Form MO780-2141 "Closure Report for Petroleum Releases at Underground Storage Tanks - Soil Analysis" - Missouri

What Is Form MO780-2141?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2020;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-2141 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-2141 "Closure Report for Petroleum Releases at Underground Storage Tanks - Soil Analysis" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
ENVIRONMENTAL REMEDIATION PROGRAM
CLOSURE REPORT FOR PETROLEUM RELEASES AT UNDERGROUND STORAGE TANKS – SOIL ANALYSIS
CR-S
RESULTS OF SOIL ANALYSIS
SITE NUMBER
SUBMITTAL DATE
PREPARED BY
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Select one:
On-Site
Off-Site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Arithmetic
Arithmetic
MW / SB No.
Average
Maximum
Average
Maximum
Sampling Date
Only for review purposes,
not necessarily used as
Sample Depth (feet)
representative concentrations.
Organics (all concentrations must be in mg/kg)
Benzene
Toluene
Ethyl benzene
Xylenes (mixed)
Ethylene Dibromide (EDB)
Ethylene Dichloride (EDC)
Methyl-tert-butyl-ether (MTBE)
Acenaphthene
Anthracene
Benzo(a)anthracene
Benzo(a)pyrene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Chrysene
Dibenzo(a,h)anthracene
Fluoranthene
Fluorene
Naphthalene
Pyrene
MO 780-2 141 (12-20)
Page 1 of 2
MISSOURI DEPARTMENT OF NATURAL RESOURCES
ENVIRONMENTAL REMEDIATION PROGRAM
CLOSURE REPORT FOR PETROLEUM RELEASES AT UNDERGROUND STORAGE TANKS – SOIL ANALYSIS
CR-S
RESULTS OF SOIL ANALYSIS
SITE NUMBER
SUBMITTAL DATE
PREPARED BY
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Select one:
On-Site
Off-Site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Off-site
Arithmetic
Arithmetic
MW / SB No.
Average
Maximum
Average
Maximum
Sampling Date
Only for review purposes,
not necessarily used as
Sample Depth (feet)
representative concentrations.
Organics (all concentrations must be in mg/kg)
Benzene
Toluene
Ethyl benzene
Xylenes (mixed)
Ethylene Dibromide (EDB)
Ethylene Dichloride (EDC)
Methyl-tert-butyl-ether (MTBE)
Acenaphthene
Anthracene
Benzo(a)anthracene
Benzo(a)pyrene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Chrysene
Dibenzo(a,h)anthracene
Fluoranthene
Fluorene
Naphthalene
Pyrene
MO 780-2 141 (12-20)
Page 1 of 2
RESULTS OF SOIL ANALYSIS – CONTINUED
TPH-GRO
TPH-DRO
TPH-ORO
Tertiary-amyl-methyl-ether (TAME)
Tertiary-butyl- alcohol (TBA)
Ethyl-tert-butyl-ether (ETBE)
Di-isopropyl ether (DIPE)
Ethanol
Methanol
Metals (all concentrations must be in mg/kg)
Arsenic
Barium
Cadmium
Chromium (III)
Chromium (VI)
Lead
Selenium
Note: Non-detects must be entered as <detection limit (for example: <0.005).
Maximum is the greater of (i) the detected values, and (ii) one-half of the detection limit.
Mandatory Attachments: 1. Site map showing location(s) of surficial soil samples.
2. Any laboratory analytical datasheets and chain of custody forms not previously submitted to the department.
N/A: Not applicable
MO 780-2 141 (12-20)
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