DERR-2024-006380

Utah DEQ Underground Storage Tank
State Use Onlv
lnstallation Notification Form
www.deq. utah.gov
Permit Required? E
Permit * L697-2024-LO
Base Fee S SoO
lnspection Fee* 5200x 4 S 800
PST lnstall fee SZOO x 4 S800
Totat . S 2L00
Date Approved & Paid tlf;q
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Certified lnstallers/Technicians on project
Name Luke KeISO cert. # rL 416 Exp. Date 0210112026
Name Cert. # TL Exp. Date
Name Cert. # TL Exp. Date
Tank owner: Resort Retailers
Address:PO Box 681030
Contact Name: DOUg SlaUgh Phone# [phone]
Facility Name: 7-Eleven #53603
FacilityAddress:1815 Canyons Dr, Park City, UT 84060
lnstallation / Upgrade /Repair Information I est. date work will commence: 0411712024
Tank #1a 1b 2a 2b 2c
Capacity 18,000 6,000 10,000 10,000 6,000
Tank Material FRP FRP FRP FRP FRP
Piping Material Poly Poly Poly Poly Poly
Substance stored Unleaded DEF Premium Diesel Ethanol Free
Check if upgrade or repair only._l (Describe details below)
Describe Details of lnstalUUpgrade/Repair in the box below (submit a drawing/site map of work to be donel
Remove all existing tanks and lines. Prep new tank hole, and set (2) new split compartment tanks. Set (3)
new otspensers sumps and run all new prpe
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Mailcompleted form to:
DEQ/DERR
Box 144840
salt Lake city, Utah 84LL4-484O
195 N. 1950 W. 1't Floor
Salt Lake City, Utah
Phone [phone]
Fax (801) 3s9-8853
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