DDW-2025-001214

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Utah Division of Drinking Water
IPS Deficiency Correction Notice
Water System Name Kennecott Utah Section 21
Water System ID #UTAH 18003
Instructions
Please use this form to report the correction of sanitary survey deficiencies identified on your
IPS report. List the individual Facility ID (where applicable), deficiency code, how deficiency
was corrected and the date of the correction below. You may attach a copy of your IPS report
with the date of the correction noted on the report. Pictures of corrections or a brief description of the corrections are encouraged. Include the name of the facility and the correction date on any
documentation you provide.

I certify that the information submitted with this report is true and accurate. You may electronically sign this form by typing your name in the Signature block.
Trevor Paulson
Print Name Signature Date
Corrections listed on attached IPS report Supportive documentation attached
DDW Approval Date / /
Facility ID
ST005
Deficiency Code How deficiency was corrected Date Corrected
V016 Drain identified; screen installed. Jan 20, 2025
Jan 20, 2025

ST005 Upper Refinery Tank Drain