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Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
www.tooelehealth.org
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
If you have additional documents to send, please email them to eh@tooelehealth.org.
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
E-Signature
Date
Payment Information:
Method of Payment:
Credit/Debit Card
eCheck
Update Name from Above
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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