HomeMy WebLinkAboutDERR-2025-001669State Use Only
Permit Required?
Permit# _____________________
Base Fee $ __500
Inspection Fee* $200 x ___ $_ ___
PST Install Fee $200 x ___ $_ ___
Total $_____
Date Approved & Paid ___________
*Applies in non-LHD contract areas
Utah DEQ Underground Storage Tank
Installation Notification Form
www.undergroundtanks.utah.gov
Facility ID 1200313
New UST Install
Upgrade/Repair
Installation Company:Csesco, Inc.
Contact Name:Tracy Boswell
Phone:(801) 292-4404
Address:830 West Northpointe Circle, North Salt Lake, Utah 84054
Certified Installers/Technicians on project
NameZane Christensen
Cert. # TL 0456
Exp. DateFebruary 1, 2026
Name
Cert. # TL
Exp. Date
Name
Cert. # TL
Exp. Date
Tank Owner:NEBCO Inc.
Address:96 North State Street - Morgan, Utah 84050
Contact Name:Justin Smith
Phone#(801) 791-0777
Facility Name:NEBCO SERVICE
Facility Address:96 North State Street - Morgan, Utah 84050
Installation / Upgrade /Repair Information
Est. Date work will commence: 2/25/2025
Tank #
5/ 5A
Capacity
6,000
Tank Material
FRP
Piping Material
FRP
Substance stored
Premium
Check if upgradeor repair only.(Describe details below)
Describe Details of Install/Upgrade/Repair in the box below (Submit a drawing/site map of work to be done)
Install (1) new OPW double wall fill spill bucket with overfill prevention coaxial drop tube with new fill adapter and cap on the existing Premium Unleaded Tank. Test new spill bucket/
overfill drop tube and submit results.
Mail completed form to:
DEQ/DERR
Box 144840
Salt Lake City, Utah 84114-4840
195 N. 1950 W. 1st Floor
Salt Lake City, Utah
Phone (801) 536-4100
Fax (801) 359-8853
Ver. 8/1/2016