DERR-2024-004299

Utah DEQ Underground Storage Tank
lnstallation Notification Form
Facllity to4002151
tnstaltation @mpany: SpaCkman EnterpriseS
contact lrrame: TrOy SpaCkman Phone:[phone]
Address:PO Box 12TG, Centerville Utah 94014
permit# tLe?6t _ZdE+_
Base Fee S 5Oo
lnspectionfeer$200x I S ZOD
PST rnsta[ Fee 5200 x I sbo
Total
Date Approved & Paid
C.crtlffed lnstallercfiechnlclans on pioiect
Name Troy D Spackman cert. # n 139 Exp. Date 0110212026
Name Aaron A Spackman cert. # n 0479 Exp. Date 0/,10112025
Name Darren Edman cert. #rL 0478 Exp. Date 0410112025
rank orner: Utah State Fuel Network
rddress:43l5 south 2100 west , Taytorsville utah 94111
Contact Name: Bfett GUrney
Faciuty Name: Matheson Courthouse
FacilttvAddress:45O south state street, salt Lake city Utah
lnstallation I Upgrade/Repair tnformatlon Est. date work wlll commencez 0211212024
details below
ln the box below (submlt a
This is a removal"twtttrrlqrtmr-+rrr
Map attached
Mailcompleted form to:
DEQ/DERR
Box 144840
Salt Lake City, Utah B4LL44B4O
195 N. 1950 W. 1s Floor
Salt Lake City, Utah
Phone [phone]
Fax [phone]
UIAh LIEPAHT$ENI af
ENVIRQI{MENTAL QUALITY
ENVIROT{ME I{TAL RESPONSE
& FEMEDIATION