DERR-2025-004585

Utah DEQ Underground Storage Tank
Installation Notification Form
www.ĚĞƋ.utah.gov
Facility ID New UST Install [ ] Upgrade/Repair [ ]
Installation Company:
Contact Name:Phone:
Address:
Tank Owner:
Address:
Contact Name:Phone#
Facility Name:
Facility Address:
Installation / Upgrade /Repair Information Est.Ěate work will commence:
Tank #
Capacity
Tank Material
Piping Material
Substance stored
Check if upgrade or repair only. (Describe details below)
Describe Details of Install/Upgrade/Repair in the box below (Submit a drawing/site map of work to be done)
Mail completed form to:
DEQ/DERR
Box 144840
Salt Lake City, Utah 84114-4840
195 N. 1950 W. 1st Floor
Salt Lake City, Utah
Phone [phone]
Fax [phone]
Ver. 8/1/2016
State Use Only
Permit Required?
Permit # _____________________
Base Fee $ __500
Inspection Fee* $200 x ___ $_ ___
PST Install Fee $200 x ___ $_ ___
Total $__ ___
Date Approved & Paid ___________
*Applies in non-LHD contract areas
Certified Installers/Technicians on project
Name Cert. # TL Exp. Date
Name Cert. # TL Exp. Date
Name Cert. # TL Exp. Date
CSESCO Inc.
Luke Kelso 801.664.7953
830 North Pointe Circle, Salt Lake City, UT 84054
Luke Kelso 416 02/02/2026
Walmart Inc.,
2101 SE Simple Savings Drive.
Sara Gallien (Fuel Compliance Manager)479.258.2364
Walmart Supercenter #5234
1632 North 2000 West, Clinton, Utah 84015
T1
20,000
Fiberglass
1 1/2 Inch Flexible Double Wall Primary Piping
Gasoline (Regular)
Installing USTs and associated fuel station canopy, piping, and dispensers.
T2a
12,000
Fiberglass
1 1/2 Inch Flexible Double Wall Primary Piping
Gasoline (Regular)
T2b
8,000
Fiberglass
1 1/2 Inch Flexible Double Wall Primary Piping
Gasoline (Premium)
T3
10,000
Fiberglass
1 1/2 Inch Flexible Double Wall Primary Piping
Diesel
N/A
✔
10/15/2024
1697-2025-4
4 800
4 800
2100
3000571