DERR-2025-001990

Utah DEQ Underground Storage Tank
lnstallation Notification Form
nrww. undcrgroundtank. utah. 6ov
Facility lD 1008105 New UST lnsall f]Upgrade/RepairE
lnstallation Company: M&M Cathodic Protection Service, lnc
Contact Name: Robert Butner Phone: [phone]
Address:303 Redbery Rd., Draper, UT 84020
State Use
Pernrit Required? E]
lnspection Fee* $20O,
-
S
PST lnstall Fee 5200 x
-
S
Total S
Date Approved & Paid
*Applies in non-LHD @ntract areas
s soo
Permit #
Base Fee
Certified I nstallersfedtnicians on project
Name Robert Butner Cert. *TL 0471 Exp. Date 6-2426
Name Cert. # TL Exp. Date
Name Cert. f TL Exp. Date
Tank Owner: FAST GAS f5
Address: 1G)1 N SIATE SIREET OREM, UT
Contact ilame: l,lrlLEY WESIRING Phone# [phone]
Facility Name: FAST GAS fl5
Facility Address: l(X)l N SIATE SIREET OREM, UT
Est. Date work will commence: Week of MARCH 10, 2025lnstallation / Upgrade /Repair lnformation
1 2 3 4 5Tank #
6(8K 8K 8K 12KCapacity
STIP3 STIP3 STIP3Tank Material STIP3 STIP3
FRP FRP FRPPiping Material FRP FRP
UNLl UNL2 UNL3Substance stored PREM DSL
Check if u or repair only {Describe details
Describe Details of tnstalUUpgrade/Repair in the box below (submit a drawing/site map of work to be done)
Replacement of positive wiring to anodes with HMWPE due to concrete/asphalt damage to wiring. Digout and
resealing of exposed negative wiring, RETEST
Mail completed form to:
DEQ/DERR
Box 144840
salt Lake city, utah 8417+4840
195 N. 1950 W. 1't Floor
Salt Lake city, utah
Phone [phone]
Fax [phone]s3
UIAH O€PAPT}.4EHf af
ENVIFONIIENTAL AUALITY
ENVIROHITIE HTAL R ESPOHSE
& RET'IEBIATIOH
1000105 3/17/2025