Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
3010 MAIN ST./RTE 6A(BARN.) - Health
3010 MAIN STREET , BARNSTABLE A= o �' August 4,1998 Mr. Richard Packard Bureau of Waste.Site Cleanup Horsley&Witten;Inc. Massachusetts Department of Environmental Protection Southeast Regional Office Sextant liip 20 Riverside Drive so Rote sA Lakeville, MA 02346 Sandwich,MA 02563 RE: RTN 4-13792, (508)833-6600 Class A-1.Response Action Outcome Statement Fax(508)833-31 5o MBO Precast Inc.Hydraulic Oil Spill April 10, 1998 Route 6A, Barnstable;,Massachusetts - Dear Mr. Packard Horsley &Witten, Inc. (H&W)has prepared this Response Action Outcome (RAO) Statement and supporting documentation on behalf.of MBO Precast Inc., in accordance with the Massachusetts Contingency.Plan(MCP) 310 CMR 40.0000; for the above referenced hydraulic oil spill in-Barnstable, Massachusetts.:All response actions have been completed, including,the t•final disposal of all oil-contaminated media: Attached;.please find supporting documents including a completed Immediate.Response (IRA) Completion Statement Transmittal'Form (BWSC-105),•a Response Action Outcome (RAO) Statement Transmittal Form (BWSC-104),and a Bill of Lading documenting soil recycling. In accordance with the Massachusetts Contingency Plan; specifically 310 CMR 40.1036(1), this Class A-1.RAO Statement submittal indicates that the following conditions apply to this release: (1) remedial response actions have been undertaken.at,the Site; (2) oil has been removed to background levels; (3) a'Permanent Solution has been.achieved. The spill occurred on the morning of April 10, 1998,on Route 6A west of Barnstable Village (adjacent to 3010 Route 6A). The incident occurred.when a hydraulic line ruptured on a truck delivering precast concrete drainage structures. The truck was owned by: MBO Precast Inc. 169 Camelot Drive Plymouth, MA 02360 Tel: (508) 74674939 Jeffery Opachnski, President Boston&Sandwich,MA Mr. Richard Packard August4,.1998 Page 2 The spill occurred during heavy rain, resulting in a rapid preading of emulsified oil over the paved road surface and into,a nearby catch basin and associated Aischarze area. The Department of Environmental Protection was provided with a two'-hour verbal notification: Subsequent' evaluation of the vehicle by M130 Precast indicated that three to five gallons' of oil were released. Although a reportable quantity of oil may not have been released; response actions were taken, following a discussion.with Mr.Robert Kearns of the DEP, to respond to the public.safety.threat caused by oil on the roadway and a threat to the environment from oil in the catch basin and discharge area. The Town of Barnstable Department of Public Works sanded the effected area of roadway and,MBO contracted with H&W and Enviro-Safe - Corporation to oversee and complete the clean-up Oil y sand used as an adsorbent material on the paved areas was.:removed by the:DPW.for temporary storage at the Town DPW yard. ;Enviro:-Safe used a!vacuum truck.to remove oily water from the impacted catch basin: The floorof the catch basin was constructed of concrete and.contained.the.spill.;, Small spots of oil Were also removed with adsorbent,pads from,the catch basin discharge point in a drainage area adjacent to Route 6A. All of the contamination was visually.identified and completely removed on-April 10, 1998. Approximately 70 gallons of liquid wastes and adsorbent materials were transported for disposal by Enviro-Safe to General Chemical in Framingham, Massachusetts. Oily.sand was temporarily stored by the DPW pending test results for recycling by asphalt batching. A.sample from the sand stockpile.used`as adsorbent material was submitted to a certified laboratory for analysis of Total Petroleum Hydrocarbons , (TPH) by EPA Method.418.,1. -The analytical result for this sample indicated : a concentration of TPH at 3,500 milligrams per kilo gram:(mg/kg).'On June 19, 1998; Enviro-Safe transported a total.of 6:5 tons of oily,sand to a Bardon Trimount asphalt batching facility.in South Dennis, Massachusetts. Based on the remedial response actions performed to date,a Class A RAO has been achieved for RTN 4-13792 in accordance with the criteria established in 310 CMR 40.1036. Horsley&Witten,.Inc. Mr.-Richard Packard August 4 1998 Page 3 If you have.any questions,please contact-.the undersigned at(508)833-6600._ Sincerely, HORSLEY&WITTEN, INC. . Jim Begley Sr. Environmental ngineer Attachments CC: Barnstable Board of Health P.O. Box 534 .Hyannis,MA 02601 ; ATTN: Glen Harrington Towri'of Barnstable A. 367 Main Street ,. Hyannis, MA 02601 f ATTN: James Tinsley, Town Manager Jeffery Opachinski, President MBO Precast Inc: 169 Camelot Drive Plymouth;MA 02360 Horsley&Witten,Inca . % : ...oaaa�.mmuavaw muhv}+emmnnrmens yr ennronmerl[al fatbtBCtlon 13WSC-105 r Bureau of Waste Site Cleanup - IMMEDIATE RESPONSE ACT110N (IRA) Release Tnu+cJdnp Number TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) 13792 A. RELEASE OR THREAT OF RELEASE LOCATION: - ReleaseName:(optional) MBO Precast Spill Strom Route 6A T LocationAld: Adjacent to 3010 Route 6A CltylTawn: Barnstable, MA _ 23PCode: 02630 ❑ Check here If a Tier Classification Submittal has been provided to DEP for this Release Tracking Number. ❑ Check here if V location is Adequately.Regutated,pmasuaM to 310 CMR 40.011"114. Specify Pmgmn: ❑ CERCLA ❑ HSWA Corrective Action ❑ Soiid Waeta f. Related Release Tracking Numbers That This IRA Addresses: . Management ❑ RCRA State Program(21 C Faaiities) B.THIS FORM IS BEING USED TO: (check all t to apply) ® Submit an IRA Plan(complete Sects A,B.C.D.E.H.1,J and IQ. ❑ Check here If this IRA Plan is an update or modification of a previously approved written IRA Plan., Date Submitted: - ❑ Submit an Imminent Hazard EvMua m(complete Sections A,B,C.F.H,1.J and IQ. ❑ Submit an IRA Status Report(complete Sections A.B,C.E,H.1.J and IQ. ❑ Submit a Request to TenNnate an Active Remedial System and/or Terminate a Continuing Response Action(s)Taken to Address an kriminamt Hazard(complete Sections A.B,C,D,E,H,1.J and IQ. " ❑ Submit an IRA Compktlon Statement(complete Sections A.S.C.D.E.G.H.I.J and IQ. - You mast attach W supporting dousnentatfon required for each use of form indicated,Including copies of any Legal Notices and Notices to Public 0111dals required by 310 CMR 40.UN. C. RELEASE OR THREAT OF RELEASE CONDITIONS THAT.WARRANT IRA: Identity Media and Receptors Affected: (check all that apply) ❑ Air ❑ Groundwvater ❑ Surface witnip,. ❑ Sediments soil ® Welland, ❑X Storm Drain ®-Paved Surface ❑ Private Well: -❑ Public Werner Supply ❑ Zone 2 ❑ Residence ❑ .Scholl ❑ Uniawwn ❑ Other specify. Identify Conditions That Require IRA,Pursuant to 310 CMR 40.0412 check all that apply)apply) 2 Her Reporting Conditlon(a) ❑ 72 Hour Reporting Conditions) ❑ Substantial Release Migration Otther Condition . - (s) Describe: sudden release of hydraulic oil from a truck Identify Oils and Hazardous Materials Released: (check 29 that apply) ® Oils ❑ ChloriniIftd Sdvents ❑ Heavy Meals ❑ Others Specify.. hydraulic oil D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply) ❑ Assmwnent and/or Monitoring Only X❑ Deployment of Absorbent or Containment Materials X❑ Excavation of Contaminated Soils ❑ Temporary Cams or Caps Q R&4m,Recycling or Treatment ❑ Bxeniedistior Q On site Off site Est.VoL: 8 cubic yards i ❑ Sod vapor Ehdraation Describe: of ly sand rack k up Structure Venting System ❑ Store O On Site Q OR Site Est Val.: cubic yards 0 ❑ Product or NAPL Recovery ❑ Landfill O Cover 0 Disposal Est.Vol.: cubic yard ❑ Groundwater Treatment Systems ❑ Removal of Drums,Tanks or Containers ❑ Air Sparging Describe: ❑ Temporary Water Supplies SECTION D IS CONTINUED ON THE NEXT PAGE Revised 2124/95 Supersedes Forms BWSC-005, 006, 010(in part)and 011 Page 1 of 3 Do Not Alter This Form oumau or waste we caeanup _ IMMEDIATE RESPONSE ACTION (IRA) RelaaseTraddrp"` TRANSMITTAL FORM Pumuantto 310 CMR 40.0424-40.D427(Subpart D) - 13792 D. DESCRIPTION OF RESPONSE ACTIONS(continued): ❑X Removal of Other Contami aWd Media ❑ Temporary Evacu stion or Relosortiotr of Residents Specify Type and volume., oily water-70 gallons ❑ Fencing and Sign Posting ❑ Other Response Actions Describe: ❑ Check e this IRA involves the Technologies Clearinghouse). use of Innovative Technologies(DEP is interested in using this information to aid in creating an Innovative Describe Technologies: E. TRANSPORT OF REM EDIATION WASTE: (U RemediatIm waste has been sent to an off-sties taeility,answer the following questions) Name ofFacdiir. Oily water: General Chemical Tmn and State. 133 Leland St, Framingham, MA 01701 h Quantity of Remediation Waste Transported to Dale: 70 gallons F. IMMINENT HAZARD EVALUATION SUMMARY: (dock am of thefatbwing) ❑ Based upon an evaluation,an Imhrdnent Hamrd erosts In comeetton with this Release or Threat of Release. ❑ Based upon an eva moon,an Imnmmt Hazard does not and in connection with irks Release or Threat of Release. ❑ Based upon an evaluation,It Is w*nown whether an Imminent Hazard eosts in eorunecion with this Release of Threat of Reuse.and further asaessnIft activities will be undertaken. _ Based upon an evaluation,It Is unknown w other an Immmnent Hazard ensts in connection Win this Release or Threat of Release. Howeirer, response actions will address those conditions that com pose an Imminent Hazard. G. IRA COMPLETION STATEMENT: . Check nee hf future response,acion�s•addresong this Release or TMenf'of Release wit be conducted acpaht�of the Response Actions planned+ for a SRe#W has&ready been Tier CtasOMW under a ditW Release Tracking Number,Ora Silo that fs,, -n,d on the Transition List as- described In 310 CMR 40=0 Q.a.,ii Tranaiion Site,which includes Sie3 with approved Wahvers). T a heft ddil W acuom must occur according to the deadlines applicable to the earlier Release Tm:i ft Number p.&.Sle ID Number), State Release Tracking Number C.a.,Slte ID Number)of Tier Classified Site or Transition Mr. If any Re nadlatlon Waste will be stored,trasted,managed,recycled or reused at the site following Stmernent,you must=d nntt either a Release Abatement Measure(RAM)Plan or a Phase IVn won of the IRA with appropriate transmittal tarn,as an attachment to the IRA Complet�kongfamrwr�Pam'along"wittn the. H. LSP OPINION: I attest under the pains and penanks of perjury that 1 have personally eiain w eel and am familiar with this trarmmittel form,inch ng any and all doctonenls ac;conpanring this submittal. In m y professional ophion and judgment based,upon applicahen of(Q the surd of care in 309 CMR 4�(1).(iQ the applicable previsions of 309 CMR 4.02(2)and(3),and(1 the provisions of 309 CMR 4.03(5),to the best of my knowledge, information and belief, • !f Section 8 of Mks fleas indicates that an bUfflediata Response Action Phn is being subftW,the respsxse action(s)that Is(are)the this submittal n has(have)been developed in a- om 1-oe with the this of appropriate and reasonable to a of M.G.L o 21 E and 310 CMR 40.1X100,[7 is(are) CMR 40.0000 and the purposes of such response action(a)as set forth In the applicable provisions of M.G.L.e.21 E and 310 P +(Y)with the identified provisions cf ai orders,permits,and approvals ide tiled in ffds subn-dtsl; If Section B of title form indwi es that an huWnsnt Hazard Evak atlon is being=&mfKed,this Imminent Hazard Evaluation was developed In accordance with the applicable s IHazani values provisions of M.G.L c 21 E and 310 CMR 40.0000,and all assessmned activltfee(y)undertaken to this oomplies(Y)with the sOca Provisions of M.G.L c.21 E and 310 CMR 40.0000; • if Section B of this fort Indicates Mat an/mmediste Response Stapes Report is being submitted,the response actions)thatIs(are)the sulijed I of this submittal m Is(are)being Implemented In accordance with the applicable provisions of M.G.L.a 21 E and 310 CMR 40.0000,(It)Is(are) appropriate and reasonable to accomplish the purposes of such response aetion(s)as set forth in the apptieable provisions of M.G.L cr 21 E and 310 CMR 40.0000 and pil)complier,*)with tine identified provisions of all orders,permits,and approvals idedi6ed In this submittal; • ff I Section B of this form indicates that an lmmedLta Response Response Action Completion Ststamsrrt ores Regrrast to Tinrbeats an Activa RanwdW System and/or Twmhiate a Continuinga Actlon s Taken to Address an/mmbmm Hazard is baling submitted,the response action(s) that is(are)the subject of this submittal n.has(have)been developed and irnpienernted in accordance with the appiigbia provisions of M.G.L c.21 E and 310 CMR 40.00o0,(t)is(are)appropriate and reasonable to accomplish the purposes of such response ection(s)as set forth in the applicable ProVisions of M.G.L c.21 E and 310 CMR 40.0000 and rl complies(y)with the identified provisions of all orders,permits,and approvals identified in this submittal. SECTION H IS CONTINUED ON THE NEXT PAGE Revised 224e95 Supersedes Forms BVfSC-W5, 006, 010(n part)and 011 Page 2 of 3 Do Not Alter This Form maammunuse>:w ueparunent of Environmental Protection . BWSC-105 Bureau of Waste Site Cleanup IMMEDIATE RESPONSE ACTION (IRA) T Relea:e Traddng Number TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) ❑ 4 - 13792 H. LSP Opinion(continued): I am aware that significant penalties rmy result,including,but not limited to,possible fines and imprisonment,If I submit Information which I know to be false, inaccurate or allay incomplete. ❑ Check here if the Response Action(s)on which this opinion is based,lf any,are(were)subject to DEP or EPA. If the boot is checked,you MUST attach a statement any order(s),permit(s) and/or approval(s) issued try Ong the applicable provisions thereof. _ LSPName: Mark E. Nelson LSPtx 7893 Stamp: OF Telephone: 508-833-6600 Ext.; FAX:(optional) 508-833-3150 PARK e M`Ttilb co Signature: '/i fj,.% Date: j ✓ (:. i Z8/�P I. PERSON UNDERTAKING IRA: Name of Organ¢ation: MBO Precast Inc. Name of Contact Jeffrey Opachinski Title: President Street: 169 Camelot Drive City/Town: Plymouth State: MA 02360 ZIP Code: Telephone: 5 0 8—7 4 6=4 9 3 9 Ed.: FAX:(optional) ❑ Check here if there has been a dange in the person undertaking'the IRA. J. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA: (check one)' RP or P.RP. Spedfyr Q owner O •Operatat" Q;' Q..T oilier R c rarmsporter P or PRP. ❑` Fiduciary,Secured Lendir.or Municipality with Exempt Status(as defined by M:G.L cp21 E,s:2j ❑ Agency or Public Utility on a Right of Way(as defined by M:G.L c.211,s.SM) ❑ Any Other Person Undertaking IRA Specify Relationship: K. CERTIFICATION OF PERSON UNDERTAKING IRA: attest under the pains and penalties of perjury O that I have fam the in�Wined in this submittal,including any and all documents actor PAIN mined and n of those individuals i parrying this transmittal Conn, a that, i based on my inquiry responsible for obtaining the information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and 0ii)that I am fully authorized to make this attestation on behalf of the entitythis responsible for Possiblee tines and imp�n crentity on whose behalf this submittal is made amps aware throat there are significant penalties,including b limited to, prisc.�ment,for willfully submitting false,inaccirme,or incomplete information. B C. . Y " Tale. For ' C Gate: ho /n (Print name of person or entity recorded in Section 1) Enter address of the person providing certification,if different from address recorded in Section 1: Street: City/Taem. State:. ZIP Code: Telephone' End.: FAX(optional) YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE. Revised 2/24/95 Supersedes Forms BWSIr005, 006, 010(in part)and 011 Page 3 of 3 Do Not Alter This Form I dLCUUon Y.J W •Bureau of Waste Site Cleanup Release Tracking _ RELEASE NOTIFICATION & NOTIFICATION RETRACTION' Number - FORM -L13792 I Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart If assigned by DEP A►. RELEASE OR THREAT OF-IRELEASE LOCATION: Street: Route 6A ,�Location Aid: Ad j acent to 3010 Route 6A Cityfrown: Barnstable, MA t �P 0 6�'30 IrQ CdotleCFIV r � B. THIS FORM IS BEING USED (check TO: one) JUN 15 1998 X Submit a Release Notification(complete all sections of this form).M TOWN OF BARNSTAhf 1 Submit a Retraction of a Previously Reported Notification of �Re , or Thr at of Release(complete Sections A, B,E, F and G of this form). You MUST attach the supporting documentation required by,31d)MR 440 03, � C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEAS:l�(TOR)�;,.•�" Date and time you obtained knowledge of the Release or TORApril 10,199 8rme: 9:00 . r�, Date: Specify: In' AM ` PM The date you obtained knowledge is always required. The time you obtained knowledge is nit required If reporting only 120 Day Conditions. IF KNOWN. record date and time release or TOR occurred. April 10, 1998 Time: 7:30-8;00 — Date: Specify: L AM , PM X oC hy).eck here if you previously provided an Oral Notification to DEP(2 Hour and 72 Hour Reporting Conditions Provide date and time of Oral Notification. April 10, 1998 Timer 9:35 Date: Y Specify: 'E AM PM Check all Notification Thresholds that apply to the Release or Threat of Release: (for more information see 310 CMR 40.0310-40.0315) 2 HOUR REPORTING CONDITIONS 72 HOUR REPORTING CONDITIONS 120 DAY REPORTING CONDITIONS X II Sudden Release Subsurface Non-Aqueous Phase q ' Release of Hazardous Materials)to Soil or r— Liquid(NAPL)Equal to or Greater Groundwater Exceeding Reportable Threat of Sudden Release than 1/2 Inch Concentrations) Oil Sheen on,Surface Water Underground Storage Tank` (UST)Release _ Release of Oil to Soil Exceeding Reportable Poses Imminent Hazard Concentration(s)and Affecting More than 2 Cubic — Yards — Threat of UST Release Could Pose Imminent Hazard Release of Oil to Groundwater Ex:_eding Release Detected in Private Reportable Concentration(s) — ;— Release to Groundwater near Well s Water Supply 'g Release to Storm Drain r— _ Subsurface Non-Aqueous Phase Liquid(NAPL) Release to Groundwater near Equal to or Greater than 1/8 Inch and Less than Sanitary Sewer Release School or Residence 12 Inch " (Imminent Hazard Only) List below the'Oils or Hazardous Materials that exceed their Reportable Concentration or Reportable Quantity by the greatest amount. If necessary, attach a list of additional Oil and Hazardous Material substances subject to reporting. Name and Quantities of Oils(0)and Hazardous Materials(HM) Released: O or HM Released O HM CAS# Amount or Reportable Concentrations ) Units Exceeded,if Applicable (check one (if known Concentration (RCS-1,RCS-2.RCGW-1,RCGW-2) Hydraulic Oil !T 3-S gallons D. ADDITIONAL INVOLVED PARTIES: Check here if attaching names and addresses of owners of properties affected by the Release or Threat of Release,other than an owner who is submitting this Release Notification(required). Check here if attaching Licensed Site Professional(LSP)name and address(optional). You may write in names and addresses on the bottom of the second page of this form. Revised 3/1/95 Supersedes Form BWSC-003 Pa9e1 of 2 Do Not Alter This Form f �- c� NWp;husetts DepjPeAftd gnvironmental Protection UW§C-4403- Bureau of Waste Site Release Tracking* Number RELEASE NOTIFICATION & NOTIFICATION RETRACTION ( 4 Ij _. 13792 FORM Pursuant to 310 CMR 40.0335 and 310 CM 40.0371 (Subpart C) If assigned by DEP E. PERSON REQUIRED TO NOTIFY: Name of MBO Precast Organization: �� y fJ C //�S / Name of Title: �2e S,Gr!Ci77`- Contact: Street: 169 Camelot Drive City/Town: Plymouth, State 14A ZIP Code: 02360 Telephone: 508-746-4939 Ext.: FAX: o tional F. RELATIONSHIP OF PERSON REQUIRED TO NOTIFY TO RELEASE OR THREAT OF RELEASE: (check one) XI RP or PRP Specify 0 Owner (D Operator O Generator 0 Transporter Other RP or, t PRP: IJ Fiduciary, Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21E,s.56)) r Any Person Otherwise Required to Notify Specify Relationship: G. CERTIFICATION OF PERSON REQUIRED TO NOTIFY: attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form,(ii)that, based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii)that 1 am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made amfis aware that there are significant penalties, including,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. By: Title:. (sign uure) / For /�'c 6 - �2 F N /J r� S t < C Date: /q Z'(2 (print name of person or entity recorded in Section E) Enter address of the person providing certification,if different from address recorded in Section E. Street: City/Town: State ZIP Code: Telephone: Ext. FAX: owionall YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE Mark E. Nelson, LSP 90 Route 6A, Sextant Hill Sandwich, MA 02563 508-833-6600 ,(tele) 508-833-3150 (fax) LSP # 7893 e PPvi-Pd 3/1/95 Supercedes Form BWSC-003 Page 2 of 2 Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME(RAO) STATEMENT& Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM a_ 13792 Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)a 40.1056(Subpart J) A. SITE OR DOWNGRADIENT PROPERTY LOCATION: site Name:(optional) MBO Precast Spill Street: Route 6A Location Aid: Adjacent to 3010 Route 6A Citylrown: Barnstable MA ZIPCode: 02630 Check here if this Site location is Tier Classified. If a Tier I Permit has been issued,state the Permit Number. Related Release Tracking Numbers that this Form Addresses: If submitting an RAO Statement,you must document the location of the Site or the location and boundaries of the Disposal Site subject to this StatemenL If submitting an RAO Statement for a PORTION of a Disposal Site,you must document the location and boundaries for both the portion subject to this submittal and,to the extent defined,the entire Disposal Site. If submitting a Downgradient Property Status Submittal, you must provide a site plan of the property subject to the submittal and,to the extent defined,the Disposal Site. B. THIS FORM IS BEING USED TO: (check all that apply) Q Submit a Response Action Outcome(RAO)Statement(complete Sections A,B.C,D,E,F.H,I,J and Q. 0 Check here if this is a revised RAO Statement. Date of Prior Submittal: aCheck here if any Response Actions remain to be taken to address conditions associated with arty of the Releases whose Release Tracking Numbers are listed above. This RAO Statement will record only an RAO-Partial Statement for those Release Tracking Numbers. Specify Affected Release Tracking Numbers: • Q Submit an optional Phase 1 Completion Statement supporting an RAO.Statement or Oowngradient Property Status_Submittal (complete Sections A,B,H 1,J,and Q. Submit a Downgradient Property statusSubmittal(complete Sections A,,B,G H I,.J and 14.,. „ 0 Check here it this is a revised Downgradient Property Status Submittal Daie'of,Prior Submittal Submit a Termination of`a Downgradient Property-Stitus Submittal(complete Sections A,8,1,J and Q Submit a Periodic Review Opinion evaluating the status of a Tempora ,Solutio (completeSecAB,;H 1 J and L.;ry . ; Specify one: For a Class C RAO For a Waiver Completion Statement indicating a Temporary Solution Provide Submittal Date of RAO Statement or Waiver Completion Statement: You must attach all supporting documentation required for each use of forth indicated,including copies of any Legal Notices and Notices to Public Officials required by 310 CMR 40.1400. C. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply) Assessment and/or Monitoring Only XQ Deployment of Absorbant or Contaminent Materials ® Removal of Contaminated Soils El Temporary Covers or caps Re-use,Recycling or Treatment [:] Bioremediation On Site 0 Off Site Est.Vol.: 1.3 cubic yards Soil Vapor Extraction Describe: o i ly sand Structure Venting System Q Landfill O Cover O Disposal Est.Vol.: cubic yards Product or NAPL Recovery Removal of Drums,Tanks or containers Groundwater Treatment Systems Describe: �E] Air Sparging ® Removal of Other Contaminated Media Temporary Water Supplies Specify Type and Volume: oily water 70 gallons Temporary Evacuation or Relocation of Residents Other Response Actions Fencing and Sign Posting Describe: SECTION C IS CONTINUED ON THE NEXT PAGE. Revised 4/7/95 Supersedes Forms BWSC-004 and 010 in art Page 1 of 4 S P ( P Do Not Alter This Form L Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME (RAO) STATEMENT& Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) E-1 13 792 C. DESCRIPTION OF RESPONSE ACTIONS: (continued) Check here if any Response Action(s)that serve as the basis for this RAO Statement involve the use of Innovative Technologies. (DEP is interested in using this information to create an Innovative Technologies Clearinghouse.) Describe Technologies: D. TRANSPORT OF REMEDIATION WASTE: (f Remediation Waste was sent to an off-site facility,answer the following questions) Name of Facility: Oily Water: General Chemical Corp. Oily Sand: Bardon Trimount Town and State: 133 Leland St,Framingham, MA 01701 Great Western Road, Dennis, MA 0263 Quantity of Remediation Waste Transported to Date: 70 gallons 8 cubic yards E. RESPONSE ACTION OUTCOME CLASS: Specify the Class of Response Action Outcome that applies to the Site or Disposal Site. Select ONLY one Class: XQ Class A-1 RAO: Specify one of the following: (!) Contamination has been reduced to background levels. Q A Threat of Release has been eliminated. Class A-2 RAO: You MUST provide justification that reducing contamination to background levels is infeasible. Class A3 RAO: You MUST provide both an implemented Activity and Use Limitation(AUL)and justification that reducing contamination to background levels is infeasible. If applicable,provide the earlier of the AUL expiration date or date the design life of the;remedy wiU end: Q Class B4 RAO: Specify one of.the following: Q Contamination is consistent with background levels' 0 Cohtaminaboh Is NOT consistent with background levels: i , Class B-2 RAO: You MUST provide an implemented AUL. } If applicable,provide the AUL eirafion.date: L r Class C RAO: Check here if you will conduct post-RAO Operation,Maintenance and Monitoring at the Site. Specify One: O Passive Operation and Maintenance Q Monitoring Only O Active Operation and Maintenance(defined at 31MCMR 40.0006) F. RESPONSE ACTION OUTCOME INFORMATION: If an RAO Compliance Fee is required,check here to certify that the fee has been submitted. You MUST attach a photocopy of the payment. Check here if submitting one or more AULs. You must attach an AUL Transmittal Form(BWSC-113)and a copy of each implemented AUL related to this RAO Statement. Specify the type of AUL(s)below: (required for all Class A-3 RAOs and Class B-2 RAOs) Q Notice of Activity and Use Limitation O Grant of Environmental Restriction Number of AULs attached: Specify the Risk Characterization Method(s)used to achieve the RAO described above and all Soil and Groundwater Categories applicable to the Site. More than one Soil Category and more than one Groundwater Category may apply at a Site. Be sure to check off all APPLICABLE categories,even if more stringent soil and groundwater standards were met. Risk Characterization Method(s)Used: Q Method 1 Method 2 Method 3 Soil Category(ies)Applicable: El S-1 S-2 Q S-3 Groundwater Category(ies)Applicable: GW-1 GW-2 GW3 > When submitting any Class A-1 RAO or a Class B-1 RAO where contamination is consistent with background levels,do NOT specify a Risk Characterization Method. > When submitting any Class A-2 RAO or a Class B-1 RAO where contamination is NOT consistent with background levels,you cannot use an AUL to maintain a level of no significant risk. Therefore,you must meet S-1 Soil Standards,if using Risk Characterization Method 1. Revised 417/95 Supersedes Forms BWSC-004 and 010(in part) Page 2 of 4 Do Not Alter This Form " Massachusetts Department of Environmental Protection BWSC-104 Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME (RAO) STATEMENT& Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM Pursuant to 310 CMR 40.0160(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) G. DOWNGRADIENT PROPERTY STATUS SUBMITTAL: ❑ If a Downgradient Property Status Submittal Compliance Fee is required,check here to certify that the fee has been submitted. You MUST attach a photocopy of the payment. ❑ Check here if a Release(s)of Oil or Hazardous Material(s),other than that which is the subject of this submittal,has occurred at this property. Release Tracking Number(s): Q Check here if the Releases identified above require further Response Actions pursuant to 310 CMR 40.0000. Required documentation for a Downgradient Property Status Submittal includes,but is not limited to,copies of notices provided to owners and operators of both upgradient and downgradient abutting properties and of any known or suspected source properties. H. LSP OPINION: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of()the standard of care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge,information and belief, > if section B indicates that a Downgradient Property Status Submittal is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L c.21 E and 310 CMR 40.0000,(i) is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in 310 CMR 40.0183(2)(b),and(iii)complies(y) with the identified provisions of all orders,permits,and approvals identified in this submittal; . > if section B indicates that either an RAO Statement,Phase I Completion Statement and/or Periodic Review Opinion is being provided,the response action(s)that is(are)the.subject of this submittal O has(have)been developed and implemented in accordance with the.applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(i)as set forth in the applicable provisions of M.G.L.:c.21 E and,310 CMR A0.0000,and(iii)complies(y).with the identifed.provisions.of all.orders„permits,,and approvals.,•�r identified in this submittal. am aware that significant.penalties may result,including,,twt not limded3o,•possible fnes,and imprisonment,if•'I submit information.which;l,know to be false,inaccurate or materially incomplete. f. 'Check here if the Response Actions)on which this opinion is based;if any,;are(were).subject to anyvrder(s),.permit(s)and/or approvals) - r, issued by DEP or EPA. If the box is checked,you MUSE attach astatement identifying the applicable provisions thereof: LSP Name: Mark E. Nelson LSP#: 7893 Stamp: Telephone: 508-833-6600 Ext.: FAX:(optional) 508-833-3150 [+� 7893 Signature: Date: 1. PERSON MAKING SUBMITTAL: ` Name of Organization: MBO Precast, Inc. Name of Contact: _ Jeffrey Opachinski Title: President Street: 169 Camelot Drive City/Town: Plymouth State: MA ZIP Code: 02360 Telephone: 508-746-4939 Ext.: FAX:(optional) J. RELATIONSHIP TO SITE OF PERSON MAKING SUBMITTAL: (check one) RP or PRP Specify: O Owner O Operator O Generator O Transporter Other RP or PRP: ❑ Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) ❑ Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.5(j)) ❑ Any Other Person Submitting This Form Specify Relationship: Revised 417i95 Supersedes Forms BWSC-004 and 010(in part) Page 3 of 4 Do Not Alter This Form (M��;4Wlaaicaw v�p�lir>Ii.Fll��ia ve ���ruv�m��n� r.�wa�a.aw�� vr■vvc...-W Bureau of Waste Site Cleanup I I RESPONSE ACTION OUTCOME (RAO) STATEMENT& Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM 13792• Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) f K. CERTIFICATION OF PERSON SUBMITTING DOWNGRADIENT PROPERTY STATUS SUBMITTAL: 1, ,attest under the pains and penalties of perjury(i)that 1 have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form;(ii)that,based on my inquiry of the/those individual(s)immediately responsible for obtaining the information,the material information contained herein is,to the best of my knowledge, information and belief,true,accurate and complete;(iii)that,to the best of my knowledge,information and belief,I/the person(s)or entity(ies)on whose behalf this submittal is made satisty(ies)the criteria in 310 CMI2 40.0183(2);(iv)that 1/the person(s)or entity(ies)on whose behalf this submittal is made have provided notice in accordance with 310 CMR 40.0183(5);and(v)that I am fully authorized to make this attestation on behalf of the person(s)or entity(ies)legally responsible for this submittal. I/the person(s)or entity(ies)on whose behalf this submittal is made is/are aware that there are significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. By: Title: (signature) For. Date: (print name of person or entity recorded in Section 1) Enter address of the person providing certification,if different from address recorded in Section I: Street: - Cityfrown: State: ZIP Code: Telephone: Ext.: FAX:(optional) L CERTIFICATION OF PERSON MAKING SUBMITTAL:" If you are completing only a Downgradient Property Status Submittal,you do not need:to'completethis section-of the,,form.-< attest under the pains and penalties of perjury i that I have personally.examined and am n IIZ P P O Pe ly. familiar w the information contai ed in this submittal;including'any and all documents accompanying this transmittalforin;(ii)that;`based ommy inquiry :a of those individuals immediately responsible for obtaining the information,the material information contained in.thissubmittatis;.to,the best of my .knowledge and belief,true_accurate'and complete,and(iii)that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal.,I/the person or entity on whose behalf this submittal is made:am/is=aware that.there are.significant,penalties,.including,,but not limited to possible fines and imprisonment,'for willfully submitting false,inaccurate,or incomplete,information. {,„ By: - V. Title: ll�yL� (signature For. �()g/t>� S V! . S Date: (print name of person or entity recorded in Section 1) Enter address of the person providing certification,if different from address recorded in Section I: Street: City/Town: State: ZIP Code: Telephone: EA.: FAX:(optional) YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE,AND YOU MAY INCUR ADDITIONAL COMPLIANCE FEES. Revised 417/95 Supersedes Forms BWSC-004 and 010(in part) Page 4 of 4 Do Not Alter This Form f% ..vr..rYnove646 V\ GIVIIV1 III 11 11ulu rroje r=Ot1 BWSC-105 Bureau of Waste Site Cleanup IMMEDIATE RESPONSE ACTION (IRA) R"e°6e Tn Number D TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) 13 7.9 2 A. RELEASE OR THREAT OF RELEASE LOCATION: Release Name:(optionaq MBO Precast Spill Street: Route 6A LxationAid Adjacent to 3010 Route 6A City/Town: Barnstable MA 02630 ZJP Cods: ❑ Check here if a Tier C auiffcation Submittal has been provided to DEP for this Release Tracking Number. ❑ Check here if this locatiorn is Adequately Regulated,pursuant to 310 CMR 40.0110-0114. SPcafY Program:❑ CERCLA ❑ HSWA Corrective Action ❑ Solid Waste Manages ❑ RCRA State Program(21 C Faa7itias) Related Release Tracking Numbers That This IRA Addresam. B.THIS FORM IS BEING USED TO: (check a1 that apply) ❑ Submit an IRA Plan(complete Sections A,8,C,D,E.H,1.J and Iq. ❑ Check here if this IRA Plan is an update or modification of a prevbusly approved written IRA Plan. Date Submitted: ❑ Submit an Imminent Hazard Evaluation(complete Sections B C F �►. F.H.1.J and � IQ. ❑ Submit an IRA Stftw Report(oomple s Sections A.S.C.E,H.1.J and IQ. ❑ Submit a Request to Terminate m ActIm Remedial System m andlor Terminate a Continuing Rasponee Action(s)Taken to Address an hNnant HatSrd(complete Sections A.8,C,D.E,H.1.J and IQ' ' ❑X Submit an IRA Completion Statement {. (complete Sections A,S.C,®:E.G,W.I.J and You must attach all supporting documentation required lbesech use of foirrl irldita d;indudirxg'oopies cf any Legal.Notices and Notions to-Publie gMdals squired by S10 CHAR 401400 C. RELEASE OR THREAT OF RELEASE CONDITIONS THAT,.WARRANT IRA. Identify Media and.Receptors Affected; (check all that apply)`. El Q AU ❑ Grounder .Surl7aci witei ❑M Sedln;et,ts a. Soil ® Wetland X Storm Drain ❑ ❑ Paved Sur(aos ❑ Private Wei ❑ Pubitc water supph► ❑ :Zone 2.❑ YRes dance . .School ❑ Unknown ❑ other SI M v Identify Conditions That Require IRA,Pursuant to 310 CMR 40.0412: (check all that apply) 2 Hour R sporting Condition(s) . ❑ 72 Hour Reporting condmon(s) ❑ Srbitantlel Release Migration 0 Other Describe: sudden release of hydraulic oil from a truck Identify Oils and Hanrdous Materials Released: (check an that apply) ® Oils ❑ Chlorinated Solvents ❑ Heavy Metals ❑ Others Specify: hydraulic oil D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply) ❑ Assessrnent and/or Monitoring only X❑ Dal3loyment of Art or Containment Materials ❑X Excavation of Contaminated Soils ❑ Temporary Covers or Caps X❑ Re-krse,Recycling or Treatment ❑ Bioremediation Q On Site off Site Est.Vol.: pubic yards ❑ SON Vapor Extraction Describe: oily sand Q /6V,-d 6 Potj 1 K�1 <4 U� ❑ Structure venting System ❑ Store Q On Site O OR Site Est.Vd.: cubic yards ❑ Product or NAPL Recovery ❑ Landfill O Cover O Disposal Est.Vol.: cubic yards ❑ Groundwater Treatment Systems ❑ Removal of Drums,Tanks or Containers ❑ Ae Spwft Describe: ❑ Temporary Water Supplies SECTION D IS CONTINUED ON THE NEXT PAGE Revised 2/24I95 Supersedes Forms BWSC-005, 006, 010 On part)and 011 Page 1 of 3 Do Not Alter This Form 9 rvtrY %evowla ws caavrraYrrrrmrruna rrutaxtvn 113W�tir•7115 Bumau of Waste Site Cleanup - IMMEDIATE RESPONSE ACTION (IRA) RehssrradirgHumber b TRANSMITTAL FORM Pumuantto 310 CMR 40.0424-40.0427(Subpart D) 13792 D. DESCRIPTION OF RESPONSE ACTIONS(continued): QX Removal of Other Contaminated Media ❑ Temporary Evaauadw or Relocation of Residents Specify Type and Volume: oily water-70 gallons ❑ Feudng and Sign Posting ❑ Other Response Actions Describe: ❑ Check here if this IRA involves the use of Innovative Technologies(DEP Is irked in using this information to aid It creating an Innovative Technologies Clearinghouse). Describe Technologies: E- TRANSPORT OF REMEDIATION WASTE: (if Rernediation Waste has been seat to an off-site facility,answer the folkwlM questions) Name offadlllr. Oily water: General Chemical Oily sand: Bardon Trimount Town and State: 133 Leland St, Framingham, MA 01701 Great Western Road, Dennis, MA 02638 Quantity ofRemcdiationWs3teTransportedt0OaW 70 gallons 8 cubic yards F. IMMINENT HAZARD EVALUATION SUMMARY: (check are of the fallowft) ❑ Based upon an evaluation.an Imrninert Hazard emits In connection with this Release or Threat of Release. ❑ Based upon an evaluation,an hrftwt Hazard dos riot east ln eOn><uedim wth this Ribose or Throat of Rebeae. ❑ Based upon an evaluation,it Is unknown whetter an Imminert Hazard edsts in connection with this Release or Threat of Release.and further assessrnert activities will be undertaken. - Barad upon an evatuatlon,a b unkuortT whethef an Imminent Hazard em�sts"in conneetiorr with tfrfs'Releaae a Tlieet of Release.'However; response actions will address those'conditions that could pose an Imminent Hazard. G: IRA COMPLETION STATEMENT: ❑ Cheat hero if tress * response actions addressing this Relesse ar:Thrskt:of Reese will tie-conducted as part of the'Response'Actioris planned,' ' for a Site list has a6eactybeen Tier Classified tuuder a diBerent Rebese Traddrrp''Nurtiber,`or a Sbethat Isadergilled an the Transition List as desatbed In 310 CMR 40.01m900 Q.a..a Transition Site,which includes Sites with approved Waivers). These additional response actions rniust �' occur accordlnp to the deadlines applicable to the awliBrRelesse Tracking Number p.'e.;Sfia 10 Number). Stab Redeesa Tracking Number(l-e.,Site ID Number)of Tier Classified Site or Transition Sites U any Remedlaflon Waste will be stored,traded,ranged,recyded or reused at the site following suubadesion of the IRA Completion Statement,you must submit either a Release Abatement Measure(RAM)Plan or a Phase N Remedy implementation Plan,along with the appropriate transmittal form,as an dtadunent to the IRA Completion StatenoraL H. LSP OPINION: I attest under the pains and penalties of perjury Mat 1 have personally ammnined and am familiar with this transmittal form,including any and all ----81 enb accompanying this submittal. In my professional opinion and judgment based upon application of(Q the starded of care in 309 CMR 4.020),()the applicable pr-visions of 309 CMR 4.02(2)and(3).and un the provisions of 309 CMR 4.03(5).to the best of my knowledge, information and belief, • if Section B of tiro form in6eates that an In nwdbft Response Action Plan is being submitted,the respones action(s)that is(are)the subject of Oft submittal()has(have)been developed In axondance with the applicable provisions of M.G.L.C.21 E and 310 CMR 40.0W0,02 is(are) approp iste and reasonable to accomplish the purposes of such response aetion(a)as ad forth In the aPpH=We provisions of M.G.L c.21 E and 310 CMR 40.0000 and(i ni)compoe*)with the identified provisions of all orders,permits,and approvals identified ice this submattal; • if Sedian 8 of Bmis form k-Ndbates that an bnmkw rt Hazard Ewatndon is being submitted,this Imminert Hazard Evaluation was developed in Imminent E� provisions of M.G.L c.21 E and 310 CMR 40.0000,and all asaarrm t aetiviysa(y)undertaken to support this can"*)with the applicable provisions of M.G.L e.21 E and 310 CMR 40.000(% if S8c6on B of this form Indicates that an bnradfata Response Status Report Is being subnmitted,the response acftKs)that is(are)the subject of this submittal()Is(are)bang implemented in accordance with the applicable provisions of M.G.L.m 21 E and 310 CMR 40.00W.M Is(are) appropriate and reasonable to accomplish the paper of such response actkn(s)as ad forth in the applicable provisions of M.G.L.a 21 E and 310 CMR 40.0000 and(ii)compfies(y)with flee identified provisions of all orders,permdts.and approvals identified in this submittal; • if Section B of thus fbrm indicates that an brmrediate Response Acorn Complation Statement or a Request to Tarnbats an Active Renwdial Systarr and/or Tar it ate a Continuing Response Adfon(s)Taken to Addiass an In mhme d Hazard is being submted,the response action(s) that is(are)the subject of this submittal(I)has(have)been deweknped and Implemented in axordance with the applicable provisions of M.G.L c.21 E and 310 CMR 40.0000,00 is(are)appropriate and reasonable to accomplish the purposes of such response action($)as act forth in the applicable provisions of M.G.L c.21 E and 310 CMR 40.0000 and(in-)complies(y)with the identified provisions of all orders,permits,and approvals identified in this submittal. SECTION H IS CONTINUED ON THE NEXT PAGE Revised 2r24tg5 Supersedes Forms BWSC-005, W15, O10(n part)and 011 Page 2 of 3 Do Not Alter This Form • massacnua a:t= uepwment ar Cnvlronmentm Frotwuon . BWSC-105 . Bureau of Waste Site Cleanup E IMMEDIATE RESPONSE ACTION (IRA) Release Tracking Number TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) ❑ 4 - =92 H. LSP Opinion(continued): I am aware that significant penalties may result,including,but not limited to Inaccurate or y Incomplete. .possible fines and imprisonment„if submit information which I know to be raise, ❑ Check here N the Response Action(s)on which this opinion is based.if any,are(were)subject to any order(s),permit(s)and/or approvals)issued by DEP or EPA. If the boot is checked,you MUST attach a statement tdentifft the applicable provisions thereof. LSPName: Mark E. Nelson LSP9- 7893 Sip: Tie. 508-833-6600 Ext.: FAX(optional) 508-833-3150 Signature: Nr►7= °s w Date: y A qoj 19-n I. PERSON UNDERTAKING IRA: Name of organQation: MBO Precast Inc. Name of Contact: Jeffrey Opachinski Title: President Street; 169 Camelot Drive Cttyfrown: Plymouth State:.: MA ZIP Code: 02360 Telephone: 508-746-4939 Ek: FAX-.(optional) a. r ❑ Check here if there hws been a 'change m., person ka�dertalang the tRA M J.,•RELATIONSHIP TO'RELEASE-OR THREAT OF'RELEASE`OF'PERSON UNDERTAKING IRA: (chreck one) 11.�77 RP or PRP S FS 81 P M..Q owrer O Operator O Q„ ,T r ottra RP'or.PRP j� :. ❑ Fiducary,`Sek ured Levi i6i'"M'uii ai a ity wNih Fro' Shatus.(as defined E,s, r ` by NI G.L c"'21 ❑ Agency or Public Utility on a Right of Way(as defined by M.G.L c.211,s.5(D) ❑ Any Other Person Undertaking IRA Specify Relationship: K. CERTIFICATION OF PERSON UNDERTAKING IRA: I' .attest under the pains and penalties of perjury n that I have contained In this submittal i Plr eommined and familiar with the information cont am Of those individuals i 9�Y and docurrreYrts aParMnB thle trensmitlal ri that,based on my inquiry mmediately responsible for obtaining the information,the material information contained in thus submittal is,to the best of my knowledge and belief,true,accurate and complete,and 07 that I am fully akrd ized to make this attestation on behalf of the entity legally responsible for this submittal. Ifthe person or entity on whose behalf this submittal is made amfis aware that there are significant penalties,including,but not limited to, possible-fines and impriscnment,for willfully submitting false.inaccurate,or incomplete information. (sigma) Title: For. �1-y.,1 0 f�l u 6C.0 �l/1 �� a Date: (print name of p person or entity recorded in Section I) Enter address of the person providing certification,if different from address recorded in Section is Street: City/Town: State., ZIP Code. Telephone. E).: FAX(dal) YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE. Revised 224I95 Supersedes Forms BWSC-005, 006, 010(in part)and 011 Page 3 of 3 Do Not Alter This Form 9 Bardon Trimount,Inc. 1101Turnpike Street • t^ . ,s' '; Stoughton Massachusetts 02072 °t Tel: 781-344-1100 # �� Fax:781-341-2440 ( " rrm .. z �U _ _ June 26, 1998 HEATHER ATWOOD ENVIRO-SAFE CORP. P.O. BOX 810 EAST SANDWICH, MA 02537 Re: Soil, MBO Precast Route 6A Barnstable, MA Release Tracking ##: 4-13792 The recyclable soil from.the above address was received at our facility on June 19, 1998. Attached are the shipper's log of soil receipts which total,6.5•tons:along with • the Bills of Lading and other receipt documentation. P .. We. will issue a "Certificate of Recycling upon r&quest,after,processing. f Thank you for recycling soil at our So. Dennis facility. Yours truly, r" David M. Peter V.P., Environmental Services A subsidiary of Bardon Group,Inc. f 06-11-1998 11!46AIl FP,01•I Hor•sleV 3 1►ttters! Inn, TO 8689093 P.02 MM�AMIIUMItN LJ"u11MILyr ut Wes y1au.oarani rsvuwa.Uvjt , Burosu of Waffe aw amw .�..a.�,.w...'t B1 1 OF LADING (pnfsto ofiosic CUR moo30) 13792 A. LOCAngN OF SiTlr OR DISPOSALS"WHERE REM EDIAnaH WAstr WAs GENERATED: Rmttaso'Name;(opeonap: HBO Precast spill �.. stroot _i„Rotite by �_„� L=tcnA :_ Adjacent to 3010 Route 6A maown: B•rns two ie _ -- aP CoCo: 02030 as ffl anod of'Ganerndp : 4 /-.;_o/•_98 ID _4-/.1Q /ems A"bwv j Reigaao Tfad&g Num"rs Aaaoli oW VMet Rda fig of lAtring• fVbfi: Nihls gi0 01 Lad+rg rs our rflsuR d e LinitMd Rt,moraf ACoorr((.RBI left Wt error tp Notifieaf/orr,a Release Trsakdn,� MNrtear is Aw naomd. B. PERSON CONDIICT1NI1 RESPOND ACTION ASSOCIATEO WITH BILL OF LADING: Name of OrgwIimdon. 30 p�i s t Name ofCon,,ic I Jeff=,fttichinshi. ode• Presidents $root. _ 1 CA-de-Lot Drive' Gtyrrow�: p�rrnr)ut�h __r..__ Srato: ._ KA ap r.fktz: — Tslepnena: 1�- I YAG-49 39 _ m C. RE(.AT)dNSHIP!TO RELEASE ORTHREATOFRi'2.JrASE OF PERSON CONDUCTING RESPONSE ACTION ASSOCIATED Wr BILL OF LADING: (sue RP II --1�"1 rf I ❑• , 9 ( vine): Owner flpar+sor Gw walar T1• -wear Mw RP: (� PRP 89*QNY( 9Ae): Qafwrtttor T_�r�porp�r, OOwr PRF. _ v Rdudarygiaaned Iwider ❑ Agttncywtroftc Ulu on a Fight of Way c { orN Per m: t . Man owriw w4W opw26.a not conductnq ale ron�ac:SW assowtad wKh,tfto®1 of Laain9.ptwde on an atffi6finent Cie'nano WntaG parson,ad number,kned xwq any lusts tries anti e�cierssfon fa eai :it tvrdwn, " D. TRANSPd O'MMON CARRIER IHPORMATION: Tran:porteuCoromon c�Irrtsr Name: Enviro-Safi,Corp. C"AactPerson: Heather.Atwo Title, President_ auger. P.0.� Bux 10 ' �rrg E.11at SandVLC-b State: MA, — tip Cone: 02537 �• i9;8 - $8S a 5�•78_ tfat.�„r E. RECEIVING FACILITYfMMPORART MRAGE LOCATION: p tpr�aetdtjfuama:! Berdon Trimount Environ:aantal SaryicPs Con,.actporer►i�Dplvid Peter : !latlag2r at�t: GreAt 1TeAern — t,'Ilyr?own: 5. De r.A s ZO Cody: Q26 60 — Telephone: SV 94 " 6655 _ EL��— Typa of Fac0ty:' Asphalt BawvCofd Mbr Q Inab+orntar (Owwk Ono) i Asphalt FlawNrbt PAR ❑ Lwwm/Oatly coves ❑ YM►paaor © ThotTy ptp002*v ❑ landflpr9trutaral Flu 9torago I Otter, f)i+raion or"OtisCM&Im of Said Waste � wafwCtissArorrrvttl: S95-942 moss r'+o"tPerrtutt: EpAtdanoPcauoes:,tano �Z`�L 3irr� � Aca,avAnaaoaise Perioe of TafnaofwV Etaffigc(11PO lr dates tr uppueaV*): /_._.. /..._ o /--- Rerian for Temporary S►orago(if app(tcabte): Aw4,zjjd iWIta4 Page t of 3 TOTFIL P.©% 06-la-1996 i0:02AM FRO11 Horsley E. I Itten• Inc, TO BEF9093 P,03 M`ssechusetts Department of Envlronmmtntal Protpetlon OWSC-012A 9Lreau of Waste Sits Cleanup i arlrr TrwRlrr N+a►r BILL OF LADING Moat w 3To cum 4ao wo) �- 13792 F- RfCEMHO FACILCrYREMAORARY STORAGE LOCATION(eontlnu6d): Twpavy rape Aadrass r r Cily/ronrn:� _ State' 21p coo.- F. OBC IPTION OF RRIIARDIIITION WASTE; (d"all 41 apply)+ ® fa ntar"tod a(drde aU that apply)" QLCOftlrudon owxlrator 5urfeoo Waier 01n t: Ct ft4inafod ObbriS(droto all?nat apply): waste Vlagotatiort�rgenic Marerials ' j (nery#Ilc AD5or0alit MrlNflal6 Ov►er. .`.___.-• ._ _ ____, ❑ Mor*AI ardouc IUncOnrtirori=od Wacro(«da d that aPDti)' +a4vaovs Phaao Liquid Qrrrvr: ❑ Nor►haeardow Litalner¢ed Was$@(ode all ftMoppty): Tanit Doaomslaudges CGtttair.dra Drums b+gl+red Impoundments Cow: -_ Type of Contarnin"(e els•p thm apply): r4,Ano Distal Fuel 9201 0409 0604 Waste Cl wrML� Jot Fuel trr.. H9drauli.r n.1 Estimale0 Vblumo of Mftwniats- cube Yard:: Other: ' - Contam+nant Soueco 09-Ok OAMpoe ): a) TrUMP&M6001 Aeeidont ❑Urldefyround Stora©p.%* -❑Otnor: Alovenla Abler 'I►ssprs•Ded with MI of Lading(elide mne): Iitrnttilate geeoertes M polease'•Abaeement W4muru I Udety neaama Abato~nt fAmmure Lkniled ntxntrval Acton%M,)i CtanprommmAie Ftaspornr;a Aepyt. Aimadiaoord Wawa Chwaci irdatroA Support Ooaanentat+en attached; OLJ'Sko Mig IrVpnlfsun ❑ 60MQe.�g aM0 MiJy0C�1 Metr+DOL',3nE,Praovduraa ® .t.oDdOVXy Oata ❑ .Frew 9crMw+ln9 D* R'aupporifrt0on Aocumajtatlon Is rivi spp*hd'd pvAdb eA alwA ri*nt abatnng.MW ea7o are in oonnecson-Wm vd►al docvnrn`tl uv.,yn;,2im&V' patprt?veu�y submitlW to OG': G. L=rNiE!! PROFESSIONAL(LSP)OPINION: ' Horsley & ThtLen. Inc. liame�of Ot�erti&t�Ilprtf . LSP I�amo: Nar:c. E. Nclson Toe: TVW*ne: :S 08 'T 833 - 6 6 00 p� I I~"t Thaw tab examined end am Fmwi•►welt Ow inhurnatlon oonmined In nic eubrrirttet,indudrg err end eM docut+onto aca`ompanying this wbrMtal,and in my profoccionol opinion and jud9mont basod upon application of ttrpat+ne a erw In M9CUR 4.02(t), Imam is provkgpns of 309 CMF14A=end CJ).and [i+)the of No CMR 4,00(611, to One bast of I -MW9o,Inlormolyon Lind"Ne agw9wnent actions underla►wr►to charbearisv dw P—edration Wallop which.Is Iwo)tfm eub)oct of Otis PAmnktnl tar ae�pmr�oo at MA fsdlty Idwellod In mtt:tubmkW comply with the epolh�bro p►aviskm bf 3lo CMA 40.0000.and g%x ►1e 14 ie perm w to awoot pomodLldo6 Waste hwviv One ofwVOsOm debarked in 011e subrnitt d. I am a+vpro OW eignlfiaont penoldoe may►stint,inoluding,but neeZmieoa to, pm4lbte tines end k*is«w+ert,it I submit irkxnntlnr whk h 1 Mho.+to be hise,Inaeevrete at rrls"111y;ftVAPIMS r I Data.`�i��•�,,,�. . UMMta Nul twr: i 7693 Pb T1� .. •ga pn 06-13-19�8 10=©3AP1 FROM Horsley & Litter.,, Inc. TO 8E8909: P,04 Maimchulsotte Department of Environmental Protection BWSC-01 aA Bwileu Of Waste Slte Cleanup FA*M?• *MmAor BIL� OF LADING(pursuant w 3to cwR to,002O) D— 13792 H. CQRTFICATIOh OIL PERSON CONOUCTING RESPONSE ACTION ASSOCIATED WITH THIS BILL OF LADING: I cm*under panalded of Iasr that r hM per-e4gy aRamkvd and am lambai wnn Iho intamwon c®nnlnoe in this.s mm".Irle „e r„y am al do&mGr4 aapomp1 'Ing mlt.canI cation. and *Qk baud on my IngUIry ct M9 Individuals irmwdiat*mpon:iblo br ObtmiR Cta hfts,tlson.96 r iawtid InlormaOon oontani+d herein is,to itw bast of my knvw"m and page+,rm.a=vats and compleb. I lfft awwq that tftore am iNeant penal108, iAduding, DUI not.Ilmlted to. passible rina5 and imprisonment, for wilfully.submilgN false, inamsaw. .2r bp= plots In"dam' i . l I i I • i i O,T Lf QM! 0I1/ P� 06-1121-1996 1: 10HPI FRU11 Horsley & willen, Inc. Massachusetts Depa dment of Environmental Protection BWSC-012B Bureau o1 Waste Site Cleanup „ Trod" BILL OF U101NG Grtartwnt ate CtAfi ao tiwo) FI_ 1 `71�� o LOB SHSET 1. LOAD INrd.Fk AATION: F19-- ty/To tat Repr entatVa. f Ship 'p'Q '1bm dSf�iar���:•o!e� � ; d '� Tim Raoolpt: _ l.L2 /113. O� farm ens ai� Trtlrl�Ifnscoor fREtgiatratlon: 7raier Registration Of any): i �� ( an m teal LOAD 2: 666 adrs of Ttanapa w Represranfad* i Receiving I=adtity/Ternporary storage Repleeonf lm: r Date of 8hiprnenc fine ai Sldpment Dap of Receipt: Time of Recut: / (drde cite)amdpm Trad0maur RO&ralon: Trailer Rogitbabon(if any): r PCfe one)"M j L=W Slse(m ydsAom): LOAD 3:. fti►efum d Transponor Repr� lft: i Raceivbfp FaWly Temporary Storage Represenadw Date of SNpm": TYno of Shipment i Dab d Raeelpt: Tine of RftMpr Tnj*ff m Raplsoadm! TYaitrr Repistraom itl ay): i (aisle of re)eM" r I.LOW..Otte(eu.Yd.840nek LOAD 4: _sfgi►ettui a Tran&WW Repreeenhdttoi Wromp ary Storage Awesentaum: r_.per t Receipt. Tim of Receipt: Dap of owmeft Time of Shipment TruowTrador R®gislrabanc, Tedkr Roglorallon(ff any) {,, �x •..,. _(cirdo ana)�mlprri' r: Lead Stro(urn ydeJtoms). LOAD fi Si9�+of Tr`anopww f wosonfa": i'`R ah Y+p tyltbrnporarl atorago Repiasemam' r Oafs of Shipment: Time of shipment r Owe d R000ips: une of Receipt: Riede am)=,Vpm Tnrtd frwA r Rerfl idiom TWIN AegaisVOW of any): � (olrole am)aff Vn Load Sirs.(cu.ydtJfens): _ LOAD B: Slntlre of Transporter Represerpdivo: A"*flw paary Stange Repreeft"O a: Defor or 9triprtrent: T'rmv of 8hipraent i.;.Dam of AAoefpt: . Time of Reowpt: . r;-w,"4/,..� ,..,..... •�_ 'Rl dNtleo(of Re ltsslion: Tlre&w Regilriradan Of any); i },, t )anupm LOAD 7: S(grtapro a lmftpormr Re NWMdva:' r. w Dam of Asadpt: Time d Raoaipt: Dste of ShiFTNW: Tmw of Shipment yyam�: r i ww�/ •�� /nw� • - (041Y fie). �! k fi.�A,�y�}p� ��`w r Trtll: Tratdor Ao�liwsitfon: Trailer Reglatratlon(it any): $ ' (oirole aft)am/pm r r L00�Sin(W.YOLAM); J. wo sHEU VOLUME INFORMAMrl: ���TotelYalrane thm�(a+Y��). fi grll�f fyfietlFpwtlyd(ou.rdtAdnt): _ x Total S* �.Ary f Massachusetts Department of Environmental Protection BWSC-012C Bureau of Waste Site Cleanup Rek- -TraWrg Number: BILL OF LADING(pursuant to 310 CMR 40.0030) ®— l3 �9 Z ' SUMMARY SHEET OF _�_ K. SUMMARY OF SHIPMENTS: DATE OF SHIPMENT: DATE OF RECEIPT: NUMBER OF LOADS SHIPPED: DAILY VOLUME SHIPPED(CU.YD --------------- -- =�---98-- ---------------Z---------- ---- -------------- -----J----- ------------------------- ------- ---------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- ---------------------------- ----------------------------- M --- - - - - - -- - - - - - - -- - -- - in ., --------------- --------------- -- ----- ---� -�- 1-- -�- -------- ---� ---- ---- ---- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- ---------------- --------------------------------------------- ----------------------------- ----.----------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- ---------------- ---------------------------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- SUMMARY SHEET TOTAL SHIPPED: BILL OF LADING TOTALSHIPPI D(only if different): Revised 10/V94 I nisr s prin tea Un recyclea paper. Page 1 of 2 Massachusetts Department of Environmental Protection BWSC-012C Bureau of Waste Site Cleanup Release TrvX g r#mber: BILL OF LADING (pursuant to 310 CMR 40.0030) SUMMARY SHEET L. ACKNOWLEDGEMENT OF RECEIPT OF REMEDIATION WASTE AT RECEIVING FACILITY OR TEMPORARY STORAGE LOCATION: Receiving Facility a porary David M. Peter Location Repro t 've(print), Title: V.P.—Env. Services Signature: Date: M. ACKNOWLEDGEMENT OF SHIPMENT AND RECEIPT OF REMI&ATION WASTE BY PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH THIS BILL OF LADING: I certify under penalties of law that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this certification, and that, based on my Inquiry of those Individuals Immediately responsible for obtaining the information,the material information contained herein Is,to the best of my knowledge and belief,true,accurate and complete. 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. Signature: Date: 7 / -r/ 5'F Name of Person(print): . ;2 r Revised 10/U94 1153 form is pane on recycled paper. Page 2 of 2 COMMONWEALTH OF MASSACHUSETTS A F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m , d DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE'.... ,. WILLIAM F.WELD w`" TRUDY CORE Governor Secretary ARGEO PAUL CELLUCCI' DAVID B.STRUHS Lt.Governor _ Commissioner URGENT LEGAL MATTER: PROMPT ACTIDN NECESSARY CERTIFIED MAIL: RETURN RECEIPT •REOUESTED` �.. April ;16, 1998 , MBO Precast RE , BARNSTABLE-BWSC _ . 169 Camelot Drive :L. Route '6P; Plymouth, MA. 02360 RTN#' 4 13792` NOTICE OF ' RESPONSIBILITY ` w ;M G 'Z° c ;21E 3:10 MR C -40 0000 - 1 j.` ATTENTION: .Jeff `Opachitski- ,, On April 10, 1998 ,at 9:35 am -the Department �of °'Environmental Protection (the "Department" ) received oral :;,notification of a release and/or threat of release,-.of-'0i'l `and/or' hazardous material at the above referenced property which requires, one , or , more-,A response aetiors. A hydraulic . ine1 ruptured' discYarg ng approximately, 20 1 gallons' of,,oil ,,.`onto, <the roadway, -mand into a . catchbasin which- discharg6; into `wetlands . The Massachusetts, ,1 Oil, and Hazardous .,'.Material- Release Prevention and Response 'Act.,, M.G L^. -c'. 21E, and. the' Massachusetts Contingency Plan.. ;. (the '!MCP") , 3.10 CMR -k}40 . 0000,..-•. require the performance of ,response inactions to prevent harm to .$health, safety, p onment-which --may- :j r' sult ` from- this ublic welfare, and" the"',.envir - 120 Riverside Drive•Lakeville,Massachusetts 02347• FAX(508)947-6557•Telephone(508)946-2700 Printed on Recycled Paper release and/or threat of release and govern the conduct of such actions . The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used- herein shall have the meaning ascribed to such terms and ,phrases by the MCP unless the context clearly indicates otherwise The Department has reason to believe that the release and/or ' ' threat of release which has been reported is cr may be a disposal ' site as defined by the M.C.P. The Department also has reason to believe that you (as used in this letter, "you refers to MBO PrecastM.B.O. Precast are a Potentially Responsible Party (a "PRP" ) with liability under M.G.L. c.21E 95, -for response action costs . This liability is "strict meaning that it. is not +based on fault, but solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L. c.21E §5 . This liability is also "joint and several meaning that you may be liable for� all response action. costs ,incurred at a. disposal site regardless of the existence of any other liable parties . The Department encourages parties with liabilities under M.G.L. c. 21E to take prompt and appropriate actions in response to releases and threats of release of oil .,and/or hazardous materials . By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for 'costs incurred by the Department in taking .such� actions . You may also avoid the imposition of., the. amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR , 4 . 00 . Please refer to M.G.L. c .,21E for a complete description of . potential liability. For your convenience, a summary of liability under M.G.L. c.21E is attached to this notice. : You should be aware. that you may have claims 'against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup.. , Such claims - do not exist indefinitely but are governed bylaws which - establish the time allowed for bringing litigation. The Department encourages you to take any action necessary to protect any such claims you may have against third parties. At ' the time of oral . notification to the Department, the following response actions, were approved as an Immediate Response Action (IRA) : m • Deployment of Absorbent/Containment Materials. . 3 ' • Excavation and. disposal of up to 10 : cubic yards of contaminated soil . • Removal of up to .100 gallons of Contaminated Water. ACTIONS REQUIRED Additional submittals are necessary with regard to this notification including, but not limited to; ' the filing ` of a written IRA Plan, IRA Completion Statement and/or . an RAO statement . The MCP requires that a fee of $750 .00 be submitted to the Department when an RAO. statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the Department for the implementation of all IRAs and Release Abatement Measures (RAMs) . Assessment activities, the construction of a fence' .and/or the 'posting of signs are actions that are exempt from this approval requirement .. In addition to oral notification, 310 ` CMR 40 . 0333 'requires that a completed Release Notification Form (BWSC-.103 , attached) be submitted to the Department within sixty (60) calendar days of April 10, 1998 . You must employ or engage asLicensed Site Professional (LSP) to manage, supervise or actually .perform the necessary,,response actions at this site. You may obtain a list of the names and ' addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1145 . Unless otherwise provided by the Department, potentially responsible parties ( "PRP' s" ) have one year from the initial date of notification to the , Department of a - release or threat of a . release, pursuant to 310 CMR 40 . 0300, or. from the date the Department issues a Notice of Responsibility, . whichever occurs earlier, to file with - the Department one: of the following submittals : (1) a completed Tier Classification Submittal; (2) a Response Action Outcome Statement or, if applicable, (3) a Downgradient Property Status . The deadline for either . of the first two' submittals for this disposal site is April 10, 1999 , If required by the MCP, a completed Tier I Permit Application must also accompany a Tier Classification Submittal. This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a ' l'evel of No Significant Risk" 4 exists or has been achieved in compliance with M.G.L. c.21E and the MCP. If you have any 'questions relative to ..this notice, please contact Robert Kearns at the letterhead address or at (508) 946- (508) 946-2865 . All. future communications regarding this release must reference the following Release Tracking Number: 4-13792 . Very truly yours, Richard F. Packard, Chief Emergency Response / Release Notification Section P/RK/re CERTIFIED MAIL #Z 333 584 .330 e . RETURN RECEIPT REQUESTED Attachments : Re lea se ,Notification Form BWSC-103 and Instructions Summary of. Liability under M.G.L. c . 21E CC : Board of Selectmen Town Hall, 367 Main St . Hyannis, MA 02601 Board of Health Town Hall, 367 Main St . Hyannis, MA 02601 Fire Dept . 95 High School Road ' Hyannis, MA 02601 June 10; 1998 Mr. Richard Packard Bureau of Waste Site Cleanup Massachusetts Department of EnvironmentalProtection Horsley&Witten,Inc. Southeast Regional.'Office Sextant Hill 20 Riverside Drive ' ; $' 90 Route 6A Lakeville MA 02346 ' Sandwich,MA 02563 RE: RTN 4-13792, Release Notification and Immediate Response Action Plan (50e)833 shoo MBO.Precast Inc. Hydraulic Oil Spill. April 10, 1998 `} Fax(508)833-3150 Route 6A, Barnstable, Massachusetts Dear Mr. Packard: Enclosed please find 'a completed.Release Notification and. Immediate Response Action (IRA).Transmittal Form for the above referenced hydraulic oil spill in Barnstable, Massachusetts. This letter provides information necessary to-document the IRA plan for this spill site. All response actions.have been completed with the exception,of final - disposal of oil contaminated sand,`planned for the week of June 15, 1998. The spill occurred on the}:morning of April 10,,1998,,,on, Route 6A west of u Barnstable Village (adjacent to 3010 Route 6A):The incident occurred ., when a hydraulic-,line ruptured on�a truck delivering precast concrete drainage.structures. The truck was owned,by: MBO Precast Inc. 4 169 Camelot Drive Plymouth, MA 02360 ° Tel: (508) 746-4939 =, Jeffery'Opachinski, President The spill occurred during heavy-rain, resulting in a.rapid,spreading of emulsified oil..The Department of Environmental Protection was provided a.two hour verbal notification. Subsequent evaluation of the vehicle by MBO.Precast'indicated 3 to 5 gallons of oil was released. The Town of .Barnstable Department of Public,Works anded the roadway and,MBO xcontracted with Horsley & Witten; Inc:`.and;Enviro- Safe and to oversee and complete clean-up. Oily sand`was removed 4; by: the.DPW for temporary storage.at the Town DPW yard. Enviro-Safe used a vacuum truck'to :remove oily water from an impacted"catch basin: Small spots of oil were also removed with adsorbent pads from the catch Boston&Sandwich,MA f i Mr.'Richard Packard June.10, 1998 Page 2 basin discharge point in.,a drainage area adjacent to Route 6A. All of the contamination was visual.identified and completely removed on April 10, 1998. Although a reportable quantity of oil may not have been`released, with:Mr. Robert. followin a discussionw response actions were taken, g Kearns of the DEP, to respond to the public safety threat caused by oil on the roadway and a threat to the environment.from oil in the catch basin and drainage area. Liquid wastes,and adsorbent materials were transported for disposal by Envi.ro-Safe. Oily sand was temporarily stored by the DPW pending test results for recycling by,asphalt batching. Final disposal of oily sand isplanned for the week'of June 15, 1998. Following soil disposal,'anIRA Completion Statement and .a Response Action Outcome will be forwarded to DEP. If you have any questions, please contact meat (508) 833-6600. Sincerely, HORSLEY & WI N, INC. egle Senior Envi o ental Engineer Barnstable Board of Health P.O. Box 534 . Hyannis, MA 02601 ATTN: Glen Harrington J Town of Barnstable _ 367-Main Street. Hyannis, MA.02601 ATTN: James Tinsley, Town Manager Jeffery Op.achinski, President, MBO.Precast Inc. 169 Camelot Drive Plymouth, MA 02360 Horsley&Witten,Inc. 3026 OLD KING'S HIGHWAY; BARNSTABLE A=279-022 HENRY CROCKER HOUSE Ij 4 1 I I V FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE RESIDENTIAL KITCHEN FOR BED+BREAKFAST $45.00 SEATING: 0 MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: LE TOWN OF BARNSTA$ OARDop 00- OF HEALcTH �r � 3 �, PERMIT TG'DPERAT&A FOOD�ES�TAl3LISHMENT 3 PERMIT NO: 531 � �a g JANUARY 1, 1999 � g i ,� ,�� � a�;�,,,�� ram. .. In accordance w th regul tionskprom Igate�l unde thQnty of Chapter 94, Section 395A an Chapter 11�1,11S�cfilpn 5 of 1the General La',s, a permit is hereby granted to: DONALD & BARBARA BRACK P "k D/B/A: HENRY CROCKER HORSEbhlk- Whose lace of businessfiis ,3026 OLDE KING'S I�IGHWAY , BA`RNSTAB E, MA 02630 p � � in ss and an` restnctlons: Type of busa BED A"ND BREAKFAST ESTABLISHMENT To operate a food establis4meiwin."e TOWN OFF BARNS ABLE Permit expires: December 31. 1999 ";o BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P.H. Thomas A. McKean, RS, CHO Director of Public Health i� I f - oFVEr Town of Barnstable Department of Health, Safety, and Environmental Services 1 � Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health SEATING_6 ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO.�1q/�a�` e2�� DATE la- Q APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT ZiD RR L, D �� ���O( $���fl R C tN— NAME OF FOOD ESTABLISHMENT R E Q)R X_ C&-c EK A16 v5 R d ADDRESS OF FOOD ESTABLISHMENT ,3Da(o rj A l P3 ST 3E j)W5'TAB L t/i L LAG& TELEPHONE NUMBER TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD ,ABED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER:X__YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF XPPLICANT RESTRICTIONS: HOME ADDRESS 36eL& 11t4) l) .ST 891=& 1 HOME TELEPHONE# 75-- ©1D 01 foodest%db/q o ou" TOWN OF BARNSTABLE 1 BOARD OF HEALTH c0M ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date �+ Owner Tenant -P(-4VAV (2)20 C DUB Address Aciclress�20zy-a MAW Complionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities q P6 me/as Arf- 3. Bathroom Facilities �, -k 4. Water Supply IV Tolk) 5. Hot Water Facilities / V 1 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits �Z' 13. Installation and Maintenance of Structural Elements IZ �y ^ 14. Insects and Rodents A� / �y�� � ��PA/ `WK V4 15. Garbage and Rubbish Storage and Disposal USAV, , 3-re 16. Sewage Disposal 17. Temporary Housing PART II /161 1. /V/�VIE 37. Placarding of Condemned Dwelling; l��Vz-�� Ue V J/A&�!j Removal of Occupants; Demolition SW ke �^ 01 �/ J [ ' C Inc Person(s) Interviewed !6aat�' Inspector Vol& If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN,INC. PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2000 531 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: DONALD&BARBARA BRACK D/B/A: HENRY CROCKER HOUSE Whose place of business is: 3026 OLDE KING'S HIGHWAY, BARNSTABLE, MA 02630 Type of business and any restrictions: BED AND BREAKFAST ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 0 ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE:FOOD SERVICE ESTABLISHMENT: Susan G. RBsk, R.S.,Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: $45.00 Sumner Kaufman,M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2000 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK'CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE I Name: 6,4R A f3 23 Rto ce please print Name of Food Establishment: 17+ ji�7 i e-4-e6cxr JQ l u's r Location of Establishment: 3�z1, N,4/1y .s' r. P A x1u S Fn13 Lr l//L L46-c street name and village Today's Date: 0 Ly�'�tHE Town of Barnstable ELAM Ms Board of Health MAM0 9 167 Main Street, Hyannis,MA 02601 '°lFc ter' CERTIFICATE Of ATTENDANCE Safe Food Handling Training - --------------------------------- OFFICE USE ONLY This certificate of attendance expires two years after the date of attendance. .et YO ' Verification TOWN OF BARNSTABLE b yQ HEALTH DEPT. FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: SEATING: 0 RESIDENTIAL KITCHEN FOR BED+BREAKFAST $45.00 MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: ..::a=`arc-` ,e,,..,"`°N. tip.r, F•�� '`.* - - x- TOWN OF BARNSTABLE-,, KKY BOARD.-.OF HEALTW r PERMIT, A O OPERATE FOOD ESTABLISHMENT PERMIT NO: 531 p �r` µ JANUARY 1 1998 In accordance with:regulations promulgated under author ty of'Chapter 94, Section 395A andChapter 111• ':Section 5 of the General Laws, a permit is �'M 0" hereby granted to• J DONALD & BARBARA BRACK ' D/B/A• HENRY CROCKERs,HOUSE ; . .x ` Y. .. _ - ,, ` g Whose place of business is: 3026 OLDS KING'S HIGHWAY , BARNSTABLE•, MA 02630 Type of business and any restrictions: BED AND BREAKFAST ESTABLISHMENT Yp Y s To operate a food establishment in the: TOWN OF-BARNSTABLEz3' ' ^J lii 3 4, +✓ al Permit expires: December 31k1998 AW 331,� -� „ .. ` BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S H. Thomas A. McKean, RS, CHO Director of Public Health 1 EXISTING B&B. ZONING IS RF-2. CURREN Y ES NOT HAVE A SPECIAL PERMIT. IS LICENSED AND RENTING 3 MS/6 G STS.,; TS TO INCREASE THIS TO 5 ROOMS/10 GUESTS. DOES HE NEE A VARIANCE??? PLEASE CALL. i DISTINGUISHED BED &DREAKFAST O INGS IN HISTORIC' i BARNSTABLE VILLAGE ' CAPE COD,MASSACHUSETTS DONALD&BARAARA BRACK 3.026 Olde King's Highway Barnstable;MA 02630 , 508-362-6348 . • C2. f r +ik E 1 �oe � 1v ` TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION e Date / Owner o5TL, 1".6 54 MA?61�qm AQ(�'4 Address 9(0 Address Com ionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply U 5. Hot Water Facilities 0 AZ ��rr►► 6. Heating Facilities �1 7. Lighting and Electrical Facilities A7 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal � 16. Sewage Disposal 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition G tia Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN,INC. RETAIL FOOD STORE: FEES FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST $46.00 MOBILE FOOD UNIT: ANNUAL: YES SEASONAL: TOBACCO SALES: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN`OFBARNSTABLE BOARD OF HEALTH ` ;Yt PERMIT TO OPERATE A FO'OQESTABLISHMENT PERMIT NO: 451 t r JANUARY 1, 1997 In accordance wlth'regutations promulgated under a-t6orlty of Chapter 94, Section 395A and Chapter 111, Sectiort 5 of the General Laws; A permit is hereby granted to: � • � � �..``"'y' � ,-�• �.r�. �' v �r'�"` �'' t`-ten` � a � e � DONALD AND BARBARA BRACK .. D/B/A: HENRY CROCKER HOUSE Whose place of businesls 3026 MAINS R£ET ��i BARNSTABLE, MA 02636 s. .; v� Type of business and any'restrt�ons: BED AID BREAKFAST ESTABLISHMENT Nam. , .s W Too operate a food establishment In �e TOWNS OF"BARNSTABLE.. p Permit expires: December' 199�F71 �w BOARD OF HEALTH E Susan G. Rask, R.S., Chairperson Brian R.Grady, R.S. RESTRICTIONS IF ANY: Ralph A. Murphy, M.D. Thomas A. McKean, R.S:,CHO Director of Public Health, TOWN OF BARNSTABLE � 1 � ^ BOARD OF HEALTH ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION r Date I • 1 n Ut o Owner _ OA-4 Tenant - Ql r VV Address *2,0'../ IlA of> ) �-r Address J Complionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities /f 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities f 6. Heating Facilities ` 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service ~� 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal a 17. Temporary Housing PART II 0 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed / !% - R !� �J `' Inspector ..c..uw a� If Public Building such as Store or Hotel/Motel specify here HOBBB&WARREN,INC. oFtME,�,� Town of Barnstable Board of Health * BAMSTABLE, 9� MASS.9. �0g 367 Main Street,Hyannis MA 02601 p CERTIFICATION OF ATTENDANCE Safe Food Handling Training Name: GC�1--mac..c Gt please print Name of Food Establishment: Today's Date: --------------------------------------------------------------------------- * This certificate of attendance expires two years after the date of attendance. Verfication FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST: $40.00 MOBILE FOOD UNIT: ANNUAL: YES TEMPORARY FOOD ESTABLISHMENT: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO: 451 JANUARY 1, 1996 In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111, Section 5 of the General Laws, a permit is hereby granted to: DONALD AND BARBARA BRACK D/B/A: HENRY CROCKER HOUSE Whose place of business is: 3026 MAIN STREET , BARNSTABLE, MA 02630 Type of business and any restrictions: BED AND BREAKFAST ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit expires: December 31, 1996 BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Brian R. Grady, R.S. RESTRICTIONS IF ANY: Ralph A. Murphy, M.D. Thomas A. McKean, R.S., CHO Director of Public Health `� t h..^� Ste". -,4r.• ..p,,. s-�£w r•t Yy _,�,,•-�r�;,: :*. :y:'��1' -':,-tc r��.�i�'.�}y�n�:-e�f°i�{"�i•?8Ar �:t'�„, R-� TOWN OF BARNSTABLE BOARD OF HEALTH c� ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION Date 5� Owner )C68AA Tenant Address '�b 1(7 N�a4,k 5J Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements ' 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing PART 11 f C 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed� Inspector - If Public Building such as Store or Hotel/Motel specify here HOBBs$WARREN,INC. r L NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 17 $50.00 TUWR of BARNSTABLE Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. 17 J&WA Y 14 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: I ROBERT rld.:_ ZEE D/B/A lit IM CROCkER HOUSE Whose place of business is 5O2G 11AiT; ::>Tt�,F;ET, BA.: STAu,I,I� i Type of business and any restrictions BED AID BREAKFAST To operate a food establishment in `fOVX1 OF BWNTS TABLE (City or Town) Permit Expires DECEKI1BFP. 31 y 19 95 Copy Board This Copy To Be Retained By Local of Board of Health Health FORM 738 Re,1986 JV',E, T TOWN OF BARNSTABLE BOARD OF HEALTH L� �J a,,� R�TICLE :MINIMUM STANDARDS FOR HUMAN HABITATION I Date 6 0• X Owner I�n�"�'hu-f Tenant Address )0.. �� � 11 1� (� Address Compliance Regulation# Remarks or 9 Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities / 4. Water Supply ` 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities i 8. Ventilation 9. Installation and Maintenance of Facilities / 10. Curtailment of Service / 11. Space and Use 12. Exits , 13. Installation and Maintenance of Structural / Elements 14. Insects and Rodents j 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition II, Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here H013BS&WARREN,INC. of IKE/qy, ti . Town of Barnstable BARNBTABLE, MA8& Health Department i63q. A�eo.n " 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A. McKean FAX: 508-775-3344 Director of Public Health SEATING 6 ANNUAL ✓ SEASONAL ASSESSORS MAP AND PARCEL NO. 79 DATE9y, APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT � A� NAME OF FOOD ESTABLISHMENT � �,�y� � i ADDRESS OF FOOD ESTABLISHMENT_2,:::b2,,�,, TELEPHONE NUMBER TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD CONTI BR. . RES.KITCHEN MOBILE FOOD UNIT ✓ BED AND BREAKFAST SOLE OWNER: v Yes No IF APPLICANT IS A' PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT e�,' �Q RESTRICTIONS: HOME ADDRESS 1L�26 � S HOME TELEPHONE HOME �� ��6o2_ �P�S