DERR-2024-006653

Utah DEQ Underground Storage Tank
Installation Notification Form
www.u nd e rgroundtanks.utah.gov
Facility ID 4001574 I New UST I nstall D I Upgrade/Repai r~
Installation Company: M&M Cathodic Protection Service, Inc
Contact Name: Robert Butner I Phone : [phone]
Address: 303 Redberry Rd ., Draper, UT 84020
Certified Installers/Technicians on project
Name Robert Butner Cert. # TL 0471
Name Cert. #TL
Name Cert. #TL
Tank Owner: ACORE CONCRETE CUTTING
Address: 5360 SOUTH RIELY LANE, MURRAY, UT
State Use Onlv
Perm it Required? D
Permit# _______ _
Base Fee $ 500
Inspection Fee * $200 x _ ~$ __
PST Install Fee $200 x _ -$ __
Tota l .._$ __
Date Approved & Paid ___ _
*Applies in non-L HD contract areas
Exp. Date 6-2024
Exp. Date
Exp. Date
Contact Name: AARON BAYLESS I Phone# [phone]
Facility Name: ACORE CONCRETE CUTTING
Facility Address: 5360 SOUTH RIELY LANE, MURRAY, UT
Installation / Upgrade /Repair Information I Est. Date work will commence: Week of APRIL 15
Tank# 1 2 3 4 5
Capacity 6,000 6,000
Tank Material STIP3 (LINED) STIP3 (LINED)
Piping Material STEEL STEEL
Substance stored Diesel REG
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)
EXTENSIVE CONCRETE CUTTING AND DISPENSER UPGRADES DAMAGED EXISTING CP SYSTEM. THIS WILL REQUIRE
CORROSION ENGINEERS DESIGN AND INSTALLATION OF GALVANIC ANODES ON TANKS, PIPES IN STPS, AND PIPES
UNDER DISPENSERS.
Mail completed form to: 195 N. 1950 W. 1st Floor Q DEQ/DERR Salt Lake City, Utah
UTAH DEPARTM r T of
E'NVIRONM NTAL QUALITY
Box 144840 Phone[phone] ENVIRONMENTAL RESPONSE
Salt Lake City, Utah 84114-4840 Fax {801) 359-8853 & REMEDIATION
r
M&M Cathodic Protection Service s
303 Redbe rry Rd .
Draper, UT 84020
OO(g@ ~D\'!7rn@
APR Z 2 2024
Environmental ResJ)Ollse & Remed'ialion
SALT t:.:AKE CITY UT · 840
i5 APR 2024 PM3 L -
~@rno wrn@
1)6Q I L/-C7l/Z_ APR 2 2 20 ~1 4
-;l? ~ /l/-lf fC( 0 Env ironmental Response&Rem ediation
~/h-r UfJcE ~ t H, UI
?Cf Cf I V-((No
Ei4i :i 4-I I I II 11 I I I I I 1,111 I, I,, I I I I I I I I, I, • , , , ,, II I 1 111 I I II I I' I 1111 11 I,,,,