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Home My WebLink About0088 POINT ISABELLA ROAD - Health 88 Point Isabella Rob LCotuit n-074 -020 -- — - -- --- i r DEPARTMENT OF THE ARMY NEW ENGLAND DIVISION, CORPS OF ENGINEERS 424 TRAPELO ROAD WALTHAM, MASSACHUSETTS 02254-9149 TTE TONTION OF / A December 7 1994 ATTE Engineering Management Mr. James Begley Federal Facilities Remediation Massachusetts Department of Environmental Protection 20 Riverside ,Drive Lakeville, Massachusetts 02347 Dear Mr. Begley: In response to your letter of October "24 , 1994, the Tier I Transition Classification and Permit Statement (enclosure 1) was signed on December 7, 1994, for the disposal site known as the Former Camp Candoit off Point Isabella Road in . Barnstable, Massachusetts (Disposal Site No. WSC/SA-4-1230; Permit No. 82743) . New England Division accepts the classification of the disposal site as a Tier IA site. Should you have any -questions or require further information, -please contact the engineering manager, Ms. Deborah Acone, at (617) 647-8433. Sincerely, Enclosure Richard D. Reardon Director of Engineering Copy Furnished: Mr. Warren J. Rutherford Barnstable Town Manager 367 Main Street Hyannis, Massachusettsl _ Board of Health Attn: Brian Grady, R.S. , Chairman 367 Main Street Hyannis, Massachusetts 02601 -2- Barnstable County Health Department Attn: Mr. Stetson Hall Superior Court Building Route 6A Barnstable, Massachusetts 02530 Town of Barnstable Department of Natural Resources Attn: Ms. Dale Saad 1189 Phinney' s Lane Hyannis , Massachusetts 02601 Mr. Herbert G. Anderton, Jr. (w/encl) Cotuit Bay Shore Association P.O. Box 810 Cotuit, Massachusetts 02635 s Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office Q William F. Wald. Governor Daniel S.Greenbaum Commissioner �4 July 15, 1993 'U. rmy Corps of Engineers RE: BARNSTABLE--WSC/SA 4-1230 New England Division Former Camp Candor 424 Trapelo Road Point sabella Road C?.t-d� Waltham, Massachusetts 02254-9149 DERP Project":"'-UOIMA050200 NOTICE OF RESPONSIBILITY M.G.L. c.21E and MCP, ATTENTION: Col. Brink Miller 310 CMR 40.000 Division„ Engineer Ay Gentlemen: The Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , has determined that the Former Camp Candoit Department of Defence (DOD) facility at Point Isabella Road, Barnstable, Massachusetts (the "Site") is a disposal site as defined in M.G.L. c. 21E and the Massachusetts Contingency Plan (the "MCP") , 310 CMR 40. 000. Because this location has been confirmed as a disposal site, it will appear on the next "List of Confirmed Disposal Sites and Locations to be Investigated" published by the Department. There is an area of petroleum contaminated sediments in the intertidal zone at the site. The origin and source of the of this contamination is presently unknown. According to a December 5, 1991 report by Applied Marine Ecology Labs of Falmouth, Massachusetts and analysis of samples taken by the Department on June 6, 1991, the sediments contain up to 5, 100 ug/Kg toluene, 3 ,900 ug/Kg ethylbenzene, 7, 900 ug/Kg total xylenes, 2 , 300 ug/Kg acenapthene, 960 ug/Kg benzo(b) fluoranthene, and 500 ug/Kg benzo(a)pyrene. This condition constitutes a release of oil and/or hazardous materials to the environment. The Department has reason to believe that you (as used in this letter "you" refers to the DOD) are a potentially responsible party (PRP) with liability under M.G.L. c.21E. Liability under M.G.L. c. 21E is strict, meaning it is not based on fault but solely on your status as an owner, operator, generator, transporter or disposer. It is also joint and several, meaning that you may be liable for all response action costs incurred at the site, regardless of the existence of any other liable parties. 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 • Telephone (508) 946-2700 _- A f �rn —2- . You may be liable for damages to natural resources and liable under M.G.L. c.21E, Section 11 and other laws for each violation of c. 21E or other laws, or under M.G.L. c. 21A, Section 16, for violations of c. 21E and other statutes, regulations, orders, or approvals. You have indicated a willingness to conduct remedial measures at the Site and have found the Site to be eligible for funding under the Defense Environmental Restoration Program-Formerly Used Defense Sites according to a Determination dated May 12, 1992. The information currently available is insufficient to allow the Department to fully evaluate the Site, therefore, the Department requires that a schedule for completion of the following activities be submitted to this office within thirty (30) days of receipt of this letter: 1. Preliminary Assessment ("PA") , as designated in 310 CMR 40.535, 40.541. 2 . Phase I _ Limited Site Investigation, as designated in 310 CMR 40. 535, 40.543 . 3 . Interim Site Classification Form with sufficient supporting evidence, referenced by document and page, in accordance with 40. 544 of the MCP. These documents will help to provide information needed to determine what remedial response actions are necessary. The tasks that should be completed for a Phase I report are outlined in 310 CMR 40.543 . An Interim Site Classification Form is enclosed. If at any time an "imminent hazard" , as defined in 310 CMR 40. 542 , is discovered at the Location, you must immediately notify the Department, and submit a proposal for a Short Term Measure (STM) . No STM may be commenced without prior Department approval. If the STM is not performed in a timely manner, the Department is authorized to perform the STM and .recover the costs for performing this work. Your cooperation in this matter is appreciated. If you have any questions, please contact Jonathan Hobill at (508) 946-2870. In any correspondence to this office, please refer to case number WSC/SA 4-1230. Very truly yours, f J es F. B6eg/le�y,��hi ederal Facilities Se tion B/JH/j t -3- CERTIFIED MAIL NO. P808 782 643 RETURN RECEIPT REQUESTED cc:' Robert Davis U.S. Army Corps of Engineers 424 Trapelo Road Waltham, MA 02254 Mark Applebee U.S. Army Corps of Engineers 424 Trapelo Road Waltham, MA 02254 Susan G. Rask, Chairperson Board of Health 367 Main Street Hyannis, MA 02601 Board of Selectmen 367 Main Street Hyannis, MA 02601 Cotuit Bay Shores Association P.O. Box 810 Cotuit, MA 02635 ATTN: Mr. Herbert G. Anderton DEP - BWSC - Boston ATTN: Div. of Response and Remediation DEP - SERO ATTN: Data Entry Commonwealth of Massachusetts Executive Office of Environmental Affairs ,r Department of Environmental Protection ' Southeast Regional Office William F. Weld Governor 'rs Daniel S.Greenbaum Commissioner October 27, 1993 Ms. Deborah Acone RE: BARNSTABLE--BWSC/SA 4-1230 U.S. Army Corps of Engineers Former Camp Candoit 424 Trapelo Road Point Isabella Road Waltham, Massachusetts 02254-9149 DERP Project # D01MA0502000 Dear Ms. Acone: r The Department of Environmental Protection (DEP) has reviewed the documents titled "Draft Geophysics Plan" and "Draft Site Safety and Health Plan" for the former Camp Candoit prepared on your behalf by ABB Environmental Services Inc. The following DEP comment is provided regarding the Draft Geophysics Plan. It i's unclear if a GPR investigation of the site will occur if the magnetometer survey of the site does not. identify potential. areas of underground objects. The DEP believes that a GPR survey of the site should occur regardless of the magnetometer survey results. The DEP offers the following scenarios where. GPR work could identify areas of contamination where magnetometer surveys would not. If drums were sufficiently corroded so as not to provide , a magnetic signature, the waste saturated sediments in the area of a buried drum could be detected by GPR. - There is a possibility that the source area of the petroleum detected breaking out on the beach is related to buried bituminous materials. These materials could be detected by GPR. If ' a probable source area is not defined during the magnetometer survey of the site, it is suggested that GPR investigation of the site continue by stepping upgradient of the breakout area to define the area of saturated sediments. The GPR survey should also be used to rule out the presence of. buried drums, tanks, and fuel lines. 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 9 Telephone (508) 946-2700 If you have any questions regarding these comments please contact Jonathan Hobill of this office at (508) 946-2870. Sincerely yours, Inn ez ti 1 ' 4 'Jaales F. Begley, on .Chief ief \ e eral Facilitie a ediation B/JH/rr _ cc: U.S. Army Corps of Engineers 424 Trapelo Road Waltham, MA 02254 ATTN: Robert Davis Board of Health 367 Main Street Hyannis, MA 02601 ATTN: Susan G. Rask, Chairperson Board of Selectmen 367 Main Street Hyannis, MA 02601 ATTN: Jacalyn A. Barton, Chairman Cotuit Bay Shores Association P.O. Box 810 Cotuit, MA 02635 ATTN: Mr. Herbert G. Anderton Barnstable County Health Department Superior .Court Building Route 6A Barnstable, MA 02530 ATTN: Dale Saad Town of Barnstable-Department of Natural Resources 1189 Phinney's Lane Hyannis, MA 02601 ATTN: Darcy Munson DEP - BWSC - Boston ATTN: Div. of Response and Remediation DEP - SERO - Data Entry DEP - SERO ATTN: George Crombie Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection ' Southeast Regional Office William F.Weld Govemor Trudy Coxe Secretary,EOEA m . P October 24, 1994 United States Army Corps RE: BARNSTABLE-WSC/SA-4-12.30 of Engineers Former Camp Candoit New England Division Point 1sabeila Road 424 Trapelo Road Permit No. 82743 Waltham, Massachusetts 02154 Tier I Classification and Transition ATTENTION: Colonel Earle C. Richardson Statement Division Engineer Cotuit Bay Shores Association Post Office Box 810 Cotuit, Massachusetts 02635 ATTENTION: Herbert G. Anderton, Jr. Gentlemen: The Massachusetts Department of Environmental Protection (DEP) has redesigned the Waste Site 'Cleanup Program. The revised Massachusetts Contingency Plan ("MCP") and related fee regulations' . (310 CMR 4 . 00) became effective on October 1, 1993 . The new MCP (310 CMR 40. 0000) includes specific requirements for sites which had been classified as "priority disposal sites" under the 1988 version of the MCP in order for them to .make the .transition into the redesigned program. (See enclosed Transition Fact Sheet #5 for more information. ) This letter is being sent to you regarding the above- referenced site which was previously classified as a "priority disposal site" and listed as such on DEP's August 1993 Transition List of Confirmed Disposal Sites and Locations to Be Investigated, or Addendum thereto. You have been previously identified as a "Potential Responsible Party" (PRP) for the above-referenced site with liability under MGL c.21E §5. TRANSITION CLASSIFICATION Under the new MCP, sites will be classified as either Tier I or Tier II. All Tier I sites require permits to proceed with assessment and remediation. Sites classified as Tier IA will be managed by a Licensed Site Professional (LSP) under the l 20 Riverside Drive 9 Lakeville,Massachusetts 02347 • FAX(508)947-6557 • Telephone (508) 946-2700 -2- Department's direct oversight. Tier IB and IC sites will be managed by LSPs and will not receive direct oversight by DEP, but will be subject to DEP audit. The Transition regulations of the new MCP (310 CMR 40. 0640) , categorically classify all sites which had been listed as "priority disposal sites" as Tier IA sites. Therefore, the above-referenced site is Tier IA. . r TRANSITION PERMIT STATEMENT The new MCP does not require submittal of ' a new permit application for priority disposal sites. Instead, DEP will issue a "Transition Classification and Permit Statement" I (Transition Statement) to those with potential liability under MGL c.21E §5 which "describes the site's classification and the terms of . the transition permit. This Statement, if signed and dated by .the PRP, or other person performing the response actions, becomes a valid Tier I permit for the site effective upon its receipt by the Department. The Transition Statement for the above-referenced site is attached for your review and action. According to 3-10 CMR 40. 0640 (3) , .you must/return the Transition Statement to DEP within_ 120 days of your receipt of this letter indicating whether you (1) accept the. terms of the Transition Statement, (2) disagree with DEP's classification of the site, or (3) do not accept the terms of the Transition Statement. These options are as follows: (1) Accept Transition Statement: To accept the terms of the Transition Statement, please sign and date both copies of the Statement at Paragraph 111". and return one copy to this office. (Please also send a copy of one of the signed Transition Statements to the Chief Municipal Official, and Chairman of the Board of Health. ) Annual Tier IA .Compliance fees will not be assessed starting. October 1, 1993 as this site is currently funded under the Department of Defense and State Memorandum of Agreement/cooperative Agreement (DSMOA/CA) . Please note: a Tier IA permit application fee is not required for a Tier , IA permit issued pursuant. to the Transition Provisions, 310 CMR 40. 0600. The Tier IA • Transition .Permit is effective upon the Department's receipt . . of the. signed and dated Transition Statement [310 CMR 40. 0640 (3) (.b) 1.a] (2) Disagree with Transition Statement: If you do not agree with' the Department's determination that this site should be classified as Tier IA because, in the Opinion of an LSP, the. site should be reclassified as IB, IC, 'or Tier II, sign and date both copies of the Statement -at Paragraph 112" and return one copy to this office within 120 days. (Please also send a copy of one of the signed Transition Statements to the Chief -3- Municipal Official and Chairman of the Board of Health. ) . In order to change the site's permit category and in order to continue response actions at the subject site, you must obtain a Major Permit Modification from DEP. To do so, you must submit a "Major Permit Modification" application (310 CMR 40. 0707) , which includes an LSP Tier Classification Opinion, and fee of $1200 will not be assessed as this site is currently funded under" the Department of Defense and State Memorandum of Agreement/Cooperative Agreement (DSMOA/CA) . This application wit-- then be processed according to the provisions of 310 CMR 40. 0700. If .you wish to conduct assessment activities (such as the sampling of existing monitoring wells, the sampling of surficial soils, and the. . monitoring of vapors inside buildings) within• 120 days in an effort to document a lower Tier Classification far the purposes of filing a Major Permit Modification with DEP, you may do so. However, ".intrusive" assessment activities (subsurface investigations , involving test pits, new monitoring, wells, and soil borings, etc. ) will require prior DEP approval, unless they are being done as part of a response action which already has DEP approval. (3) Do Not Accept Transition Statement: If you do not accept this Transition Statement, you must sign and date the Statement at Paragraph 113-A" or 113-B" and return one copy to this office. (Please also send a .copy. of one of the signed Transition . Statements , to the . Chief Municipal Official and Chairman of the Board of Health. ) You must also indicate whether or not you intend to conduct any response actions which were approved by DEP prior to October 1, 1993 . If you do not intend to conduct such response actions, you must include an explanation pursuant to 310 CMR 40. 0171 and 40. 0172 . If you do intend to conduct these response actions, you must include a schedule for completing them.. Whether or not you intend to complete work previously approved, you must submit a Status Report which includes an LSP Opinion as to whether a Temporary or Permanent Solution has been or will be achieved, at the site, and if not, the response actions necessary to do so (310 CMR 40. 0640 (3) (b) 3] . Please note that if this site is adjacent to another disposal site where response actions are being conducted, it may be necessary to coordinate your response actions with .those being undertaken on the adjacent site. All persons authorized to conduct response actions under a Tier I permit musti comply at all times with MGL c. 21E, 310 CMR 40. 0000, permit terms and conditions and any other applicable federal, state, and local law. Failure to comply with all applicable requirements shall be cause for the Department to initiate enforcement. action, including, without limitation, permit suspension and revocation. -4- , To ensure that the required response actions for the above- referenced site are initiated and completed in a timely, manner please return the enclosed Transition Statement .to the Department within 120 days of its receipt. pursuant to 310 CMR 40. 0640 (3) (b) . . Please note that should there be more than one PRP performing response actions at the above-referenced site, all must sign the Transition Statement and . are encouraged to designate a .Primary . Representative. We recognize that there may be difficulties and. confusion during the transition of existing sites from the old MCP to the new MCP. The new MCP, however, offers many . incentives and opportunities for streamlined, timely, and efficient cleanups. It is our intent to provide you with as smooth a transition as possible. Should , you have any questions about this letter or the Transition Statement, please contact me at .508-946-2871 or . at the above address. Ver truly yours, Jam s Begley, Secti n C 'ef era Facilities Re ediati.on B/MJ/jt CERTIFIED MAIL #Z235 539 816 RETURN RECEIPT REQUESTED (Unites States Army Corps) CERTIFIED MAIL #Z235 539 817 RETURN RECEIPT REQUESTED (Cotuit Bay Shores Association) Attachments: Summary of Redesigned Program Fact Sheet on LSPs Transition Fact Sheet #5 . 310 .CMR 40. 0730 cc: Mr. Warren J. Rutherford Barnstable Town .Manager 367 Main Street Hyannis, MA 02601 Board of Health 367 Main Street Hyannis, MA 02601 ATTN: Brian Grady, R. S. , Chairman _5v cc: Barnstable County Health Department Superior Court Building Route 6A Barnstable, MA 02530 ATTN: Mr. Stetson Hall Town of Barnstable Department of Natural Resources 1189 Phinney's Lane Hyannis, MA 02601 ATTN: Ms. Dale Saad Debbie Acone U.S Army Corps of Engineers 424 Trapelo Road Waltham, MA 02254 DEP - BWSC - Boston ATTN: Madeline Snow DEP - SERO ATTN: Andrea Papadopoulos, Deputy Regional Director Data Entry Commonwealth of Massachusetts Executive Office of Environmental Affairs :d Department of E ' Southeast Regional Officenvironmental Protection William F.Weld Governor Trudy Coxe Secretary,EOEA co � �^'"i Thomas B. Powers C Acting Commissioner December 22, 1994 Commander RE: BARNSTABLE--BWSC 4-1230 U.S. Army Corps of Engineers Former Camp Can Do It ATTN: CENED-ED-EH/Ms. Deborah Acone Release Abatement Measure 424 Trapello Road Waltham, Massachusetts 02254-9149 ../ Dear Ms. Acone: The Department of Environmental Protection (DEP) has reviewed the Draft Release Abatement Measure (RAM) Plan for the removal of contaminated soil at Camp Can Do It in Cotuit, Massachusetts. The Plan was prepared on your behalf by ABB Environmental Services of Portland, Maine and dated November 1994 . The DEP concurs with the scope and approach of the proposed RAM and provides the following comments on the Draft document. The Final RAM Plan will be reviewed prior to formal approval of the RAM. General Comments: 1. Additional interpretation and evaluation of risks associated with levels of contamination found in soil borings (ie SB-214 and SB-221) in the slope area west of the beach are necessary. This area is not the focus of the RAM with the exception of the test pit investigation of the magnetic anomaly. 2 . Additional remedial actions beyond the scope of the proposed RAM may be necessary depending on the results of the above referenced evaluation, determination of the source of contamination and follow up actions depending on the conditions discovered during implementation of the RAM (ie. removal of more than 50 feet of source pipe) . Page Specific Comments: 1. Page 13 Section 4 . 2 . 2 The first bullet in this Section specifies excavation in the 20x20 foot area at SB-9 . to a depth of two feet bgs. Sample results from SB-9 indicated the highest levels of contamination was at -1. 5 to 2 feet bgs at this location. This bullet should specify the areal and vertical limits of excavation will also be based on on-site laboratory analysis for TPH and VOCs: The second bullet should also specify 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(808)947-6557 9 Telephone (508) 946-2700 r -2- �• vertical limits of excavation will be based on on-site laboratory analysis. 2 . Page 14 Section 4 .2 . 3 What is the P disposition of soil excavated from the proposed location of the magnetic anomaly? This material should be removed from the site or placed back in,`the'` excavation if it is considered clean. .� 3 . Page 15 Section 5. 0 This Section should identify regulatory requirements associated with the disposition of remedial wastes. 4. Page 16 Section 6.0 Individual grab samples are preferred over composites for confirmatory analysis. Grab samples allow for the identification of hot spots and provide more information than composites. Please make any changes necessary to the Contract Design Plans and Specifications based on these comments and provide the DEP with a response to this letter and Final RAM Plans. If you have any questions please contact me at (508) 946-2871. Very Truly Yours, es F. Begl ion Chief Federal Facilities Remediation JB/rr cc DEP/SERO George Crombie, Regional Director Mr. Warren J. Rutherford Barnstable Town Manager 367 Main Street Hyannis, Massachusetts 02601 Town of Barnstable _Board of Health 367 Main Street Hyannis, Massachusetts 02601 ATTN: Brian Grady, R.S. , Chairman -3- cc: Town of Barnstable Department of Natural Resources 1189 Phinney's Lane Hyannis, Massachusetts 02601 ATTN: Ms. Dale Saad - Mr. Herbert G. Anderton, Jr. Cotuit Bay Shores Association P.O. Box 810 Cotuit, Massachusetts 02635 I r r r` Cotuit Bay Shores Association P.O. Box 810 Cotuit, Massachusetts 02635 December 6 , 1994 partment Environmental Protection Sou east Regi nal Office Commo ealth of ssachusetts 20 River ' de Drive Lakeville , . ,02347 Attention:James Begley , tionr.Chief Re :BARNSTABLE-WSC/SA-4-1230 Former Camp Candoit Point Isabella Road ,Cotuit Permit No..82743 Gentlemen; I am returning herewith a complete copy of the Tier I Transition Classification and Permit State- ment which you sent ` to me on October 24th. The enclosed copy has been signed by me as an "Authorised Representative"of Cotuit Bay Shores Association, Inc but not as a. "Permittee" , since the Association is the Permittee ,not- me. I discussed this matter with you on the telephone and we both agreed that the change was proper . You will note that I changed Pages 1 and 6 to reflect this change ,and completed and signed Page 5 to ,be consistent with the change. Copies of Pages 1 , 5 and 6 are being mailed to tha Town Manager of Barnstable and the Chairman of the Barnstable Board of Health as . requested . Sincerely Herbert G. Anderton ,Jr . cc :Mr. Warren J.Rutherford ,Town Manager Town of Barnstable 367 Main Street Hyannis ,MA. ,02601 v Mr . Brian- R.Grad`y ,Chairman Board of Health Town of Barnstable 367 Main Street Hyannis ,MA. ,02601 f' n Y r Masaachuaetb Department of Environmental Protection Bureau of Waste Site Cleanup (BWSC) TIER I TRANSITION CLASSITICATION AND PERMIT STATEMENT T{i1.4 Pemdt is Issued to: For DEP Use only ❑ One Permittee Effective Date: Expiration Date: ❑ More than One Pennitteeo Permittee: Name of Organization: United States Army Corps of Engineers New England Division Permittee Name: Colonel Earle C.Richardson Division Engineer Street: 424 Trapelo Road City/Town: Waltham State: MA Zip code: 02154 • Use the following space if this is a joint permit. Copy this page and attach to this Statement if there are additional Permittees. Permittee: Cotuit Bay Shores Association,Inc. Authorised. Representative: Herbert G.Anderton,Jr. Address: P.O.Box 810, Cotuit,MA.,02635 1 r' Transition Statements Note: Rach Flenzattes mutt comylete this section. For ;ales with more than one copies o aectaoo. complete thin infoamat,,. and then attach au cotuiea to this Trani. Permit. Check one of the following to indicate your response and then sign the appropriate paragraph (1 through 3)and the Certification of Submittal: I accept the Transition Permit (sign "I") O I do not accept the Transition Permit and I am attaching a Major Permit Modification application (sign "2") O I do not accept the Transition Permit and I intend to conduct response actions which were approved by the Department prior to October 1,1993. (sign "3-A") l7 I do not accept the Transition Permit and I do not intend to conduct response actions which were approved by the Department prior to October 1,1993(sign "3-B"). 1. Transition Permit Acceptance Statement I agree to conduct all response actions pursuant to the terms and conditions of any and all Department approvals that are in effect as of October 1,1993as shown in Attachment Bl. I agree to conduct all future response actions at this disposal site which are not subject to an existing Department approval in accordance with this Permit and the provisions of 310 CMR 40.0000,inciuding response actions with approvals pending on October 1, 1993 and subsequently approved and listed in Anechnwa B2. I believe that I have the technical,financial,and legal ability to proceed with response actions at this site in accordance with M.G.L.c.21 E,310 CMR 40.00OOand other applicable requirements. I am aware of the requirements set forth in 310 CMR 40.0172for notifying the Department in the event that I am unable to proceed with such response actions. Fermittee: Cotuit Bay Shores Association,Inc. Authorised Representative: Herbert G.Ander.ton,Jr. SiSnature4k'' �" 4\ Date: Y T Primary Representative and LSP Formation Primary Representative (only applicable if there is more than one Pwruttee) For more than one Permittee,a Primary Representative can be designated and authorized. If you are designating a Primary Representative provide the following information: ❑ Check if Primary Representative is also a Permittee. Name of Organization: CotUit b tj* 33hore, A,gsoc cat i on,lnc. Primary Representative Name: L-Ie9 'b8,'�ry.G.An((c:ct0n,Jr. Tide: A,u.uhorised Representative Street: 2 Bra n;i, 1+rr,ae. 'Court City/Town: COtuit State: MA.. Zip code: 02635 Telephone: 508 - 428 - 7,575 Primary Representative Certification: I certify under the penalties of law that I am fully authorized to act on behalf of all persons conducting response actions under this permit for the following purposes: a) to receive oral and written correspondence from DEP with respect to this permit; b) to receive oral and written correspondence from DEP with respect to the performance of response actions upon issuance of a Tier I permit; and c) to receive any statement of fee required by 310 CMR 4.03(3)under this Tier I permit. 1 I am aware that there are significant penalties, including,but not limited to,possible fines and imprisonment, for wilfully submitting false,inaccurate, or incomplete information. Name (Print): NArhArt f'>,,A,vtdArtrm,jr- Position or Title: Signature: Date: December 1,1994 Note: The Primary Representative for more than one Permittee will receive the annual compliance assurance fee statement for the disposal site. Rev. 12/93 5