DERR-2024-006456

FArrrrY rr. * _ 400 127 9
PETROLEUM STORAGE TANK FUND APPLICATION
FACILITY INFORMATION:
Owner Name: w:r-MMER ELEcrRrc a r,rcutfirei lity Name
Street Address:
City City
Cou
IOTOSS: 5330 So. Riley LaneMurrav. tIT
Street Add reSS: same
Counry-
State:84r07 Z'FCode:
Phone:
U tah zi p CoEer State:Phone:-
ContactTerson:ContactPe.rson
TYPE OF OWNER:
[ ] Marketer, or non-marketer with annual monthly throughput greater than 10,000 gallons
[x] Non-marketer with annual monthly throughput less than 10,000 gallons (Must verify).
DESCRIPTION OF UNDERGROUND STORAGE TANKS:
Tank #
Age
Capacity
Substance
L97 8 1918
2,000 qaI. 2,000 qaI.
TANK TIGHTNESS TEST
Tank #
Pass/Fail
see attachne L_
CERTI FICATE OF REGISTRATION
x
x
All Underground Storage Tanks (UST) at this facility have been registered.
All registration TANK Fees have been paid.
COMPLIANCE WITH UST REGULATIONS:
l
l
ls the applicant currently in compliance with all Federal, State, and Local UST regulations
lx I Yes [ ] No - lf "No" please describe item(s) of non-compliance:
PREVIOUS POLLUTION INCIDENT S
Have you ever had a pollution incident at your facility?
[ ] Yes -- lf "Yes" please provide LUST (Leaking Underground Storage Tank) lnformation:
["] No - lf "No'please attach a letter stating that under customary business inventory-- practice standards you are not aware of any release from any tank(s) at thiS facility
PST FUND FEES
Dl Full payment for every tank at this facility is included with this application.
i[ Quarteay payment(s) for every tank at this facility are included with this application.
I certily urder ponalty ol lal that the abo/e r€pr€sentations rnads by me are tru€ and correct.
Applicant's sig
LOCATION OF TANKS:
4
Date sioned: < /;t t ,/qt------,--------_
1. CERTIFICATE OF REGISTRATION:
[ ] ! am in compliance with release detection requirements.
I I Tanks installed belore 1965 or unknown: release detection by Dec. 1989.
[ | Tanks installed 196$1988: release detection to be completed by my compliance date.
[ | Release detection completed upon installation.
[ ] I am in compliance with all other Federal, State, and Local UST regulations
3. PST FU ND FEES .. ANNUAL FACILITY MONTHLY THROUGHPUT:
t
t I All Underground Storage Tanks (UST.s) hayg leg1-registered -.iorq 2530 (Revised 9:89)..
I j negistrati5n Tank Fees-have beeh paici - 1988/1989 : $2sltank/yr, 1990/1Si91 : $4S/tank/yr
2. COMPLIANCE WITH UST REGULATIONS:
[ ] I am a marketer, or I am a non-marketer with annualfacility
than 10,000 gallons.
monthly throughput greater
I t $zSO payment/tank: Fiscalyear (Juty 1, 1990 - June 30, 1991).
[ | Quarterty payments @ $62.50/tank (Due the lst day ol Jul, Oct, Jan, and Apr).
[ ] I am a non-marketer with annuq!taci!ry_qrglllll.y thrgy-ghpgle$^tlq!. l-qp90 gallons.
[ 1 t nave compteted the APPL|GATION FoR NON-MARKETERS DISCOUNT form.
t I $tZS paymentltank: Fiscalyear (July 1, 1990 - June 30, 1991).
I t Quarterly payments @ $31.25/tank (Due the lst day of Jul, Oct, Jan, and Apr).
4. TANK & LI NE TIGHTNESS TEST -- ACTIONS REQUIRED AFTER TEST:
t I All systems pass the tank and line tightness tests.
t j I am submitting the results of the tank tightness test and a copy of the field report.
t I All tanks do not meet_the req_uirements set by rule regarding tank tightne-ss testing.
I i I nave contacted the State USt office and will submit-evidence of a plan for review.
5. PREVIOUS POLLUTION INCIDENTS:
POLLUTION INCIDENTS form which states whethert I I have comoleted the PREVIOUS
LiOer custombry business inventory practice standards, I am aware of any release from the
tank
6. INDEPENDENT FINANCIAL ASSURANCE (Keep records at you r facility):
[ ] I have obtained financial responsibility requirements for the first $25,000/release:
ffi Sell lnsurance
I I Risk retention group
[ | Gommercial lnsurance [ | Surety Bond
II
tI
r{
Guarantee
Letler of Credit
I I I have obtained independent third-pafi financial assurance by my compliance date
I i i witL oOtain indepentient third-party financial assurance by my compliance date.
*See explanatlons under "How do I get started?"
FIOUIY ID.400127 9
PREVIOUS POLLUTION INCIDENTS
To:Mr. Dennis Downs
Executive Secretary
Utah Solid & Hazardous Wastes Committee
Dear Mr. Downs:
As required by paragraph 26-74e-4O4 of the Underground Storage Tank Act, I have
performed a tank and line tightness test on each underground storage tank at my facility,
and based on this test, there has not been a release of petroleum. Additionally, based
on "customary business inventory practices standards", I am not aware of any release of
petroleum from my tanks.
a&
I have had the following releases of petroleum (detailed below; also mention any action
you took to clean up the release).
operator
/
Failure to report previous releases could void )rour coverage under the Petroleum Storage
Tank Fund.
StaYe of Utah
DEPARTMENT OF HEALTH
DMSION OF ENVIRONMENTAL HEALTH
.lt'o\
BuJeau ol Solid & Hazaldous Waste
288 North 1460 West, P.O. Box 16690
salt Lake city, utah 841 1 6-0690
9'r6
WII,IMER ELECTRIC &-LIGHTING
ig-3o-sourH RrI'EY LANE
uuRRAY, uT 84107
0
PEFITIIT wn
u. s. FosrAGE'
PATD
Sil tdoOty, Ut