1. Contact local fire marshal. 5. Provide a sketch locating piping, tanks and soil a P.E. or L.G., with all closure site sampling locations. assessment reports bearing the signature 2. Plan entire closure event. and seal of the P.E. or L.G. If a release has 6. Submit a closure report in the format of 3. Conduct Site Soil Assessment. not occurred, the supervision, signature or (including the form UST-2) within thirty (30) seal of a P.E. or L.G. is not required. 4. If removing or closing in place, refer to days following the site investigation. API Publication 2015 Cleaning Petroleum 8. Keep closure records for three (3) years. 7. If a release from the tanks has occurred, the Storage Tanks and 1604 Removal and site assessment portion of the tank closure Disposal of Used Underground Petroleum must be conducted under the supervision of Storage Tanks. V. WORK TO BE PERFORMED BY Contractor Name: Contractor Company Name: Address: State: Zip Code: Phone No: Primary Consultant Name: Primary Consultant Company Name: Consultant Phone No: VI. TANKS SCHEDULED FOR CLOSURE OR CHANGE-IN-SERVICE Proposed Activity Tank ID No. Size in Gallons Last Contents Closure Change-In-Service Removal Abandonment in Place * New Contents Stored * Prior written approval to abandon a tank in place must be received from a DWM Regional Office. VII. OWNER OR OWNER’S AUTHORIZED REPRESENTATIVE I understand that I can be held responsible for environmental damage resulting from the improper disposal of my USTs. Print name and official title: Signature Date Signed SCHEDULED REMOVAL Notify your DWM Regional Office DATE 48 before this date if scheduled removal date changes UST-3 Rev 01/2017
1. Contact local fire marshal. 2. Plan entire closure event. 3. Conduct Site Soil Assessment. 4. If removing or closing in place, refer to API Publication 2015 Cleaning Petroleum Storage Tanks and 1604 Removal and Disposal of Used Underground Petroleum Storage Tanks. 5. Provide a sketch locating piping, tanks and soil sampling locations. 6. Submit a closure report in the format of (including the form UST-2) within thirty (30) days following the site investigation. 7. If a release from the tanks has occurred, the site assessment portion of the tank closure must be conducted under the supervision of a P.E. or L.G., with all closure site assessment reports bearing the signature and seal of the P.E. or L.G. If a release has not occurred, the supervision, signature or seal of a P.E. or L.G. is not required. 8. Keep closure records for three (3) years. V. WORK TO BE PERFORMED BY Contractor Name: Contractor Company Name: Address: State: Zip Code: Phone No: Primary Consultant Name: Primary Consultant Company Name: Consultant Phone No: VI. TANKS SCHEDULED FOR CLOSURE OR CHANGE-IN-SERVICE Tank ID No. Size in Gallons Last Contents Proposed Activity Closure Change-In-Service Removal Abandonment in Place * New Contents Stored * Prior written approval to abandon a tank in place must be received from a DWM Regional Office. VII. OWNER OR OWNER’S AUTHORIZED REPRESENTATIVE I understand that I can be held responsible for environmental damage resulting from the improper disposal of my USTs. Print name and official title: Signature Date Signed SCHEDULED REMOVAL DATE Notify your DWM Regional Office 48 before this date if scheduled removal date changes UST-3 Rev 01/2017
STIRA%20Appendices%20CHANGE%206.docx