HomeMy WebLinkAboutDERR-2025-001130SALT LAKE CITY UT A4O
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M&M Cathodic Protection Services
303 Redberry Rd.
Draper, UT 84020
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Utah DEQ Underground Storage Tank
lnstallation Notification Form
www. undergroun dtanks. utah. gov
State Use Only
Permit Required? tr
Permit #
Base Fee S SoO
lnspection Fee* $2oO *
-
S
PSTlnstallFee S200x- S
Total S
Date Approved & Paid
rApplies in non-LHD @ntract ar€as
Facility lD 3000111 New UST lnstallf]Upgrade/Repair [l
lnstallation Company: M&M Cathodic Protection Service, lnc
Contact Name: Robert Butner Phone: 8O1-75e3O61
Address: 303 Redberry Rd., Draper, UT 84020
Certlfied lnstallers/f edrnicians on project
Name Rober.t Butner Cert. #TL 0471 Exp. Date 5-15-2026
Name Ce*.#TL Exp. Date
Name CerL # TL Exp- Date
Tank Owner: DAL SOGLIODtSTRtBt Tt0ttt
Address: 8370 S, STATE STREET, MIDVALE, UT
Contact Narne: firESfESl- TED fiFFE Phane* 891-9$-7456
Facility Name: DAt SOGIIO USIRIBUflON
Facility Addruss:8370 S. SIATE STREET, nfiDVALE, UT
Est. Date work ndll corrnence: tlleel of FEa t0,m25lnstallation I Upgrde lRegair lnformation
4 5Tank #t 2 3
Capacity 10,000 6.000 6.000
Steel-LINED Steel-LINEDTank Material Steel- LINED
Piping Material FRP FRP FRP
UHL PREM DieselSubstance stored
Check if or details below)
Describe Details of InstaltlUpgradelRepair in the box below tsubmit a drawinglsite map of work to be done|
INSTALIATION OF NEW STRUCTURE WIRE FROM RECflFIER TO VENT1 LOCATION
Mail completed form to:
DEO/DERR
Bc.xL44HD
Salt Lake City, LJtah 84114-4840
195 N. t95oW. lsFtoor
Salt Lake Gty, Utah
Plwne (801153G4,L0o
Fax (801) 3s9-8853
UTAH OEPAtrT'.iIEI..? Af
ENVIRQHMENT.CL OUALITY
E NVIRO I* trlE iITAL R ESPONSE
& RET.IEDIATION/