HomeMy WebLinkAboutUST - UNDERGROUND STORAGE TANK REMOVAL - OT General - 7/7/2026 Mason County Community Services
615 W. Alder Street, Shelton, WA 98584
Phone (360) 427-9670 ext. 352 /i .masoncountywa.gov
UNDERGROUND STORAGE TANK
REMOVAL/ABANDONMENT CHECKLIST
Instructions.Complete the Underground Storage Tank(UST)checklist below. Return the completed
checklist and, if required,site assessment reports necessary for Dept.of Ecology compliance,to the
Mason County Permit Assistance Center within i 5 days after the UST is abandoned.
Property Owner: � ` Qhitltip'�
Mailing Address: PO X tzc1Q9 City&State: Q115Yp001r mi
Directions to site:
Parcel Number: y =galescription:
Date of Abandonment/Removal: ��rZ�t 2uZtiJ
Name of Certified IFCI contractor performing abandonment procedures:
Contractor Phone: IFCI Certification#(include a copy of license):
3(90-: 7-5RICI2 NI
Washington State Co tractor Registration#: Bonding Agent:JWtE 0172 MTh M '
Tank Information
Tank cleaned: Method used for cleaning tank(s):
(Indicate by circling)
ONE OFF-SITE
How was sludge disposed of? Name of location or Person(s)for disposal:
59 611. oky-11 I. Yldlvwbr fVIV70vtnrt rt-tiii Inc,
Was the tank removed? 4 Location tank was disposed: N(-A.
Type of product in tank? fji
Tank capacity? Vl Estimated age of tank V vjvwVj
I certify that the information provided is true and correct.
I certify that no leaks or soil contaminates were found.
I certify the UST was abandoned or removed in accordance with current Washington State regulations and Mason
County ordinances.
Date:.,#f O7 I202L Signature-- 8
Residential UST system'" means an UST system located on property used imarily for dwelling
purposes. Such properties do not include dormitories,convents, mobile parks, apartments, hotels and
similar facilities, unless the UST system is used by the owner solely for his or her own personal use,
rather than to maintain the overall
c
UNDERGROUND STORAGE TANK
ABANDONMENT INSTRUCTIONS:
1. Drain and flush the piping into the tank,
2. Remove all liquids that can be pumped out. It may be necessary to use a hand pump to remove the
bottom few inches of product, Contaminated water may not be discharged to the ground or sewers
and must be retained.
3. Dig down to the top of the tank.
4. Remove the fill(drop)tube. Disconnect the fill, gauge, and product'lines. Cap or plug open ends of
lines,which are not to be used further_ The vent line is to remain connected until the tank is filled as
outlined in step 7.
5. Fill the tank to overflowing with water to purge off all products.As the level of liquid rises,the
remaining product should flow to the top of the water. When the floating product reaches the fill
opening, suspend the filling, remove the floating product and place it in a suitable container for
disposal.
6. After the water has overflowed the tank, cut one or more large holes in the tank top. This can be
accomplished with several blows from a baclthoe. Pump out the water and dispose of it in a suitable
manner.
7. Install a suitable solid, inert material through the top of the tank. Options include: concrete slurry,
dirt and sand mix,of free flowing sand,
8. Disconnect and cap the vent line.
9. Once the process is achieved, complete the UST removal checklist,and return to the Mason County
Permit Assistance Center.
If there is evidence of product in the ground contact the Department of Ecology at(360)407-6264 for
further guidance.
ADVANCE
Underground Storage Tank
Decommissioning Report
Located At:
23830 N US Hwy 101
Hoods port,
Prepared
Mick Phiflips — Home Owner
1
r9rniW1IIpgrniILcom
Prepared by:
Brittany Smotherman, Office Manager'
Advance nviron ental Inc.
P: (360)457-5666
July 7, 2026
%G'Z0 41tl Aveiw SW. 'P soul .:'3 t -3157-g144
14orl O' 51 "e si" ;,k IV wri+.co s
Advance Environmental Inc. 26-352 US Hwy 101
Purpose
The purpose of this site work was to properly decommission one underground storage
tank from the residential property, the tank was previously used for holding diesel to
heat the home.
Site Description
The building & excavation site is located at 23820 N. US Hwy 101Hoodsport,
Washington This site consists of one single family residential home.
Decommissioning Activities
On June 29w' 2026; Advance Environmental Inc. pumped all diesel material from the
tank prior to decommissioning. Our crew closed the underground storage tank in place
using manual methods & back filled the tank with pea gravel. After closing the LIST in
place, one soil sample was collected & sent to Libby Environmental, Inc. for a 45-hr
turnaround analysis. The soil sample was analyzed for Diesel (NWTPH-Dz).. There were
no signs of any contamination at the time of inspection.
Soil Analysis
Method Blank 07/02/2026 the Blank Not Detected
LCS 07102/2026 Not Detected
US-1 Soil 037103212126 Bottom of Pit Not Detected
Sincerely,
V4L7
Brittany Smotherman, Office Manager
Advance Environmental Inc.
(380)-357-5666
o4qV Ave
1vaai , `d
Advance Environmental Inc. 26-352 US Hwy 101
Appendix A: Laboratory Analysis: Soil Results
3G D 4Th fi/evtwe SW. T4to4le:3 t-3 Oly
Oh w pia,W1 615151Z fax: 3G0 35
Advance Environmental Inc._ 6-362 US 1
Libby Environmental, c
3322 South Bay Road Ni • Olympia,WA 985062957
Phone(360)332-2110•hbbyenv9tgmail.corn
ftlyy 2026
(nibnelCaznargo
Advance hvironmental-
3620 49th y SW
Olyrnpu,WA 98512
RI Uhllwy101
Work Order ,L26O003
Enclosed am the results of ly s for samples received by our laboratory on 71112026,
Applicable detection limits and data are mclrsample(s)will be disposed of within 30 days
unless we are contacted to arrange long Semi storage.
Libby invirootnental,Inc appreciates the opportunity to have provided analyticalservices for this project,If you
have any further r queslions about the data report,please feel free to contact us.It was a pleasure working wwith you
on this prrqeci.and we are looking f to the nest opportunity to work together
binceretyr
Sherry Chilcutt
Senior(hcrnist
32O4)t s tr esty; ttt (?µ
Advance Environmental Inc. 26-352 US Hwy 101
Libby Environmental,Inc. Chain of Custody Record tae e M
3222 ScFlh Bay Read NE,Ol, a.WA 6R+S06 r�i+ama 360352.2110 a {
CWn Data.,Vm 1M 202tt Pa e: 1 at I
Addm3s: 4 LW1WW PraectMana er: 1L)OV1r1 Gl1tYY1Q U a
Ciy Dtçw YV Tap ?Z P 'ect Name: t*i1YY& 10t
Phone:. 0 1 V7tt1E1t Fax:31Q93M PLt5 LOG aaen:Z34Ui3t1 U tWi 101 C .state: H00dW of.w
Pmlect 0 2 312 E,na,:AtO+�t21t1A2i conitt
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�. Date of Bampto t ontaUtar a yr .M a� a tk pth l
N ber Collactim Ttma T T +a�" ' dQ 4 •t 4 Fkb Nates
1 • I 24 2U 2'00 5411 y0 .
2
3
4
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& F
____ __-____
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11
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13
14
16
_______ ____
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Advance Env ronrr nta Inc. 26"352 US Hwy 101
Libby Environmental, Inc.
3620 49tb Amy 6W $md* 21352 Otdez 3
Notes and s
01 O1
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Work Order Sample Summary
S 06/29/2026 03/01 2026
tt gat 7
mpw''/J GIY1 6i : C-357-1a
Advance Environmental Inc.__ 26-352 US Hwy 101
Libby Environmental, Inc.
161 1 4ks WA
3520 45th*sens SW $Umbe 26-x2 Work ordor L260003
e W 98512 _ -01I W29
Sample Results
Client Sample D U54
Lab ZD U"03-01, )
t QoW tO. UWtx
NO 64 m. 07/112/2026 55
011 NO 10 drys 07/02/2026 SS
SSWatr2F8P fo1 33.2-156 07/0f2026 . `
Motgturtt 21 050 91 07/02/2026 Qil
3 ZO 4 t Avetiw Sw: Povy ; 3 O-351 SGGS
OI { a, 611 rxt 3 -357- Ga
Advance Environmental Inc. 26-352 US Hwy 101
Libby Environmental, Inc.
set u lot d 1 S
.2 3
L 93522 PuJt 4Gobr33 COOWçIO P 62/06/2026 11.29
Quality Cuab
Dess and Oft tE
r
: ) 6 .71"
330 943 033949 Wet
03 ND 350 33494 Wet
839433300. 18 t 2530 £ ,332#S
045014 403 511 264394331t' 543 43234390
14 t# All 272133
ON043 ND 190 t%Y ND 33
94et133We 214433 014 ; zar 0 412 156
504945094 0'5094450504
ao O u W CLLa
Advance Environments n 26452 US Hwy 101
Libby Environmental, Inc.
a etsl US lot 1 Z WA
,111A 1235jth ,07/06/2036 ti.29
QWAl1ty control
t Molstan by ASTM 01216-19
Rh Ec MUOSa chew
-
LOt )
Advance Environmental Inc. 26-352 US Hwy 101
Libby Environmental, Inc. 3322 South Bay Road NE
Olympia,WA 98506
US Hwy 101 Project Phone:(360)352-2110
Advance Environmental FAX:(360)352-4154
Libby Work Order#L26G003 Email:libbyenv®gmail.com
Date Received 71112026
Time Received 3:42 PM Received By AA
Sample Receipt Checklist
Chain of Custody
1.Is the Chain of Custody Is complete? El Yes ❑ No
2.How was the sample delivered? Q Nara DeWered 0 Pidad Up ❑ Shipped
oar In
3.Cooler or Shipping Container is present. 0 Yes ❑No ❑ N/A
4.Cooler or Shipping Container is in good condition, 0 Yes 0 No ❑ N/A
5.Cooler or Shipping Container has Custody Seats present, ❑Yes El No ❑ WA
6.Was an attempt made to coot the samples? 0 Yes ❑No ❑ N/A
7,Temperature of cooler(0°C to 8°C recommended) -16.4 °C
8.Temperature of sample(s)(4°C to 8°C recommended) 10.1 °C
9.Did all containers arms in good condition(unbroken)? Q Yes ❑No
10.Is it clear what analyses were requested? 0 Yes ❑No
11.Did container labels match Chain of Custody? 0 Yes ❑No
12.Are matrices correctly identified an Chain of Custody? 0 Yes ❑No
13.Are correct containers used for the analysis indicated? 0 Yes ❑ No
14.Is there sufficient sample volume for indicated analysis? 0 Yes ❑No
15.Were all containers property preserved per each analysis? Elves ❑ Na
16,Were VOA vials collected correctly(no headspace)? ❑Yes ❑ No CJ7 N/A
17.Were all holding times able to be met? 0.Yes 0 No
Discrepancies/Notes
18.Was client notified of all discrepancies? ❑Yes 0 No 0 N/A
Person Notified: Date:
By Whom: Via:
Regarding:
19.Comments.
Page 7 of 7 I
312.0 44Th Avevrcte SW. 1,v ile:3(O-35 -5
Obi ,WA gge512 'fax:3400-357-5G2 5