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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1Aemp:b1dg:forms:ocaprv1 3/25/04
Underground Storage Tank Closure
Site Assessment Report
Ecology Site ID: 9046
Project Location:
23601 Edmonds Way
Edmonds, Washington
November 5, 2005
Prepared For:
Laurelhurst Oil Company
7040 2e Avenue NE
Seattle, Washington 98115
(206) 523-4500
Prepared by:
Environmental Management Services, LLC
652 8th Avenue
Fox Island, Washington 98333
(253) 921-7059
www.emsgrouplic.com
J J
rw upvd' Environmental Management Services, LLC
Environmental Services Providing Practical Environmental Compliance Solutions
vmwemsgrouplic.com
0
Underground Storage Tank Closure
Site Assessment Report
Ecology Site ID: 9046
November 5, 2005
Project Location:
23601 Edmonds Way
Edmonds, Washington
Prepared For:
Laurelhurst Oil Company
7040-26 th Avenue NE
Seattle, Washington 98115
(206) 523-4500
Prepared By:
Environmental Management Services, LLC
6528 th Avenue
Fox Island, Washington 98333
(253) 921-7059
MEMBER
Stephen M. Spencer, LSA
Principal Environmental Scientist
Ecology Licensed/Registered Site Assessor
EPA Licensed Risk Assessor - WA-R-9256-1
Washington State Licensed Risk Assessor - 0205
0
0
UST Closure and Site Assessment Report November 5, 2005
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
Table of Contents
ExecutiveSummary .................................................................................................................... I
1.0 Introduction ...................................................................................................................... 2
1.2 Site Location and Description ......................................................................................... 2
2.0 Site Conditions ................................................................................................................. 3
2.1 Health and Safety ........................................................................................................... 3
2.2 Utility location identification ............................................................................................ 3
3.0 UST Closure & Site Assessment Activities ................................................................... 4
3.1 Product Distribution Disassembly ................................................................................... 4
3.2 UST Decommissioning and Removal ............................................................................. 4
3.3 UST Inspection ................................................................................................................. 4
4.0 UST Site Assessment ...................................................................................................... 5
5.0 Summary & Conclusions ................................................................................................. 6
6.0 Standard Limitations ....................................................................................................... 6
FIGURES
FIGURE 1 - SITE LOCATION MAP
FIGURE 2 - UST SITE MAP
FIGURE 3 - SAMPLE LOCATION MAP
FIGURE 4 - PROJECT PHOTOGRAPHS — 3 SHEETS
TABLES
TABLE 1 - SOIL SAMPLE ANALYTICAL RESULTS
MTCA CLEANUP CRITERIA — METHOD A UNRESTRICTED LAN USE
ATTACHMENTS
ATTACHMENT A -
LABORATORY ANALYTICAL RESULTS
LABORATORY CERTIFICATION
ATTACHMENT B -
LIST 30 DAY NOTICE
UST CLOSURE & SITE ASSESSMENT NOTICE
LIST SITE ASSESSMENT CHECKLIST
ATTACHMENT C -
LIST DECOMMISSIONING CERTIFICATION
UST DECOMMISSIONING PERMITS
LIST CLEANING & DISPOSAL CERTIFICATION
PRODUCT TRIPLE RINSE DISPOSAL CERTIFICATION
PROJECT PROFESSIONAL'S CERTIFICATION
Environmental Management Service, LLC Page ii
0
UST Closure and Site Assessment Report November 5, 2005
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
Executive Summary
Environmental Management Services completed an underground storage tank site assessment
as required by Washington administrative code (WAC) 173-360 during the decommissioning
and closure of one (1) -12,000 gallon UST located at 23601 Edmonds Way, Edmonds,
Washington
The UST associated piping including the pump island was dismantled, excavated and removed
on October 4, 2005. The 12,000 gallon steel diesel fuel UST was excavated and removed from
the site for disposal on October 5, 2005.
Confirmation samples were collected from below the UST, from the perimeter of the UST
excavation at 8 to 10 feet below ground surface (bgs), from the excavation floor beneath the
former UST fill pipe area at 10 to 11 feet bgs, from the excavated soil stockpile, and one sample
from under each of the four fuel dispensers (Figure 3). Each sample was analyzed for diesel
range petroleum hydrocarbons (DRO) by method NWTPH-Dx. Samples were analyzed at
Freidman & Bruya, Inc. a Washington Department of Ecology (Ecology) accredited laboratory.
Sample S1-PI1 was reported containing 8,700 mg/kg diesel range hydrocarbons (C10-C25),
exceeding the Model Toxic Control Act (MTCA) Method A (MTCA-A) Cleanup Criteria of 2000
mg/kg. The remaining samples were reported by the laboratory below the MTCA-A cleanup
criteria.
Approximately 10 cubic yards of petroleum contaminated soil (PCS) was excavation from the
north end of the former pump island. The soil was transported to Rinker Materials in Everett,
Washington a licensed disposal facility disposal. Additional samples were collected from the
excavation area immediately below the former northern fuel dispenser. Samples S14 and S15,
collected from the north and south excavation floor at 48 inches bgs were analyzed by Friedman
& Bruya for diesel range hydrocarbons and reported below the MTCA-A cleanup criteria.
Following UST closure and site assessment activities, the excavation was backfilled using
imported pit run. Imported pit run (medium to coarse grained sand with 2 inch minus rounded
gravel) was used to backfill the excavation from 10' bgs to the 6" bgs. Backfill was placed in 24
inch lifts and compacted. Crushed rock (5/8 minus) was used to top the excavation area. A
dewatering well was installed on the excavation during the backfill process extending from the
surface to 12 feet bgs.
Environmental Management Service, ILLC Page 1
0
0
UST Closure and Site Assessment Report
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
1.0 Introduction
November 5, 2005
Environmental Management Services, LLC (EMS) has prepared this underground storage tank
(UST) closure and site assessment report on behalf of Laurelhurst Oil Company located at
7040-26 1h Avenue NE Seattle, Washington 98115.
UST closure and site assessment activities were completed in accordance with the following
documents published by the Washington State Department of Ecology (Ecology) by an Ecology
licensed UST Site Assessor:
Relevant Publications:
• Guidance for Site Checks and Site Assessments for Underground Storage Tanks (Ecology
02/1991);
• The Model Toxics Control Act Cleanup Regulation, Chapter 173-340 WAC (Ecology,
02/2001);
• Collecting and Preparing Soil Samples for VOC Analysis — Ecology Memorandum Number
5, June 2004.
The project scope was to provide UST closure and site assessment services during the
decommissioning and closure of one - 12,000 gallon diesel underground storage tank (UST).
Soil samples were collected from the UST excavation side walls and excavation floor and
excavated soil stockpiles following soil and groundwater remediation activities.
Each discrete soil sample was submitted to Friedman & Bruya, Inc. under industry standard
chain of custody protocols. All confirmation soil samples were reported below the laboratory
reporting limits for DRO and below the MTCA-A cleanup criteria.
1.2 Site Location and Description
The subject site, Ecology site number 9046, is located at 23601 Edmonds Way, Edmonds,
Washington. The area is developed for mixed commercial and residential use. The adjacent
properties to the north and south are commercially developed. The property to the east and
west is developed for multi -family use.
Environmental Management Service, LILC Page 2
0
0
UST Closure and Site Assessment Report
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
2.0 Site Conditions
November 5, 2005
The site has been operated as a commercial fueling station for the last 15 years. The UST was
located near the center of the property under a canopy and east of the pump island. Four fuel
dispensers were located on the pump island. The developed area of the property is paved with
areas of landscaping. There is an undeveloped area east of the UST.
The surface topography is sloped to the north. A storm water catch basin is located on the
north end of the site, discharging stormwater into the City of Edmonds storm water conveyance
system. The remaining site utilities are located on the north end of the site. Water was
disconnected during the excavation activities. Power and telephone remains connected to the
site's maintenance shed, located west of the UST excavation area.
2.1 Health and Safety
A site-nspecific Health and Safety Plan was prepared in accordance with Chapter 296-62 of the
Washington Administrative Code (WAC) and 29 CFR 1910.120 (Code of Federal Regulations).
The HASP identified potential physical and chemical hazards and specified personal protection
and safety monitoring requirements. Site health and safety meetings were conducted during
fieldwork at the beginning of each workday to review aspects of the HASP, and to provide an
opportunity for EMS site workers and contractor personnel to discuss health and safety issues
or concerns. On -site personnel associated with the field activities were required to be familiar
with and comply with provisions put forth in the HASP. Subcontractors on -site were required to
have their own HASP that identified potential physical and chemical hazards associated with
their own work activities.
2.2 Utility location identification
Prior to implementing UST decommissioning activities at the Site, the public underground
utilities alert network was notified of intrusive excavation activities. The service contacted
appropriate agencies or companies with underground utilities in the area. These agencies then
marked the location of their utilities along the right-of-ways and easements of the property.
Environmental Management Service, LLC Page 3
UST Closure and Site Assessment Report
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
3.0 UST Closure & Site Assessment Activities
November 5, 2005
Laurelhurst Oil Company hired EMS to complete LIST site assessment activities and project
oversight during the decommissioning of 1-12,000 gallon diesel fuel UST. Saybr Construction,
Inc. (Saybr) was hired as the UST decommissioning company.
3.1 Product Distribution Disassembly
The fuel system dispensers and associated piping were removed on October 5, 2005. Each
dispenser was drained and removed. Concrete covering the UST was removed and the soil
covering the USTs excavated and stockpiled south the excavation area (Photo 10). The top of
the UST was approximately three feet bgs and the piping was approximately twenty four inches
bgs. The UST was prepared for removal by draining and disconnecting all associated piping
then removing the UST product piping. Temporary vent lines were installed on the UST to allow
for proper venting during carbon dioxide inertion.
3.2 UST Decommissioning and Removal
40 Saybr utilized a vacuum pump truck (Petroleum Reclaiming Services) to remove any remaining
liquid from each UST. Once emptied, each UST was triple rinsed with water (Photo 05). The
liquid was disposed of at Petroleum Reclaiming Service, a licensed local disposal facility.
Following UST triple rinsing activities each LIST was interted. Saybr provided decommissioning
oversight and used bottled carbon dioxide (CO2) to inert the UST. Approximately 2 pounds of
CO2 was used for each 100 gallons. The LIST was filled with CO2 until oxygen levels were
below 6%.
Following the UST cleaning and inertion, the UST was removed from the excavation and
transported to off site for disposal. All site activities were completed under the supervision of
Stephen Spencer; Ecology licensed UST Site Assessor and Mickey McAloon, Ecology Licensed
UST Decommissioner.
3.3 UST Inspection
The UST was inspected for signs of deterioration or evidence of a release following removal
from the excavation. The UST was constructed of steel and appeared in excellent condition
(Photo 09). UST tightness records were reviewed and showed the USTs and associated
system to be tight.
Environmental Management Service, LLC Page 4
Ol
UST Closure and Site Assessment Report
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
4.0 UST Site Assessment
November 5, 2005
Confirmation samples were collected from below the LIST at approximately 10 to 11 feet bgs,
from the perimeter of the UST excavation at 8 to 10 feet bgs and from the excavated soil
stockpile at three locations (Figure 4). Subsurface soil consisted of sandy loam with organics to
18 inches bgs. Medium to course grained sand was observed within the LIST excavation area
from 18 inches bgs to a depth of 11 feet bgs. Extremely dense silty fine grained sand with few
cobles was observed on the excavation sidewalls from 18 inches bgs and along the excavation
floor below 11 feet bgs.
Each confirmation sample was analyzed for diesel range petroleum hydrocarbons (DRO) by
method NWTPH-Dx. In addition to the DRO analysis, sample S1-PI1 was analyzed for volatile
aromatic hydrocarbons (benzene, toluene, ethylbenzene, and xylene). Samples were analyzed
at Freidman & Bruya, Inc. a state accredited laboratory.
Each confirmation sample with the exception of S1-PI1 was reported by the laboratory below
the Unrestricted Model Toxic Control Act (MTCA) Method A Cleanup levels of 2000 mg/kg.
Ol Sample (S1-PI1) collected from below the northern pump island at 24 inches and sample S10-
P11A collected from the same location at 30 inches bgs were reported containing diesel range
hydrocarbons at 8,700 mg/kg and 18,000 mg/kg respectfully, exceeding the MTCA Method A
(MTCA-A) Cleanup Level of 2000 mg/kg (Table 1). Additional excavation of this area was
completed to a depth of 48 inches bgs, approximately 18 inches below the original sampling
depth (Photo 13). Impacted soil was transported to Rinker Materials, a licensed petroleum
contaminated soil disposal facility, in Everett Washington. Impacted soil was treated by indirect
thermal desorption.
0
Samples S14-N and S15-S were collected from the floor of the excavated area beneath the
former northern pump island. Each sample was analyzed for diesel range petroleum
hydrocarbons and reported below the MTCA-A cleanup criteria.
No groundwater was observed during UST closure activities.
Soil sampling and analytical reporting for this project was based on the current MTCA UST site
assessment and soil sampling guidelines.
Environmental Management Service, LILC Page 5
0
UST Closure and Site Assessment Report November 5, 2005
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
Each discreet sample was analyzed for (Table 1):
• Benzene, Toluene, Ethylbenzene & Xylene Range (BTEX-Volatile Aromatic
Hydrocarbons) - Method 8021 B Sample (S 1 -PI 1 Only)
• Diesel -range Hydrocarbons (DRO) — Method NWTPH-Dx
Sampling protocol was derived from the "Guidance for Site Check and Site Assessments for
Underground Storage Tanks, Ecology October 1992 and "Collecting and Preparing Soil
Samples for VOC Analysis (Method 5035) — Ecology Memorandum Number 5, June 2004".
During the soil sampling activities, several field -screening techniques were utilized:
• Olfactory Observations
• Visual Observations
• Sheen Test
5.0 Summary & Conclusions
The UST and the associated piping was effectively decommissioned and closed according to
Department of Ecology guidelines. Subsurface soil was characterized adjacent to and below
each UST location, from associated piping and fuel distribution equipment. Confirmation soil
samples were collected from the excavation perimeter sidewalls, from the excavation floor, from
the excavated soil stockpile and from below each of the former UST dispensers (Figure 3). A
de-minimis amount of petroleum contaminated soil was confirmed and removed from below the
northern fuel dispenser and disposed off site at Rinker Materials, a licensed disposal facility.
Additional soil samples were collected following the removal of the impacted soil and each were
reported below MTCA-A cleanup criteria. No groundwater was observed during UST closure
activities.
Each discrete confirmation soil sample was reported by the laboratory below the Model Toxic
Control Act method A cleanup criteria for unrestricted land use. No further action regarding this
UST system closure is warranted.
6.0 Standard Limitations
The findings and conclusions documented in this report have been prepared for the specific
application to this project and have been developed in a manner consistent with that level of
care and skill normally exercised by members of the environmental science profession currently
Environmental Management Service, LLC Page 6
0
UST Closure and Site Assessment Report
Ecology Site ID: 9046
23601 Edmonds Way
Edmonds, Washington
November 5, 2005
practicing under similar conditions in the area. A potential always remains for the presence of
unknown, unidentified, or unforeseen contamination. No warranty, expressed or implied, is
made. This report is for the exclusive use of Laurelhurst Oil Company and / or their client or
representatives.
If new information is developed in future site work (which may include excavations, additional
borings, or other studies), EMS should be contracted to re-evaluate the interpretations in this
report, and to provide amendments as required.
Environmental Management Service, LLC Page 7
1 4
Figures
FIGURE 1 - SITE LOCATION MAP 4)
FIGURE 2 - UST SITE MAP
FIGURE 3 - SAMPLE LOCATION MAP
FIGURE 4 - PROJECT PHOTOGRAPHS 3 SHEETS
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Site Location Map
Date: November 5, 2005
Figure No.:
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UST Closure & Site Assessment
23601 Edmonds Way
Completed: S.Spencer
Checked By: S-Spencer
01
Environmental Services
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PCs to be placed onto 6 mil plastic
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and covered with 6 mil plastic.
It V-
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4 ' 0' 210' 0 4
Approxilpate Scale In Feet
Date:
Figure No.:
Site Map
November 5, 2005
V�e
UST Closure & Site Assessment
23601 Edmonds Way
Completed: S.Spencer
Checked By: S.Spencer
02
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Environmental Services
www.emsgroupllc.com
Edmonds, Washington
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S1 4-N (48-
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S15-S(48-
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S1 1 -P14 (30-
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S1 2-P13 (30- l:
Dx 280 m(
S1 3-P14 (30- k
Dx 180 m(
Former Pump Island
Asphalt Driveway
Soil Stockpile
S3-NSW(8-10-
Dx <50 mg/kg
Forn
Turbine Sump
Turbine!
,oduct Distribution Piping.
Landscaped Area I
2000 Gallon LIST
SW (8-1 O'b9s)
10 mg/kg S2-Floor (.10-1 I'bgs)
Dx <50 m
54-ESW (8-10'bgs)
)x <50 mglkg
LIST Vent
1 —NUST Fill Area
S6-SSW (8-1
Dx <50 m",
13'
S9-SP3
Dx <50 mg/kg
S7-SP1
AN Dx <50 mg/kg
S8-SP2
Dx <50 mgtkg
30'
Figure No.:
Sample Location Map Date: November 5, 2005
UST Closure & Site Assessment Completed: S.Spencer
23601 Edmonds Way Checked By: S.Spencer
MArne%ne4e XA1nehir%^ff%r% 03
Environmental Manaqement Services, LLC
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Pump island & canopy - View to the north
Canopy after removal - View to the south
Cleaning ( 'pie rinse) UST
Pump island & 4 fuel dispensers
vi*lk
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�7,'A�- 61,
Excavation of UST - View to the north
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Date: November 5, 2005
Figure No.:
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UST Closure & Site Assessment
Completed: S.Spencer
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23601 Edmonds Way
Checked By: S-Spencer
04
Edmonds, Washington
Environmental Services
www.emsgroupllc.com.
Sheet 01 of 03
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Photo 0 A
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Continued excavation of UST
Removal of UST - View to the south
Excavation fo pump island - View south
Continued excavation of UST - View to the north
UST excavation - View south
10 Lei to IR-74 all KIIJI III lit] 1 6
Project Photographs Date: November 5, 2005 Figure No.:
UST Closure & Site Assessment Completed: S.Spencer
23601 Edmonds Way Checked By: S.Spencer
Edmonds, Washington 04
Environmental Services
wwwenr.arouDlic.com Sheet 02 of 03
Environmental Management Services, LLC
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Excavation a a - North end Or PUMP island Excavation area north end of pump island
Straw placed for erosion control
Excavation area following UST closure
Straw placed for erosion control
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Excavation area following backfill placement and grading
Project Photographs
Date: November 5, 2005
Figure No.:
UST Closure & Site Assessment
Completed: S.SpenGer
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23601 Edmonds Way
Checked By: S.Spencer
04
Edmonds, Washington
Environmental Services
www.emsgrouplic.com
Sheet 03 of 03
Environmental management z:ierviceS, LLC
Tables
TABLE 1 - SOIL SAMPLE ANALYTICAL RESULTS W
MTCA METHOD A UNRESTRICTED LAND USE CLEANUP CRITERIA "o
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Table I - Soil Sampling Results
UST Site Assessment
23601 Edmonds Way
Edmonds, Washington
November 4, 2001
Sample
Number
Sample Location
Sample Depth
Sample Date
Diesel
mg/kg
Heavy oil
mg/kg I
Volatile Aromatic Hydrocarbons (8021b)
Benzene
mg/kg
Toluene
mg/kg
Ethylbenzene
mg/kg
Xylenes
mg/kg
S1-PI1
Northern Pump Island
18"bgs
10/05/05
8700
<250
<0.02
<0.02
<0.02
<0.06
S2-Floor
West Excavation Sidewall
7-9 ft
10/05/05
<50
<250
N/A
N/A
N/A
N/A
S3-NSW
North Excavation Sidewall
8-10' bgs
10/05/05
530
<250
N/A
N/A
N/A
N/A
S4-ESW
East Excavation Sidewall
8-10' bgs
10/05/05
<50
<250
N/A
N/A
N/A
N/A
S5-WSW
West Excavation Sidewall
8-10' bgs
10/05/05
<50
<250
N/A
N/A
N/A
N/A
S6-SSW
South Excavation Sidewall
8-10' bgs
10/05/05
<50
<250
N/A
N/A
N/A
N/A
S7-SP1
Stockpile Sample
1-2 ft
10/05/05
<50
<250
N/A
N/A
N/A
N/A
S8-SP2
LIST 3: excavation floor
10-12 ft
10/05/05
<50
<250
N/A
N/A
N/A
N/A
S9-SP3
UST 2: excavation floor
10-12 ft
10/05/05
65
<250
N/A
N/A
N/A
N/A
S10-Pli
Pump Island 01
30"bgs
10/06/05
18000
<250
N/A
N/A
N/A
N/A
S1 1 -P12
Pump Island 02
30"bgs
10/06/05
190
<250
N/A
N/A
N/A
N/A
S12-PI3
Pump Island 03
30" bgs
10/06/05
280
<250
N/A
N/A
N/A
N/A
S113-PI4
Pump Island 04
30"bgs
1 10/06/05
180
1 <250
N/A
N/A
I N/A
N/A
Page 1 of 2
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Table 1 - Soil Sampling Results
UST Site Assessment
23601 Edmonds Way
Edmonds, Washington
November 4, 2001
Volatile Aromatic Hydrocarbons (8021 b)
Sample
Diesel
Heavy oil
Sample Location
Sample Depth
Sample Date
Number
Benzene Toluene Ethylbenzene Xylenes
mg/kg
mg/kg mg/kg mg/kg mg/kg mg/kg
S14-N
Pump Island 01 North
48" bgs
10/28/05
460
<250
N/A
N/A
N/A
N/A
S15-S
Pump Island 01 South
48"bgs
10/28/05
430
<250
N/A
NIA
N/A
N/A
Laboratory Reporting Limit Soil
50
250
0.02
I--- --
0.05
L
1 0.05
0.05
I
Model Toxic Control Act (MTCA) Method A Cleanup Levels For Soil
2000
2000
1 0.03
1 7.00
6.00
1 9.00
BOLDIRED = Analyte above MTCA 2001 Method A Cleanup levels for unrestricted land uses.
Values are reported in milligrams per kilogram (mg/kg) soil or micrograms per liter (ug/L) groundwater.
< # (ND) = analyte not detected above the analytical method detection limit cited.
Analytical Method: Diesel / Mineral Oil / Oil by NWTPH-Dx, Gasoline by NWTPH-Gx, BTEX by Method 8021 B
Groundwater. Diesel range petroleum hydrocarbon Method A Cleanup Levels for groundwater are 500 ug/L
Soil Diesel range petroleum hydrocarbon Method A Cleanup Levels for soil are 2000 mg/kg Diesel & Oil, 4000 mg/kg Mineral Oil, 500 ug/L
Groundwater: Gasoline range petroleum hydrocarbon Method A Cleanup Levels for groundwater are 1000 ug/L unless Benzene is present then 800 ug/L cleanup levels
Soil: Gasoline range petroleum hydrocarbon Method A Cleanup Levels for soil are 100 mg/kg unless Benzene is present then 30 mg/kg cleanup levels
MTCA 2001 Method A Cleanup Levels for Soil from the Model Toxics Control Act (MTCA) amendment Table 740-1 WAC 173-340 -900 Tables.
bgs=below ground surface
NA=Not Applicable
Page 2 of 2
MTCA Cleanup Regulation
173-340-900
Table 740-1
Footnotes:
Method A Soil
Cleanup Levels
a
Caution on misusing this table. This table has been developed
for Unrestricted Land Uses.'
for specific purposes. It is intended to provide conservative
cleanup levels for sites undergoing routine cleanup actions or for
Hazardous Substance
CAS Number
Cleanup Level
sites with relatively few hazardous substances, and the site
qualifies under WAC 173-340-7491 for an exclusion from
Arsenic
7440-38-2
20 mg/ke
conducting a simplified or site -specific terrestrial ecological
evaluation, or it can be demonstrated using a terrestrial
Benzene
7143-2
0.03 mg/kgc
ecological evaluation under WAC 173-340-7492 or 173-340-
d
7493 that the values in this table are ecologically protective for
Benzo(a)pyrene
50-32-8
0.1 mg1kg
the site. This table may not be appropriate for defining cleanup
Cadmium
744043-9
2 mg/kgc
levels at other sites. For these reasons, the values in this table
should not automatically be used to define cleanup levels that
Chromium
must be met for financial, real estate, insurance coverage or
Chromium VI
18540-29-9
19 mg/kgn
placement, or similar transactions or purposes. Exceedances of
the values in this table do not necessarily mean the soil must be
Chromium 111
16065-83-1
2,000 mg/kgf2
restored to these levels at a site. The level of restoration depends
on the remedy selected under WAC 173-340-350 through 173-
DDT
50-29-3
3 mg1ke
340-390.
Ethylbenzene
100414
6 mg1kgh
b
Arsenic. Cleanup level based on direct contact using Equation
740-2 and protection of ground water for drinking water use
Ethylene dibromide (EDB)
106-934
0.005 mg/kg'
using the procedures in WAC 173-340-747(4), adjusted for
natural background for soil.
Lead
7439-92-1
250 mg/kgJ
c
Benzene. Cleanup level based on protection of ground water for
Lindane
58-89-9
0.01 mglkgk
drinking water use, using the procedures in WAC 173-340-
747(4) and (6).
Methylene chloride
75-09-2
0.02 mg/kg
d
Benzo(a)pyrene. Cleanup level based on direct contact using
Mercury (inorganic)
7439-97-6
2 mg/kg'
Equation 740-2. If other carcinogenic PAHs are suspected of
being present at the site, test for them and use this value as the
MTBE
1634-04-4
0.1 mg/kgn
total concentration that all carginogenic PAHs must meet using
the toxicity equivalency methodology in WAC 173-340-708(8).
Naphthalenes
91-20-3
5 mg/kgo
e
Cadmium. Cleanup level based on protection of ground water
PAHs (carcinogenic)
See
for drinking water use, using the procedures described in WAC
benzo(a)pyrene d
173-340-747(4), adjusted for the practical quantitation limit for
soil.
PCB Mixtures
I mg/kgP
n
Chromium V1. Cleanup level based on protection of ground
Tetrachloroethylene
127-18-4
0.05 mg/kgq
water for drinking water use, using the procedures described in
WAC 173-340-747(4).
Toluene
108-88-3
7 mg/kgr
f2
Chromium Ill. Cleanup level based on protection of ground
water for drinking water use, using the procedures described in
Total Petroleum Hydrocarbonss
WAC 173-340-747(4). Chromium VI must also be tested for
[Note: Must also test for and meet
cleanup levels for other petroleum
and the cleanup level met when present at a site.
components --see footnotes!]
g
DDT (dichlorodiphenyltrichloroethane). Cleanup level based
on direct contact using Equation 740-2.
Gasoline Range Organics
h
Ethylbenzene. Cleanup level based on protection of ground
water for drinking water use, using the procedures described in
Gasoline mixtures
100 mg/kg
WAC 173-340-747(4).
without benzene and
i
Ethylene dibromide (1,2 dibromoethane or EDB). Cleanup
the total of ethyl
level based on protection of ground water for drinking water use,
benzene, toluene and
using the procedures described in WAC 173-340-747(4) and
xylene are less than
adjusted for the practical quantitation limit for soil.
I% of the gasoline
j
Lead. Cleanup level based on preventing unacceptable blood
mixture
lead levels.
All other gasoline
30 mg/kg
k
Lindane. Cleanup level based on protection of ground water for
mixtures
drinking water use, using the procedures described in WAC 173-
340-747(4), adjusted for the practical quantitation limit.
Diesel Range Organics
2,000 mg/kg
I
Methylene chloride (dichloromethane). Cleanup level based
Heavy Oils
2,000 mg(kg
on protection of ground water for drinking water use, using the
procedures described in WAC 173-340-747(4).
Mineral Oil
4,000 mgfkg
m
Mercury. Cleanup level based on protection of ground water
for drinking water use, using the procedures described in WAC
1,1,1 Trichloroethane
71-55-6
2 mg/kgt
173-340-747(4).
Trichloroethylene
79-01-6
0.03 mg/kgu
n
Methyl tertiary -butyl ether (MTBE). Cleanup level based on
protection of ground water for drinking water use, using the
Xylenes
1330-20-7
9 mg/kgv
procedures described in WAC 173-340-747(4).
0
Naphthalenes. Cleanup level based on protection of ground
water for drinking water use, using the procedures described in
0
WAC 173-340-747(4). This is a total value for naphthalene, I -
methyl naphthalene and 2-methyl naphthalene.
p
PCB Mixtures. Cleanup level based on applicable federal law
(40 C.F.R. 761.6 1). This is a total value for all PCBs.
February 12, 2001
Page 233
173-340-900
MTCA Cleanup Regulation
q Tetrachloroethylene. Cleanup level based on protection of
ground water for drinking water use, using the procedures
described in WAC 173-340-747(4).
r Toluene. Cleanup level based on protection of ground water for
drinking water use, using the procedures described in WAC 173-
340-747(4).
s Total Petroleum Hydrocarbons (TPH).
TPH cleanup values have been provided for the most common
petroleum products encountered at contaminated sites. Where
there is a mixture of products or the product composition is
unknown, samples must be tested using both the NWTPH-Gx
and NWTPH-Dx methods and the lowest applicable TPH
cleanup level must be met.
• Gasoline range organics means organic compounds measured
using method NWTPH-Gx. Examples are aviation and auto-
motive gasoline. The cleanup level is based on protection of
ground water for noncareinogenic effects during drinking water
use using the procedures described in WAC 173-340-747(6).
Two cleanup levels are provided. The lower value of 30 mg/kg
can be used at any site. When using this lower value, the soil
must also be tested for and meet the benzene soil cleanup level.
The higher value of 100 mg/kg can only be used if the soil is
tested and found to contain no benzene and the total of ethyl
benzene, toluene and xylene are less than 1% of the gasoline
mixture. No interpolation between these cleanup levels is
allowed. In both cases, the soil cleanup level for any other
carcinogenic components of the petroleum (such as EDB and
EDC], if present at the site, must also be met. Also, in both
cases, soil cleanup levels for any noncarcinogenic components
Lsuch as toluene, ethylbenzene, xylenes, naphthalene, and
MTBE], also must be met if these substances are found to
exceed ground water cleanup levels at the site. See Table 830-1
for the minimum testing requirements for gasoline releases.
• Diesel range organics means organic compounds measured
using method NWTPH-Dx. Examples are diesel, kerosene, and
#1 and #2 heating oil. The cleanup level is based on preventing
the accumulation of free product on the ground water, as
described in WAC 173-340-747(10). The soil cleanup level for
any carcinogenic components of the petroleum [such as benzene
and PAHs], if present at the site, must also be met. Soil cleanup
levels for any noncarcinogenic components [such as toluene,
ethylbenzene, xylenes and naphthalenes], also must be met if
these substances are found to exceed the ground water cleanup
levels at the site. See Table 830-1 for the minimum testing
requirements for diesel releases.
• Heavy oils means organic compounds measured using
NWTPH-Dx. Examples are #6 fuel oil, bunker C oil, hydraulic
oil and waste oil. The cleanup level is based on preventing the
accumulation of free product on the ground water, as described
in WAC 173-340-747(10) and assuming a product composition
similar to diesel fuel, The soil cleanup level for any
carcinogenic components of the petroleum [such as benzene,
PAHs and PCBs], if present at the site, must also be met. Soil
cleanup levels for any noncarcinogenic components [such as
toluene, ethylbenzene, xylenes and naphthalenes], also must be
met if found to exceed the ground water cleanup levels at the
site. See Table 830-1 for the minimum testing requirements for
heavy oil releases.
• Mineral oil means non -PCB mineral oil, typically used as an
insulator and coolant in electrical devices such as transformers
and capacitors, measured using NWTPH-I)x. The cleanup level
is based on preventing the accumulation of free product on the
ground water, as described in WAC 173-340-747(10). Sites
using this cleanup level must also analyze soil samples and meet
the soil cleanup level for PCBs, unless it can be demonstrated
that: (1) The release originated from an electrical device that
was manufactured after July 1, 1979; or (2) oil containing PCBs
was never used in the equipment suspected as the source of the
release; or (3) it can be documented that the oil released was
recently tested and did not contain PCBs. Method B must be
used for releases of oils containing greater than 50 ppm PCBs.
See Table 830-1 for the minimum testing requirements for
mineral oil releases.
1,1,1 Trichloroethane. Cleanup level based on protection of
ground water for drinking water use, using the procedures
described in WAC 173-340-747(4).
Trichloroethylene. Cleanup level based on protection of
ground water for drinking water use, using the procedures
described in WAC 173-340-747(4).
Xylenes. Cleanup level based on protection of ground water for
drinking water use, using the procedures described in WAC 173-
340-747(4). This is a total value for all xylenes.
Page 234 February 12, 2001
nt A
C
RESULTS 'D
FICATION
KI
.L U e L t Vin U-+; -twpm r- UU11-
FRIEDMAN & BRUYA, INC.
ENVIRONMENTAL CHEMISTS
James E. Bnjy-a, MD. 3012 l6th Avenue West
charlme Marrow, M.S. Seattle, WA 98119-2029
Yeleria Aravkiina, M.S. TEL: (206) 285-8282
Bradley T. Benson, B.S. FAX: (206) 283-5044
Kurt Jobinson, B-S- e-mail: NPisornedia.corn
October 13, 2005
Steve Spencer, Project Manager
Environmental Ko.n.,agement Services, LLC
652 8th Avenue
Fox Island, WA 98333
Dear Mr. Spencer:
Included are the resu)ts from the testIng of material 4-ubmitted on Octobe.r.7, 2005
from the Laurelhurst- Edmonds, F&BI 51,0057 project. There are 4 pages included
in this report. Any samples that may remain art- currently scheduled for disposal, in
.30 days. If you. would like us to return your samples, or arrange for long term
i le
storage at our offices, please contact us assoon as possib .
We appreciate this opportunity to be of ser�n.cp to you and hope you will call if You
should have any questions.
Sincerely,
FRIEDMAN & BRUYA, INC.
Michael Erdahl
Project Manager
Enclosures
FAX: (253) 369-6228
T.N.S10M.D00
0
lu/14elut) 04:40pm t-. wocs
0
r -I
L—A
� 0
FRIEDMAN & BRUYA, TKC
ENVIRONMENTAL C14EMISTS
Date of Report:
10/13/05
Date Received;
1.0/07/05
Project: Laurelhurst-Eduaondq, F&BI 510057
Date Extracted:
10/07/05
Date Analyzed'.
10/07/05
RESULTS FROM THE ANALYSIS OF THE SOIL SAMPLES
FOR BENZENEq TOLUENE, ETHYLBENZENE AND XYLENES
USING EPA METHOD 8021B
Results Reported on a Dry Weight Basis
Results Reported. as �Lg/g (ppm)
Ethyl Total Surrogate.
Sample ID Benzene Toltiene Benzene Xylenes (% Recovery)
Laboratory ID (Umit 50-150)
si.-Pli <0.02 <0.02 <0.02 <0,06 90
113.00,57-01.
Method Blank <0.02 <0.02 <0.02 <0.06 88
I
��e �ZD ��; ��Piil r
FRIEDMAN & BRUYA, INC.
ENVIRONMENTAL CHENUSTS
Date of Report:
10/13/05
Date Received:
10/07/05
Project: Laurelhurst-Edmonds, F&BI 51005"1
Date Extracted:
10/07/05
Date Analyzed:
10/07/05
RESULTS
FROM THE ANALYSIS OF THE SOIL
SAMPLES
FOR TOTAL PETROLEUM HYDROCARBONS AS DTESFL
USING METHOD NWTPH-Dx
Extended to Include Motor Oil Range Compounds
Results Reported ona Dry Weight Basis
Results Reported as �tg/g (ppm.)
Surrogate
Sample ID
Diesel Range Motor Oil Pgn�e
ffo Reco very)
Laboratory ID
(Cin-C20 (C25-(.,3r,)
(T.A,Tnit 67-131)
SI-Pil
8,700 <250
81
5.10057-01.
S2-Fl.00r
<50 <250
97
S3-NSW
530 <250
100
510057-03
S4-ESW
<50 <250
99
510057-04
S.9-wSw
<50 <250
102
5 100 153 7 -0 5
S6-SSW
<50 <250
100
510057-06
Method Blank
<50 <250
98
0
2
.. ..... ... .
FRIEDMAN & BRUYA, INC.
ENVTRONW,NTAL CHEMTSTS
Jwnes E. Biruya, Ph.D.
Charlene Morrow, M.S-
Yelena Ar-avkina, M.S.
BTadley T. Benson, B.S.
Kurt Johnson, B.S.
October 14, 2005
Steve Spencer, Prqjk-,ct M.,anager
Environmental Management Service.,-;, LLC
652 8th Avenue
Fox Island, WA 98333
Dear Mr. Spencer:
3012 16th Avenue West
Seattle, WA 981 J 9-2029
TEL: (206) 285-8282
FAX: (206) 283-5044
e-mail: fbi(a
,,)isomediaxom
Included are the results from the testing of material submittOld on October 10, 2005
from the Laurelhu.rst-Ed-Mond,-;, F&BI 510083 project, There are 2 pages included
in this report. Any samples that may remain arp currently scheduled.for disposal in
30 days. If you would like us to return your samples or ornange for long term
storage at our offices, please contact us as soon as possible.
We appreciate this opportunity to be of service to you and hope you will call if you.
should have any questions.
Sincerely,
FRIEDMAN& BRUYA, IN
Michael Erdahl
Project Manager
Enclosurps
FAX: (253) 369-6228
IWS1014R.DOC
04:4upm V. 00=5
FRIEDMAN & BRUYA,, INC.
ENVIRONWNTAL CHEMISTS
Date of Report: 10/14/05
Date Received: 10/10/05
Project: Laurelhurst-Edmonds,F&BI 510083
Date Extracted: 10/10/05
Date Analyzed: 10/10/05
RESULTS FROM THE ANALYSIS OF THE SOIL SAMPLES
FOR TOTAL PETROLEUM HYDROCARBONS AS DIESEL
USING METHOD NWTPH-Dx
Extended to Include Motor Oil Range Compounds
Results Repo-rted on a Dry Weight.Basis
Results Reported as �Lg/g (PPIDA)
Surrogate
Sample ID
Diesel Range
Motor Oil K-,I—n�gP,
N Reco very)
Laboratory ID
(00-C25)
((12r.-Gla)
(Limit 67-14 1.)
S7-SPI
<50
<250
135
51008.3-01
S&SP2
<50
<250
117
11008-3-02
S9-SP3
65
<250
125
510083-03
S10-P11B-36"
18,000
<250
C,1.08,1-04
S11-P12-36"
190
<250
127
510083-05
S12-P13-18"
280
<250
132
51008.13,06
S13-P14-18"
180
<250
133
51.0083-07
Method Blank
<50
<250
1.27
ip - P . Compounds in the s;ample matxix i terfered with the
Jwcovery fell outsidc of nornial control limit% r
quantittition of the analytr...
I
11/02/OS 12:13pm P. 002
0
FRIEDMAN & BRUYA, INC.
ENVIRONMENTAL C14EMSTS
James E. Bruya, Ph.D.
Charlene Morrow, M.S.
Ye(ena Aravkina, WS.
Bradley T. Berson, B-S.
Kurt Johnson, B.S.
November 2, 2005
Steve Spencer, Project Manager
Environmental Management Services, LLC
652 8tb. Avenue
Fox Island, WA 98333
Dear Mr. Spencer:
3012 16tb Avemie West
Seattle, WA 98119-2029
TEL: (206) 285-8282
FAX: (206) 283-5044
e-mail: fbi@isomediazorn
Included are the results from the testing of materialsubtuittea on October 28, 2005
from the Laurelhu.rst, F&BI 510290 project. There are 2 pages included in this
report. Any samples that may remain are currently scheduled for disposal in 30
days. If you would like us to return your sainples or arrange for long term storage
at our offices, please contact us as soon as possible.
We appreciate this opportunity to be of service to you and hope you will call if you
should have any questions.
s
Sincerely,
FRIEDMAN &,BRLTYA,
Michael Erdahl
Project Manager
Enclosures
FAX: (253) 369-6228
EMS I 102R.. DQU,
0
11/02/06 12:ISPM P. 003
FRIEDMAN & BRUYA, INC.
FNVIPONMENTAL 11EMISTS
Date. of Report.
11/02/05
Date Received:
10/28/05
Project: Laurelhuv.;t, F&BI 510290
Date Extracted:
10/28/05
Date A-ualyzed.:
10/28/05
RESULTS FROM THE ANALYSTS OF THE SOIL SAMPLES
FOR TOTAL PETROLEUM HYDROCARBONS AS DIESEL
USING METHOD NWTPH-Dx
Extended to Include Motor Oil Range Compounds
Res,ults Reported on a Dry Weigbt Basis
Results Reported a.,3 4g/g (ppm)
Surrogate
SaMple. ID
Diesel RaAge
T.RPH
(%,RecoveLry)
Laboratory ID
(CM-C211)
(clo-c's)(J)
(Li'mit, (')'7-131)
N ex
460
460
7 6)
510290-01
S ex
430
430
97
5002W-02
Method Blank
<50
<250
97
0
10
111"02/OS 12113PM P. 004
FRJEDMAN & BRUYA, INC.
0 E-NVIRONWNTAL CHEMISTS
Date of Rtaport: 11/02/05
Date Received: 10/28/05
Project: Laurelhiust, F&BI 510290
9
is
QUALITY ASSURANCE RESULTS FROM THE ANALYSIS OF SOIL SAMPLES
FOR TOTAL PETROLEUM HYDROCARBONS AS DIESEL EXTENDED
USING METHOD NWTPH-Dx
Laboratory Code: 510296-04 (Matrix Spj:ke)
Pcrwnt Porcent
Reporting Spike
Sample
Recovery Recovery Acceptancc R.'IJD
Analyt.c
Units Level
Rewlt
M.8 MSD Criteria 0,imit 20)
Diesel Extended
pglg (PPD3.) 5,000
<50
11.6 117 61-1.36 1.
Laboratory Code:
Laboratory C ontrol S-,.i-mple
Percent
Reporting Spike
.13,(,�covery Acceptanw
Analyte
Units Level
LCS
Criteria
Diesel, Extended
�tg/g (ppTn,) 5,000
119
61-1,40
PA
0
0
Attachment B 11 IT
LIST 30 Day Notice
LIST Closure & Site Assessment Notice
LIST Site Assessment Checklist
W A S H I N 6 T 0 N S T A T E
D E P 4 R T M i N T 0 F
0 L 0 G
UNDERGROUNDSTORAGETANK
30 DAY NOTICE
See back of fonn for instructions
Please V the appropriate box: X Intent to Close
Site Information
Site ID Number: 9046
(Available from Ecology if the tanks are registered)
Site/Business Name: LAURELHURST OIL CO INC
Street
Site Address: 23601 Edmonds Way
City/State: Edmonds, Washington
Zip Code: 98026 Telephone: (360) 683-9522
FOR OFFICE USE ONLY
Site ID #:
Owner I D #:
Owner Information
(This form will be returned to this address)
LIST Owner/Operator: LAURELHURST OIL CO INC
Mailing Address: 7040 26th Avenue NE
City/State: Seattle, WA 98155
Zip Code: 98134 Telephone: 206-523-4500
Tank Installation Company (if known). Fill out this section ONLY if tanks are being installed.
Service Company Contact Name
Address
Street P.O. Box
Telephone ------
City State Zip Code
Tank Permanent Closure Company (if known). Fill out this section ONLY if tanks are being closed.
Service Company: Environmental Management Services, LLC Contact Name: Stephen Spencer
Address: 652 8th Avneue
Street
Fox Island Washington 98333 Telephone (253) 921-7059
City State Zip Code
Tank Installation
Tank Closure Information
Information
Fill out this section ONLY if tanks are being closed.
Fill out this section ONLY if
tanks are being installed.
Is There
Projected Product In If No, Date
Closure Tank Substance Date Tank the Tank Tank Was
Approx.
Tank ID Date Capacity Stored Last Used (Yes/No) Pumped
Tank ID Install Date
UST 1 June 15, 2005 12000 Gallons Diesel Unknown No March 2005
To receive this document in an alternative format, contact the TOXICS CLEANUP PROGRAM at 1-800-826-7716 (VOICE) OR (360) 407-6006 (TDD)
ECY 020-95 (Rev. 3-01)
Instructions
0 Please Read Carefully
Check the appropriate box for tank closure, tank installation, or both.
AFTER COMPLETING THIS FORM. RETURN TO:
TOXICS CLEANUP PROGRAM
DEPARTMENT OF ECOLOGY
P.O. BOX 47655
OLYMPIA, WA 98504-7655
Site and Owner Information
Fill in the site and owner information. Please include the Ecology site number for tank closures; also, be sure to
provide telephone numbers so that any problems can be resolved quickly. Confirmation of receipt of this form
will be returned to the owner.
Tank Installation Company
List the installation company, if known. Upon receipt of the completed form, Ecology will validate it and return
it to the owner. This validated form allows you to receive a one time drop of product, for UST system testing
purposes only. To dispense product and receive additional deliveries, you must complete the Master
Business License registration and obtain your Tank Tag from Ecology. The registration information
must be submitted to the Department of Licensing within 30 days of installation to receive a Master
Business License with the appropriate tank endorsement(s).
Tank Permanent Closure Company
List the closure company, if known. Upon receiving a completed 30 day closure form, Ecology will stamp the
date received on the form and return a copy to the owner.
Contact your local fire marshal and planning department prior to tank closure to find out if any additional
permits are required by county or other local jurisdictions. Compliance with the State Environmental Policy Act
(SEPA) Rules, Chapter 197-11 WAC, may be necessary.
Closure may proceed 30 days after the date stamped on the form. A site assessment is required at the time of
closure. Contamination found or suspected at the site must be reported to the appropriate Ecology regional
office within 24 hours. If the contamination is confirmed, a site characterization report must be submitted to the
regional office within 90 days; if contamination is not confirmed, a site assessment report must be submitted to
the above address within 30 days.
Please note: Individuals performing UST services MUST be certified by the International Fire Code
Institute (IFCI), or have passed another qualifying exam approved by the Department.
Tank Information
List tanks to be installed or closed. Please report tank ID number(s) for tanks to be closed and assign new tank
ID number(s) to tanks being installed. Do not use existing numbers from closed tanks.
The following tanks are exempt from notification requirements:
-*e Farm or residential tanks, 1, 100 gallons or less, used to store motor fuel for personal or farm use
only. The fuel must not be for resale or used for business purposes.
4- Tanks used for storing heating oil that is used on the premises where the tank is located.
Tanks with a capacity of I 10 gallons or less.
Equipment or machinery tanks such as hydraulic lifts or electrical equipment tanks.
44- Emergency overflow tanks, catch basins, or sumps.
UNDERGROUNDSTORAGETANK FOR OFFICE USE ONLY
Site ID
Closure and Site Assessment Notice
Owner ID #:
0 W A S H I N T 0 N S T A T E
DEPARTMENT OF
E C 0 L 0 G Y See back of form for instructions
Please V the appropriate box(es)
El Temporary Tank Closure El Change -In -Service X Permanent Tank Closure X Site Check/Site Assessment
Site Information
Site ID Number: 9046
(Available from Ecology if the tanks are registered)
Site/Business: Laurelhurst Oil Company
Street
Site Address: 23601 Edmonds Way
City/State: Edmonds ashi
Zip Code
Owners Sig
Service Company: Saybr Conti
Certified Supervisor: Mickee
*Supervisor's Signature:
Address: 12115 Canyon Road
Street
Puyallup Washington
city State
Tank Cloduk/Ch
n
Owner Information
(This form will be returned to this address)
UST Owner/Operator: Laurelhurst Oil Company
Mailing Address: 7040 - 26th Avenue NE
Street
City/State: Seattle, Washignton P.O. Box
Zip Code 9_1115 Telephone (206) 523-4500
In -Service Company
P.O. Box
98373 Telephone (253) 531-2144
Zip Code
Date
Site Check/Site Assessor
Certified Site Assessor: Stephen M. Spencer
Address: 652 8th Avenue
Street P.O. Box
Fox Island Washington 98333 Telephone (253) 921-7059
city State Zip Code
Contamination Present
Tank Information at the Time of Closure
Tank ID Closure Date Closure Method Tank Capacity Substance Stored X
UST 01 October 5, 2005 Removal 12000 Gallons Diesel Yes No Unknown
Check unknown if no obvious
contamination was observed
and sample results have not
yet been received from
analytical lab.
X 0
Yes No
If contamination is present,
has the release been reported
to the appropriate regional
office?
To receive this document in an alternative format, contact the TOXICS CLEANUP PROGRAM at 1-800-826-7716 (VOICE) OR (360) 407-6006 (TIDID).
ECY 020-94 (Rev. 6-99)
0
0
Instructions
Please Read Carefully
This form is to be completed by the tank owner and submitted to
Ecology within 30 days of tank closure. Mark the appropriate
box(es) for temporary tank closure, permanent tank closure,
change -in-service, or site assessment.
AFTER COMPLETING THIS FORM. RETURN TO:
TOXICS CLEANUP PROGRAM
DEPARTMENT OF ECOLOGY
P.O. BOX 47655
OLYMPIA, WA 98504-7655
Permanent Closure and Change -In -Service require a site assessment be performed.
Site and Owner Information
Fill in the site and owner information. Include the Ecology site number, if known; also, be sure to provide
telephone numbers so that any problems can be resolved quickly.The tank owner MUST sign this form.
Tank Closure/Change-In-Service Company and Site Check/Site Assessor
List the closure company and fill in the site assessor information for pen-nanent closure or change -in- service.
Ask to see the closure company supervisor's IFCI Certification and make sure that the certified supervisor signs
this form.
Please note: Individuals performing services MUST be certified by the International Fire Code Institute
(IFCI), or other nationally recognized association by which they demonstrate appropriate
knowledge pertaining to USTs or have passed another qualifying exam approved by the
Department.
Tank Information and Contamination Present at Time of Closure
Please fill in the tank information requested using tank ID numbers previously reported to Ecology. In the
column entitled "Closure Method," indicate what manner of closure was used, such as closure in place or
removal. Check the appropriate box(es) indicating if contamination is present and has been reported.
Contamination found or suspected at the site must be reported to the appropriate Ecology regional office within
24 hours [see below for telephone numbers]. If contamination is confirmed, a site characterization report
must be submitted to the regional office within 90 days; if contamination is not confirmed, then this form,
a site assessment checklist, and a site assessment report must be submitted to the above address within 30
days.
Central
(509) 574-2490 (voice)
(509) 454-7673 JDD)
Eastern
(509) 456-2926 (voice)
(509) 458-2055 (TDD)
Southwest
(360) 407-6300 (voice)
(3601) 407-6306 (TDD)
Northwest
(425) 649-7000 (voice)
(425) 649-4259 (TDD)
The following tanks are exempt from notification requirements:
Farm or residential tanks, 1, 100 gallons or less, used to store motor fuel for personal or farm use
only. The fuel must not be for resale or used for business purposes.
Tanks used for storing heating oil that is used on the premises where the tank is located.
Tanks with a capacity of I 10 gallons or less.
4- Equipment or machinery tanks such as hydraulic lifts or electrical equipment tanks.
-*.- Emergency overflow tanks, catch basins, or sumps.
For more information, call toll free in the state of Washington 1-800-826-7716 (Message).
UNDERGROUNDSTORAGETANK
Site Check/Site Assessment Checklist
W A S H I N 6 T 0 h S I A T E
1 , I T E N
C 6 L' O'G 'y
FOR OFFICE USE ONLY
Site #:
Owner
When a release has not been confirmed and reported, this Site Check/Site Assessment Checklist must be completed and signed by a
person certified by IFCI or a Washington registered professional engineer who is competent, by means of examination, experience, or
education, to perform site assessments. The results of the site check or site assessment must be included with this checklist. This
form must be submitted to Ecology at the address shown below within 30 days after completion of the site check/site assessment.
SITE INFORMATION: Include the Ecology site ID number if the tanks are registered with Ecology. This number may be found on
the tank owner's invoice or tank permit.
TANK INFORMATION: Please list all tanks for which the site check or site assessment is being conducted. Use the owner's tank
ID numbers if available, and indicate tank capacity and substance stored.
REASON FOR CONDUCTING SITE CHECK/SITE ASSESSMENT: Please check the ppropriate item.
Underground Storage Tank Section
CHECKLIST: Please initial each item in the appropriate box. Department of Ecology
PO Box 47655
SITE ASSESSOR INFORMATION: This information must be signed by the registered Olympia WA 98504-7655
site assessor who is responsible for conducting the site check/site assessment.
Site ID Number (Available from Ecology if the tanks are registered): 9046
Site/Business Name: Laurelhurst Oil Company
Site Address: 23601 Edmonds Way
Street
Edmonds
city
Washington
State
Zip Code
TANK INFORMATION I
Tank ID No. Tank Capacity Substance Stored
UST01 12,000 Gallons Diesel
Check one:
Investigate suspected release due to on -site environmental contamination.
Investigate suspected release due to off -site environmental contamination.
Extend temporary closure of UST system for more than 12 months.
UST system undergoing change -in-service.
X UST system permanently closed with tank removed.
Abandoned tank containing product.
Required by Ecology or delegated agency for UST system closed before 12/22/88.
Other (describe):
ECY 010-158 (Rev. 6-99) page 1
4
4
7Eachitem of the 7followirng checklist shall be initialed by the person registered with the Department of
colo m of s si ollow g I INO
E whose signature appears below.
u
1. The location of the UST site is shown on a vicinity map.
X
2. A brief summary of information obtained during the site inspection is provided.
(see Section 3.2 in site assessment guidance)
X
3. A summary of UST system data is provided. (see Section 3.1.)
X
4. The soils characteristics at the UST site are described. (see Section 5.2)
X
5. Is there any apparent groundwater in the tank excavation?
X
6. A brief description of the surrounding land use is provided. (see Section 3.1)
X
rX
7. Information has been provided indicating the number and types of samples collected, methods used to
collect and analyze the samples, and the name and address of the laboratory used to perform the
analyses.
8. A sketch or sketches showing the following items is provided:
- location and ID number for all field samples collected
X
- groundwater samples distinguished from soil samples (if applicable)
X
- samples collected from stockpiled excavated soil Pea Gravel PID Samples Collected
X
- tank and piping locations and limits of excavation pit
X
- adjacent structures and streets
X
- approximate locations of any on -site and nearby utilities
X
9. If sampling procedures different from those specified in the guidance were used, has justification for
using these alternative sampling procedures been provided? (see Section 3.4)
NA
10. A table is provided showing laboratory results for each sample collected including; sample ID number,
constituents analyzed for and corresponding concentration, analytical method and detection limit for
that method.
X
11. Any factors that may have compromised the quality of the data or validity of the results are described.
XX
12. The results of this site checkJsite assessment indicate that a confirmed release of a regulated
XX
substance has occurred.
Stephen M. Spencer
Person registered with Ecology
Business Address: 652 8th Avenue
Street
Environmental Management Services
Firm Affiliated with
Telephone: (253) 921-7059
Fox Island Washington
city State
I hereby certify that I have been in responsible charge ofperfonning the
submittingJalse information are subject to penalties under F-1
,,Gh-dp--te—r 73,
;11
November 5, 2005
Date Signature
98333
Zip Code
described above. Persons
Ecology
Ecology is an equal opportunity employer
page 2
Attachment C
r
UST Decommissioning Certification
4)
UST'Decommissioning Permits
E
UST Cleaning & Disposal Certification
Product & Triple Rinse Disposal Certification
Project Professional's Certification
0
City of Edmonds Permitting Requirements
Underground Storage Tank
Closure & Site Assessment Project
Ecology Site Identification Number: 9046
Project Location:
23601 Edmonds Way
Edmonds, Washington
May 9, 2005
Prepared for:
Laurelhurst Oil Company
7040 26 1h Avenue NE
Seattle, Washington 98115
(206) 523-4500
Prepared by:
Environmental Management Services, LLC
652 8th Avenue
Fox Island, Washington 98333
(253) 921-7059
www.emsgroupllc.com
U
Environmental Management Services, LLC
k A
0
0
Environmental Management ServiceS, LLC
IVA
I , 0
Laurelhurst Oil Company
Underground Storage Tank Closure Project
23601 Edmonds Way
Edmonds, Washington
Proiect Information Sheet
Project Name: Laurelhurst Oil Company
Underground Storage Tank Closure
23601 Edmonds Way
Edmonds, Washington
Project Contact: Stephen Spencer, Project Manager
Environmental Management Services, LLC
6528 1h Avenue
Fox Island, WA 98333
(253) 921-7059 Direct
(253) 369-6228 Fax
sspencer@emsgroupllc.com
Application Submitted By.
Laurelhurst Oil Company
7040-26 th Avenue NE
Seattle, Washington 98115
(206) 523-4500
Proffiect Application Completed By:
Environmental Management Services, LLC
Stephen Spencer, Project Manager
6528 th Avenue
Fox Island, WA 98333
(253) 921-7059 Phone
(253) 549-2717 Fax
sspencer@emsgroupllc.com
Environmental Management Services, LLC
6528 th Avenue Fox Island, Washington 98333
Phone: (2531921-7059 Fax: (253) 369-6228 erns(a-)ernsorouoIIc.corn
Ll
U
Environmental Management Services, LLC
List of Permit Attachments
• Property Information Sheet (2 pages)
• Critical Areas Checklist (2 Pages)
• SEPA Checklist (24 Pages)
• UST Decommissioning & Site Assessment Scope of Work (3 pages)
• LIST Closure 30 Day Notice to Ecology (2 Page)
• Project Figures
• Figure 1 - Site Location Map (1 Page)
• Figure 2 - LIST Closure (1 Page)
Environmental Management Services, LLC
6528 1h Avenue Fox Island, Washington 98333
Phone: (253) 921-7059 Fax: (253) 369-6228 erns(d)ernsorouollc.corn
SnohomishOnllno Government Information & Services
County4*
Washington
R E A L * Property Information
County Quick Info Directo Departments EmpLoynent Calendar Questions Search County Home
links: I
Common Assessor Home Treasurer Home Information on which Department, to contact
links: I
Please view Disclaimer If you have questions, comments or suggestions, please Contact Us.
Date/Time:5/10/2005 1 �02:08 PM Answers to Frequently Asked Questions about Parcel Data (opens as new window)
Return to Pro erty Information Entr"ggg
Parcel Number 00463300300401 Prev Parcel Reference 46330030040106
View Map of this parcel (opens as new window)'
11
Links to property information below
* Qe.neral Information. Names & Addresses, Property Legal Description
9 Treasuref's Tax Information
9 Assessor's. Property Values
Total Current Year's Taxes and other information
Market Values, Current Use Values (if any)
• Assessor's P oDertv Characteristics Tax Code Area, Use Code, Parcel Size
.- I r I . .............. ... ..... ............... .. ........
• Assessor's Structure(s) Data Data related to the structures on a parcel
• Assessor's. Property Sales
• Assessor's Mapping Information
Sales recorded since 7/31/1999
Traditional and Interactive maps, Neighborhood
General Information
Taxpayer Name 11 Address (contact the Treasurer if you have questions)
MARIER & MARIER LLC 117040 26TH AVE NE --- SEATTLE, WA 98155
If the above mailing address is incorrect and you want to make a change, see the information on Name and
Address Changes
Owner Name 11 Address (contact the Assessor if you have questions)
MARIER & MARIER LLC 117040 26TH AVE NE - - - SEATTLE, WA 98155
Street (Situs) Address (contact the Assessor if you have questions)
23601 EDMONDS WAY - - - EDMONDS, WA 98026
Parcel Legal Description
HANBURYS SOUND VIEW TRS BLK 003 D-01 - THAT PART TRACT 4 LY N & E OF CO RD LESS
ST HWY
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Treasurer's Taxinformation
Taxes For answers to questions about Taxes, please contact the Treasurer's office. (opens as
new window)
2005 Taxes for this parcel $1,696.81
0
0
(Taxes may include Surface Water Management and/or State Forest Fire Patrol fees. LID charges, if any, are not
included.)
To obtain a duplicate tax statement, either download our Tax Staternent-Request form or call 425-388-3366 to
request it by phone.
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Assessor's Property Data Characteristics and Value Data below are for 2005 tax year.
Please contact the Treasurer's office for answers to questions about Taxes (opens as new window)
For questions ONL Y about property characteristics or property values (NOT taxes),
please contact the Assessor's.- Office (opens as new window)
Property Values do not reflect adjustments made due to an exemption, such as a senior or disabled persons
Values exemption.
Reductions for exemptions are made on the property tax bill.
Tax Year 2005 Market Land $123,000 Market Improvement $32,3001 Market Total $155,3001
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Property Characteristics
Tax Code Area (TCA) 00227 View Taxing. Districts for this Parcel (opens as new window)
Use Code 553 Gasoline Service Stations
Size Basis ACRE Size 0.24
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Property Structures
No structures found for this parcel
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Property Sales since 7/31/1999
Explanation of Sales Information (opens as new window)
Sales data is based solely upon excise affidavits processed by the Assessor.
Transfer Receipt Sales Excise Deed Grantor (Seller) Grantee (Buyer) Other
Date Date Price Number Type Parcels
8/4/1999 $0 362390 QC THOMAS&CAROLE;FRANK&CAROL MARIER & No
MARIER MARIER LLC
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Property Maps Township/Range/Section/QLiarter, links to maps
Neighborhood 5601000 Explanation of Neighborhood Code (opens as new window)
Township 27 Range 04 Section 31 Quarter SW Find parcel maps for this Township Range/Section
View Map of this parcel (opens as new window)
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Critical Areas
Checklist
(2 Page)
#P20
V ED
All City of Edmonds
Development Services Department
P annin Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received:
City Receipt #:
Critical Areas File #:
Critical Areas Checklist Fee:— $135.00
Date Mailed to ADDlicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
laincomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER
Owner/Applicant:
DATE
PLEASE PRINT CLEARLY
Applicant Representative:
Laurelhurst Oil Co. — Tom Marier Stephen Spencer — EMS, LLC
Name Name
7040-26 1h Avenue N.E.
Street Address
Seattle WA 98115
city State Zip
*Telephone: (206) 523-4500
Email address (optional): rjmarier*uswest.net
6528 1h Avenue
Street Address
Fox Island WA 98333
city State Zip
Telephone (253) 921-7059
EmailAddress(optional): sspencer*emsgroupllc.com
#P20
Critical Areas Checklist CA File No:
*Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 23601 Edmonds Way, Edmonds WA
2. Property Tax Account Number: 00463300300401
3. Approximate Site Size (acres or square feet): 0.24 Acres
4. Is this site currently developed? X yes; _ no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
X Flat: 'less than 5-feet elevation change over entire site.
on
0 7
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% (a vertical rise of 10-feet
over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
Site contains areas of year-round standing water: No ; Approx. Depth:
Site contains areas of seasonal standing water: No ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway: No floodplain
of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? No
Flows are year-round? Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc) Asphalt Paved
11. Obvious wetland is present on site: None
1.
2.
3.
4.
For City Staff Use Only — --- — ---- — — — — ---------------- —
Plan Check Number, if applicable?
Site is Zoned?
SCS mapped soil type(s)?
Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
DETERMINATION
STUDY REQUIRED
Reviewed bv:
Date:
WAIVER
Critical Areas Checklist - 23601 Edmonds Way/5.10.2005
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�
SEPA ���w ��NN i � ��
4 Pages)
'
OV EDAf
St.
Purpose of Checklist.
CITY OF EDMONDS
ENVIRONMENTAL CHECKLIST
The State Environmental Policy Act (SEPA), chapter 43.2 1 C RCW, requires all governmental agencies to consider the environmental
impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with
probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help
you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal, if it can be done) and to
help the agency decide whether an EIS is required.
Instructions for Applicants:
This environmental checklist asks you to describe some basic information about your proposal. Governmental agencies use this
checklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS. Answer
the questions briefly, with the most precise information known, or give the best description you can.
You must answer each question accurately and carefully, to the best of your knowledge. In most cases, you should be able to answer
the questions from your own observations or project plans without the need to hire experts. If you really do not know the answer, or
if a question does not apply to your proposal, write "do not know" or does not apply". Complete answers to the questions now may
avoid unnecessary delays later.
Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations. Answer these questions if
you can. If you have problems, the governmental agencies can assist you.
Whe checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels of
land. Attach any additional information that will help describe your proposal or its environmental effects. The agency to which you
submit this checklist may ask you to explain your answers or provide additional infon-nation reasonably related to deten-nining if there
may be significant adverse impact.
NOTE: Projects generating new traffic will be required to submit a Traffic Study prepared by a licensed Professional Civil Engineer.
Specific requirements for the Traffic Study may vary depending upon the project, and will be provided by the City Engineer upon
request. Please contact the Engineering Division at 425-771-3202 for specific study requirements. City review of the Traffic Study
may require assessment of the "Development Project Peer Review" fee of $45 plus the cost of the review.
Use of checklistfor nonproject proposals:
Complete this checklist for nonproject proposals, even though questions may be answered "does not apply." IN ADDITION,
complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D).
For nonproject actions, the references in the checklist to the words "project," "applicant," and "property or site" should be read as
"proposer," and "affected geographic area," respectively.
A. BACKGROUND
1 Name of proposed project, if applicable: Laurelhurst Oil Co. UST Closure Project
2. Name of applicant: Laurelhurst Oil Co.
3. Address and phone number of applicant and contact person:
7040 — 26h Avenue NE
Seattle, WA 98115
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�pa chccklist - 23601 edmonds way:5.10.2005
4. Date checklist prepared: May 9, 2005
0 5. Agency requesting checklist: City ofEdmonds
6. Proposed timing or schedule (including phasing, if applicable):
UST Closure Scheduled for Mid June 2005
(STAFF COMMENTS)
7. Do you have any plans for future additions, expansion, or further activity related to or connected with this
proposal? If yes, explain.
Yes
(STAFF COMMENTS)
8. List any environmental information you know about that has been prepared, or will be prepared, directly related
to this proposal.
UST Closure and Site Assessment to be completed Mid June 2005
(STAFF COMMENTS)
9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting
the property covered by your proposal? If yes, explain.
None Pendiniz
(STAFF COMMENTS)
Page 2 of 24
sepa checklist - 23601 cdmonds way.5.10.2005
10. List any government approvals or permits that will be needed for your proposal, if known.
UST Closure Permit — Edmonds Fire Department
Ecology 30Day UST Closure Notification
Edmonds Critical Areas Checklist
(STAFF COMMENTS)
11. Give brief, complete description of your proposal, including the proposed uses and size of the project and site.
There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You
do not need to repeat those answers on this page.
Under orund Storage Tank (UST) Closure by Removal. One 12,000 gallon UST will be properly decommissioned by a
licensed UST closure contractor. The UST will be excavated, transported off site and disposed per WAC 173-340. A
UST Site Assessment will be completed during the UST closure by a licensed UST Site Assessor (WAC 173-340). A
UST Site Assessment Report will be generated detailing the site conditions during and following the UST closure.
(STAFF COMMENTS)
12. Location of the proposal. Give sufficient information for a person to understand the precise location of your
proposed project, including a street address, if any, and section, township, and range, if known. If a proposal
would occur over a range of area, provide range or boundaries of the site(s). Provide legal description, site plan,
vicinity map, and topographic map, if reasonably available. While you should submit any plans required by the
agency, you are not required to duplicate maps or detailed plans submitted with any permit applications related
to this checklist.
SE Comer of Edmonds Wgy and 236"Street SW, Edmonds Washington
(STAFF COMMENTS)
Page 3 of 24
scpa checklist - 23601 edmonds way:5.10.2005
TO BE COMPLETED BY APPLICANT
&- ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle- one): Flat, rolling, hilly, steep slopes, mountainous, other:
Flat, graded into storrn water conveyance system
(STAFF COMMENTS
b. What is the steepest slope on the site (approximate percent slope)?
<1%
(STAFF COMMENTS)
C. What general types of soils are found on the site (for example, clay, sand, gravel, peat, and muck)? If you
know the classification of agricultural soils, specify them and note any prime farmland.
Medium to cource sand with jzravel — Assumed.
(STAFF COMMENTS)
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
No
(STAFF COMMENTS)
Page 4 of 24
sepa checklist - 23601 edmonds �ay:5.10.2005
e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source
of fill.
Back fill will be placed into the UST excavation follwong UST removeal. Approximately 45 yards of We 17
engioneered fill material will be placed into the excavation and coLnpleted to 95%
(STAFF COMMENTS)
f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
No
(STAFF COMMENTS)
g. About what percent of the site will be covered with impervious surfaces after project construction (for
example, asphalt or buildings)?
90%
(STAFF COMMENTS)
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
None
(STAFF COMMENTS)
2. AIR
a. What types of emissions to the air would result from the proposal (i.e., dust, automobile, odors, and
industrial wood smoke) during construction and when the project is completed? If any, generally describe
and give approximate quantities if known.
Excavator exhaust during the three days of site work.
(STAFF COMMENTS)
b. Are there any off -site sources of emissions or odor that may effect your proposal? If so, generally describe.
Page 5 of 24
sepa checklist - 23601 edmonds way:5.10.2005
0
0
(STAFF COMMENTS
C. Proposed measures to reduce or control emissions or other impacts to the, if any:
(STAFF COMMENTS)
3. WATER
a. Surface:
(1) Is there any surface water body on or in the immediate vicinity of the site (including year-round and
seasonal streams, saltwater, lakes, ponds, and wetlands)? If yes, describe type and provide names.
If appropriate, state what stream or river it flows into.
No
(STAFF COMMENTS)
(2) Will the project require any work over, in, or adjacent to (within 200 feet) the described waters? If
yes, please describe and attach available plans.
(STAFF COMMENTS)
(3) Estimate the amount of fill and dredge material that would be placed in or removed from surface
water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill
material.
0 (4)
(STAFF COMMENTS)
Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known.
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sepa checklist - 23601 cdmonds �ay.5.10.2005
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(STAFF COMMENTS)
(5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan.
No
(STAFF COMMENTS)
(6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the
type of waste and anticipated volume of discharge.
No
(STAFF COMMENTS)
b. Ground:
(1) Will ground water be withdrawn, or will water be discharged to ground water? Give general
description, purpose, and approximate quantities if known.
(STAFF COMMENTS)
sepa checklist - 23601 edmonds way:5.10.2005
Page 7 of 24
(2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if
any (for example: Domestic sewage; industrial, containing the following chemicals ... ; agricultural;
etc.). Describe the general size of the system, the number of such systems, the number of houses to
be served (if applicable), or the number of animals or humans the system(s) are expected to serve.
(STAFF COMMENTS)
C. Water Runoff (including storm water):
(1) Describe the source of runoff (including storm water) and method of collection and disposal, if any
(include quantities, if known). Where will this water flow? Will this water flow into other waters?
If so, describe.
None — Project to take 3 days
(STAFF COMMENTS)
(2) Could waste materials enter ground or surface waters? If so, generally describe.
No
(STAFF COMMENTS)
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
None
(STAFF COMMENTS)
9 4. Plants
a. Check or circle types of vegetation found on the site:
Page 8 of 24
sepa checklist - 23601 edmonds way:5. 10.2005
deciduous tree: alder, maple, aspen, other:
evergreen tree: fir, cedar, pine, other:
x shrubs
grass
pasture
crop or grain
wet soil plants: cattail, buttercup, bulrush, skunk cabbage, other:
water plants: water lily, eelgrass, milfoil, other:
other types of vegetation:
(STAFF
b. What kind and amount of vegetation will be removed or altered?
None
(STAFF COMMENTS)
C. List threatened or endangered species known to be on or near the site.
None
(STAFF COMMENTS)
d. Proposed landscaping, use of native plants, or other materials to preserve or enhance vegetation on the site,
if any:
Page 9 of 24
sepa checklist - 23601 edmonds way:5.10.2005
(STAFF COMMENTS)
5. Animals
a. Check or circle any birds and animals that have been observed on or near the site or are known to be on or
near the site:
birds: hawk, heron, eagle, songbirds, other:
mammals: deer, bear, elk, beaver, other:
fish: bass, salmon, trout, herring, shellfish, other:
(STAFF COMMENTS)
b. List any threatened or endangered species known to be on or near the site.
None
(STAFF COMMENTS)
C. Is the site part of a migration route? If so, explain.
No
(STAFF COMMENTS)
d. Proposed measures to preserve or enhance wildlife, if any:
None
Page 10 of 24
sepa checklist - 23601 edmonds �ay:5.10.2005
0 (STAFF COMMENTS)
6. Energy and Natural Resources
a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used to meet the completed
project's energy needs? Describe whether it will be used for heating, manufacturing, etc.
None
(STAFF COMMENTS)
b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally
describe.
No
(STAFF COMMENTS)
C. What kinds of energy conservation features are included in the plans of this proposal? List other proposed
measures to reduce or control energy impacts, if any:
None
(STAFF COMMENTS)
0 7. Environmental Health
Page I I of 24
scpa checklist - 23601 edmonds way-.5.10.2005
a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and
explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so describe.
isUST closure and associated hazards to be managed by properly licensed UST porofessionals
(STAFF COMMENTS)
(1) Describe special emergency services that might be required.
Medical
(STAFF COMMENTS)
(2) Proposed measures to reduce or control environmental health hazards, if any:
Site Specific Health & Saft Plan
Properly licensed and traned employees
(STAFF COMMENTS)
b. Noise
(1) What types of noise exist in the area which may affect your project (for example: traffic, equipment,
operation, other)?
None
(STAFF COMMENTS)
Page 12 of 24
sepa checklist - 23601 edmonds way:5. 10.2005
(2) What types and levels of noise would be created by or associated with the project on a short-term or
a long-term basis (for example: traffic, construction, operation, other)? Indicate what hour's noise
would come from the site.
Excavator - 24 hours total
Soil Compaction — 4 hours total
(STAFF COMMENTS)
(3) Proposed measures to reduce or control noise impacts, if any:
Lift work hours
(STAFF COMMENTS)
8. Land and Shoreline Use
0 a. What is the current use of the site and adjacent properties?
Site Use: Fuel Station
Adjacent PropeM: Multi Family Residential
(STAFF COMMENTS)
b. Has the site been used for agriculture? If so, describe.
No
(STAFF COMMENTS)
Page 13 of 24
sepa checklist - 23601 edmonds �ay:5.10.2005
C. Describe any structures on the site.
8 x 8 Storage Shed
40 x 40 Fuel Dispenser Canop
4 x 40 Fuel Dispenser PuLnp island
(STAFF COMMENTS)
d. Will any structures be demolished? If so, what?
3 — 12,000 gallon UST, 40 x 40 Fuel Dispenser Canopy & 4 x 40 Fuel Dispenser Pump Island
(STAFF COMMENTS)
e. What is the current zoning classification of the site?
Commercial
(STAFF COMMENTS)
f. What is the current comprehensive plan designation of the site?
Unknown
(STAFF COMMENTS)
g. If applicable, what is the current shoreline master plan designation of the site?
NA
(STAFF COMMENTS)
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sepa checklist - 23601 edmonds way.5.10.2005
h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify.
No
(STAFF COMMENTS)
i. Approximately how many people would reside or work in the completed project?
None
(STAFF COMMENTS)
j. Approximately how many people would the completed project displace?
None
(STAFF COMMENTS)
k. Proposed measures to avoid or reduce displacement impacts, if any:
NA
(STAFF COMMENTS)
1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if
any:
None
(STAFF COMMENTS)
Page 15 of 24
sepa checklist - 23601 edmonds way:5.10.2005
9. Housing
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
housing.
NA
(STAFF COMMENTS)
b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-income
housing.
NA
(STAFF COMMENTS)
C. Proposed measures to reduce or control housing impacts, if any:
NA
(STAFF COMMENTS)
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including antennas; what is the principle
exterior building material(s) proposed?
NA
(STAFF COMMENTS)
Page 16 of 24
sepa checklist - 23601 edmonds way-.5.10.2005
b. What views in the immediate vicinity would be altered or obstructed?
0 None
(STAFF COMMENTS)
C. Proposed measures to reduce or control aesthetic impacts, if any:
None
(STAFF COMMENTS)
11. Light and Glare
a. What type of light or glare will the proposal produce? What time of day would it mainly occur?
NA
(STAFF COMMENTS)
b. Could light or glare from the finished project be a safety hazard or interfere with views?
NA
(STAFF COMMENTS)
C. What existing off -site sources of light or glare may affect your proposal?
None
(STAFF COMMENTS)
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sepa checklist - 23601 edmonds way:5.10.2005
d. Proposed measures to reduce or control light and glare impacts, if any:
NA
(STAFF COMMENTS)
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity?
Unknown
(STAFF COMMENTS)
b. Would the proposed project displace any existing recreation uses? If so, describe.
No
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the project or applicant, if any:
None
(STAFF COMMENTS)
Page 18 of 24
sepa checklist - 23601 edmonds way:5. 10.2005
13. Historic and Cultural Preservation
a. Are there any places or objec ts listed on, or proposed for, national, state, or local preservation registers
9 known to be on or next to the site? If so, generally describe.
(STAFF COMMENTS)
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance
known to be on or next to the site.
None
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts, if any:
None
(STAFF COMMENTS)
14. Transportation
a. Identify public streets and highways serving the site, and describe proposed access to the existing street
system. Show on site plans, if any.
NA
(STAFF COMMENTS)
Page 19 of 24
scpa checklist - 23601 edmonds way, 5 10 2005
b. Is site currently served by public transit? If no, what is the approximate distance to the nearest transit
stop?
Yes
(STAFF COMMENTS)
C. How many parking spaces would the completed project have? How many would the project eliminate?
None
(STAFF COMMENTS)
d. Will the proposal require any new roads, streets, or improvements to existing roads or streets, not
including driveways? If so, generally describe (indicate whether public or private).
No
(STAFF COMMENTS)
e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so,
generally describe.
No
(STAFF COMMENTS)
Page 20 of 24
sepa checklist - 23601 edmonds way-5 10 2005
f. How many vehicular trips per day would be generated by the completed project? If known, indicate when
peak volumes would occur.
None
(STAFF COMMENTS)
g. Proposed measures to reduce or control transportation impacts, if any:
None
(STAFF COMMENTS)
15. Public Services
a. Would the project result in an increased need for public services (for example: fire protection, police
protection, health care, schools, other)? If so, generally describe.
No
(STAFF COMMENTS)
b. Proposed measures to reduce or control direct impacts on public services, if any:
None
(STAFF COMMENTS)
Page 21 of 24
scpa chccklist - 23601 edmonds way-5 10 2005
16. Utilities
a. Circle utilities currently available at the site<� natural gas(�i) refuse service
Q� septic system, other:
(STAFF COMMENTS)
b. Describe the utilities that are proposed for the project, the utility providing the service, and the general
construction activities on the site or in the immediate vicinity which might be needed.
None
(STAFF COMMENTS)
0
C. SIGNATURE
The above answers are true and complete to the best of my knowledge. I understand that the lead agency is relying on them to
make its decision.
Signature of Proponent
Date Submitted
Page 22 of 24
sepa checklist - 23601 edmonds way:5.10.2005
D. SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS
(do not use this sheetforproject actions)
Because these questions are very general, it may be helpful to read them in conjunction with the list of the elements of the
environment.
When answering these questions, be aware of the extent the proposal, or the types of activities likely to result from the
proposal, would affect the item at a greater intensity or at a faster rate than if the proposal were not implemented. Respond
briefly and in general terms.
1. How would the proposal be likely to increase discharge to water; emissions to air; production, storage, or release of
toxic or hazardous substances; or production of noise?
No Possibili1y
Proposal measures to avoid or reduce such increases are:
2. How would the proposal be likely to affect plants, animals, fish, or marine life?
0 No Possibilfty
Proposed measures to protect or conserve plants, animals, fish, or marine life are:
None
3. How would the proposal be likely to deplete energy or natural resources?
No Possibili1y
Proposed measures to protect or conserve energy and natural resources are:
None
Page 23 of 24
sepa checklist - 23601 edmonds ay: 5,10.2005
4. How would the proposal be likely to use or affect environmentally sensitive areas or areas designated (or eligible or
under study) for governmental protection; such as parks, wilderness, wild and scenic rivers, threatened or endangered
species ha b i tat, historic or cultural sites, wetlands, floodplains, or prime farmlands?
0
Proposed measures to protect such resources or to avoid or reduce impacts are:
None
5. How would the proposal be likely to affect land and shoreline use, including whether it would allow or encourage land
or shoreline uses incompatible with existing plans?
No Possibili1y
Proposed measures to avoid or reduce shoreline and land use impacts are:
None
6. How would the proposal be likely to increase demands on transportation or public services and utilities?
No Possibility
Proposed measures to reduce or respond to such demand(s) are:
None
7. Identify, if possible, whether the proposal may conflict with local, state, or federal laws or requirements for the
protection of the environment.
No Possibili1y
scpa checklist - 23601 edmonds way:5.10.2005
Page 24 of 24
C C
UST Decommissioning 'co '#W'-
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& Site Assessment
(D
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Scope of Work 0
(3 pages) Q) (D
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Environmental Management Services, LLC
May 2, 2005
Revised: June 15, 2005
Laurelhurst Oil Company
UST Closure Work Plan
23601 Edmonds Way
Edmonds, Washington
Environmental Management Services, LLC (EMS) will be managing the closure and removal of
one (1) 12,000 gallon diesel underground storage tank (UST) located at 23601 Edmonds Way,
Edmonds, Washington. This work plan detailed the closure activities and project responsibilities
during the UST decommissioning project.
The tasks included in this work plan are presented below.
Task I — Pre -Construction Activities
Pre -construction activities will include the following tasks:
• Preparation of site specific Health and Safety Plan;
9 Application for UST Decommissioning permit through Edmonds / King County Fire
Department;
• Notification of proposed UST closure activities to the Department Of Ecology (Ecology);
• Submittle of UST Closure Bid to select contractors.
The decommissioning contractor will be responsible for physically preparing the site for
upcoming work and deliver needed personnel, machinery, and supplies to the worksite will be
the responsibility of the selected contractor. Work activities in this task include:
• Oversee the mobilize excavation equipment and supplies to the site;
• Install temporary security fencing where necessary (location for fence shown on site map
attached);
• Install silt fencing, straw bails and other storm water management best management
practices (BMP's) around the work area perimeter (BMP Placement shown on site map
attached);
• Install signage (e.g. "Keep Out", "No Trespassing", "Emergency Phone Numbers", etc.)
Task 2 — Surface Demolition Activities
The decommissioninc - items:
I contractor will be responsible for the following
Concrete and asphalt covering the underground storage tank and the pump island area will be
removed and disposed of off site at a local disposal or recycling facility by the contractor. Dust
Environmental Management Services, LLC
6528 th Avenue Fox Island, Washington 98333
Phone: (253) 921-7059 Fax: (253) 369-6228 ems@emsgroupllc.com
UST Closure and Site Assessment Work Plan & Cost Proposal
Laurelhurst Oil Company UST Closure
23601 Edmonds Way
Edmonds, Washington
April 4, 2005
control will be provided as necessary using water. No water will be discharged from the site
durinq demolition activities. Straw bails or silt fence will be placed on the down gradient side of
the excavation area. Any water accumulating on the northern end of the site will be pumped,
transported off site and disposed at a local disposal facility.
Trucks entering the property site will enter from the south bound lanes of Edmonds Way. The
trucks will leave the site from the north entrance/ exit on to 236 th Street to the east through the
intersection and south along Edmonds way to 1-5. Flagging use exiting the site to 236th is not
anticipated as the total truck traffic will be limited to four loads of import and one load of export.
PCS transport off site is not anticipated.
Task 3 — UST Closure Activities
EMS will be responsible for permitting through the City of Edmonds or King County. This
process will be required for the UST closure activity. The permitting process can take several
weeks. A 30 day notice will be required by the Department of Ecology. This notice is to be
submitted by the UST decommissioning company or the project environmental consultant. It is
not uncommon for Ecology to wave the 30 day notice if the closure schedule can be expedited.
The decommissioning contractor will be responsible for the following items:
Upon receipt of the proper permitting, decommissioning activities will be started. Each
dispenser and piping backflow devises will be dismantled to allow all gasoline to be drained
back into the USTs prior to any excavation activity. Each dispenser pump will be drained and
removed from the pump islands. The UST will be pumped of all existing contents and triple
rinsed to remove any residual contents. UST contents will be disposed at a local recycling
facility. All associated product piping will be exposed by excavation and inspected by the UST
Site Assessor prior to removal.
The UST be excavated exposing the top of the UST and associated piping. All piping will be
removed only after it is inspected by the UST Site Assessor. Piping location will be plugged
with the appropriate sized plugs. A vent will be erected on each UST to allow for venting of the
UST during the inertion process.
Following the UST inertion and cleaning process, each UST will be excavated and removed
under the supervision of a State of Washington certified UST Site Assessor and an IFCI certified
UST decommissioner per Ecology decommissioning requirements set out in WAC 173-360.
Each fiberglass UST will be disposed of through a local demolition debris disposal company.
The UST excavation area will be backfilled with pit run material following the UST closure and
site assessment activities. Backfill will be compacted to meet 95% proctor or as specified by the
project engineer. The excavation area will be capped with 5/8" recycled or better gravel backfill.
Environmental Management Services, LLC
6528 1h Avenue Fox Island, Washington 98333
Phone: (253) 921-7059 Fax: (253) 369-6228 ems@emsgroupllc.com
UST Closure and Site Assessment Work Plan & Cost Proposal
Laurelhurst Oil Company UST Closure
23601 Edmonds Way
Edmonds, Washington
Task 4 — Sampling, Closer Report Preparation and Submittal
April 4, 2005
UST Site Assessment activities will be completed as outlined in the Washington Administrative
Code (WAC) 173-360 and new Ecology sampling method 5035 by a licensed UST Site
Assessor provided by EMS. Soil samples will be collected from below the UST, from each
excavation sidewall, from the excavated soil stockpile, from below the UST system piping at 100
foot intervals and from below each UST dispenser. Up to 12 samples are anticipated. If
groundwater is encountered during excavation activities, representative samples (2) will be
collected from the excavation. Each sample will be analyzed for diesel range petroleum
hydrocarbons by method NWTPH-Dx. Sample analyses will be complete by an Ecology
accredited laboratory.
Following LIST closure and sampling activities, a UST Site Assessment and Closure Report will
be completed detailing the closure activities, site conditions and sample analytical results.
Site assessment and report preparation time can vary depending on conditions encountered
during the decommissioning process. Total time on site is anticipated not to exceed 8 hours. In
the event unanticipated services are required, additional time and expense beyond this scope
will be accrued only after prior client approval based on the attached rate sheet.
The following field screening techniques will be used on each sample collected:
• Olfactory Observations
0 Visual Observations
• Photoionization Detector (PID) — As necessary
• Sheen Test
Task 5 — Petroleum Contaminated Soil Management
Petroleum Contaminated Soil (PCS) exceeding the Model Toxic Control Act (MTCA) method A
cleanup limits (MTCA WAC 173-340), will be staged onsite for later disposal. A PCS staging
area will be completed using hay bails or other appropriate storm water management BMP's.
All PCS will be placed on and covered with 6 millimeter plastic. It is not expected that PCS will
be encountered during this proffiect.
Task 6 — Test Pit Sampling
Following the closure of the UST system, EMS will complete up to five test pit excavations to a
depth of 10 to 12 feet bgs using the onsite contractor's excavation equipment. Soil samples will
be collected from each test pit at 4 to 5 feet bgs and 10 to 12 feet bgs. Each sample will be
analyzed for total petroleum hydrocarbons by method HCID (Hydrocarbon Identification Scan).
EMS will complete a separate report detailing the sample collection process and analytical
results along with recommendations. I
Environmental Management Services, ILLC
6528 th Avenue Fox Island, Washington 98333
Phone: (253) 921-7059 Fax: (253) 369-6228 ems@emsgroupllc.com
10
0
UST GloSure.130 Day
Notice to Ecology
(I Page)
I
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CD 01
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=3 0
C6
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(f) z
alm� UNDERGROUND STORAGE TANK
30 DAY NOTICE
W A S H I N G T 0 N S T A I I
I E P A R T M E N T 0 F
E C 0 L 0 G Y See back of form for instructions
Please -.1 the appropriate box: X Intent to Close
Site Information
Site ID Number: 9046
(Available from Ecology if the tanks are registered)
Site/Business Name: LAURELHURST OIL CO INC
Street
Site Address: 23601 Edmonds Way
City/State: Edmonds, Washington
Zip Code: 98026 Telephone: (360) 683-9522
FOR OFFICE USE ONLY
Site ID
Owner ID #:
Owner Information
(This form will be returned to this address)
UST Owner/Operator: LAURELHURST OIL CO INC
Mailing Address: 7040 26th Avenue NE
City/State: Seaftle, WA 98155
Zip Code: 98134 Telephone: 206-523-4500
Tank Installation Company (if known). Fill out this section ONLY if tanks are being installed.
Service Company Contact Name
Address
0 Street P.O. Box— -- Telephone ( --- )
City
State Zip Code
Tank Permanent Closure Company (if known). Fill out this section ONLY if tanks are being closed.
Service Company: Environmental Management Services, LLC Contact Name: Stephen Spencer
Address: 652 8th Avneue
Street
Fox Island Washington 98333
City State Zip Code
Tank Closure Information
Fill out this section ONLY if tanks are being closed.
Projected
Closure Tank Substance Date Tank
Tank ID Date Capacity Stored Last Used
UST 1 June 15, 2005 12000 Gallons Diesel Unknown
To receive this document in an alternative format. contact the TOXICS CLEANUP
Is There
Product In
the Tank
(Yes/No)
No
i
Telephone (253) 921-7059
Tank Installation
Information
Fill out this section ONLY if
tanks are being installed.
If No, Date
Tank Was Approx.
Pumped Tank ID Install Date
March 2005 1
-826-7716 (VOICE) OR (360) 407-6006 (TIDID).
ECY 020-95 (Rev. 3-01)
Instructions
0 Please Read Carefully
Check the appropriate box for tank closure, tank installation, or both.
AFTER COMPLETING THIS FORM. RETURN TO:
TOXICS CLEANUP PROGRAM
DEPARTMENT OF ECOLOGY
P.O. BOX 47655
OLYMPIA, WA 98504-7655
Site and Owner Information
Fill in the site and owner information. Please include the Ecology site number for tank closures; also, be sure to
provide telephone numbers so that any problems can be resolved quickly. Confirmation of receipt of this form
will be returned to the owner.
Tank Installation Company
List the installation company, if known. Upon receipt of the completed form, Ecology will validate it and return
it to the owner. This validated form allows you to receive a one time drop of product, for UST system testing
purposes only. To dispense product and receive additional deliveries, you must complete the Master
Business License registration and obtain your Tank Tag from Ecology. The registration information
must be submitted to the Department of Licensing within 30 days of installation to receive a Master
Business License with the appropriate tank endorsement(s).
Tank Permanent Closure Company
List the closure company, if known. Upon receiving a completed 30 day closure form, Ecology will stamp the
date received on the form and return a copy to the owner.
*Contact your local fire marshal and planning department prior to tank closure to find out if any additional
permits are required by county or other local jurisdictions. Compliance with the State Environmental Policy Act
(SEPA) Rules, Chapter 197-11 WAC, may be necessary.
Closure may proceed 30 days after the date stamped on the form. A site assessment is required at the time of
closure. Contamination found or suspected at the site must be reported to the appropriate Ecology regional
office within 24 hours. If the contamination is confirmed, a site characterization report must be submitted to the
regional office within 90 days; if contamination is not confirmed, a site assessment report must be submitted to
the above address within 30 days.
Please note: Individuals performing UST services MUST be certified by the International Fire Code
Institute (IFCI), or have passed another qualifying exam approved by the Department.
Tank Information
List tanks to be installed or closed. Please report tank ID number(s) for tanks to be closed and assign new tank
ID number(s) to tanks being installed. Do not use existing numbers from closed tanks.
The following tanks are exempt from notification requirements:
Farm or residential tanks, 1, 100 gallons or less, used to store motor fuel for personal or farm use
only. The fuel must not be for resale or used for business purposes.
Tanks used for storing heating oil that is used on the premises where the tank is located.
Tanks with a capacity of I 10 gallons or less.
Equipment or machinery tanks such as hydraulic lifts or electrical equipment tanks.
Emergency overflow tanks, catch basins, or sumps.
1 0
Project Figures
Figure 1 - Site Location Map (1 Page)
Figure 2 - Site Plan (1 Page)
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Site Locations Map
UST Closure Bid Request
23601 Edmonds Way
Edmonds Washington
Project No./Name: Laurehurst Fuels IFigure / Sheet No
Edmonds UST Project
Date: May 07, 2005 1 of 3
Drawn / Created By: S.Spencer
Checked By: S.Spencer
Environmental Management Services, LLG 1-roviaing i-racricie Lnvironmenrat uomptiance ooiuvons
0
Trucks to 1-5
236th Street SW
Concrete Curb
Truck Exit
19 6
. .. ............ .
0
Aainto�nan e�
jt'Idling
ld�in lump Isl�nd W/
�uRi em'a in P4 Dispensers T
(To Be Removed)
Temporary PCs Storage Area Asphalt Parkin(
PCs to be placed onto 6 mil plastic
and covered with 6 mil plastic.
L"M X
V.,
Straw Bails I Silt Fence
for Water Runoff Control
12,000 Gallon
Diesel Fuel LIST
(To Be Removed)
Concret ueling Pad
(To Be emoved)
Pump Island Canopy
(To Be Removed)
Water For Dust Control
(Used As Necessary)
Lot
Concrete Curb
C
0
CO
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2
0-
4,0�. 40'
Approximate Scale In Feet
Project No./Name: Laurehurst Fuels Figure / Sheet No.
Site Map
t Edmonds LIST Project
'z,J LIST Closure Bid Request
Date: May 07, 2005
W 0 Oil 23601 Edmonds Way 2 of 3
L/"Y' EMS Edmonds Washington Drawn / Created By: S.Spencer
" U Checked By: S.Spencer
Invironmental Services
Environmental Management Services, LLC Providing Practicle Environmental Compliance Solutions
0
0
Pump island & canopy - View to the north
Pump island & canopy - View to the south
Approximate UST location
Pump island & 4 fuel dispensers
Pump island & canopy
On site storage & Maintenance shed - To Remain
Project Photographs Project No./Name: Laurehurst Fuels Figure / Sheet No.
Edmonds UST Project
UST Closure Bid Request
23601 Edmonds Way Date: May 07, 2005 3 of 3
wv�L)!
� I,. OEMS Edmonds Washington Drawn / Created By: S.Spencer
-Environmental Services Checked By: S.Spencer
Environmental Manaqement Services, LLC Providing Practicle Environmental Compliance Solutions
IJ-"
Environmental Management Services, LLC
0
Underground Storage Tank Decommissioning Certification
November 5, 2005
This is a statement of Underground Storage Tank Decommissioning. This statement is
provided by Environmental Management Services, LLC (EMS) following the decommissioning of
1 - 12000 gallons diesel fuel underground storage tanks (UST) for Laurelhurst Oil Company.
EMS issues this statement to the property owner or they're representative from where the LIST
was decommissioned. EMS states this decommissioning has occurred following the local and
state rules and regulations as defined by the Uniform Fire Code (UFC) and Washington
Administrative Code (WAC).
Project Client:
Project Name:
Project Address:
Type Of Decommissioning
Decommissioning Date:
Permit Issuance Date:
UST Dimensions:
UST Total Gallons:
Certified LIST Decommissioner:
Certified LIST Site Assessor:
Stephen IT �pencer, C�A
Laurelhurst Oil Company
Edmonds UST Closure Project
23601 Edmonds Way
Edmonds, Washington
Removal from Sub -surface
October 5, 2005
August 2005 (City of Edmonds)
9.0' x 25.0'
12,000 Gallons (Approximate)
Mickey McAloon
Stephen Spencer
Environmental Management Services, LLC.
652-8"'Avenue, Fox Island, Washington 98333
Phone: (253) 921-7059 Fax: (253) 369-6228 E-Mail: ems@emsgroupllc.com
November 5, 2005
Date