DERR-2025-001215

Utah UST 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 0717
100223
OLI 8/07/2024, Release discovered and reported to DERRReceived approval for Work Plan and Budget No. OLI-01Petroleum Storage Tank Fund
Fuel Network Program Manager