DERR-2025-001992

Utah DEQ Underground Storage Tank
lnstallation Notification Form
www.undergroundtank.utah. gov
Facility lD 4000135 New UST tnstaUfl Upgrade/Repair [l
I nsta llation Compa ny: M &M Cathodic Protection Service, lnc
Contact Name: Robert Butner Phone: [phone]
Address: 303 Redberry Rd., Draper, UT 84020
State Use
Permit *
-
Base Fee S SoO
tnspection Fee* $20O x
-PST tnstall Fee 5200 x
Total
Date Approved & Paid
*Applies in non-LHD contract areas
Permit Required?
s
s
s
Certified I nstallers/tedrnicians on project
Name Robert Butner Cert. * TL 0471 Exp. Date 6-2026
Name Cert. # TL Exp, Date
Name Cert. #TL Exp. Date
Tank Owner: Maverik, inc.
Address: 514 west 39fi) south
Contact Name: Justin Wood Phone# [phone]
Facility Name: Maverik store 285
Facility Address: 514 west 3flX! south Muray, UT
Est. Dat€ work wlll comnrence: Week of MARCH 10, 2025lnstallation / Upgrade /Repair lnformation
2 3 4Tank #1 5
Capacity 12,000 12,000 8,000 8,000
Tank Material FRP STEEL.LINED STEEL-LINED STEEL-LINED
Piping Material PLASTIC FRP FRP FRP
Substance stored UNLl UNL2 PREM DSL
Check if detailsor
Describe Details of lnstall/Upgrade/Repair in the box below (fubmit a drawinglsite map of work to be donel
ETTRACflON OF ANODE WITH SPECIALIZED TOOL AND EXTRACTION OF COKEBREEZE.
This is to remove the anodes and backfill for those identified as not current producing and to prepare these vaults
for anode replacement AND REPISCEMENT WITH EQUAVAI.ENT ANODES TO REPAIR SYSTEM
Mail completed form to:
DEQ/DERR
Box 144840
salt Lake city, utah 8l.174-48pJa
195 N. 1950 w. 1't Floor
Salt Lake City, Utah
Phone [phone]
Fax (801) 3s9-8853
utAH OGFAtrlMEH? ef
ENVIROHT,ICNTAL OUALITY
EHVIROHMEf.ITAL R ESPONSE
& REI,IEDIATIOH
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3/17/2025