund may reimburse up to
$990,000 ($490,000 for non-marketer facilities) of the investigation and remediation costs. For
releases reported after May 11, 2010, the PST Fund may reimburse up to $1,990,000 ($990,000
for non-marketer facilities) of the investigation and remediation costs.

All costs, including the deductible amount, must be for customary, reasonable, and legitimate
work as determined by the DERR. Expenses that are eligible for reimbursement from the PST
Fund include costs for vapor abatement, subsurface investigation, soil and groundwater
sampling, corrective action, and provision for alternative drinking water supplies.

1

Expenses that are not eligible for reimbursement by the PST Fund include costs to achieve
compliance with UST system leak detection requirements, upgrading of an UST system, removal
or installation of an UST system, loss of business, and legal fees.

If a facility has a current PST Fund-eligible release and a subsequent PST Fund-eligible release
occurs at that facility, the PST Fund allowable coverage for the subsequent release will be
limited to the amount required to investigate and remediate only the subsequent release.
Additional PST Fund monies cannot be obtained for the investigation and remediation of the
original release through the coverage of a subsequent release, i.e., the maximum coverages for
each release cannot be aggregated. The DERR will determine the coverage based on the
magnitude of the subsequent release. In addition, a $10,000 deductible will apply to the
subsequent release.

Environmental Consultants and Subcontractors
Environmental consultants overseeing and directing work at LUST sites must be DERR-
Certified UST Consultants in accordance with UST Rule R311-201-2. The Certified UST
Consultant must have a current and approved PST Fund Statement of Qualification (SOQ) on file
with the DERR in accordance with UST Rule R311-207-3. Consulting firms must update their
PST Fund SOQs each year and the SOQs must be approved by the DERR before PST Fund
money is expended.

Environmental consultants must obtain a minimum of three bids from qualified subcontractors
for subcontracted work (drillers, excavation contractors, etc.) in accordance with UST Rule
R311-207-4(e). The requirement to obtain three bids for subcontracted work is waived if the
subcontracted work is expected to cost, and actually does cost, less than $5,000.

Work Plans and Budgets
Work Plans and Budgets (WP&B) for work required to investigate and remediate a release must
be pre-approved by the DERR and the PST Fund claimant. The claimant and their
environmental consultant must complete, sign, and submit a Work Plan Approval Application
and Agreement (WPAA&A) form for each WP&B before the work is performed.

If the claimant does not want to sign a WPAA&A form for each individual WP&B, the claimant
may complete and sign one form that will cover all subsequent work plans with the same
environmental consultant. However, the claimant must submit a cover letter with the form to
document that this is what they want to do. This authorization will remain in effect until the
claimant notifies the DERR otherwise in writing.

An approved work plan may be changed and the budget may be exceeded only after obtaining
approval from the DERR. Emergency work (work that prevents or abates substantial danger to
public health or the environment) can be approved verbally (with a written follow-up submitted
within 48 hours requesting an amendment and explaining the need for the change in the scope-
of-work and budget).

2

Reimbursement amounts are determined by the actual time and material costs expended for the
work, up to but not exceeding the approved budget amount for each task.

PST Fund Reimbursement Documentation
In accordance with UST Rule R311-207-4, all expenses must be documented on a monthly basis
and submitted on Whe ³SWandaUdi]ed InYoice´ or equivalent. Information from invoices must be
compiled on the PST Trust Fund, Request for Payment Voucher. PST Fund reimbursement
requests that do not comply with UST Rule R311-207 will be returned to the claimant for
correction. The costs for correction of reimbursement requests will not be reimbursable by the
PST Fund. Requests for PST Fund reimbursement must be received by the DERR within one
year of the date that the work was performed or reimbursement will be denied.

The following information is required for PST Fund reimbursement:

Ɣ Employee name, labor category (e.g., P102-Project Geologist or P104-Field Geologist,
etc.), date of work, task or description of work (e.g., groundwater sampling, operation
and maintenance, report preparation, etc.), hourly labor rate, and the number of hours
spent on each task;
Ɣ Laboratory analytical costs;
Ɣ Equipment rental and materials costs;
Ɣ Utility costs;
Ɣ Other direct costs;
Ɣ Invoices from general contractors, subcontractors, and suppliers with a work description
and listing of price and quantity of labor, equipment, and materials used; and,
Ɣ Proof of Payment. If reimbursement is to be made to the PST Fund claimant, proof of
payment to the consultant must be provided. If reimbursement is to be made directly to
Whe conVXlWanW, When pUoof of pa\menW Wo Whe conVXlWanW¶V VXbconWUacWoUV and VXppliers is
required. Proof of payment may be in the form of canceled checks, lien waivers, or
affidavits from the entity that is owed the money. PST Fund claimants are primarily
liable for all costs incurred and should obtain lien releases or lien waivers from the
companies, contractors, and subcontractors providing materials or performing services
associated with the release.

Third Party Claims
If a third party claim resulting from the release is brought against a PST Fund claimant, or if any
action or situation is likely to result in a third party claim, the PST Fund claimant must
immediately report it to the Department of Administrative Services, Risk Manager at
[phone] and to the DERR Project Manager.

3

PST Trust Fund
Eligibility Application
2/24/17
Utah Department of Environmental Quality
Division of Environmental Response and
Remediation
Petroleum Storage Tank Trust Fund

Were tanks in compliance when leak was detected?
Yes No

LUST Release Number:

Facility ID Number:

Applicant Name (please print)

Signature

Date

Mailing Address

City

State

Zip

Telephone
( )

Applicant is a:

Tank System Owner Facility Owner Tank System Operator Land Owner (Must demonstrate authority to file claim)

If the tank system owner or
operator, the facility owner,
or owner of the land on which
the tank system is located is
different than the applicant
shown above, complete the
appropriate spaces in this
portion of the form.

Tank System Owner Facility Owner Tank System Operator
Land Owner

Mailing Address

Telephone

Dates of Ownership

From To

Name of facility where the release occurred:

Facility Address:

Contact person at the facility:

Telephone
( )

Date Release occurred or was discovered:

Date release was reported to the DERR:

Number of tank systems that contributed to the release at the site (attach additional sheets if needed).

Tank Number

Tank Volume

Product

Installation/Closure Date

Is this release covered under independent insurance?

Yes (if yes, please submit a copy of your insurance policy) No

Number of tank systems that were or will be removed during the course of this site cleanup?

How was the release confirmed? (Attach a brief summary that includes laboratory analysis, field instrument readings, visual
observations, tank tightness test results, etc.)

Is there evidence of a previous release? If so, describe how the release was determined.

Was the release caused by a third party? If so, explain the circumstances and provide the name, address, and telephone number of
Whe Whird parW\ and Whe Whird parW\¶V inVXrance compan\.

HaYe \oX receiYed an\ reimbXrVemenW or offerV of reimbXrVemenW from a Whird parW\ or a Whird parW\¶V inVXrance company? If so,
how much and when was it received?

Have you signed a release? Utah Code Ann. 19-6-426(7) prohibits responsible parties from doing anything that may prejudice the
right of the State to recover from third parties.

Petroleum Storage Tank Trust Fund

Work Plan Approval Application and Agreement

Work Plan No. __________, Amendment No. __________

Facility Name: ____________________________________

Address: _________________________________________

Facility ID No.: ____________________________________

Release ID: _______________________________("Release")

Owner/Operator, responsible party, or other person seeking PST Trust Fund Reimbursement:
_________________________________________________________________________("Claimant")

Utah-Certified UST Consultant: ______________________________________________("Contractor")

In submitting Work Plans_______________________ and amendments thereto for the above referenced
Release ___________ for approval, the Claimant and the Contractor collectively, the "Parties," represent
and agree to the following:

Definitions:

"Contractor" means the person identified as such above.
"Claimant" means the person identified as such above.
³PaUWieV´ meanV ClaimanW and ConWUacWoU.
"Division Director" means the Division Director of the Division of Environmental Response and
Remediation.
³PST FXnd" meanV Whe PeWUoleXm SWoUage Tank TUXVW FXnd.
"Release" means the release identified above.
"State" means the State of Utah including its agencies, officers, employees, volunteers and specifically,
the Division of Environmental Response and Remediation (DERR), the Division Director of the
Division of Environmental Response and Remediation, and the Petroleum Storage Tank Trust Fund.

"Work Plan" means the work plan identified above.

1. The key personnel, for which qualifications are submitted under R311-207-3(c), are:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. The Claimant acknowledges that the Claimant is required to obtain a payment bond from the
Contractor under Section 14-2-1 of the Utah Code. If the Claimant fails to do so, the Claimant is

liable to each person who performed labor or services or supplied equipment or materials
("Subcontractors") in the event the Contractor does not pay the subcontractors, even if the
Claimant has paid the Contractor (Utah Code Section 14-2-2). The Claimant acknowledges and
agUeeV WhaW Whe PST FXnd Zill noW UeimbXUVe Whe ClaimanW foU VXch SXbconWUacWoUV¶ claimV foU
payment against the Claimant if the PST Fund has already made payment to the Claimant or
Contractor. The Claimant understands that the premium paid for a payment bond is
reimbursable. Therefore, the Claimant:

a. Has required the Contractor to obtain 100 percent payment bond through a United States
Treasury-listed bonding company, and attached a copy, or;

b. Has obtained other equivalent assurance and waives all claims and remedies against the
State if the equivalent assurance does not adequately protect the Claimant.
The equivalent assurance is described as follows:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

3. The Parties agree that the Contractor shall have no cause of action against the State for payment.
The Parties acknowledge and agree that the State is not a party to any contract with the Claimant
or the Contractor for reimbursement from the PST Fund in the execution of this Work Plan,
except to the extent provided by a contract signed by the Division Director. Instead, the
ClaimanW¶V UeimbXUVemenW iV goYeUned b\ Whe UWah UndeUgUoXnd SWoUage Tank AcW and Whe UWah
Underground Storage Tank Rules. The Contractor is entitled to reimbursement solely under
his/her contract with the Claimant.

4. The Parties agree that they will use a subcontracting method consistent with the requirements of
R311-207.

5. The Parties agree that, as a condition of performing the work under the work plan, the Contractor
shall carry the insurance specified in R311-207-3(c)(4). The Contractor represents that the
Certificate of Insurance documenting the required insurance is attached or that a current
certificate is on file with the Division Director and has been provided to the Claimant. The
Parties assume the risk and responsibility of ensuring that the appropriate insurance coverage is
in place.

6. The Parties agree that payments from the PST Trust Fund shall be limited to amounts that are
customary, legitimate, reasonable and consistent with R311-207. Unless the Parties and the
Division Director have entered into a written Pay-for-Performance agreement, the Parties
acknowledge that payments will be for actual time and materials expended up to, but not
exceeding, the amount of the Division Director approved work plan and Division Director
approved change orders, if any.

7. The Parties shall maintain financial and operation records in sufficient detail to document all
transactions relating to PST Fund reimbursement for the execution of this work plan. The Parties
shall make available for audit and inspection all such records relating to the completion of the

work plan and related services, requirements, and expenditures until all audits initiated by State
auditors are completed, or for a period of five years from the date of PST Fund reimbursement
related to the execution of this work plan. Records which relate to disputes, litigation, or the
settlement of claims arising out of the performance of this work plan, or to cost and expenses of
this work plan as to which exception has been taken by the Division Director, shall be retained
by the Parties until disposition has been made of such disputes, litigation, claims, or exceptions.

8. The Parties certify that there is a contract between the Claimant and the Contractor for the
performance of work under the work plan for which approval is sought ("Contract") and
incorporate the provisions herein into that Contract. To the extent that the Contract or
amendments thereto conflict with any provisions herein, the provisions herein govern. The
Parties shall provide the Contract to the Division Director upon request.

9. The Division Director is a third party beneficiary of this Petroleum Storage Tank Trust Fund
Work Plan Approval Application and Agreement and may enforce its provisions.

10. This Petroleum Storage Tank Trust Fund Work Plan Approval Application and Agreement does
not limit the Division Director¶V rights and remedies under applicable law.

Contractor_____________________________________________________________________
Signature, Printed Name, and Date

Claimant______________________________________________________________________
Signature, Printed Name, and Date

Revised 5/11/12

PROFESSIONAL SERVICES
DERR
LABOR
CATEGORY

DERR LABOR
CODE

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1
2
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6
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WORK PLAN TOTAL
STANDARDIZED INVOICE
Utah State Petroleum Storage Tank Fund
FACILITY ID. # E
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LOCATION
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NAME
RELEASE ID.

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Petroleum Storage Tank Trust Fund
AFFIDAVIT: PROOF OF PAYMENT

This form should be used when a claimant submits an affidavit from the consultant as proof of payment
for costs claimed for reimbursement. See R311-207-4(d) Utah Admin. Code

ClaimanW¶V Name ______________________________________________________________________

Site Name and Address _________________________________________________________________

_________________________________________________________________

Facility Identification No. __________________________________ Release Site___________________

STATE OF UTAH )
: ss
COUNTY OF ______________________ )

I, being first duly sworn upon oath and being of lawful age, state that the following invoices relative to the referenced application for
reimbursement from the Utah Petroleum Storage Tank Trust Fund have been paid in full through the execution of a promissory note by the
claimant.

INVOICE # INVOICE
DATE
AMT. PAID INVOICE # INVOICE
DATE
AMT. PAID

I further state that there is no relationship or affiliation between myself and the claimant.

I hereby certify that the foregoing information is correct to the best of knowledge, information, and belief. I understand there are severe civil
and/or criminal penalties for any false statement or misrepresentation of a material fact, knowing it to be false, or failing to disclose a material
fact with the intent to defraud.

Signature: Date:
Print Name: Title: Phone:
Consultant Company Name:
Consultant Company Mailing Address:

Subscribed and sworn to before me in the county of _______________________, Utah, this _____ day of
_________________(month), __________(year). My commission expires ________________________.

______________________________________________
Notary Public Signature

SUBCONTRACTORS¶/MATERIALMENS¶ LIEN :AIVER

For valuable consideration, the receipt and sufficiency whereof is hereby acknowledged, the

undersigned Subcontractor/Materialman having performed services or furnished materials for

that certain project known as ___________________________________________________,

located at ___________________________________________________________________,

heUeb\ UeleaVeV, UelinqXiVheV, and ZaiYeV an\ and all mechanic¶V lienV, maWeUialman¶V lienV, and

all other liens of every nature and kind, and/or the right to file any such lien, against said project

for labor, services, equipment, and material supplied and performed through ________________,
201____.

The undersigned certifies that:

1. Full payment, less retainage if any, has been received for all invoices submitted
through ___________________________, 201____; and

2. The undersigned has paid all of its subcontractors for work and services
performed and all of its materialmen for materials furnished to said date.

DATED this _______ day of _______________________, 201____.

___________________________________
Authorized Representative of:

___________________________________