30-Day Notice Form Of Intent To Decommission Usts Or Complete A Change-In-Service Page 2

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THIS NOTICE AND THE 3-DAY TELEPHONE NOTICE ARE REQUIRED prior to starting decommissioning work on a
regulated underground storage tank (UST). Decommissioning work includes but is not limited to excavation and removal of the tank
and its appurtenances, removal of underground piping (product, vent and vapor recovery piping), soil sampling, and groundwater
sampling. (Decommissioning USTs or completing a change-in-service must be done in accordance with the conditions and
requirements of OAR 340-150-0166, the general permit to decommission USTs).
THIS NOTICE IS NOT REQUIRED for decommissioning unregulated tanks. To determine whether an underground tank is
regulated please refer to OAR 340-150-0008 for UST’s that are excluded or deferred from regulation, and OAR 340-150-0010 (82)
for the definition of a UST, or contact DEQ. (Examples are heating oil, and most residential or farm motor fuel tanks under 1100
gallons.)
ALL PAST DUE UST GENERAL PERMIT ANNUAL COMPLIANCE FEES MUST BE PAID before this decommissioning
notice will be accepted by DEQ.
MAKE SURE THIS FORM IS COMPLETE WITH ALL ATTACHMENTS as a notice that is incomplete will not be accepted.
RETURN COMPLETED AND SIGNED FORM TO THE DEQ REGIONAL
OFFICE FOR YOUR AREA (Addresses are listed below).
3-DAY NOTICE: Contact your local DEQ Regional Office 3-days before starting work.
(Phone numbers are listed below).
EASTERN
NORTHWEST REGION:
REGION:
Clackamas, Clatsop,
Baker, Crook,
Columbia, Multnomah,
Deschutes,
Tillamook & Washington
Gilliam, Grant,
Counties
Harney, Hood
River, Jefferson,
Klamath, Lake,
Malheur,
WESTERN REGION: Benton,
Morrow,
Coos, Curry, Douglas, Jackson,
Sherman,
Josephine, Polk, Lane, Lincoln,
Umatilla, Union,
Linn, Marion & Yamhill Counties
Wasco, Wheeler
& Wallowa
Counties
EASTERN REGION / BEND
WESTERN REGION / COOS BAY
WESTERN REGION / MEDFORD
475 NE BELLEVUE, SUITE 110
381 N SECOND STREET
221 STEWART AVE., SUITE 201
BEND, OR 97701
COOS BAY 97420
MEDFORD, OR 97501
Phone: 541-388-6146
Phone: 541-269-2721
Phone: 541-776-6010
Fax: 541-388-8283
Fax: 541-269-7984
Fax: 541-776-6262
NORTHWEST REGION
WESTERN REGION / EUGENE
700 NE MULTNOMAH ST.
165 EAST 7TH AVE., SUITE 100
PORTLAND, OR 97232
EUGENE, OR 97401
Phone: 503-229-5263
Phone: 541-686-7838
Fax: 503-229-6945
Fax: 541-686-7551
For information or assistance with this form call (503) 229-6652 or the UST HELPLINE:
1-800-742-7878 (Toll Free in Oregon).
Program information, registration forms, administrative rules and
other publications can also be found on our Homepage at:
May 2015
Page 2 of 2
webpage updates/forms/30 day decom notice 5-5-15

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