DERR-2025-003816

-il Utah Department of Environmental Quality Facility ID S QO 00 -S Co
Permanent Closure Inspection Paae \ of ct-
OwnershlD of Tanks Locatton of Tanks
Owner Name N\,._ \)Q. 1, \J(_ \\r{._,, Location Name M1i..'i~<1~ ~)~
Address \~', ~ ~t~~ (\v{e~ ~+t~(j:) Address ~ ~ \ t N\,.Jin St(\f J'
City Sl,,.t, State l)\ Zip ~l-\ll\ City ?rt£ State UT Zip Q>Yt;O \
Contact ·'2_, U\\, • \tii~s Phone 'i)G\ <',\J~o10, Contact Phone
Tanks Closed. Use addltlonal Paaes for addltlonal tanks. Tank No. \ Tank No. ~ Tank No. '3 ! Tank Ho,
Caoacitv (aallons) lo K \D~ 10 K
Material of Construction (Steel, FRP, Composite, etc.) frp v ,'O 't',;fJ
Substance Stored 60\S ~~"""' Di-esi\
Date Last Used
Date Permanently Closed '
How Closed {Removed, In Place, Chanqe In Service) ~~d'-v.. a.
Oriqinal Number of tanks: "?-, I Closed Tanks: ~ New Tanks: ---Final Number of tanks: )?
Tank Cleaning and Removal ;;..,,~,. -.. 'I, '.f. • .,
UST Remover: (_V\d J 1'0\~e \I Cert.#: TR (\ 7ilo~ Exe. Date: \/I :;ic.
g_ o~t.Q \ \ \=t\L~~ -\1 't:> °o Exo. Date: J//'t; /~ Groundwater/soil Sampler: Cert.#: GS
Owner/Ooerator has an aooroved Closure Plan '{es) No A coov of the a po roved Closure Plan is on site ~ No
~ Bv: Mo..v ~i, ·F½ V Product removed No Disposal Site:
Sludqe removed 'lu No Bv: ~ ~ +-r. Disposal Site: s c\--\t
Tanks cleaned ~ No By: ~ d"K. Rinsate disposal site: S,t-\-L
Non-explosive atmosphere inside tank obtained by: D Purqinq i;J"lnerting LEL or% Oxvoen obtained:
Product lines were: D Cleaned, secured in place, and capped it'Removed. Disposal site: V 1\" '-\ ) ow'\\ h,h; 0 "'\
Tank disposal site: Ci-:\" s~il\.•t~h~ n Soil disposal site: '2.t ~0), '1' (., 'w>i~~ ~ fG\)l
Site Assessment ' ., , .. _,._, ., .t;.t I' . . . ., . ,
PIO or FID meter readinqs (show reading locations on the site plat): -'t,Y\ \\G{ I .
I Calibration specs: MeterTvpe: Gain or span:
Soil Contamination is evident: If@ No Depth of Contamination: 0-3 Feet Greater than 3 Feet
Groundwater contamination is evident: Yes ~ Depth to Water Table: Surface slope direction:
Number of samples collected: IGW Soil lusc Certified Lab: G~tv\'\~G "1 hrcA
Land Use of surrounding area: D Residential D Industrial l;Y Commercial D Other (specify):
Show sample analysis Information below. Samples with the same analysis can be grouped together. Include-any samplu taken. by the-
lnsoector. Show sam• e tYDes tlncludlna USC,, locatlons, and depths on the site plat.
Samele number(s) Substance in Tank
Inspector observed collection of samples: Yes
Contaminated soil was over-excavated:1')~~'1et Yes
Sample Type
No
Compounds analyzed Analysis Methods
Inspector collected and submitted duplicate samples: Yes
Yes n/a If yes, confirmation samples were collected:
Potential Receotors. ,ndlcate ttie distance On feet) and direction to the nearest receptors. Show receptor locatle>M on the site Diet.
Residences Commercial Buildinqs r;,o Property Line 'J Cj'" Active Water Well
Surface Water Sewer Line Water Line Natural Gas line
Telephone Line Electrical Line Storm Drain Other:
I name certif that I ins ected the above-named facilit on date :
'7 Cert.#: Tl
No
No
Closureinsp0908.doc
Utah Department of Environmental Quality
UST Facility Site Plat
NORTH
F actllty ID t;o00o ...µ.,,.~-.j
Page :i of"?, ----
Sub Pump S
Tank Fill F
ATG Probe A
Inter. Probe I
Vapor Rec. V
Capped C
UTM Northing: Easting: Other s eci O
Show locations of all buildings, streets, tanks, piping, and dispenser islands. 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 sample collected by the certified
sam ler or the inspector. Indicate the locations of an re orted PIO or FID readin s. Show locations of otential rece tors.
s,1epla10908.doc