DERR-2024-006623

Utah DEQ Underground Storage Tank
Installation Notification Form
www.undergroundtanks.utah.gov
Facility ID 1200059 I New UST Install D I Upgrade/Repair~
Installation Company: M&M Cathodic Protection Service, Inc
Contact Name: Robert Butner I Phone: [phone]
Address: 303 Red berry Rd., Draper, UT 84020
Certified Installers/Technicians on project
Name Robert Butner Cert.# TL 0471
Name Cert.# TL
Name Cert. #TL
Tank Owner: GOLDEN SPIKE ENTERPRISES
Address: 5500 WEST 5500 SOUTH, HOOPER, UT
State Use Onlv
Permit Required? O
Permit# _______ _
Base Fee $ 500
Inspection Fee* $200 x _ ~$ __
PST Install Fee $200 x _ ..._$ __
Total i..$ __
Date Approved & Paid ___ _
*Applies in non-LHD contract areas
Exp. Date 6-2024
Exp. Date
Exp. Date
Contact Name: NICK MANNING j Phone# [phone]
Facility Name: GOLDEN SPIKE SINCLAIR
Facility Address: 5500 WEST 5500 SOUTH, HOOPER, UT
Installation/ Upgrade /Repair Information I Est. Date work will commence: Week of APRIL 15
Tank# 1 2 3 4 5
Capacity 12,000 12,000 12,000
Tank Material Steel Steel Steel
Piping Material OW PLASTIC OW PLASTIC OW PLASTIC
Substance stored Diesel PREM UNL
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)
CLIENT NOTICED DURING RECTIFIER CHECKS THAT RECTIFIER CURRENT OUTPUT HAD FAILED. CLIENT CALLED US
TO TROUBLSHOOT. ANODE GROUNDBED HAS FAILED AND REQUIRES REPLACEMENT. WE WILL PERFORM DESIGN
SPECIFICATION BY STAFF CORROSION EXPERT AND INSTALL NEW ANODE GROUNDBED.
Mail completed form to: 195 N. 1950 W. 1st Floor Q UIAH DEPA~TMENT of
DEQ/DERR Salt Lake City, Utah ENVIRONMENTAL QUALITY
Box 144840 Phone [phone] ENVIRONMENTAL RESPONSE
Salt Lake City, Utah 84114-4840 Fax [phone] & REMEDIATtON
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M&M Cathodic Protection Services
303 Redberry Rd.
Draper, UT 84020
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APR 2 2 2024
Envimnmental Response & Remediation
SALT LAKE CITY UT 840
15 APR 2024 Pt-1 3 L
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APR 2 2 2024
Environmental Response & Remediation
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