HomeMy WebLinkAboutDERR-2025-002818April 14, 2025
Division of Environmental Response and Remediation
Petroleum Storage Tank Section
P.O. Box 14484
Salt Lake City, Utah 84114-4840
Email Transmittal: TankCompliance@utah.gov
Re: Notification of Aboveground Petroleum Storage Tanks
Conservancy Oil /DBA RelaDyne West
444 West 200 North
Delta, Utah
August Mack Project Number JX2981.250
Dear Sir/Madam:
August Mack Environmental, Inc. (August Mack), on behalf of RelaDyne West, is
submitting the Notification of Aboveground Petroleum Storage Tanks (APST) for the site
located in Delta, Utah. This notification is being submitted at the request of the U tah
Department of Environmental Quality (DEQ), Division of Environmental Response and
Remediation (DERR). Based on the facility being a bulk petroleum distributor with SIC
Code 5171, the facility is exempt from the regulation as an APST under this rule.
If you have any questions, please do not hesitate to contact us at 317.916.8000.
Sincerely,
Anthony Henley
Senior Consultant
ATTACHMENT A
Utah Notification for Aboveground Petroleum Storage Tanks
(Delta, UT)
Page 1 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ
Utah Notification for AbovegroundWĞƚƌŽůĞƵŵ Storage Tanks
Division of Environmental Response and Remediation
Underground Storage Tank Section
P.O. Box 144840
Salt Lake City, Utah 84114-4840
Phone #(801) 536-4100
Fax #(801) 359-8853
Email:TankCompliance@utah.gov
Web site:deq.utah.gov
STATE USE ONLY
Facility ID #: _____________
Date Received: ___________
Data Entry Clerk Initials: ____
This form must be completed for each location containing aboveground ƉĞƚƌŽůĞƵŵstorage tanks (AWSTs) that are regulated
by the State of Utah.
I. Ownership of tank(s)II. Location of tank(s)
Owner Name _________________________________________
Mailing Address _______________________________________
City ____________________ State ___________ Zip _________
Contact______________________________________________
Phone # ____________________ Cell # ____________________
E-mail _______________________________________________
Facility ID # (unless new location) ____________________________
Facility Name _________________________________________
Street Address ________________________________________
County ________________City ________________ Zip _______
Facility Phone #______________
Latitude: ________________ Longitude: ________________
III. Type of Notification IV. Other
New Notification Amended Notification
Located on land within an Indian reservation
or on other Indian trust lands.
Name of Tribe:_____________________________________
Federally regulated underground storage tanks are at
this location. If so, please enter the Facility ID assigned in
the space above under Section II.
V. Type of Owner VI. Type of Facility VII. Exempt
Commercial
Private
Federal Government
State Government
Local Government
Tribal Government
Auto Dealership
Contractor
Federal – Non-military
Federal – Military
Gas Station
Industrial
Railroad
Residential
Trucking or Transport
Utilities
Other (explain)
_________________________
Commercial Airport(fueling)
Farm/Agriculture
Petroleum Distributor/Refiner (SIC
Code 2911 or 5171)
Oil or Gas Production and
Gathering
Heating Oil used on premises
Less than 501 gallons
VIII. Contact Person in Charge of Tanks
Name:
Job Title:
E-mail: Address: Phone Number (Include Area
Code):
IX. Financial Responsibility
I plan to meet the financial responsibility requirements by using the following mechanism(s):(check all that apply)
Bond Rating Test
Commercial Insurance
Guarantee
Letter of Credit
Local Government Financial Test
Risk Retention Group
Self-insurance (Financial Test)
State Fund (Petroleum Storage Tank Fund)
Surety Bond
Trust Fund
Other Method (explain)
__________________________________
X. Certification (Read and sign after completing ALL SECTIONS of this notification form)
I certify under penalty of law that I have personally examined and am familiar with the information submitted in Sections I through
XI of this notification form and all attached documents, and that based on my inquiry of those individuals immediately responsible
for obtaining the information, believe that the submitted information is true, accurate, and complete.
__________________________________________________________________________________________________________
Name and official title of owner or owner’s Signature Date Signed
Authorized representative (Print)
RelaDyne, Inc.
8280 Montgomery Road Suite 101
Cincinnati OH 45236
Tessah Chappelow
317.760.6163 317.760.6163
tessah.chappelow@reladyne.com
RelaDyne West
444 West 200 North
Millard Delta 84624
435.828.6009
39.355776 -112.584678
✔
✔
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Bulk Petroleum Distributor
✔
Tessah Chappelow
Regulatory and
tessah.chappelow@reladyne 8280 Montgomery Rd
317.760.6163
✔
Susan Tyler, Director of Environmental Compliance 4/14/2025
Page 2 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ
XI. Description of Aboveground WĞƚƌŽůĞƵŵStorage Tanks (complete for each tank at this location)
Tank Identification Number (use additional pages
if more than 5 AWSTs)
Tank # Tank # Tank # Tank # Tank #
1.Tank system description (check all that
apply)
(if either of these apply, the AƉST is regulated)
Rests directly on soil (including gravel)
Any portion of piping buried or touches
soil (including gravel)
2. Status of Tank (check only one)
Currently in Use
Temporarily Closed
3. Date of Installation
4. Capacity (501 gallons and greater)
5. Tank Attributes (check all that apply)
Asphalt Coated or Bare Steel
Cathodically Protected Steel
(impressed current)
Cathodically Protected Steel
(sacrificial anodes)
Composite
(steel clad with non-corrodible material)
Concrete
Double Walled
Manifolded
Compartmentalized
Field – constructed
Steel Secondary Containment
Concrete Secondary Containment
Earthen Secondary Containment
Tank rests on cradles
UL Listed AWST
Connected to an Emergency Generator
Other, Specify Here ____________ ___________ ___________ ___________ ___________
6. Overfill Protection (check all that apply)
Automatic Shutoff
High-level Alarm
7. Spill Prevention
Single Walled
Dry Connect Fitting
Other, Specify Here ____________ ___________ ___________ ___________ ___________
123 45
✔✔✔✔✔
11,965 11,965 11,965 11,965 25,000
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Page 3 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ
8. Vapor Recovery Attributes (check all that
apply)
Pressure Vent Valve on Vent Pipe
Coaxial Drop Tube at Tank
Two Point Vapor Recovery at Tank
Emergency Venting
9. Piping Attributes (check all that apply)
Bare Steel
Galvanized Steel
Fiberglass Reinforced Plastic
Flexible Plastic
Copper
Cathodically Protected
(impressed current)
Cathodically Protected
(sacrificial anodes)
Double Walled
Secondary Containment
Airport Hydrant Piping
Unknown
Other, specify Here ____________ ___________ ___________ ___________ ___________
10. Piping Flexible Connectors (tank end)
Containment sump
Booted
Not in contact with soil
Cathodically Protected
(impressed current)
Cathodically Protected
(sacrificial anodes)
11. Piping Flexible Connectors (dispenser end)
Containment sump
Booted
Not in contact with soil
Cathodically Protected
(impressed current)
Cathodically Protected
(sacrificial anodes)
12. Piping Delivery Type
Safe Suction (no valve at tank)
U.S. Suction (valve at tank)
Pressure
Gravity Feed
✔✔✔✔✔
✔✔✔✔✔
✔✔✔✔✔
✔✔✔✔✔
Page 4 Version ϭϬ.1Ϯ.2021V1
13. Substance
Gasoline - Regular (up to 10% ethanol)
Gasoline - Midgrade (up to 10% ethanol)
Gasoline - Premium (up to 10% ethanol)
Gasoline – Ethanol Free
Gasoline Containing > 10% ethanol
(specify amount of ethanol and grade of product)
Diesel
Off Road Diesel
Biodiesel
Diesel Containing > 20% biodiesel
(specify amount of biodiesel)
Kerosene
Avgas
Jet Fuel
New Oil
Used Oil
Other, specify here
____________
____________
____________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
14. Release Detection (check all that apply)Tank Pipe Tank Pipe Tank Pipe Tank Pipe Tank Pipe
Tank Tightness Testing
Automatic Tank Gauging
Interstitial Monitoring
Statistical Inventory Reconciliation
Automatic Line Leak Detectors
Line Tightness Testing
ŽŵŵĞŶƚƐ
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Page 2 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ
XI. Description of Aboveground WĞƚƌŽůĞƵŵStorage Tanks (complete for each tank at this location)
Tank Identification Number (use additional pages
if more than 5 AWSTs)
Tank # Tank # Tank # Tank # Tank #
1.Tank system description (check all that
apply)
(if either of these apply, the AƉST is regulated)
Rests directly on soil (including gravel)
Any portion of piping buried or touches
soil (including gravel)
2. Status of Tank (check only one)
Currently in Use
Temporarily Closed
3. Date of Installation
4. Capacity (501 gallons and greater)
5. Tank Attributes (check all that apply)
Asphalt Coated or Bare Steel
Cathodically Protected Steel
(impressed current)
Cathodically Protected Steel
(sacrificial anodes)
Composite
(steel clad with non-corrodible material)
Concrete
Double Walled
Manifolded
Compartmentalized
Field – constructed
Steel Secondary Containment
Concrete Secondary Containment
Earthen Secondary Containment
Tank rests on cradles
UL Listed AWST
Connected to an Emergency Generator
Other, Specify Here ____________ ___________ ___________ ___________ ___________
6. Overfill Protection (check all that apply)
Automatic Shutoff
High-level Alarm
7. Spill Prevention
Single Walled
Dry Connect Fitting
Other, Specify Here ____________ ___________ ___________ ___________ ___________
678 9
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12,152 25,000 11,965 7,158
✔✔✔✔
✔✔✔✔
✔✔✔✔
Page 3 Version ϭϬ͘ϭϮ͘ϮϬϮϭsϭ
8. Vapor Recovery Attributes (check all that
apply)
Pressure Vent Valve on Vent Pipe
Coaxial Drop Tube at Tank
Two Point Vapor Recovery at Tank
Emergency Venting
9. Piping Attributes (check all that apply)
Bare Steel
Galvanized Steel
Fiberglass Reinforced Plastic
Flexible Plastic
Copper
Cathodically Protected
(impressed current)
Cathodically Protected
(sacrificial anodes)
Double Walled
Secondary Containment
Airport Hydrant Piping
Unknown
Other, specify Here ____________ ___________ ___________ ___________ ___________
10. Piping Flexible Connectors (tank end)
Containment sump
Booted
Not in contact with soil
Cathodically Protected
(impressed current)
Cathodically Protected
(sacrificial anodes)
11. Piping Flexible Connectors (dispenser end)
Containment sump
Booted
Not in contact with soil
Cathodically Protected
(impressed current)
Cathodically Protected
(sacrificial anodes)
12. Piping Delivery Type
Safe Suction (no valve at tank)
U.S. Suction (valve at tank)
Pressure
Gravity Feed
✔✔✔✔
✔✔✔✔
✔✔✔✔
✔✔✔✔
Page 4 Version ϭϬ.1Ϯ.2021V1
13. Substance
Gasoline - Regular (up to 10% ethanol)
Gasoline - Midgrade (up to 10% ethanol)
Gasoline - Premium (up to 10% ethanol)
Gasoline – Ethanol Free
Gasoline Containing > 10% ethanol
(specify amount of ethanol and grade of product)
Diesel
Off Road Diesel
Biodiesel
Diesel Containing > 20% biodiesel
(specify amount of biodiesel)
Kerosene
Avgas
Jet Fuel
New Oil
Used Oil
Other, specify here
____________
____________
____________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
14. Release Detection (check all that apply)Tank Pipe Tank Pipe Tank Pipe Tank Pipe Tank Pipe
Tank Tightness Testing
Automatic Tank Gauging
Interstitial Monitoring
Statistical Inventory Reconciliation
Automatic Line Leak Detectors
Line Tightness Testing
ŽŵŵĞŶƚƐ
✔✔
✔✔