DERR-2024-006794

5/2/2024
LP 5/2/2024
TANK REMOVER Name Troy Spackman I Cert.# TRI 70 l Exo. Date 10/15/25Company Spackman Enterprises Phone # [phone]Address PO Box 1276 I City Centerville State UT j Zip 84014SOIL/GROUNDWATER SAMPLER Name Troy Spackman I Cert. # GS432 I Exo. Date 5/1/26Company Spackman Enterprises Phone # [phone]Address Po Box 1276 l City Centerville State UT j Zip 84014Before the closure plan is submitted for approval, the local health and fire departments where the facility is located
must be contacted.
CONT ACT LOCAL HEAL TH DISTRICT: Name of Dist. State of Utah I Date 05/01/24I Title Env Scientist Phone# [phone]Contact Laura Perdue CONTACT LOCAL FIRE DEPT. Name of Dept. Roosevelt Fire I Date 05/01/24Contact Fire Marshall l Title Fire Marshall Phone# [phone]DISPOSAL lNFORMATION
Tank(s) will be disposed at: Facility NAAddress I Citv I State I ZioContact person Phone#Product lines will either be: (8J removed or D cleaned, secured in olace, and canoed.Vent lines will either be: D removed or D cleaned and secured open.Piping will be disposed at: Facility Duchesne County Landfill I State UT I Zip 84021Address 20550 W 2000 S I City DuchesneContact person Scale House Phone# [phone]Tank(s) will be emptied by: company STC Phone# [phone]Tank(s) will be cleaned by: company STC Phone# [phone]Contaminated water in the tank/rinsate will be disposed at: Facility Sump and Trap CleaningContact person Shane Adolfe Phone# [phone]Tank(s) will be: C8J purged or O rendered inert by the following method: VacuumResidual sludges will be disposed at the following facility: Sump and Trap CleaningAddress 618 S 4050 W I City Salt Lake City I State UT f Zip 841 04Contact person Shane Adolfo Phone# [phone]FOR CLOSURE IN PLACE ONLY For this closure method, you are subject to the requirements ofUAC R3 l 5-302-2(6), which requires annotating the property title andsubmitting documentation to the Division of Solid and Hazardous Waste (DSHW). For information on how to comply with theserequirements, contact the DSHW Solid Waste Landfills Section Manager at [phone].0 Aonroval for in-place closure has been granted bv the Local Fire Denartment. (Must submit annroval in writinll with Closure Plan)Fire Dept.I Phone#I Contact person I DateD Aonroval for in-place closure has been granted bv the Local Health Deoartment.Health Dept. I Phone#I Contact oerson I DateSubstance to be used to fill tanks:2
Approximate depth to groundwater in the vicinity of the tanks: 12 feet. Regional groundwater flow direction: South East State Certified Laboratory to be used: Chemtech-Ford
\ City Sandy
State I Zip 84070Address 9632 South 500 West UT Contact Person Office Phone [phone]
Please exnlain anv unusual or extenuating circumstances expected regarding the site assessment or closure:
Product piping closure only.
UST's will remain in use after product piping replacment
I certify under penalty of law that I am the owner/operator of the tank(s) referenced above and that I am familiar with
the information on this form and that it is true, accurate and complete, and further, that the procedures described herein
will be followed during tank closure.
Signature of tank owner
Full Name of tank owner 6