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Home My WebLink AboutDERR-2024-004381PST Owner Information Facility ID# PST Facility Information Owner Name: Facility Name: Address: Address: City: State: Zip: City: State: UT Zip: Contact: Phone: Contact: Phone: DESCRIPTION OF PETROLEUM STORAGE TANKS Tank # UST or AST Date Installed Capacity Substance Stored TANK/LINE TIGHTNESS TEST Indicate Pass or Fail for each tank and product line tested. Include a copy of the test. Tank # Tank Test Line Test TYPE OF FACILITY Marketing facility, or non-marketer with facility average monthly throughput greater than 10,000 gallons. Non-marketer with facility average monthly throughput less than 10,000 gallons. COMPLIANCE WITH PST REGULATIONS All Petroleum Storage Tanks (PSTs) at this facility have been registered. Registration fees and Petroleum Storage Tank Fund Fees have been paid. Are your PSTs currently in compliance with all Federal, State, and Local PST regulations, including applicable Fire Code? Yes No If "No" describe items of non-compliance: PREVIOUS POLLUTION INCIDENTS Complete the Previous Pollution Incidents form to indicate whether a pollution incident has occurred at the facility. FINANCIAL RESPONSIBILITY MECHANISM DECLARATION (check one only) * Non-regulated PSTs at the facility may be required to participate in the Environmental Assurance Program. I choose another Financial Responsibility mechanism for the PSTs at this facility. •Indicate the financial responsibility mechanism to be used: •(For self-insurance or guarantee) Indicate your company’s fiscal year end date: •(For Insurance) Indicate the date the policy is renewed each year: The Certificate of Compliance cannot be issued until all documents have been submitted and the mechanism has been approved. If the mechanism has already been approved, submit documentation of coverage for the new tanks. I certify under penalty of law that the above representations made by me are true and correct. CofCapp 1022 Utah Petroleum Storage Tank Program Application for Certificate of Compliance I choose to participate in the Environmental Assurance Program (PST Fund) *. •Indicate the financial responsibility mechanism to be used for cleanup costs not covered by the Fund. •Indicate the number of non-regulated petroleum storage tanks at the facility. Owner/operator Signature Date Signed 1 2 3 4 5 6 AST 10/27/2022 10/27/202210/27/202210/27/2022 10/27/2022 10/27/2022 6K 6K 12K 8K 4K 10K OFF HWY DSLDIESEL DIESEL DIESEL PREM UNL REG UNL PASS PASS PASS PASS PASS PASS 1 2 3 4 5 6 ASTAST AST AST AST 9000055 Pilot Thomas Logistics PTL #140 1051 Mustang Dr.380 South 200 East Grapevine TX 76051 Roosevelt 84066 Joey Huerta 432-571-8080 Joey Huerta 432-571-8080 PILOT THOMAS LOGISTICS #140 380 SOUTH 200 EAST ROOSEVELT 9000055 DUCHESNE 84066 Pilot Thomas Logistics 1051 Mustang Dr. Grapevine TX 76051 Joey Huerta 432-571-8080 432-638-8251 Joey Huerta Operations Manager Joey.Huerta@pilotthomas.com 1051 Mustang Dr. Grapevine,TX 76051 432-571-8080 9000055 1 2 3 4 5 10/27/2022 10/27/2022 10/27/2022 10/27/2022 10/27/2022 6K 12K10K 8K 4K