DERR-2025-001854

UTAH PST PROGRAM
TEMPORARY CLOSURE NOTICE (REVISED 10/21) FACILITY ID#
State Use Only
Date Received
Date Processed by
Temporary Closure Notice prepared at the request of the owner/operator (identified below) by
of (company name) Phone #
Address City State Zip
TANKS TEMPORARILY CLOSED
Tank #
Type (Steel,FRP,etc.)
Date Installed
Capacity (Gallons)
Substance stored*
Date last operated
Inches of Product remaining in
tank (to the nearest 1/8 inch)
* Indicate the specific substance stored in each tank to be closed (regular, unleaded, diesel, waste oil, etc.)
Vent lines open and functioning Product lines capped/secured Pumps, manways secured
Fuel was emptied to less than 1" Corrosion protection is operating Release detection equipment is operating
Temporary closure requirements:
When a PST system is temporarily closed, the owner/operator must:
●continue operation and maintenance of corrosion protection on tanks, lines, flex connectors, and other metallic system components.
●continue operation and maintenance of release detection OR empty the PST system to less than 1 inch of product.
When a PST system is temporarily closed for 3 months or more, the owner/operator must also:
●leave vent lines open and functioning
●cap and secure all other lines, pumps, manways, and ancillary equipment
●send a properly-completed Temporary Closure Notice form to the DERR/PST Section.
I certify under penalty of law that I am the Owner of the tank(s) described above and that I am familiar with the information on this
form and that it is true, accurate and complete and further, that the procedures described herein were followed during tank closure.
Date:
Full Name of PST Owner:
Signature of PST Owner:
Return completed Temporary Closure Notice form to: Street Address:
195 North 1950 West Salt Lake City, Utah 84116 State of Utah Dept. of Environmental Quality DERR PST Section PO Box 144840 Salt Lake City, Utah 84114-4840 Closnoticetemp1205.doc
OWNER AND FACILITY INFORMATION
Tank Owner Phone #
Address City State Zip
Facility Name
Address City State Zip
Contact person Phone #
Number of regulated PSTs at this facility: Number of regulated PSTs to be temporarily closed: