DERR-2025-002458

@ Utah Department of Environmental Quality Facility ID lt, 00 :J...'41 .
Permanent Closure Inspection Paae of
Ownership of Tanks LLJ Location of Tanks ..
Owner Name f5/', I,;) I.. /'\,,") Ill I\ I\ f Po r,b YJet"~ Location Name OJ" -rl/lA I ,J ,<,¢; I' i'A-.c:.
Address 3 'lJt:, we.~'= 5.en Sk>ul.h ~Inn Address 7~£ $e,-tA-bA _,
c;A'? v>"B6
City <LC-State tA7 Zip 'X41eJ I City <LL-State UT Zip ??lf J,,}
Contact (de, I /L#r M ur,nAv Phl~.5,.. ~ ?-1'1:> ?contact Phone
Tanks Closed. Use additional paa~ to/additional tanks. Tank No. I Tank No. Tank No. Tank No.
Capacity (gallons) -v iito n-?
Material of Construction (Steel , FRP , Comoosite, etc.) ~,/::,.tp---A.J
Substance Stored I.I A/ IL •
Date Last Used UA/Jc..
Date Permanently Closed 4 ,.).-1,,.,-,~
How Closed /Removed , In Place , Change In Service) !2.-e.....;A~ ,,l'L-,1
Original Number of tanks: l I Closed Tanks: , New Tanks : 6 Final Number of tanks : n
Tank Cleaning and Removal ..
UST Remover: AIA,tl_.,.-v--a JI .p..,, "JI\ 7 .,, _j Cert.#: TR Lrl 2__ Exp . Date : u -I --:.1.o J .7
Groundwater/soil Sampler : t2. l't /.A 1 .P✓ I lcu~j ~ Cert.#: GS ltf.2.7 Exp.Date: /;;J.-S -:J.o2£ -,
£es) ~ Owner/Operator has an approved Closure Plan No A cooy of the aooroved Closure Plan is on site No
Product removed (i;s) No By: V),',.,,.:,/..4:::; Pu~h Disoosal Site:
Sludge removed ~ No By: l < I I Disoosal Site :
Tanks cleaned ~ No By: I ( I ( Rinsate disposal site : ......
~erting Non-exolosive atmosohere inside tank obtained bv: D Puraing LEL or% Oxygen obtained:
Product lines were : □ Cleaned , secured in place , and capped CJ"Removed . Disposal site: w es~L,~~-,,, M~/5
Tank disoosal site : Soil disposal site :
Site Assessment ;!:! ,.~ ,:,/Y ,r
PIO or FID meter readings (show readina locations on the site plat):
MeterTvoe: Gain or soan: I Calibration specs:
Soil Contamination is evident: Yes No Deoth of Contamination: 0-3 Feet Greater than 3 Feet
Groundwater contamination is evident: Yes ~ Deoth to Water Table : 'V ~I Surface slope direction :
Number of samoles collected : 3 IGw Soil 2 lusc l Certified Lab: e
Land Use of surroundina area: □ Residential □ Industrial □ Commercial □ Other (specify):
Show sample analysis information below. Samples with the same analysis can be grouped together. Include any samples taken by the
inspector. Show sam[ le tvoes "ilncludlng USC locations and depths on the site plat
Samole number(s) Substance in Tank Sample Type Compounds analyzed Analysis Methods
,t; i 4,-.:2 IAN/1 ~ .-t. 'I T'n f 1-/, tfDI-I-fJ'(lol,gr: vo(;..S
u t:,r ll5L -'--I b&4/i<bts/~ U Al I<.
.......... .
Inspector observed collection of samples: No Inspector collected and submitted duplicate samples :
Contaminated soil was over-excavated: Yes .(1Qo) n/a If yes, confirmation samples were collected:
Yes
Yes
" Potential Receotors. Indicate the distance tin feet) and direction to the nearest receotors. Show receotor locations on the site olal
Residences Commercial Buildings wa' G, Prooerty Line Active Water Well
Surface Water Sewer Line Water Line Natural Gas Line
Teleohone Line Electrical Line Storm Drain Other:
that I ins ected the above-named facilit on date : Y.,.. ;1 .-
Cert .#: Tl 2}
No
Closureinsp0908. doc
L.
e Utah Department of Environmental Quality Facility ID 4 m;;J..&:fl
UST Facility Site Plat . ,
Page of
NORTH
7 t)() s~u-1::.h
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Sub Pump s
Tank Fill F
ATG Probe A
Inter. Probe I
Vapor Rec . V
Capped C
UTM Northi ng : Easting : Other (specify) 0
Show locations of all buildings , st reets, tanks , pip ing , and dispenser is lands . Indicate the product in each tank. Show locations of tank manways and identify each :
submersible pump , fill , ATG probe , vapor recovery , etc. For closures: Indicate the type (soil , GW, USC), location, and depth of each samp le collected by the certified
sampler or the inspector. Indicate the locations of anv reported PIO or FID readinas . Show locations of potential receptors .
Comme nts
S1teplat0908.doc