# DE Q Orego n Departmen t o f Environmenta l Quality Undergroun d Storag e Tan k Progra m Notificatio n o f Temporar y Closur e o f Undergroun d Storag e Tank s
OA R 340-150-0167(1 ) (d ) require s tha t th e owne ro rpermitte e o f a n undergroun d storag e tan k (UST ) t o notifyDE Q 3 0 day s befor e placin g an yUS Tsyste m int o temporaryclosure . Pleas e complet e th e infonnatio n requeste d below , the n mai l o rfa xthi s notificatio n t o DE Q a t th e addres s note d below ; DE Q wil l issu e a temporaryclosur e certificat e t o th e permitte e tha t i s vali d fo ron e year . Thirt yday s befor e th e en d o f thi s one-yea rperiod , i f yo u wis h t o kee p thi s facilit yo rtank s i n temporar yclosure , you_mus t reques t a n extension . Th e definitio n an d requirement s fo rtemporaryclosur e (OA R 340-150-0167 ) hav e bee n printe d o n th e bac k o f thi s form
. Pleas e not e tha t al l UST s i n temporaryclosur e wil l continu e t o b e assesse d th e annua l complianc e fee
.

Permitte e Informatio n Permitte e Nam e Compan yName * Mailin g Addres s City , State , Zi p Contac t Perso n Telephon e No . US TFacilit yInformatio n Facilit yI D No . Nam e o fFacilit y Stree t Addres s City , State , Zi p Date tank

s place d i n temporar

y closure Note : Informatio n o n tank s ca n b e foun d o n th e Operatio n Certificat e fo rthi s facilit y Tan k Informatio n - Fo rTank s Place d i n Temporar yClosur e Tan k I D No . DE Q Tan k

Permi t No . Tan k Siz e (gallons ) Tan k

Contents (I.e. , gas , diesel , etc. ) I s tan k no wempty? (chec k box ) OYe s ON O OYe s ON o OYe s ON o OYe s ON o OYe s ON o
•I f tank s ar e empty , attac h documentatio n tha t th e wor k wa s don e an d tha t th e content s wer e properl ydispose d o f o r recycle d (receipt , recor d fro m contractor , etc.)
. I f th e tanks ar e emptie d a t a late rdate , submi t th e documentatio n t o DE Q withi n 3 0 day s afte rth e tan k ha s bee n emptied . COMPLIANC E STATEMENT : Bym ysignatur e below , I agre e t o compl ywit h th e requirement s o f OA R 340-150-016 7 an d th e TemporaryClosur e Certificat e issue d b yDEQ
. Signatur e o fPermitte e Prin t Nam e o fPermitte e Dat e Signe d Pleas e retur n thi s for m an d an ydocumentatio n fo rempt ytank s to : Departmen t o f Environmenta l Qualit yO R Attention : US TProgra m 81 1 S W Sixt h Avenue , Portland , O R 9720 4 FA X Notificatio n To : DE Q - US TProgra m 503-229-697 7 1^Questions ? Cal l 503-229-665 2 o rI-8OO-742-787 8 (messag e line , toll-fre e i n Oregon ) 

## Visi t ou rwe b pag e a t http://www.cleq.state.or.us/lq/tanks/ust/index.ht m

* A s registere d wit h th e Oreao n Corporatio n Divisio n Jul y200 8 Pag e 1 o f 2 DEQ-08-LQ-08 6Genera l Permi t Requirement s fo rTemporar yClosur e o fa n US TSyste m Definition : 'Temporar yclosure"mean s a hal t i n operatio n activitie s o fa n US Tsyste m fo ra limite d tim e wher e th e US T syste m wil l b e brough t bac k int o operatio n o rpermanentl ydecommissione d a t som e futur e date . Fo rexample , a n US T mayb e temporaril yclose d du e t o correctiv e actio n activitie s o n site , abandonmen t b yth e owne ran d permittee , bankruptc yproceedings , failur e t o maintai n a financia l responsibilit ymechanism , sal e i n progres s o rfo ran yothe rreaso n tha t a permitte e ma ychoos e t o sto p operatin g th e UST
. Th e ter m applie s t o a n US Tsyste m tha t meet s th e definitio n o f "temporaryclosure"\N\\e\.\\e ro rno t th e departmen t ha s issue d a registratio n certificat e fo rthi s activit yt o th e owne ran d permittee . Tex t fro m OA R 340-150-0167 : (1 ) Th e departmen t wil l issu e a temporar yclosur e certificat e \. o th e permitte e upo n receip t o fth e require d notic e i n accordanc e wit h OA R 340-150-0135(5 ) (d)
. Thi s certificat e wil l expir e on e yea rfro m th e dat e o fissuance . Thirt yday s befor e th e expiratio n date , th e permitte e mus t submi t on e ofth e followin g t o th e department : (a ) A n applicatio n fo ra change-in-servic e (OA R 340-150-0166 ) o rpermanen t closur e (340-150-0168 ) genera l permit ; (b ) Awritte n reques t t o retur n th e US Tsyste m t o operationa l status ; o r (c ) Areques t fo ra n extensio n o fth e expiratio n dat e o fth e temporar yclosur e certificate
. T o b e considere d fo ra n extension , th e US Tmus t b e empt yan d a sit e assessmen t performed
. I n lie u o fa sit e assessment , othe racceptabl e documentatio n ma yb e submitted . (A ) I fth e departmen t approve s th e reques t fo rextension , th e expiratio n perio d wil l b e extende d t o a dat e . determine d b yth e departmen t an d a revise d temporar yclosur e certificat e ^\\ \ b e issue d t o th e permittee . (B ) I fth e departmen t denie s th e request , th e permitte e mus t decommissio n th e US Tsyste m b ypermanen t closur e o rchange-in-servic e byth e dat e establishe d b yth e department . Th e departmen t wil l notifyth e permitte e o fth e denia l i n writin g an d includ e th e reason s th e reques t wa s denied . (2 ) T o maintai n complianc e wit h th e genera l permi t temporar yclosur e certificate , th e permitte e must : (a ) Ca p an d secur e al l lines , pumps , access-way s an d ancillaryequipment , excep t th e ven t lines , i fth e US Tsyste m i s temporaril yclose d fo rthre e month s o rmore ; (b ) Report suspecte d release s o fregulate d substance s t o th e departmen t withi n 2 4 hour s (OA R 340-150-0500 ) an d investigat e suspecte d release s withi n seve n day s (340-150-0510) ; (c ) Report t o th e departmen t an yconfirme d release s withi n 2 4 hour s an d investigat e o rtake correctiv e actio n a s require d by : (A ) OA R 340-122-020 5 throug h 340-122-036 0 fo rpetroleu m UST s ("Cleanu p Rule s fo rLeakin g Petroleu m US T Systems")
. (B ) OA R 340-122-001 0 throug h 340-122-011 5 fo rUST s containin g nonpetroleu m regulate d substances , excep t tha t release s mus t b e reporte d i n accordanc e wit h th e requirement s o fOA R chapte r340 , divisio n 142 . (d ) Continuousl ymaintai n a financia l responsibilit ymechanis m fo rpetroleu m US Tsystem s (OA R chapte r340 , divisio n 151) ; (e ) Allo wth e departmen t acces s t o th e US Tfacilit yan d record s (OA R 340-150-0135(2)) ; (f ) Provid e informatio n t o th e departmen t upo n reques t an d submi t informatio n regardin g US Tsyste m o rUS Tfacilit y change s (OA R 340-150-0135(4 ) an d (5)) ; ^ (g ) Payal l annua l complianc e fe e invoice s b yth e specifie d du e dat e o rb e subjec t t o lat e fee s (OA R 340-150-0110) ; (h ) Report t o th e departmen t an ychang e i n ownershi p o fpropert yo rtan k o rdesignate d permitte e (OA R 340-150 - 0052) ; an d ' / (i ) No t allo wan yperso n othe rtha n a servic e provide ro rsuperviso rlicense d b yth e departmen t t o perfor m US T services , excep t a s provide d b yOA R 340-150-0156 . (3 ) I fth e US Ti s empt yo fal l regulate d substances , th e permitte e mus t compl ywit h th e requirement s o fsectio n (2 ) o fthi s rul e an d mus t submi t documentatio n t o th e departmen t tha t th e tan k wa s emptie d an d tha t th e remove d regulate d substanc e an d sludg e wa s recycle d o rdispose d o fi n accordanc e wit h state , federa l an d loca l regulations . Thi s documentatio n mus t b e submitte d wit h th e notic e provide d t o th e departmen t (OAR'340-150-0135(5 ) (d) ) o r withi n 3 0 day s afte rth e tan k ha s bee n emptied . (4 ) I fth e US Ti s no t empty , th e permitte e mus t compl ywit h th e requirement s o fsectio n (2 ) o fthi s rul e an d perfor m releas e detectio n fo rUST s an d undergroun d piping , includin g monitoring , testin g an d recor d keepin g i n accordanc e wit h OA R 340-150-040 0 throug h 340-150-0470 . (a ) I fth e US Tan d undergroun d pipin g ar e metal , th e permitte e mus t operate , tes t an d maintai n equipmen t an d kee p record s fo rcorrosio n protectio n i n accordanc e wit h OA R 340-150-032 0 an d 340-150-0325 . (b ) I fth e US Ti s lined , th e permitte e mus t periodicallyinspec t th e linin g i n accordanc e wit h OA R 340-150-0360 . (c ) Whe n necessaryt o correct , detec t o rpreven t releases , th e permitte e mus t repair , modifyo rreplac e US Tsyste m component s (OA R 340-150-035 0 throug h 340-150-0354)
. (5 ) Th e permitte e mus t maintai n al l record s relate d t o th e temporaryclosur e fo rthre e year s afte ra change-in servic e o rpermanen t closur e checklis t an d sit e assessmen t report hav e bee n approve d b yth e department . I fth e US T facilit yi s sol d withi n thi s tim e period , th e permitte e mus t provid e thes e record s t o th e ne wpropert yowne r(OA R 340 - 150-0140)
. Jul y200 8 Pag e 2 o f2 DEQ-08-LQ-08 6

# ^<c< t 

# DE Q Orego n Departmen t o f Environmenta l Qualit y Undergroun d Storag e Tan k Progra m 

## Reques t fo rExtensio n Temporar yClosur e o f Undergroun d Storag e Tank s
Pleas e complet e thi s for m i f on e o rmor e tank s a t you rfacilit yha s bee n i n temporaryclosur e fo ra yea ran d yo u woul d lik e t o exten d th e perio d o f temporaryclosur e pursuan t t o OA R 340-150-0167(2)(C) , Althoug h extension s wil l generall yb e issue d fo ra year , DE Q reserve s th e righ t t o issu e certificate s fo rshorte ro rlonge rperiod s o n a cas e b y cas e basis . I f th e tanks ar e empt yyo u mus t stil l report suspecte d releases , provid e informatio n upo n request , pa y annua l complianc e fee s an d report an ychange s i n ownership . Se e th e othe rsid e o f thi s for m fo ra mor e complet e discussio n o f th e temporaryclosur e rul e requirements .

Permitte e Informatio n Permitte e Nam e Compan yName * Mailin g Addres s City , State , Zi p Contac t Perso n Telephon e No . US TFacilit yInformatio n Facilit yI D No . Nam e o fFacilit y Stree t Addres s City , State , Zi p Date ofTemporar

yClosure , i fknow n Date Temporar

yClosur e Certificat e Issue d Date Temporar

yClosur e Certificat e Expire s ' •

- Note : Informatio n o n tank s ca n b e foun d o n th e Temporar yClosur e Certificat e fo rthi s facility Tan k Informatio n - Fo rTank s Liste d i n Temporar yClosur e Tan k I D No . DE Q Tan k

Permi t No .

! Tan k

Siz e (gallons ) Tan k

Contents (i.e. , gas , diesel , etc. ) I s tan k no wempty? (chec k box ) OYe s ON o OYe s ON o OYe s ON o OYe s ON o OYe s ON o OYe s ON o OYe s ON o Note : I f ther e ha s bee n a chang e i n permittee , tan k owne rand/o rpropert yowner , pleas e provid e th e informatio n requeste d o n th e Permi t Modificatio n for m (DEQ-05-LQ-018A ) include d wit h thi s mailing . TEMPORAR YCLOSUR E EXTENSIO N REQUEST : Pleas e exten d TemporaryClosur e Certificat e through . Bym ysignatur e below , I agre e t o compl ywit h th e requirement s o f OA R 340-150-016 7 an d th e TemporaryClosur e Certificat e issue d b yDEQ
. Dat e Signatur e o fPermitte e Prin t Nam e o fPermitte e Dat e Signe d Pleas e retur n thi s for m to : { . Departmen t o f Environmenta l Qualit y Attention : US TProgra m 81 1 S W Sixt h Avenue , Portland , O R 9720 4 O R FA X Notificatio n To : DE Q - US TProgra m 503-229-697 7 ©Questions ? Cal l 503-229-665 2 o rI-8OO-742-787 8 (messag e line , toll-fre e i n Oregon ) 

## s Visi t ou rwe b pag e a t http://www.cleq.state.or.us/lq/tanks/ust/index.ht m

* As registere d wit h th e Orego n Corporatio n Divisio n Jul y200 8 Pag e 1 o f 2 DEQ-08-LQ-08 7Genera l Permi t Requirement s fo rTemporar yClosur e o fa n US TSyste m Optio n A- Submi t a n applicatio n fo ra cliange-in-servic e o rpermanen t closure . 1 . Fo rchange-in-servic e submi t 30-Da yNotic e o fInten t t o Complet e Change-in-Servic e \ot m (DEQ-05-LQ-020A ) Compl ywit h OA R 340-150-016 6 Genera l Permi t Requirement s fo rClosur e o fa n US TSyste m b yChange-in-Servic e Submi t sit e assessmen t pla n fo rapprova l an d perfor m approve d sit e assessmen t plan . 2 . Fo rpermanen t closur e submi t 30-Da yNotic e o fInten t t o Decommissio n UST s for m (DEQ-05-LQ-020A ) Compl ywit h OA R 340-150-016 8 Genera l Permi t Requirement s fo rDecommissionin g ar i US TSyste m b yPermanen t Closur e Complet e a sit e assessmen t tha t complie s wit h th e requirement s o fOA R 340-150-018 0 Complet e an d submi t th e Undergroun d Storag e Tan k Checklis t an d Sit e Assessmentior m (DEQ-05-LQ-021A ) Optio n B - Submi t a writte n reques t t o retu m th e US Tsyste m t o operationa l status . 1 . Documen t tha t th e US Tsyste m complie s wit h OA R 340-15-016 3 Genera l Permi t Requirement s fo rOperatin g a n US T Syste m 2 . Documen t complianc e wit h OA R 34 0 - Divisio n 15 1 - US TFinancia l Responsibilit yRequirement s 3 . Documen t complianc e wit h OA R 340-150-020 0 - Trainin g Requirement s fo rUS TSyste m Operator s an d Emergenc y Respons e Informatio n Optio n C - Submi t a reques t fo ra n extensio n o fth e Temporar yClosur e Certificat e expiratio n date : 1 . Reques t a n extensio n o fth e expiratio n dat e o fth e temporar yclosur e certificat e bycompletin g thi s form
. (a ) I fth e departmen t approve s th e reques t fo rextension , th e expiratio n perio d wil l b e extende d t o a dat e

. determine d b yth e departmen t an d a revise d temporar yclosur e certificatem Wb e issue d t o th e permittee . (b ) I fth e departmen t denie s th e request , th e permitte e mus t decommissio n th e US Tsyste m b ypermanen t closur e o rchange-in-servic e b yth e dat e establishe d b yth e department . Th e departmen t wil l notifyth e permitte e o fth e denia l i n writin g an d includ e th e reason s th e reques t wa s denied . 2 . Th e US Tmus t b e empt yo fai l regulate d substance s i n orde rt o b e considere d fo ra n extensio n o ftemporary closure . T o maintai n complianc e wit h th e genera l permi t temporar yclosur e certificate , th e permitte e must : (a ) Ca p an d secur e al l lines , pumps , access-way s an d ancillaryequipment , excep t th e ven t lines , i fth e US T syste m i s temporaril yclose d fo rthre e month s o rmore ; (b ) Report suspecte d release s o fregulate d substance s t o th e departmen t withi n 2 4 hour s (OA R 340-150-0500 ) an d investigat e suspecte d release s withi n seve n day s (340-150-0510) ; (c ) Report t o th e departmen t an yconfirme d release s withi n 2 4 hour s an d investigat e o rtake correctiv e actio n a s require d by : (A ) OA R 340-122-020 5 throug h 340-122-036 0 fo rpetroleu m USTs
. (B ) OA R 340-122-001 0 throug h 340-122-011 5 fo rUST s containin g nonpetroleu m regulate d substances, excep t tha t release s mus t b e reporte d i n accordanc e wit h th e requirement s o fOA R chapte r340 , divisio n 142 . (d ) Continuousl ymaintai n a financia l responsibilit ymechanis m fo rpetroleu m US Tsystem s (OA R chapte r340 , divisio n 151) ; (e ) Allo wth e departmen t acces s t o th e US Tfacilit yan d record s (OA R 340-150-0135(2)) ; (f ) Provid e informatio n t o th e departmen t upo n reques t an d submi t informatio n regardin g US Tsyste m o rUS T facilit ychange s (OA R 340-150-0135(4 ) an d (5)) ; (g ) Payal l annua l complianc e fe e invoice s b yth e specifie d du e dat e o rb e subjec t t o lat e fee s (OA R 340-150 - 0110) ; (h ) Report t o th e departmen t an ychang e i n ownershi p o fpropert yo rtan k o rdesignate d permitte e (OA R 340 - 150-0052) ; an d (i ) No t allo wan yperso n othe rtha n a servic e provide ro rsuperviso rlicense d b yth e departmen t t o perfor m US T services , excep t a s provide d b yOA R 340-150-0156 . 3 . Asit e assessmen t mus t b e conducte d t o determin e i fa releas e ha s occurred . Othe racceptabl e documentatio n mayb e submitte d i n plac e o fa sit e assessment . Recordkeepin g Th e permitte e mus t maintai n al l record s relate d t o th e temporaryclosur e fo rthre e year s afte ra change-in-servic e o r permanen t closur e checklis t an d sit e assessmen t report hav e bee n approve d byth e department . I fth e US Tfacilit yi s sol d withi n thi s tim e period , th e permitte e mus t provid e thes e record s t o th e ne wpropert yowne r(OA R 340-150 - 0140)
.

Jul y200 8 Pag e 2 o f2 V DEQ-08-LQ-08 7