FRANKLIN STREET DEP UST6 FORM
UST6 • 5/17 Tank System Removal/Closure in Place • Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Air & Waste
Underground Storage Tank (UST) Program
UST6 – System Removal/Closure in Place
Former Auto Salvage Yard
UST Facility Name
UST Facility ID #
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Notes:
• Make additional
copies as needed.
• If you are
replacing a
removed tank with
a new tank in the
same location at
the facility, you
must register the
new tank with
MassDEP.
• For unregistered
tanks, answer the
questions in the
appropriate
sections. There
will be no UST
Facility Number
assigned to tank
systems found at
unregistered
facilities.
Check the appropriate action(s) below. Complete ONLY the appropriate section(s) and
submit with the UST1-Cover Sheet/Certification Form.
UST System Removal/Closure
Sections A.1.& B.
UST System Permanent Closure in Place
Sections A.2. & B
Removal of Unregistered UST System
Sections A.1., A.3. & B.
Permanent Closure of Unregistered UST System
Sections A.2., A.3. & B
A. UST System Removal/Closure
1. UST System Removal
1500 gal
Tank ID
1800 gal
Tank ID
Tank ID
Tank ID
a. Date of tank removal: 5/12/2025
MM/DD/YYYY
7/18/2025
MM/DD/YYYY
MM/DD/YYYY
MM/DD/YYYY
b. Were all regulated substances
removed from the tank managed
per applicable requirements?
Yes No Yes No Yes No Yes No
c. Was the tank system rendered
inert per 310 CMR 80.47? Yes No Yes No Yes No Yes No
d. Were all openings secured? Yes No Yes No Yes No Yes No
e. Was all piping removed? Yes No Yes No Yes No Yes No
f. Capacity of Tank: 1500
Gallons
1800
Gallons
Gallons
Gallons
2. UST System Permanent Closure in Place
Tank ID
Tank ID
Tank ID
Tank ID
a. Date of closure in place:
MM/DD/YYYY
MM/DD/YYYY
MM/DD/YYYY
MM/DD/YYYY
b. Has a registered professional
civil or structural engineer
determined that the tank cannot
be removed without endangering
the structural integrity of another
UST system, structure,
underground piping or
underground utilities, per 310
CMR 80.43(3)(a)(1)?
Yes No Yes No Yes No Yes No
c. Were all regulated substances
removed from the tank
managed per applicable
requirements?
Yes No Yes No Yes No Yes No
d. Was the tank system rendered
inert per 310 CMR 80.47? Yes No Yes No Yes No Yes No
e. Was the tank filled with
appropriate material (e.g.
concrete slurry mix or approved
inert material)?
Yes No Yes No Yes No Yes No
f. Capacity of Tank:
Gallons
Gallons
Gallons
Gallons
UST6 • 5/17 Tank System Removal/Closure in Place • Page 2 of 2
Massachusetts Department of Environmental Protection
Bureau of Air & Waste
Underground Storage Tank (UST) Program
UST6 – System Removal/Closure in Place
Former Auto Salvage Yard
UST Facility Name
UST Facility ID #
A. UST Removal/Closure (continued)
Notes:
• Make additional
copies as needed.
• Removal/closure
of a consumptive
use tank with a
capacity of
greater than
1,100 gallons
must comply with
the requirements
of 310 CMR 80.43
& 80.47
3. Removal/Permanent Closure of Unregistered UST System
Tank 1 Tank 2 Tank 3 Tank 4
If unregistered, where was this tank
located?
70 53'
53.44W
Longitude
42 31' 36.99N
Latitude
70 53'
53.20W
Longitude
42 31' 36.96N
Latitude
Longitude
Latitude
Longitude
Latitude
B. Assessment of Release at Removal or Closure
1500 gal
Tank ID
1800 gal
Tank ID
Tank ID
Tank ID
Was an assessment conducted in
accordance with 310 CMR 80.43(4)
within 24 hours of the removal or
before the closure in place was
completed?
Yes No Yes No Yes No Yes No