DERR-2024-012053

11/5/2024
10/17/2024
11/5/2024
11/5/2024
CONT:-\MJNATED MATERIALS MUST BE DISPOSED AT AN ACCEPT ABLE FACILITY:
All materials generated from PST closmes must be managed and disposed in a manner that does not place those materials in direct contact with the environment. On-site s!ockpi!ing of C(lntaminated soils may be required prior to any soil management activities. Any person I 'fl I I { h ) { l'O\'h in<' remet ia! uss1slance for a ee, inc II( ilw aeration am owr-excaration (of mor,; I an 50 vd ), mus! be a ( 'erti/ie1 I !.'iT c·o11s11ha111.
Contaminated soils l!.enerated as oa11 of tank removal are lo be disoosed at the fo!lowino facility:
Address I Citv I State I Zio
Contact nerson I Phone
Complete the Facility Site Plat and Sample Information Table on pages 4 and 5 to provide site llsscssment information.
CONTAMlNATIOt'. lNFOltWATION If contamination at the facility Is suspected or confirmed, the information must be reported to the DERR Division Director at [phone] within 14 hours, The Division of Water Quality must be notilicd al [phone] if Free Product is encountered or ifsul'face water has been impacted, If coniaminatlon is confirmed, any person assisting in the remediation process for a fee must be a Ce1iified UST Consultant SAMPLE INFORMATION TABLE Complete table for all samples to be taken for closure.
Sample Substance Sample stored in type1 Depth2 Compounds3
tank
SS-1 Unknown soil 5 feet TPH ORO, GRO,O&G, voes BTEXN
SS-2 Unknown Soil 5 feet TPH ORO GRO O&G voes BTEXN
USC-1 Unknown Soil 5 feet USC
GW-1 ' Water 5 feet TPH ORO, GRO, O&G, voes, BTEXN
�w-2 Unknown Water 5 feet TPH ORO GRO O&G voes BTEXN
Analysis method(s)4
8260. 8015 1664
8260 8015 1664
8260,8015,1664
8260 8015 1664
! Soil (SS). Groundwater (GW). or llnificd Soil C!as�ilicalion (USC),2 Appwx. dep!h in foct below grade. The required mi11imum sik assc�smcnl samples must be-lltken al 0-2 lect bi::low the buek11!11nativc-soil interface.3 Contami�imt comp:=nmds to lie �nalyzcd l�r each sample (from tnhk on p. 3),. ,. 4 /\pproprmtc rn1a!}s1s methods /or contanrnrnnt eompollml{s) m each smnp!c (from table on p. _1J.
4