The URL can be used to link to this page

Home My WebLink AboutRS_DOE_30-Day_Notice_Sam's_CLub_UST_Removal_Project_180713_v1.pdfUST ID #: 618986 30 -DAY NOTICE County: KING FOR UNDERGROUND STORAGE TANKS DEPARTMENT OF This form provides Ecology 30 -days' advanced notice for the follotiving ECOLOGY projects, as required by Chapter 173-360 WAC. State of Washington Instructions are found on the backpage. Please ✓ the appropriate box: ❑ Intent to Install [;4 Intent to Close ❑ Change -in -Service r , ii Il,,1-,ii_:Iia�I�E �� i!;11rI�F�.�rf Tag or UBI # (if applicable): A5255 • s Owner/Operator Name: Sam's West, Inc. UST ID # (if applicable): 618986 Business Name: Sam's West Inc. Site Name: SAM'S CLUB #4835 Mailing Address: 2101 Simple Saving Drive Site Address: 901 S GRADY WAY City: Bentonville state: AR zip: 72716 City: RENTON, WA 98057 Phone: 479-277-9639 Phone: 479-277-9639 Email: FUELCOMP21@wal-mart.com Note: Individuals performing UST services MUST be ICC -certified or have passed another qualifying exam approved by the Department of ,Ecology. 1) ❑ Installer ❑ Decommissioner M Site Assessor Company Name: Terracon Consultants, Inc. Certification Type: ICC UST Site Assessor Service Provider Name: Kyle Bennett Cert. No.: 8760811 Exp. Date: 2019 Provider Phone: 425-771-3304 Provider Email: kyle.bennett@terracon.com 2) ❑ Installer Decommissioner ❑ Site Assessor Company Name: NRC Environmental Services, Inc. Certification Type: ICC UST Decommissioner Service Provider Name: Martin Acaster Cert. No.: 1091714 Exp. Date: Provider Phone: Provider Email: macaster@nrcc.com EWwill SUBSTANCE TANK TANK ID STORED CAPACITY DATE PROJECT IS EXPECTED TO COMMENTS BEGIN 1 Gasolineed 20,000 07/12/2018 2 eaded B undine Gasoline 20,000 07/12/2018 3 Gassolineolinen ea 20,000 07/12/2018 30 -DAY NOTICE FOR UNDERGROUND STORAGE TANKS GE NERAL INSTRUCTIONS Under WAC 173-360-200 and 173-360-385, owners and operators are required to notify Ecology at least 30 days prior to beginning underground storage tank (UST) installation, decommissioning, or change -in-service projects by mailing this notice to the address below. A separate form must be used for each activity. Once this form is received by Ecology, it is date-stamped and returned to the owner/operator listed on the form. Installation and decommissioning projects cannot begin within the first 30 days after the date stamped on this form unless the wait -period has been waived by an Ecology UST inspector. If a project cannot meet the deadlines described below, an additional 30 -Day Notice must be submitted. Department of Ecology Underground Storage Tank Section PO Box 47600 Olympia, WA 98504-7600 SITE AND OWNER/OPERATOR INFORMATION Fill in the site and owner information completely so that any problems can be resolved quickly. The contact person listed on this form must confirm the exact date an installation and/or decommissioning project will begin at least three business days before proceeding. TANK INSTALLATIONS Installation projects must begin within 90 days of the date stamped on this notice. Complete the Tank Information section by assigning Tank ID numbers that have not previously been used at the facility. Once, processed, this form also allows you to receive a one-time drop of product for UST system testing proposes only. The fuel drop is not required to occur within the 90 - day period. To receive additional deliveries, you must complete the Business License application and UST Addendum to obtain your facility compliance tag from Ecology. The registration information must be submitted to the Department of Revenue within 30 days of bringing the system into use in order to receive a Business License with the appropriate tank endorsement(s). Once your tank(s) store more than one inch of product, leak detection equipment and monitoring must be in place. PERMANENT TANK CLOSURES Decommissioning_projects Contact your local fire marshal and planning department prior to tank closure to find examples of tanks that are exempt must be completed or residential tanks, within 90 days after the date stamped on this notice. Complete the Tank Information section using Tank ID numbers listed on the Business License. Use the Comments box to include additional information, such as when product was removed so that no more than one inch of residue remains in the system. 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 required. 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 chuacterization 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. The following are examples of tanks that 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 be used for farm purposes and cannot be for resale. o Tanks used for storing heating oil that is used solely for the. purpose of heating the premises. o Tanks with a capacity of 110 gallons or less.. o Equipment or machinery tanks such as hydraulic lifts or electrical equipment tanks. Emergency overflow tanks, catch basins, or sumps. If you need this document in a format for the visually impaired, call Toxics Cleanup Program at (360) 407-7170. Persons with hearing loss can call 711 for Washington Relay Service. Persons with speech disahility, call (877) 833-6341. ECY 020-95 (Rev. June 2015)