Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
eh@tooelehealth.org
Underground Storage Tank Installation / Closure Application

Please put N/A for any fields that are not applicable

Owner Name
Owner Phone Number
Address
Email Address

Facility Name
Facility ID
Address

Company
Certified Installer / Remover
Cert. #UT
Phone Number
Project Start Date
Email Address

This department must be notified 72 hours before beginning installation construction for the purpose of inspecting the critical installation activities such as tank testing, tank placement, piping installation, etc. 
Number of tanks being installed/Per Tank:   $100.00   Quantity:   Item Subtotal:  
$0.00
Number of tanks being closed/Per Tank:   $100.00   Quantity:   Item Subtotal:  
$0.00
Total:
$0.00
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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E-Signature
Date
 
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