1. Contact local fire marshal. 2. Plan entire closure event. 3. Conduct Site Soil Assessment. 4. If removing or closing in place, refer to API Publication 2015 Cleaning Petroleum Storage Tanks and 1604 Removal and Disposal of Used Underground Petroleum Storage Tanks. 5. Provide a sketch locating piping, tanks and soil sampling locations. 6. Submit a closure report in the format of (including the form UST-2) within thirty (30) days following the site investigation. 7. If a release from the tanks has occurred, the site assessment portion of the tank closure must be conducted under the supervision of a P.E. or L.G., with all closure site assessment reports bearing the signature and seal of the P.E. or L.G. If a release has not occurred, the supervision, signature or seal of a P.E. or L.G. is not required. 8. Keep closure records for three (3) years. V. WORK TO BE PERFORMED BY Contractor Name: Contractor Company Name: Address: State: Zip Code: Phone No: Primary Consultant Name: Primary Consultant Company Name: Consultant Phone No: VI. TANKS SCHEDULED FOR CLOSURE OR CHANGE-IN-SERVICE Tank ID No. Size in Gallons Last Contents Proposed Activity Closure Change-In-Service Removal Abandonment in Place * New Contents Stored * Prior written approval to abandon a tank in place must be received from a DWM Regional Office. VII. OWNER OR OWNER’S AUTHORIZED REPRESENTATIVE I understand that I can be held responsible for environmental damage resulting from the improper disposal of my USTs. Print name and official title: Signature Date Signed SCHEDULED REMOVAL DATE Notify your DWM Regional Office 48 before this date if scheduled removal date changes UST-3 Rev 01/2017
Initial Abatement Action (Site Check, UST Closure with UST-2 Form, Excavation, Soil Contamination Assessment) Report In addition to reporting initial response and abatement actions and assessment actions, and presenting an initial site characterization, when a release has been discovered, this newly-created Initial Abatement Action Report must fulfill the requirements for the following individual reports: Site Check Report (Section E), UST Closure Report (UST-12) with UST-2 Form (Section F), Post-Excavation Soil Contamination Assessment Report (Section J), and Free Product Recovery Report (Section G). If needed, check with your regional office to determine which report format is required. Complete Sections A-N, as required, including the sections specifically designated for the reports you have indicated. The Initial Abatement Action Report must be submitted to the appropriate regional office within 90 days following discovery of release. Site Information Site Identification Date of Report: Site Risk: Facility I.D.: UST Incident Number (if Site Name: Street Address: City/Town: Zip Code: County: Description of Geographical Data Point (e.g., diesel fill port): Location Method (GPS, topographical map, other): Latitude (decimal degrees): Longitude (decimal degrees): 2. Information Contacts Associated with the Leaking UST System (Addresses must include street, city, state, zip code and mailing address, if different) UST/AST Owner: Email: Address: Tel: UST/AST Operator: Address: Tel: Property Owner: Email: Address: Tel: Property Occupant: Email: Address: Tel: Consultant/Contractor: Email: Address: Tel: Analytical Laboratory: State Certification No: Address: Tel: 3. Information about the Release Date Discovered: Estimated Quantity of Release: Cause of Release: Source of Release (e.g., Dispenser/Piping/UST): Sizes and Contents of Tanks or Other Containment from which the Release Occurred: Excavation
Table B-1: Site History – UST/AST System and Other Release Information Revision Date: Incident Number and Name: UST ID Number Current / Most-Recent Contents* Previous Contents* Capacity (in gallons) Construction Details** Tank Dimensions Description of Piping and Pumps Date Tank Installed Status of UST*** Release associated with this UST System? Add additional records as necessary AST ID Number Current / Most-Recent Contents* Previous Contents* Capacity (in gallons) Construction Details** Tank Dimensions Description of Piping and Date Tank Installed Status of AST*** Release associated with this AST System? Add additional records as necessary Incident Number Material Released Date of Release Description of Release Add additional records as necessary * Gasoline (unleaded or leaded), diesel, used oil, waste oil, aviation fuel, etc., or pesticides, non-halogenated or halogenated solvents, etc. ** Fiberglass (single- or double-walled), (single- or double-walled), steel with FRP (single- or double-walled), steel with liner, other, unknown. *** Currently operational, not in use or temporarily closed (specify date), permanently closed in place (specify date), permanently closed by removal (specify date)
Table B-9: Current and Historical Groundwater Elevations and NAPL Thickness Revision Date: Incident Number and Name: Facility ID#: Well ID # Top of Casing Elevation (AMSL) Screened Interval (top of screen, bottom of screen) Date Measured (mm/dd/yy) to Water* (Uncorrected) (feet) NAPL Thickness (feet) Depth to Water* (Corrected for NAPL Thickness) (feet) Groundwater Surface Elevation** (AMSL) * Depth to Water is measured from Top of Casing ** If NAPL is present in a well, groundwater elevation is calculated by: [Top of Casing Elevation - Depth to Water] + [NAPL thickness x 0.8581]