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 known): 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 about Contacts Associated with the Leaking UST System (Addresses must include street, city, state, zip code and mailing address, if different) UST/AST Email: Address: Tel: UST/AST Operator: Email: 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: 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 Pumps 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), steel (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)
B-2: Site History - UST/AST Owner/Operator and Other Responsible Party Information Revision Date: Incident Number and Name: UST ID Number Facility ID Number Owner Name (and Contact) of Operation (mm/dd/yy to mm/dd/yy) North East Oil Company Street Address City State Zip Telephone Number Operator Name (and Contact) Dates of Operation (mm/dd/yy to mm/dd/yy) Street Address City State Zip Telephone Number Other Incidents Onsite or Commingled/In Close Proximity Incident Number Date Incident Occurred Name of Responsible Party for Incident Date Incident Reported Date Incident Closed (i/a) Street Address City State Zip Telephone Number Add additional records for all owners, operators and responsible parties as necessary.
B-8A: NAPL Recovery Information Revision Date: Incident Number and Name: Facility ID#: Date (m/dd/yy) Well ID # Product Type (gas, diesel, etc.) NAPL Recovery Method* Product Thickness before Recovery (feet) Product Thickness after Recovery (feet) Amount of Vaporized Product (gallons) Amount of Liquid (Water + Product) (gallons) Amount of Liquid Product (gallons) Total Amount of Product Recovered (gallons) (Present all calculations in an attachment) * Bailing, Skimming, Aggressive Vapor Recovery, Mobile Multiphase Extraction, etc, Table B-8B: Cumulative Volume of NAPL Recovered from Site Date of Recovery (m/dd/yy) Total Volume Recovered from Site During Current Recovery Event (gallons) Cumulative Total of Volume Recovered to Date from All Recovery Events (gallons)
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) Depth 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]