DERR-2024-009669

Utah DEQ Underground Storage Tank
I nstallation Notification Form
www.undergroundtanks.utah.gov
State Use Onlv
Permit Required? E
Permit # 7597-2O25-L
Base Fee S SOO
lnspectionFee*5200x s S 1.OOO
PST lnstall Fee 5200 x 5 S 1.000
Total S 2,500
Date Approved & Paid 1lW'
*Appries in noffi\oft .d$ rdl-fr,\,'
rt;r,.-T]] L
Certified !nstallers/Technicians on project
Name Luke A. Kelso Cert. # TL 0416 Exp. Date February L,2026
Name Zane Christensen Cert. # T10456 Exp. Date February L,2026
Name Mitch Hull Cert. # T10557 Exp. Date March LL,2026
Tank Owner: Maverik, lnc.
Address: 185 South State Street, # 800 - Salt Lake City, Utah 84tLL
Contact Name: Justin Wood Phone# [phone]
Facility Name: Maverik# 755 - Price
Facility Address: 651 South Carbon Avenue - Price, UT 84501
lnstallation / Upgrade /Repair Information I Est. Date work will commence:8lSl2O24
Tank #1A 1B 2 3A 3B
Capacity 15,000 10,000 25,000 8,000 9,000
Tank Material FRP DW FRP DW FRP DW FRP DW FRP DW
Piping Material Flexible DW Flexible DW Flexible DW Flexible DW Flexible DW
Substance stored Unleaded Unleaded Diesel Ethanol Free Premium
Check if upsrade or repair onlv.(Describe details below)
Describe Details of tnstall/Uoerade/Reoair in the box below (submit a drawins/site mao of work to be donel
lnstall (3) new Xerxes double wall fiberglass UST's (TWO-Multi-Compartment)for a total (5) new regulated tanks/
compartments. lnstall (11) new polyethylene dispenser sumps. lnstall new 1 Lf2"and 2" OPW Flexworks double
wall flexible product piping inside 4" Access Pipe to the (11) new dispenser sumps. lnstall (2) Fiberglass Transition
Sumps. lnstall new Veeder Root TLS-450 Plus ATG with (6) ln-Tank Probes, (3) interstital tank sensors, (19) sumps
sensors, and a remote overfill alarm for overfill prevention. lnstall (6) 2 HP Red Jacket Submersible Pumps with
DPLLD's. lnstall Single Wall Fiberglass vent lines underground to the vent risers at the new Diesel/ RV canopy
columns. lnstall (11) new Gilbarco Blender Dispensers and (3) High Flow Diesel DisnenfilrffiP{V E D
Mail completed form to:
DEQ/DERR
Box 144840
Salt Lake City, Utah 84LL4-484o
195 N. 1950 W. 1st Floor
salt Lake City, Utah
Phone [phone]
Fax [phone]
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ENVIRON MEHTAL R E9PONSE
& REMEDIATION
ver.8/r/20t5