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11.22.10-Ecology Response to 30-Day Notice.pdfUNDERGROUND STORAGE TANK 30 DAY NOTICE wASRINIIIItIIIIE 6E PARI NERi DF E C O L O G Y See back of form for instructions Pleapropriate box: Cl Intent Wintent Cl Both 9009 to Install to Close .?_V10 -Dept0A UP?AW nformation Uftm herr Site/Business Name ?C -a QA\ Street Site Address City/State d�w�a W 1k Zip Code Telephone L__) Mazo-sloho;ntsh FOR OF Y Site ID FS ID #: ��` ALIDATED #duv ' U ZU-10 Owner Information (This form_.will be returned to this address) USTOwner/Operator Mailing Address aaa�L& C'k6v Ava""E-- S! et P.O. Box City/State 'FV u'e._* %,VA Zip Code 'q3 Telephone �z 25`1-535'3 Tarek Installation Company (if known). Fill out this section ONLY if tanks are being installed. Service Company Contact Name Address Street P.O. Box City State Zip Code Telephone (__) Tank Permanent Closure Company (if known). Service Company Address Fill out this section ONLY if tanks are being closed. Contact Name Street P.O. Box Telephone U 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 fast Used (Yes/No) Pumped Tank ID Install Date Lol�� t,ratC t�u� c�ra� vN�L �X1kC FCY 020-95 (Rev. 01-06) STATE OF WASHINGTON DEPARTMENT OF ECOLOGY PO Box 47600 - Olympia, WA 98504-7600 - 360-407-6000 711 for Washington Relay Service - Persons with a speech disability can call 877-833-6341 Tank Owners/Operators and Other Interested Parties: This letter summarizes requirements for the removal or closure -in-place of regulated underground storage tank (UST) systems based on state UST regulations, Chapter 173-360 WAC. These requirements do not apply to non-regulated UST systems such as heating oil tanks and farm/residential UST systems of fewer than 1,100 gallons capacity. Complete UST regulations can be obtained from any Ecology regional office. The following key elements of an UST system closure are described: 1. Requirement to use licensed or certified contractors; 2. Thirty -day notification requirement; 3. Permanent closure procedures; 4. Required documentation; 5. Site Assessment requirement; 6. Responsibility for reporting releases discovered during tank removal: a. Local permit(s); b. Dangerous Waste considerations; and C. Record keeping. 1. Licensed or Certified Contractors Must Be Used Contractors who perform tank decommissioning are required to have a certification from the International Code Council (ICC). Contractors are required to carry proof of certification on site. Ecology does honor ICC certification from other states. Contact the department for further information. 2. Thirty -day Notification Re uirement The regulations (WAC 173-360-385) require that Ecology be notified at least thirty (30) days prior to beginning tank closure. This written notification should be submitted on the enclosed 30 -Day Notice form. The 30 -day notice allows time for a state or local UST inspector to contact the tank owner/operator or the contractor performing the closure possibly to be on site while closure activities are being conducted. The contents of the tank may be pumped during the 30 -day notice period. Petroleum products can possibly be recycled. Dangerous wastes will need to be disposed of in accordance with Dangerous Waste Regulations, Chapter 173-30 WAC. 3. Permanent Closure Procedures Permanent closure is required to be completed by a licensed/certified contractor within sixty (60) days after expiration of the 30 -day notice. A written request for an extension may be submitted stating the reason for the requested extension. To permanently close an UST system, the contractor must empty and clean the tank by removing all liquids and accumulated sludge's. All liquids and sludge's should be removed and disposed of in an approved manner. The tank must then either be removed from the ground or filled with a solid inert material. Sand slurry, a weak cement slurry (to avoid creating a giant boulder that may cause problems later on), or polyurethane foam are all acceptable fill materials. All piping shall be either capped (except any vent lines) or removed from the ground. Although state regulations allow in-place closures, Ecology strongly recommends tank removal. It is easier to obtain the soil samples needed for the site assessment (described below) when the tank is removed. Tank removal may make any future sale of property less complicated. A site assessment as well as a TemporarylPermanent Closure and Site Assessment Notice (enclosed) are required even if an UST system is closed in place. Local authorities should be contacted regarding local closure -in-place policies. Tank closure is a dangerous operation because of the potential for fire, explosion, and other hazards. Only qualified personnel should perform this work. An UST closure should not be done by an unqualified or inexperienced person. 4. Required Documentation Contractors must certify that their services comply with the requirements for UST closures by submitting the Temporary/Permanent Closure and Site Assessment Notice form (enclosed). The contractor must submit this form to Ecology within thirty (30) days following the completion of an UST system closure. This form must be signed by the owner or operator and by the contractor. The Temporary/Permanent Closure and Site Assessment Notice are needed as a written document to "close" tank(s)lsite(s) on Ecology's UST database. Please include the Ecology Site ID number on this form. Any active tank permits for UST systems being.closed shall also be returned to Ecology within thirty (30) days of closure activities. 5. Site Assessment Requirements 2 Before permanent closure can be completed, a site assessment must be performed. A site assessment is an investigation for the presence of a release at that portion of the UST site where the UST system is located. This investigation must be completed by a person certified by ICC or Washington registered professional engineers who are competent, by means of examination, experience, or education, to perform site assessments. The site assessment must be performed according to Ecology's Guidance for Site Checks and Site Assessments for Underground Storage.Tanks. The guidance provides information on required sampling procedures, the number and locations of samples to be obtained, and required laboratory analyses and reporting. Increasingly, insurance companies and lending institutions are requiring proof that a proper site assessment has been done. This increases the importance of a site assessment being performed according to Ecology's guidelines, and that tank owners maintain records of site assessment results. The site assessor is required to submit a Site Check/Site Assessment Checklist (enclosed) and report within thirty (30) days of completion of the site assessment. The Site Check/Site Assessment Checklist is needed to "close" Ecology's UST site files following a "clean" closure. If a release of product is discovered, a site. characterization report, outlined in the cleanup regulations (Chapter 173-340 WAC), will be required. In this case, the Site Check/Site Assessment Checklist and report is no longer required to be submitted. 6. Responsibility for Reporting Releases Discovered During Tank Removal If contaminated soil, contaminated ground water, or free product (liquid or vapor) is discovered during the tank removal, site assessment, or by any other means, the owner and/or operator must notify the appropriate regional Ecology office within twenty-four (24) hours of detection of the release. Soil contaminated by petroleum is considered a hazardous substance under the Washington Model Toxics Control Act (cleanup regulation).' Generally, it can be treated on-site or disposed of as a solid waste, but in some instances it may need to be disposed of as a dangerous waste. Soil contaminated by a hazardous substance other than petroleum must be dealt with on a case-by-case basis. a. Local Permit Requirements Although certain aspects of the Uniform Fire Code are preempted by the state UST rules, local permit requirements still apply in many areas of the state. A closure permit may be required from the local fire department or other local agency prior to closure. You should contact them at the same time you file your 30 -day notice with Ecology. b. . Dangerous Waste Considerations Underground storage tanks that have been used to store petroleum contain sludge that can have high benzene content. If the underground storage tank was used to store leaded petroleum, there may also, be a high lead in the sludge. This sludge may be regulated as a dangerous waste. Persons handling and disposing of the sludge should ensure they understand the applicable state Dangerous Waste Regulations contained in Chapter 173-303 WAC. It is the responsibility of the tank owner or operator to determine if the sludge designates as a dangerous waste based on Chapter 173-303 WAC and; if so, to obtain an EPA/state ID number by filing a.notifcation of Dangerous Waste activities on Ecology Form 2. (Ecology Form 2 can be obtained at Ecology's regional offices.) Sludge considered to be a dangerous waste must be sent to an -approved treatment, storage, and disposal (TSD) facility. if the sludge is not a dangerous waste, it a solid waste and may be disposed of at a permitted municipal landfill with the permission of the landfill operator. Gasoline, diesel, or fuel oil stored in USTs being closed and which can be directly reused as product (e.g., gasoline sold and used in a motor vehicle) are not considered to be dangerous. wastes. ,Fuel and water mixtures are also not required to have a manifest and EPA/state ID number if -they are sent off-site to be burned for energy recovery. The owner or operator should request documentation from the licensed decommissioning firm closing the tank that such fuels have, in fact, been burned for energy recovery in an approved manner. However, if it is known that other dangerous wastes (e.g., solvents) have been added to the tank contents, the whole.mixture must be managed as dangerous waste. For further information on state dangerous waste criteria, or if you need an EPA/state ID number, contact Dangerous Waste staff at the appropriate Ecology regional office. 0 c. Record Keepinq The results of a site assessment following an UST closure must be maintained for at least five (5) years after completion of the permanent closure, in one of the following ways: • by the owners and operators who took the UST system out of service; • by the current owners and operators of the UST system site; or • by mailing these records to the department or delegated agency if they cannot be maintained at the closed facility. Although the rule requires record retention for only five (5) years, it is recommended that records be maintained indefinitely; proof of a "clean closure" is very important regarding any future property transfers or related business transactions such as obtaining loans or insurance. FOR FURTHER INFORMATION OR FOR REPORTING CONTAMINATED SITES contact the following Ecology offices: Northwest Regional Office (Bellevue): (425) 649-7000 Southwest Regional Office (Lacey): (360) 407-6300 Central Regional Office (Yakima): (509) 575-2490 Eastern Regional Office (Spokane): (509) 329-3400 Headquarters (Lacey): (360) 407-7170 or 1-800-826-7716 FOR INFORMATION REGARDING SITES LOCATED ON INDIAN LANDS contact the Environmental Protection Agency at the addresses below: EPA Region 10, 1200 6th Avenue, MS OW -137, Seattle, WA 98101-1128 (206) 553-1086 or Jim Greeves, EPA Washington Operations Office, Lacey WA 98503 (360) 753-8072 If you need further information regarding underground storage tanks, please call any of the Ecology offices listed above. Revised (4.1122104) 5 i.w9dNSfh2�#9&ET�.Fib3al.z+.Y1i4z°.,'99� � Eb"C."%s R»f16"ss"r."��5%�istit4�F^-F�i UNDERGROUND STORAGE TANK VF FOR OFFICE USE ONLY Closure and Site Assessment Notice Site Owner Owner I ID #: W A S H I H 6 T 0 H S T A I E E C A U T L r M T G 0 F See back of form for instructions Please ✓ the appropriate box(es) ❑ Temporary Tank Closure ❑ Change -In -Service ❑ Permanent Tank Closure ❑ Site Check/Site Assessment Site Information Site ID Number (Available from Ecology if the tanks are registered) Site/Business Name Site Address City/State Zip Code Street Telephone (_) Owner Information UST Owner/Operator Mailing Address Street City/State Zip Code Owners Signature Tank Closure/Change-In-Service Company Service Company Certified Supervisor Supervisor's Signature Address Street P.O. Box Telephone (_) Decommissioning Certification No. Date P.O. Box Telephone (�} City State Zip Code Certified Site Assessor Address Street Site ChecklSite Assessor P.O. Box Telephone i—) City State Zip Code Tank Information Tank ID Closure Date Closure Method Tank Capacity Substance Stored Contamination Present at the Time of Closure ❑ ❑ ❑ Yes No Unknown Check unknown if no obvious contamination was observed and sample results have not yet been received from analytical lab. © ❑ 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 1-800-833-6388 (VOICE) OR 711 (TTY). ECY 020-94 (Rev. 6-99) Instructions SER COMPLE71NG THIS FORM. RETURN TO: TOXICS CLEANUP PROGRAM DEPARTMENT OF ECOLOGY Please Read Carefully P.O. sox 47655 OLYMPIA, WA 98504-7655 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. 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 permanent closure or change -in-service. Ask to see the closure company supervisor's ICC Certification and make sure that the certified supervisor signs this form. Please note: Individuals performing services MUST be certified by the International Code Council (ICC), 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 boxes) 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 (TDD) Eastern (509) 329-3400 (voice) (509) 329-3569 (TDD) Southwest (360) 407-6300 (voice) (360) 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 presale or used for business purposes. •3 Tanks used for storing heating oil that is used on the premises where the tank is located. Tanks with a capacity of 110 gallons or less. ❖ 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 1-800-8.26-7716 (Message). ftm UNDERGROUND STORAGE TANK FOR OFFICE USE ONLY Site Check/Site Assessment Checklist Site #: WA SN INBTaN STATE I E P A A 3 x f x T a F - Facility Site 1D #: IC0L0GY 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 ICC 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 IDnumber 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 CHECKISITE ASSESSMENT: Please check the ro riate item. Underground Storage Tank Section CHECKLIST: PIease 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): Site/Business Name: Site Address: Telephone: U Street City State Zip Code • - 4-• Tank ID No. Tank Capacity Substance Stored 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. UST system permanently closed with tank removed. Abandoned tank containing product. Required by Ecology or delegated agency for UST system closed before 12122188. Other (describe): ECY 010-188 (Rev. 2-06) CHECKLIST Each item of the following checklist shall be initialed by the person registered with the Department of. Ecology whose signature aepears below. YES NO 1. The location of the UST site is shown on a vicinity map. 2. A brief summary of information obtained during the site inspection is provided. (see Section 3.2 in site assessment guidance) 3. A summary of UST system data is provided. (see Section 3. 11.) 4. The soils characteristics at the UST site are described. (see Section 5.2) 5. Is there any apparent groundwater in the tank excavation? 6. A brief description of the surrounding land use is provided. (see Section 3.1) 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 - groundwater samples distinguished from soil samples (if applicable) - samples collected from stockpiled excavated soil - tank and piping locations and limits of excavation pit - adjacent structures and streets - approximate locations of any on-site and nearby utilities ' 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) 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. 1 11 ' Anv fartnrs that may have compromised the quality of the data or validity of the results are described. 12. The results of this site check/site assessment indicate that a confirmed release of a regulated substance has occurred. Person registered. with Ecology Firm Affiliated with Business Address: Telephone: (� street City state Zip Code I hereby certify that I have been in responsible charge ofperforming the site checklsite assessment described above. Persons submitting false information are subject to penalties under Chapter 173.360 WAC. Date Signature of Person Registered with Eoology if you need this publication in an alternate format, please contact Toxics Cleanup Program at (360) 407-7970. For persons with a speech or hearing impairment call 711 for relay service or 800-833-6388 for TTY.