HomeMy WebLinkAboutDERR-2025-001820State 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 1200033
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
NameMitch Hull
Cert. # TL0557
Exp. DateMar 11,2026
Name
Cert. # TL
Exp. Date
Tank Owner:B & M Gas& Food Inc.
Address:1514 West 2100 South - Ogden, UT 84401
Contact Name:Omar Mansour
Phone#(801) 294-7284
Facility Name:Super StopShell# 1
Facility Address:1514 West 2100 South - Ogden, UT 84401
Installation / Upgrade /Repair Information
Est. Date work will commence: 3/11/2025
Tank #
4
Capacity
12,000
Tank Material
Steel
Piping Material
Galvanized
Substance stored
Diesel
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 single wall spill bucket with overfill prevention drop tube on the existing Diesel Tank. Test new spill bucket/ overfill prevention 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