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Home My WebLink AboutDERR-2025-005276Utah UST Program Application for Certificate of Compliance Facility ID# UST Owner Information UST Facility Information Owner Name: Facility Name: Address: Address: City: State: Zip: City: State: UT Zip: Contact: Phone: Contact: Phone: DESCRIPTION OF UNDERGROUND STORAGE TANKS Tank # 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 UST REGULATIONS All Underground Storage Tanks (USTs) at this facility have been registered. All UST registration fees and Petroleum Storage Tank Fund Fees have been paid. Are your USTs currently in compliance with all Federal, State, and Local UST regulations? 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) I choose to participate in the Petroleum Storage Tank (PST) Trust Fund. • Indicate the financial responsibility mechanism to be used for cleanup costs not covered by the Fund. • Indicate the number of above-ground tanks and non-regulated underground tanks at the facility. Above-ground tanks and non-regulated USTs at the facility may be required to participate in the Fund. I choose another Financial Responsibility mechanism for the USTs 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. Owner/operator Signature Date Signed CofCapp 0717 FAA Cedar Breaks SSC 2248 KittyHawk Dr Cedar City UT 84721 Mike Murdoch 801-320-2159 FAA Cedar City ARSR CDC ARSR Blowhard Road Cedar City 84720 6000300 Mike Murdoch 801-320-2159 1 07/1993 4000 Diesel 2 07/1993 2000 Diesel 1 2 Scheduled 06/04/2025 Scheduled 06/04/2025 The USTs at this facility 6000300, tanks 1 and 2 have not been registered and have not paid any registration fees. the tank tightness test for both tanks is scheduled for 06/04/2025, the third party inspection is scheduled for 06/04/2025. Deep snow is present U.S. Federal Gov 4/18/2025