RepneAtinOtoeSttmn epr akg

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RepneAtinOtoeSttmn epr akg
24 May 200>
Cyn Protect \Nmnher 201882-00-TlS
Miassachusetts lDepartment of Envitritnmental Protection
Bureaiu of Waste Site Cle anup
Cental Regional Oflice
627 Main Stieet
Athol, Mlassaebusetts 01608{)
Attention; NMr. Nicholas .(Chitlds, Branch Clue- Emrtcgency Response
Re:
ftmmedyiate ResonseActionrCompltionrand
RepneAtinOtoeSttmn
epr akg
t4ho! Mfedia Clinic -uNumber 2 Fuel Oil Reteas
/46 AMan tre, A4thol. assac
thusettus 0/33/
Release lTakin Number 2- I4815
Ntice~ of Nu:otnmplianceNumr:
rNON C103-346
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P'outnti Respnsible/ P'artiPR P/)~
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Site
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Phione Numbear 978-2'49-9 736
I-ax XNmber: 9785-249- 94/4
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DeTar Mr. Chdtds:
The purpose of this submittal is in pirovide the Massachusetts Department of Environmental lProtection [MADE P4
wtiths an Immediate Response Action [IRA] C ompletion and Response Action Outcome [RA () Statemnst Repor1
Pac kage tor the abov e referenc ed site [herein refer red to as D isposal Sire]. T his package has been pr epared by Cy
Environnmental Serv ices [Cyn] oni behtalof the Potentially Responsible Party [P'RP] to maintain the site's compliance
with the Massac husetits Contingency P lan [MSC P - 3 I0 CMAR 40 0000] and to close the site release file. lnformai on
required for an IRA and RAG Statemsent Report as speci fled in 3/0 CAIR 40 0427 ta 30 CMI
AR 40./036, are
contatied itn this document as a whole. Copies or the [RA Completion [BWSC -1051 and RAO) Transmittal Foinms
[BWSC->104[ are attached as Appendix A and Appendix B of this teport, respectiv ely T he originalI forms are
provided as a separate attachment to thits report Refer to Figure I for the regional location of the site, Figutre 2 for
the layout of the site, and Appendix C for photograph of the D isposal Site.
General Terms
Cyn E nvironmientalI Services [C pn} is psroviding an IRA Completion and R(OA Report for the trelease ot an unsknow n
quantity of nmber 2 fuel oil. whitch wsas disc overed and repot ed to the MADElP on I19 June 2003. The regi onal
locatain of the Di/spos a!Sire or Properny'is showxn on the Site Locus Map as Figurec I.
Athol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-148 15
24 May 2005
This document addresses the release of oils and/or hazardous materials [OHMs] associated with the site, which was
issued Release Tracking Numbers 2-14815 by the MADEP and the PRP regulatory filing requirement for an IRA
Completion / RAO Report. Further information on the release is outline throughout this report. For the purpose of this
report and pursuant to the Massachusetts Contingency Plan [MCP' - 310 CMR 40.0000] the following terminology will
be used:
Property or Facility- is defined as the area immediately surrounding the limits of the Disposal Site.
Site - means any building, structure, installation, equipment, piping or pipeline, well, pit, lagoon, impoundment, ditch,
landfill, storage container, motor vehicle, rolling stock, aircraft, or any other place or area where OHMs has
been deposited, stored, disposed, or placed.
Disposal Site - means any building, structure, installation, equipment, piping or pipeline, well, pit, lagoon,
impoundment, ditch, landfill, storage container, motor vehicle, rolling stock, aircraft, or any other place or area
where an uncontrolled release of OHMs has come to be located as a result of any spilling, leaking, pouring,
abandoning, emitting, emptying, discharging, injecting, dumping, discarding, or otherwise disposing of such
OHMs.
Release - means any spilling, leaking, pumping, pouring, emitting, emptying, discharging, injecting, escaping, leaching,
dumping, or disposing into the environment.
Environment - means waters, land, surface or subsurface strata, or ambient air of the Commonwealth of Massachusetts
[COM].
Contaminated Media - means contaminated groundwater, sediment, soil, and/or surface waters. Release conditions
were determined to have inpact a limited area of soil located adjacent to the existing building, and directly
under the fill and vent lines of the tank.
Information required for an IRA Completion and RAO Report is contained in this document as a whole. All opinions
and conclusions made in this report are based solely upon information gathered on the property and disposal site,
relative to response actions and assessment activities conducted.
PropertyDescription and Site Sen sitivity
Currently, the site is operated as a medical clinic. Properties surrounding the site are primarily residential with
commercial business located along Main Street. Refer to Appendix C for photographs of the Disposal Site.
Based on information provided on a MADEP/GIS map [Figure 3 / Sheet A and B] and other informational sources,
the release did not occurred within the geographical boundaries of an area classified as a Current or Potential
Drinking Water Source. Thus, the release is subject to RCGW-2 Reportable Concentrations, and Method I GW-2
and GW-3 Risk Characterization Standards. Soils onsite are subject to RCS-I reportable concentrations [residential
properties located within 500-feet of the disposal site] and Method I S-I Risk Characterization Standards.
Utilities
Response actions found no evidence that the release impacted the interior of a utility structure.
Natural Resource Areas within 500 feet of the DisposalSite - 310 CMR 40.0424 (1ff(b)
Based on information derived from site reconnaissance, a USGS Topographic Quadrangle Map [Figure 1], the
MADEP/GIS NRS Site Map [Figure 3], indicate no evidence that a Class A Surface Water Body is located within %2mile radius of the site. Additionally, 314 CMR 4.00 indicates that the Disposal Site is located within the Miller River
Drainage Basin of the Connecticut River Drainage System. The Disposal Site is not located within a I-mile radius of a
Natural Heritage & Endangered Species Areas.
CYN Environmental Services
100 Tosca Drive, Stoughton, MA 02072
Cyn Project Number 201882-00-TS
Page 2 of I 1
Athol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-148 15
24 May 2005
Information collected from a MADEP/GIS Map shows that the Disposal Site is not located within the geographical
boundaries of a Potentially Productive Aquifer, Zone II, or Interim Wellhead Protection Zone. Additionally, a review of
this plan noted that the Disposal Site is located within 500-feet of a wetlands and a Classified Protected Open Space
(Local/State/ FederavfTrustee), but not located within 500-feet of a:
*
*
*
*
Species of Special Concern, Threatened or Endangered Species Habitat;
Area of Critical Environmental Concern;
Certified Vernal Pool, or Outstanding Resource Water; and/or
100-feet of an area potentially containing a Fish Habitat
The property is provided with city water, and information provided by town officials revealed that there are no private
wells located within 500-feet of the Disposal Site. The Disposal Site is located within 500-feet of a Public Water Supply
Distribution Pipeline.
Information obtained from the Town of Athol web-page derived a population density of 300-people within a 'A-mile
radius of the Disposal Site. An inspection of the property, and miscellaneous reference sources, indicates that the Site is
a classified institution. No other institutions were located within 500-feet of the Disposal Site [Residences are within
500-feet of the Disposal Site although this does not affect the groundwater classification].
Release History - 310 CMR 40.0330
As noted in the Notice of Noncompliance [dated 6 October 2003], the MADEP was contacted at 11:45-AM on 19
June 2003, that a sudden release of an unknown amount of number 2 fuel oil had occurred at the above noted site.
The release was connected with a 275-gallon aboveground storage tank, which was located within the basement of
the building, and occurred as a result of rainwater entering the fill pipe of the AST. The rainwater displaced the oil
from the tank, and cause the soil located below the fill pipe to become contaminated. At the time that the release
conditions were reported to the MADEP and the Athol Medical Clinic was advised to retain the services of an LSP
and to conduct the appropriate response actions. Based on correspondence reviewed, no actions were taken to
address this condition, or to provide the required regulatory submittals to the MADEP. As a result, the MADEP
issued a Notice of Non-Compliance Letter to advise the PRP of their obligation under the Massachusetts
Contingency Plan. This letter was followed by a Notice of Enforcement Conference Letter, which was dated 16
March 2004. To address these letters, the PRP retained the services of Cyn in April 2005 to prepare the required
regulatory paperwork. Identification numbers assigned to the site release conditions include the Release Tracking
Number 2-14815, and the Notice of Non-Compliance Number NON-CE-03-3146. A copy of the Notice of
Responsibility and other MADEP documents are attached as Appendix D of this report.
Site Reporting Conditions -310 CMR 40.0310
A review of the site conditions noted that the release triggered the following MCP Reporting criterion.
*
310 CMR 40.03//I (3) - 2-hour reporting trigger: A release to the environment indicated by a release of a
quantity of oil greater than the applicable reportable quantity [i.e., 10-gallons] and which occurred within a 24hour period;
A review of the MADEP web database recorded indicates that the site has not been cited for previous releases of oil
and/or hazardous materials.
CYN Environmental Services
100 Tosca Drive, Stoughton, MA 02072
Cyn Project Number 201 882-00-TS
Page 3 of II
A thol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-14815
24 May 2005
Limits ofA pp roved Immediate Response Actions - 310 CMR 40.0411
At the time of notification, the MADEP advised that general response actions were required in the form of an IRA [in
accordance with the 310 CMR 40.04 /0]. The requirements also included the need for employing or engaging a
Licensed Site Professional [LSP] to manage, supervise, or actually perform necessary response actions leading to a level
of No Significant Risk at the site. Based on information provided to Cyn, an LSP and response contractor was not
retained to conduct response actions, or to define a scope to the Immediate Response Action program. Cyn was not
retained to provide the required initial regulatory submittal [RNF and IRA Plan] until April 15, 2004 (submission date).
Scope of A mended IRA Measures - 310 CMR 40.0424 (3)
Though the submission of the April 15 IRA Plan, Cyn requested that the IRA Plan be amended to allow the removal
and disposal of an estimated 50-cubic yards of petroleum impacted soil. This program also outlined the removal of
groundwater through physical or mechanical processes to facilitate the removal of the impacted soil, or to address the
presence of impacted water. This water will be disposed of in accordance with the requirements of the MCP and in
an appropriate method.
Interim Deadlines - 310 CMR 40.016 7
The Notice of Non-Compliance established 3 November 2003 as an interim submission deadline for the Release
Notification Form and the Immediate Response Action Plan or Completion Statement. Lastly, the Notice of
Enforcement Conference established a date of 30 March 2004 for the PRP to meet with the MADEP to discuss and
reach an agreement on returning the site into compliance with the Massachusetts Contingency Plan.
Release Quantity Estimate
The quantity of oil released is unknown at this time.
Revulatory Compliance Submittals
The submission of this report will serve to address the sites missed regulatory filing deadlines, and bring the site back
into compliance with the Massachusetts Contingency Plan. For this submittal, Cyn has attached copies of the IRA
Transmittal Form [BWSC-l05] and RAO Transmittal Form [BWSC-104] as Appendix A and Appendix B,
The initial Non-Compliance issue was addressed when Cyn was retained to submit an RNF and a
respectively.
combined IRA Plan/Status Report on 15 April 2004.
Limitsof Investigative Testing
Available informtion indicates that a number 2 fuel oil release occurred at the site. Based on the nature of the release
conditions, Cyn would analyze the collected media samples for residual concentrations of extractable petroleum
hydrocarbons [EPHI], volatile petroleum hydrocarbons [VPH], select volatile organic compounds [BTEX (benzene,
toluene, ethylbenzene, total xylenes), MTBE (methyl tertbutyl ether), and naphthalene], and select polynuclear aromatic
hydrocarbons [2-methylnaphthalene, naphthalene, acenaphthene, and phenanthrene]. Refer to Appendix E for a copy of
Cyns Quality Assurance and Quality Control Plan, and Standards Operational Procedures.
To facilitate the disposal of impacted soils from the site, a representative soil sample was obtained and analyzed for
residual concentrations of total petroleum hydrocarbons, volatile organic compounds, flash point, paint filter, pH,
reactive cyanide, reactive sulfide, and total polychlorinated biphenyls. The results of this testing are attached as
Appendix F of this report.
PreviouslyConducted Release Assessment and Response Measures - 310 CMR 40.0424 (1)c
Prior to submitting the April 04 IRA Report, Cyn's Supervisor conducted a site inspection and noted that the fill and
vent lines had been plugged to limit a further release of fuel oil tank. No actions have been taken to address and dispose
of the impacted soils located below the lines.
CYN Environmental Services
100 Tosca Duive, Stoughion, MA 02072
Cyn Project Number 201882-00-TS
rage 4 of I 1
Athol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-14815S
24 May 2005
Recently Conducted Release Assessment and Response Measures - 310 CMR 40.0424 (l1)(c)
Following the submission of the April 04 IRA Plan Report package, Cyn has conducted the following response actions.
*
12 April 2004: Cyns Field Chemist conducted an inspection to evaluate the site conditions [photos attached as
Appendix C]. Screening of soil collected from the area under the two fill pipes recorded total organic vapor
readings varying between 67.5-part per million by volume [ppm/v] and 156-ppm/v. This inspection detected an
area of impacted soil 9-feet long and 8-feet wide [see Figure 2].
*
2/. 22. and 25 June 2004: Cyn personnel arrived onsite to commence with the excavation of petroleum-impacted
soil. This soil was stockpiled on polyethylene sheeting within an adjacent lot. During the excavation program, Cyn
Field Chemist collected and screened representative soil samples obtained from the response excavation. This
screening program was used to direct the focus of the site response actions. Lastly, a sample of the impacted
material was collected and submitted for laboratory analysis [used to arrange the disposal of impacted soils]. The
results of this testing are attached as Appendix F to this report
*
2 and 6 Julv 2004: Cyn personnel continued removing petroleum-impacted soil. During the removal process,
representative samples were obtained and screened for readings of total organic vapors using a photoionization
detector. The results of these response actions created an excavation measuring approximately 20-feet long by 9feet wide, and varying between 20 and 40-inches deep. Water was observed within the excavation at a depth of 27inches below the existing grade. Readings recorded at the limits of the response excavation were noted to vary
between less than 0.1-ppm/v and 47.8-ppm/v.
*
7 andS8Julv 2004: Cyn personnel obtained and placed hay bales around the limits of the response excavation.
*
12 Julv 2004: Cyn personnel used a vacuum truck to remove water from the response excavation. Because of a
mechanical failure, no soil removal actions were conducted.
e
19 .Julv' 2004: Cyn personnel used a vacuum truck to remove water from the response excavation. Upon the
removal of the water from the excavation, Cyn personnel excavated and removed the impacted soil. During
response actions, Cyns Field Chemist collected and screened representative soil samples obtained during the
response actions.
*
22 July 2004: Cyns Field Chemist collected representative soil samples from the limits of the response excavation.
These samples were obtained from each sidewall, with the obtained samples being prepared and submitted for
laboratory analysis. The results of this testing [received on 28 July] are summarized in Table I, the laboratory
report attached as Appendix G, and the sampling locations shown on Figure 4. A comparison of the individual
results against the applicable Method I Risk Characterization Standards noted that each was below the applicable
risk limit. Thus, it appeared that no further response actions would be required. Response actions had developed
an excavation measuring 20-feet long by 9-feet wide, and 40-inches deep.
*
2 Aueust 2004: In preparation for the removal of the impacted soils from the site, Cyn personnel mobilized onsite
and placed the impacted materials into the roll-off can. The impacted soil contained in the can was staged onsite in
the event that further assessment measures encountered impacted soils.
*
9 August 2004: Cyns Field Chemist collected representative soils samples from the base of the response excavation,
and from two additional soil-sampling points located near the edge of the wetlands. In addition, a water sample was
collected from a point located between the response excavation and the edge of the wetlands. The results of the soil
testing [received on 19 August] are summarized in Table 1, the laboratory report attached as Appendix H, and the
sampling locations shown on Figure 4. A comparison of the individual results against the applicable Method I
Risk Characterization Standards noted that each was below the applicable risk limit. Thus, it appeared that no
further response actions would be required. It should be noted that no evidence of a petroleum release was present
within the water sample.
CYN Environmental Services
100 Tosca Drive, Stoughton. MA 02072
Cyn Projeci Number 201 882-00-TS
Page 5 of I
Athol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-14815
24 May 2005
e2/ and 25 A pril 2005: Following the resolution of payment issues, Cyn personnel arrived onsite to remove the rolloff container, thirteen bags of miscellaneous trash, and 100-feet of flex hose from the site. In addition, personnel
backfilled the response excavation level with the existing grade.
Soil Characterization
A review of the soil removed during the response actions noted it to consist of Silty Sand with varying percentages of
gravel and fines, and occasional cobbles / boulders. Soils of this consistency normally have a permeability factor in
the range of 104 to 10~5 centimeters per second [cm/sec].
Groundwater Depth
During response actions, the groundwater table was encountered at a depth approximately 27-inches below the
exiting grade.
Integrity of Testing Results
To validate the integrity of the analytical data, the laboratory report were reviewed to insure that the samples were
analyzed within the required holding times, that the detection limits were below the most stringent and applicable
risk based standard, and quality assurance/quality control parameters were within acceptable limits. For each of the
samples, the surrogate recoveries were noted to be within the required and acceptable ranges, and were prepared and
preserved as required by the applicable analytical method. Next, the field and/or trip blanks were reviewed for
evidence of volatile contaminants (indication of cross-contamination issue]. No evidence of impurities was detected
within the field blank. Lastly, confirmatory soil samples used to evaluate and document the integrity of the response
excavation were extracted and/or analyzed within the applicable testing guidelines. Thus, the results would appear to
accurately reflect and document the site residual release conditions.
Management of Rem ediation Waste - 310 CMR 40.0030
Wastes generated as part of Cyn's response actions were managed using the following paperwork:
Petroleum Impacted Booms
1. 21 A pril 2005: 13 bags containing vactor hose, pad, trash, and ploy were removed from the site under Straight Billof-Lading number 14512. This material was transported to and disposed of at Cyn Oil Corporation located in
Stoughton Massachusetts.
2.
25 April 2005: 100 feet of Flex Hose and three 10-foot section of PVC piping were removed from the site under
Straight Bill-of-Lading number 16312. This material was transported to and disposed of at Cyn Oil Corporation
located in Stoughton Massachusetts.
Petroleum Impacted Liquids
1. 12 July 2004: 1,560 gallons of petroleum impacted water was removed from the site under uniform hazardous
waste manifest MA-Q-8272 17. This water was transported to and disposed of at Cyn Oil Corporation located in
Stoughton Massachusetts.
2.
19 July 2004: 685 gallons of petroleum impacted water was removed from the site under uniform hazardous waste
manifest MA-Q-827232. This water was transported to and disposed of at Cyn Oil Corporation located in
Stoughton Massachusetts.
Oily Solids:
1. 29 Aporil 2005: Impacted soils generated as part of the site response actions were removed from the site using a Billof-Lading. This paperwork documented the removal and recycling of 22.64-tons [15.09-cubic yards] of impacted
soil at the Aggregate Industries facility located in Stoughton, Massachusetts.
CYN Environmental Services
100 Tosca Drive, Stoughton, MA 02072
Cyn Project Number 201 882-00-TS
Page 6 of 11
Arhol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-14815
24 May 2005
Refer to Appendix I for a copy of the previously noted disposal paperwork.
Critical Exposure Pathway Assessment - 310 CMR 40.0414 /40.0006
Pursuant to 310 CMR 40.0414 (3) and 310 CMR 40.0006 Cyn reviewed the site conditions for evidence of Critical
Exposure Point Pathways. Critical Exposure Point Pathways are de fined as:
'a means by which oils and/or hazardous materials [OHMs] released at the disposal site are
transported, or likely to be transported to human receptors via vapor phase emissions of measurable
concentration(s) of OH Ms into the living or work space of a school, daycare, pre-school, or occupied
residential dwelling.
or
'ingestion, dermal absorption, or inhalation of measurable concentration(s) of OH Ms fromn a drinking
water supply well(s) [public or private] located at or servicing a pre-schooL, daycare school, or
occupied residential building'.
No evidence of a Critical Exposure Point Pathway was detected during the completion of the site response actions.
Imminent Hazard Evaluation
Cyn compared the reported site conditions against the Imminent Hazard criteria established in Section 40.0321 and
Section 40.0950 of the MCP. Based on a review of the site release conditions, an Imminent Hazard Condition does
not exist at the site.
Substantiaat Release Migration Assessment
To determine whether a Condition of Substantial Release Migration exists, Cyn compared the site conditions against
the criteria established under 310 CMR 40.0413. The results of this evaluation indicated no evidence that a
Condition of Substantial Release Migration existed.
Release Conceptual Site Model
A conceptual model of the release is provided as Figure 5 of this report. Product released from the tank fill impacted
the underlying soils. To address the release, the fill and vent pipes were plugged and the underlying soils removed and
disposed of. Confirmatory samples obtained from the limit of the response excavation indicated that the levels of impact
had been reduced to levels under Method I standards. Lastly, testing of a groundwater sample recorded no evidence of
the release. Based on this information, it appears the response actions have address the site release conditions and
eliminated potential migration pathways and exposure points concerns.
Media Impact Evaluaio,, - 310 CMR 40.0924 / 40.0925
An evaluation of the disposal site indicated that the release impacted the following:
*
Soil: Site response actions removed and disposed of 22.64-tons [15.09.-cubic yards] of petroleum-impacted soil
to an asphalt batching plant. Upon the removal of this material, confirmatory soil testing was conducted. The
results of this testing are summarized in Table 1 of this report. The areas of residual impact will be addressed
through the completion of a Method I Risk Characterization.
*
Groundwater: Testing of a groundwater sample detected no evidence of impact. Thus, groundwater will not be
considered an impacted media.
CYN Environmental Services
100 Tosca Drive, Stoughton, MA 02072
Cyn Project Number 201882-00-TS
Page 7 of I I
I
Athol Medical Clinic!/RAC and RAO Report
1467 Main Street, Aihol, Massachusetts 01331
24 May 2005
Release Tracking Number: 2-14815
e
Solid Sur faces and Subsurface Utilities: No evidence of impact.
*
Sediment and Surface Water: No evidence of impact.
*
Interior A ir: No evidence of impact has been detected.
Soil Characterization - 310 CMR 40.0933
This assessment is based on Accessibility, and on the Frequency and Intensity of Use of these soils to for children and
adults. A characterization of the soil in the area of the Disposal Site indicates:
*
Frequency of Use: Since the release occurred at a residence, the frequency of use for adults and children would be
considered High. This assessment is based on items 310 CMR 40.0933 (4)(a)(l)(b) (3 & 4) and 310 CMR 40.0933
(4)(a)(2);
I
I
*
I
*
Intensity of Use: The Intensity of Use by adults and children will be considered High [310 CMR 40.0933
*
Accessibility: Soils covered by pavement are classified as Accessible [310 CMR 40.0933 (4)(c)(l)].
(4()I]
Based on the above criteria, the soils will be considered and subject to S-I soil standards.
Exposure Point Con cent rations. Soils - 310 CMR 40.0926
The exposure point for the soils is defined as the horizontal and vertical distribution of the contaminant in soil, for
each applicable soil category. The exposure point concentration is calculated by using the arithmetic average of each
site related OHMs for each exposure point [in each applicable soil category]. Any data represented as a "hot spot"
must be addressed as a separate and distinct exposure point. Refer to Table 1 for a summary of the analytical
results, which were collected during the completion of the site response actions. It should be noted that based on the
conditions, the applicable Method I Risk based standard are S-. In general,
site none
applicable that
and thedetermined
sampling
the hotspotresults
evaluation
of the residual sampling results exceeded an applicable Method I Risk
Standard. As described above, the sampling points are classified as "Accessible" [S-I classified location].
In general, levels of residual petroleum impact were present within a majority of the analyzed soil samples. Based
on this information, the limits of the Disposal Site - Soil Impact will be defined by those points showing a positive
detection of petroleum impact [See Figure 4]. Cyn's risk assessment would evaluate the area of residual impact as
individual and a combined exposure point concentration.
As noted earlier all of the analytical results were below the applicable S-1 concentrations. Based on this information
point will be calculated and used to
none of the results are considered a "Hot Spot". Thus, a combined exposure
represent the "Accessible" exposure zone. The data associated with each of these exposure zones, and the calculated
exposure point concentrations are summarized in Table I of this report. A review of this table notes that each of the
individual and combined exposure point concentrations are below the applicable Method I S-I risk standards.
Groundwater Characterization - 301 CMR 40.0932
Groundwater is categorized based on proximity to drinking water sources, proximity to structures, and surface water
impact. A characterization of the groundwater in the area of the disposal site indicates:
I
*
classified as a Current or
The disposal site is not subject to GW-1 standards since it is not located within an area
Potential Drinking Water Source area;
CVN Environmental Services
100 Tosca Drive. Stoughton, MA 02072
Cyn Project Number 20i882-00-TS
PageS8 of I 1
Athol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-148l5
24 May 2005
*
GW-2 Standards will be considered applicable, since the release did occurred within 30-feet of the an occupied
building and the depth to the groundwater table may be less than 15-feet below the existing grade; and
*
As is the case for all disposal sites, groundwater at the disposal site is a potential source of discharge to surface
water bodies and, therefore, is subject to GW-3 standards.
Exyposure Point Concentrations. Groundwater - 310 CMR 40.0926
Exposure point pathways are defined, without limitation, as ingestion, inhalation, and/or dermal absorption of the
impacted media. To evaluate the groundwater conditions, a single groundwater sampling points was created between
the excavation and the adjacent wetlands. A water sample obtained from this location was collected and analyzed for
concentrations of EPH and VPH compounds. The results of the testing reported no evidence of petroleum impact
above an applicable Method I Standard. Based on this information, it appears that the release did not have an
impact on the underlying groundwater. Therefore, the computation of a contaminant exposure point concentration
was not determined or calculated [assumed as background / non-detectable].
Indoor Air Evaluation - 310 CMR 40.0995
No evidence of an indoor air issue was encountered during the completion of the site response actions
Feasibility Assessment - 310 CMR 40.0860
Pursuant to Section 310 CMR 40.0860, a feasibility assessment was conducted and based on the following criteria:
1. Evaluating the feasibility of implementing a Permanent Solution;
2.
Evaluating the feasibility of reducing the concentrations of oil and/or hazardous materials in the environment to
levels that achieve or approach background; and
3.
Evaluating the feasibility of reducing the concentrations of oil and/or hazardous materials in soils and groundwater
at the disposal site to levels at or below applicable Upper Concentrations Limits.
The findings of the investigation and response actions have reduced the concentrations of contamination to levels under
the applicable risk based standards. These residual concentrations indicate that background levels have not been
obtained. Thus, pursuant to 310 CMR? 40.1020 (3), a Feasibility Assessment (Section 40.0860) must be completed to
determine whether a Permanent or Temporary Solution, to the reported contaminants (i.e., residual concentrations), has
been achieved at the Disposal Site. The feasibility of achieving a permanent solution or restoring background conditions
at a Disposal Site is dependent upon any one of the following factors:
a)
b)
c)
d)
e)
the technical feasibility;
a cost-benefit analysis;
the availability of trained and knowledgeable personnel;
the availability of an approved off-site disposal location (i.e., Federally or State Approved); or
the location of the source (i.e., off-site release).
An evaluation for achieving a Permanent Solution, or restoring background conditions, was completed using the
technical feasibility and cost-benefit analysis procedures. According to 310 CMR? 40.0860 (S)(a), if existing technology
or reasonable modification of technology cannot remediate the contaminant at the Disposal Site to the extent necessary
to attain levels that approach of achieve background, the remedial action shall not be considered technologically
feasible. According to 310 CMR? 40.0860 (4)(b) and (6)(a), if the incremental cost of conducting the remedial actions is
substantial and disproportionate to the incremental benefit of risk reduction, environmental restoration, and monetary
and non-pecuniary values, then the benefits of implementing the remedial action to achieve a Permanent Solution and to
reduce the concentrations of the contaminants in question in the environment at the Disposal Site to levels which achieve
or approach background, are not considered feasible.
CYN Environmental Services
100 Tosca Drive, Stoughion, MA 02072
Cyni Projeci Number 201882--00-TS
Page 9 of I 1
Athol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-14815
24 May 2005
In this particular case, in order to attempt to approach or achieve background concentrations of the reported
contaminants (assuming that background concentrations are analogous to non-detectable concentrations) additional
remedial measures would be required. The confirmatory analytical results reported residual concentrations of
petroleum constituents exist. Thus, the implementation of remedial actions
contaminants insitu, or to excavate and dispose of them off-site. Additionally,
inconvenienced during the completion of the response actions. However, since a
been achieved at the site, the cost associated with initiating remedial actions
concentrations, would not proportionally reduce the current Risk Characterization.
I
would be required to treat the
the site would be disturbed and
Level of No Significant Risk has
to reduce the reported residual
Currently, the site has achieved a Level of No Sigificant Risk without implementing an Activity and Use Limitation
on the limits of the Disposal Site. Additionally, the primary source was eliminated, and the secondary source
eliminated through removal and disposal of the impacted media. Lastly, response actions have reduced the levels of
residual concentration to under Method I Risk Characterization Standards and Upper Concentration Limits. Thus, a
permanent solution has been achieved, and additional remedial measures would not be required at the site to reduce
the reported contaminant concentrations to background levels according to the provision provided in Section
40.0960 (4)(b) and 6(a).
I
Response Action Outcome C'ategorizationDetermination- 310 CMR 40.1030
Pursuant to Section 310 CMR 40./030 (2) the specific category of Response Action Outcome applicable to a site or
Disposal Site shall be established based on the following factors:
1. if site conditions pose No Significant Risk;
2. the elimination of a substantial hazard(s);
3.
a Level of No Significant Risk being achieved by remedial measures;
4.
the implementation of an Activity and Use Limitation(s) to maintain a Level of No Significant Risk; and/or that
the
5.
remedial actions achieved background levels.
*
I
has
The findings of this investigation and remedial actions have satisfied items I trough 3. Thus, a permanent solution
been achieved, and additional remedial measures would not be required at the site. Pursuant to 310 CMR 40.1036, a
Class A-2 Response Action Outcome Statement applies to the Disposal Site since:
1. A Permanent Solution has been achieved;
I
2.
The levels of oil and hazardous material in the environment have not been reduced to background; and
3.
One or more Activity and Use Limitations are not required to maintain a Level of No Significant Risk.
a Class A-2 Response Action Outcome has been achieved at a site when the source of
(5), to
40.1/003
to 30 CMR
Pursuant
the
contamination,
which
is likely
result in an increase in the concentration of the contamination in an environmental
media, is eliminated or controlled. In this case, the source was eliminated and the impacted media removed from the
site.
CYN Environmental Services
100 Tosca Drive, Stoughton, MA 02072
Cyn Project Number 20i882-0o-TS
Page 10 of I l
Athol Medical Clinic / IRAC and RAO Report
1467 Main Street, Athol, Massachusetts 01331
Release Tracking Number: 2-14815
24 May 2005
Risk to Safety Evaluation - 310 CMR 40.0960
Pursuant to 3/0 CMR 40.0960, a Level of No Significant Risk to Safety exists or has been achieved if the conditions
at the disposal site, which are related to a release of oil and/or hazardous materials, do not currently and will not in
the foreseeable future pose a threat of physical harm or bodily injury to people. In this case, the source of the release
was addressed and the impacted media were removed, and the excavated areas backfilled. Hence, a Level of No
Significant Risk exists.
Conclusion
In conclusion, a Class A-2 outcome has been achieved and no further action is required. To complete the PRPs
investigative and MCP compliance obligations, Cyn has prepared a RAO Statement [Appendix A], which details
that; a Class A-2 outcome has been achieved.
Certification
The conclusions and recommendations provided herein are based solely upon the scope of work conducted and the
availability of information at this time. Any additional information, which becomes available concerning the
disposal site or the abutting properties, should be provided to Cyn Environmental Services so that we may evaluated
whether there is a need to modify the conclusions and recommendations accordingly.
Should you have any questions or require any further information relative to this submittal, please feel free to contact
me.
Sincerely,
Cyn Environmental ervices
Philip D cBain, LSP
Sr. Project Manager
Tables
I
Summary of Soil Testing Results
Figures
1
2
3
4
5
Site Locus Map
General Site Layout Plan
MADEP / GIS Map
Soil Sampling Location Plan
Conceptual Site Modeling Plan
Appendix
A
B
C
D
E
F
G
H
Immediate Response Action Transmittal Form [BWSC-105], Photocopy
Response Action Outcome Transmittal Form [BWSC-104], Photocopy
Site Photograph
MADEP Correspondence
Standard Operational Procedures and QA/QC Plan
Disposal Arrangement Paperwork and Testing Report
July 2004 Laboratory Report - Soil Testing Services
August 2004 Laboratory Report - Soil and Groundwater Testing Services
Bill-of-Lading and Uniform Hazardous Waste Manifests-
I
cc:
Athol Medical Clinic
Cyn File
-
Athol, MA
CYN Environmental Services
t00 Tosco Drive, Stoughton, MA 02072
Cyn Project Number 2018824O0-TS
Page t t of It1
Table
I.
Summary of Soil Testing Results
CYN Environmental Services
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APPENDIX A
Immediate Response Action
Transmittal Form, B WSC-J105, Photocopy
CYN Environmental Services
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
',
BW SCI105
IMMEDIATE RESPONSE ACTION (IRA) TRANSMITTAL
Release Tracking Number
2 14815
FORM Pursuant to 310 CMR 40.0424 -40.0427 (Subpart 0)
A. RELEASE OR THREAT OF RELEASE LOCATiON:
1. Release Name/Location Aid:
Athol MediCal CilniC
42-35'-25"N /71-12'-58"W
2. Street Address: 1467. Main Street
3. Cityrrown:
Athol, MassaChusetts
4. ZIP Code: 01331
S5. Check here if a Tier Classification Submittal has been provided to DEP for this disposal site.
Jb. Tier iB
c. Tier iC
LId. TierlII
56. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.0110-0114.
oa.CERCLA LIb. HSWA Corrective Action 5 c. Solid Waste Management
Od. RCRA State Program (2lC Facilities)
a. Tier iA ~
Specify Program (check one):
B. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of Initial IRA Written Plan (If previously submitted):
(mm/ddyyy)
El2. Submit an InItial IRA Plan.
El3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.
El4. Submit an Imminent Hazard Evaluation. (check one)
5a. An Imminent Hazard exists in connection with this Release or Threat of Release.
LIIb. An Imminent Hazard does not exist in connection with this Release or Threat of Release.
111c. Itis unknown whether an Imminent Hazard exists In connection with this Release or Threat of Release, and further
assessment activities will be undertaken.
It is unknown whether an imminent Hazard exists in connection with this Release or Threat of Release. However,
response actions will address those conditions that could pose an Imminent Hazard.
Eld.
5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent
6. Submit an IRA Status Report .
9
7. Submit an
IRA Completion Statement.
a. Check here if future response actions addressing this
Release or Threat of Release notification condition will be
LIconducted as part of the Response Actions planned or ongoing
at a Site that has already been Tier Classified under a
different Release Tracking Number (RTN) . When linking RTNs, rescoring via the NRS is required
If there Isa
reasonable likelihood that the addition of the new RTN(s) would change the classification of the site.
b. Provide Release Tracking Number of Tier Classified Site (Primary RTN):H
-
I
These additional response actions rnust occur according to the deadlines applicable to the Primary RTN.
Use the Primary
RTN when making all future submittals for the site unless specifically relating to this Immediate Response Action.
58. Submit a Revised IRA Completion Statement.
(All sections of this transmittal form must be filled out unless otherwise noted above)
Revised: 11/04/2003
Pae1o
Page 1 of 6
Massachusetts Department of Environmental Protection
BW SC105
Bureau of Waste Site Cleanup
IMMEDIATE RESPONSE ACTION (IRA) TRANSMITTAL
FORM Pursuant to 310 CMR 40.0424 -.40.0427 (Subpart 0)
Release Tracking Number
2
-
|14815
C. RELEASE OR THREAT OF RELEASE CONDmoNS THAT WARRANT IRA:
1. Identify Media Impacted and Receptors Affected: (check all that apply)
Ela.
Elb. Basement Elc. Critical Exposure Pathway [I d. Groundwater []e. Resi dence
f. Paved Surface Elg. Private Well flh. Public Water Supply [ 1. School ~)J. Sediments
k. Soil fl1. Storm Drain
flm. Surface Water [3n. Unknown [ o. Wetland E p. Zone 2
[3q. Others Specify'
Air
2. Identify Oils and Hazardous Materials Released:
(check all that apply)
I]a. Oils [3b. Chlorinated Solvents [3c.Heavy Metals
[3d. Others SM Number 2 Fuel Oil
D. DESCRIPTION OF RESPONSE ACTIONS:
(check all that apply, for volumes list cumulative amounts)
El1. Assessment and/or Monitoring Only
[33. Deployment of Absorbent or Containment Materials
D5. Structure Venting System
[17. Product or NAPL Recovery
[39. Groundwater Treatment Systems
11l.Bloremediation
13. Excavation of Contaminated Soils
a. Re-use, Recycling or Treatment
iia. Receiving Facility:
El 2. Temporary Covers or Caps
El 4. Temporary Water Supplies
El 6. Temporary Evacuation or Relocation of Residents
[3 8. Fencing and Sign Posting
El 10. Soil Vapor Extraction
El 12. Air Sparging
[31. On Site
Estimated volume in cubic yards
li. Off Site
Estimated volume In cubic yards
Aggregate IndustrieS
iib. Receivng Facility:
Town-:
Stoughton
Town:
22.64-tons
State:
MA
State:
iii. Describe:
[3b.
Store
Eli. On Site
Estimated volume in cubic yards
l3
i.Off Site
Estimated volume In cubic yards
iia. Receiving Facility:
Town:
State:
lib. Receiving Facility:
Town:
State:
Revised: 11/04/2003
Page 2 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IMMEDIATE RESPONSE ACTION (IRA) TRANSMITTAL
FORM Pursuant to 310 CMR 40.0424 - 40.0427 (Subpart D)
BWSCI105
Release Tracking Number
2b. 1481
D. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply, for volumes list cumulative amounts)
c. Landfill
S i. Cover
Estimated volume in cubic yards
Receiving Facility:
ii. Disposal
Town:
Estimated volume in cubic yards
Receiving Facility:
U
_
_
_______________
_
State:
_
Town:
State:
b. Receivng Facility:
Town:
State:
c. Receiving Facility:
Town:
____
14. Removal of Drums, Tanks or Containers:
a. Describe Quantity and Amount:
-
state:
-
2115. Removal of Other Contaminated Media:
a.Specify Type and Volume:
100' Flex Hose, 30' PVC Pipe, 13-bags of non-hazardous soils
[vaCtor hose, pads, trash, and poly], and 2245-gal oily water
16.
b. Receiving Facility: Cyn Oil Corporation
Town:
c. Receiving Facility:
Town:
State: MA
State:
Other Response Actions:
Describe:
Ei17.
Stoughton
___________
Use of Innovative Technologies:
Describe:
____________
Revised: 11/04/2003
Pae3o
3 of 6
Page
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IMMEDIATE RESPONSE ACTION (IRA) TRANSMITTAL
FORM
BW SC1 05
Release Tracking Number
2
Pursuant to 310 CMR 40.0424 -40.0427 (Subpart D)
-
|14815
E. LSP SIGNATURE AND STAMP:
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 (i) the standard of care in 309 CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR 4.03(2), and
(iii) the provisions of 309 CMR 4.03(3), to the best of my knowledge, Information and belief,
if Section B of this form Indicates that an Immediate Response Action Plan is being submitted, the response action(s) that Is
(are) the subject of this submittal (i) has (have) been developed inaccordance with the applicable provisions of M.G.L. c..21E and
310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the purposes of such response action(s) as set forth in
the applicable provisions of M.G.L. c. 21E and 810 CMR 40.0000 and (iii) complies(y) with the identified provisions of all orders,
permits, and approvals Identified inthis submittal;
>
if Section B of this form indicates that an Imminent Hazard Evaluation is being submitted, this Imminent Hazard Evaluation was
developed in accordande with the applicable provisions of M.G.L c. 21E and 310 CMR 40.0000, and the assessment activity(ies)
undertaken to support this Imminent Hazard Evaluation comply(ies) with the applicable provisions of M.G.L c. 21E and 310 CMR
40.0000;
>
if Section B of this form indicates that an Immediate Response Status Report is being submitted, the res ponse action(s) that is
(are) the subject of this submittal (i) is (are) being implemented inaccordance with the applicable provisions of M.G.L. c. 21E and
310 CMR 40.0000, (ii) Is (are) approipriate and reasonable to accomplish the purposes of such response action(s) as set forth in
the applicable provisions of M.G.L c. 21E and 310 CMR 40.0000 and (lii) comply(ies) with the identified provisions of all orders,
permits, and approvals Identified inthis submittal;
>
if Section B of this form indicates that an Immediate Response Action Completion Statement orea request to Terminate an
Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard is being submitted, the res
ponse
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. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the purposes
of such response action(s) as set forth inthe applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000 and (iii) comply(ies)
with the Identified provisions of all orders, permits, and approv'als identified In this submittal.
>
Ilam aware that significant penalties may result, including, but not limited to, possible fines and Imprisonment, if I submit
information which I know to be false, inaccurate or materially incomplete.
1. LSP #: 5121
2. First Name:
Philip
3.Last Name:
3 1
4. Telephone:
5. Ext.:
_
_
_
6. FAX:
McBain
(7 1 4 -6
6
7. Signature:
8.
Revised: 11/04/2003
Dae:
~9.
Revied:11/0/203
LSP Stamp:
Pae 4of
Page 4 of 6
I
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IMMEDIATE RESPONSE ACTION (iRA) TRANSMITTAL
ReasTrcigNmr
2 - 14815
FORM Pursuant to 310 CMR 40.0424 - 40.0427 (Subpart 0)
-
BWSC 105
F. PERSON UNDERTAKCNGIRA:
1. Check all that apply:
U
2. Name of Organizailon:
Athol MediCal CliniC
a. change in contact name
~ jb.change of address
Jose / Joseph
3. Contact First Name:
4. Last Name:
1467 Main Street
5. Street:
7. CIty/Town:
8. State:
(978) 249-9736
ne in teperseaons
Amparo / Mathew
6.Title: Owners
Ah
10. Telephone:
Elc
11. Ext.:
NA
MA
12. FAX-
9. ZIP Code:
01331
(978) 249-9414
G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:
1. RP or PRP
C
j
a. Owner
e.Other RP orPRP
b. Operator ~Jc. Generator
EJd. Transporter
Specify:
El2. FiducIary, Secured Lender or Municipality with Exempt Status (as defined by M.G.L. c. 21 E, s.2)
Fl3. Agency or Public Utility on a Right of Way (as defined by M.G.L. c. 21 E, s. 5(j))
4~
. Any Other Person Undertaking IRA
Specify Relationship:
H. REQUIRED ATTACHMENTU AND SUBMIflALS:
1. Check here If any Remediation Waste, generated as a result of this IRA, will be stored, treated, managed,
recycled or
at the site following submission of the IRA Completion Statement. if this box Is checked, you must submit
one of the
following plans, along with the appropriate transmIttal form.
5reused
El
a.A Release Abatement Measure (RAM) Plan (BWSC106)
fjb.Phase IV Remedy Implementation Plan (BWSC1O8)
2. Check here if the Response Action(s) on which this opinion Is based, if any, are (were) subject
to any order(s), permIt(s)
and/or approval(s) Issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying
the applicable
provisIons thereof.
3. Check here to certify that
the Chief MunicIpal Officer and the Local Board of Health have been notified of the
Eiimplementation of an Immediate
Response Action taken to control, prevent, abate or elIminate an Imminent Hazard.
4. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified
of the submittal of a
Completion Statement for an Immediate Response Action taken to control, prevent, abate or eliminate an Imminent
Hazard.
5. Check here If any non-updatable Information provided on this form is Incorrect, e.g. Release Address/Location
Aid. Send
corrections to the DEP Regional Office.
6. Check here to certify that the LSP Opinion containing the material facts, data, and other Information Is attached.
Revised: 11/04/2003
Page 5 of 6
Pae5o
~Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
BWSCI105
IMMVEDIATE RESPONSE ACTION (IRA) TRANSMITTAL
FORM Pursuant to 310 CMR 40.0424 - 40.0427 (Subpart D)
Release Tracking Number
2
14815
-
L CERiFICATION OF PERSON UNDERTAKING IRA:
1. JoeA paoJoehMahw,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 inquiryof 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 I am fully authorized to make this attestation on behalf of the entity legally responsible for
this submittal, l/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.
2. By'-
3. Title:.
Signature
4. For-
Owners
Athol MediCal CliniC
5. Date:
(Name of person or entity recorded in Section F)
(mmddyyy)
6. Check here if the address of the petson providing certification is different from address recorded
in Section F,
7. Street-______
8. City/Town:
..
9. State:
11. Telephone:
12. Ext.:
___
_____
10. ZIP Code:
________
13. FAX:
YOU MUST LEGIBLY 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 DEADLUNE.
Date Stamp (DEP' USE ONLY:)-
Revised: 11/04/2003
Page 6 of 6
APPENDIX B
Response A ction Outcome Statement
Transmittal Form, BWSC-104, Photocopy
CYN Environmental Services
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
RESPONSE ACTION OUTCOME (RAO) STATEMENT
Pursuant to 310 CMR 40.0580 (Subpart E) &840.1056(Subpart J)
BW SC104
Release Tracking Number
W
-
14815
A. SITE LOCATION:
Athol MediCal Clinic 42-35'-25"N / 71-12'-58"W
1. Site Name/Location Aid:
1467 Main Street
2. Street Address:
3. City/Town:
Athol, MA
4. ZIP Code:
01331
fl5. Check here if aTier Classification Submittal has been provided to DEP for this disposal site.
El a.Tierl1A
b. Tieri1B fJ c. Tier 10Cf d. Tier 2
6. If a Tier I Permit has been issued, provide Permit Number:
B. THIS FORM
_______________
IS BEING USED TO:
(check all that apply)
1. List Submittal Date of RAO Statement (if previously submitted):
L6
2. SubmIt a Response Action Outcome (RAO) Statement
mm/dd/yyy
Ela. Check here if this RAO Statement covers additional Release Tracking Numbers (RTNs).
previously linked toea Primary Tier Classified RTN do not need to be listed here.
b. Provide additional Release Tracking Number(s)
covered by this RAO Statement.
El3. Submit a Revised Response Action Outcome Statement
RTNs that have been
1KW LI-W
a. Check here if this Revised RAO Statement covers additional Release Tracking Numbers (RTNs), not listed
on the
SRAO Statement or previously submitted Revised RAO Statements . RTNs that have been previously linked to a
Primary Tier Classified RTN do not need to be listed here.
b. Provide additional Release Tracking Number(s)
covered by this RAQ Statement.
Fl4.
LELIZIE D-W
Submit a Response Action Outcome Partial (RAO-P) Statement
Check above box, if any Response Actions remain to be taken to address conditions associated with this
disposal site
having the Primary RTN listed In the header section of this transmittal form. This RAO Statement
wilt record only an
RAO-Partial Statement for that RTN. A final RAO Statement will need to be submitted that references all RAO-Partial
Statements and, if applicable, covers any remaining conditions not covered by the RAO-Partial Statements.
EJ5.
SubmIt an optional Phase I Completion Statement supporting an RAO Statement
S6. Submit a Periodic Review Opinion evaluating the status of a Temporary SolutIon for a Class C RAO Statement
'(Section
E is optional)-
O7.Submt aRetraction
aentrequired)
of a previously submitted Response Action Outcome Statement (Sections D & E
(All sections of this transmIttal form must be filled out unless otherwise noted above)
RevIsed: 0512712003
Revised:
06/27/2003
Page I of 7
Page 1 of 7
Massachusetts Department of Environmental Protection
BWSCI104
Bureau of Waste Site Cleanup
Release Tracking Number
RESPONSE ACTION OUTCOME (RAO) STATEMENT
2
Pursuant to 310 CMR 40.0580 (Subpart E) & 40.1056 (Subpart J)
C. DESCRIPION OF RESPONSE ACIONS:
jJ1.
-
14815
(check all that apply, for volumes list cumulative amounts)
52. Temporary Covers or Caps
[J4. Temporary Water Supplies
56. Temporary Evacuation or Relocation of Residents
Assessment and/or Monitoring Only
Deployment of Absorbent or Containment Materials
fl3.
EJ5. Structure Venting System
7. Product or NAPL Recovery
8. Fencing and Sign Posting
510. Soll Vapor Extraction
512. Air Sparging
-J9.Groundwater Treatment Systems
11
i. Bloremediation
13. Removal of Contaminated Soils
a. Re-use, Recycling or Treatment
Eli.On Site
Estimated v'otume in cubic yards
ii.0Off Site
Estimated volume incubic yards
Stoughton,
Facility Name: Aggregate industries
.hia.
22.64-Tons
State:
MA______
State:
______
Town:
jib. Facility Name:
iii. Describe:
El b. Landfill
Eii. Cover
Estimated volume in cubic yards
Facility Name:
Jli. Disposal
State:
Town:
State:
______
Estimated volume in cubic yards
Facility Name:
514.
Town:
_
_
Removal of Drums, Tanks or Containers:
a. Describe Quantity and Amount:-
b. Facility Name:
Town:
State:
c. Facility Name:
Town :
State:
Revised: 06/27/2003
____
____
Pae2o
2 of 7
Page
_
_
MassaChusetts Department of Environmental ProteCtion
Bureau of Waste Shte Cleanup
RESPONSE ACTION OUTCOME (RAO) STATEMENT
Pursuant to 310 CMR 40.0580 (Subpart E) & 40.1056 (Subpart J)
C. DESCRIPTION OF RESPONSE ACTIONS (cont.):
BWSCI104
Release Tracking Number
2
-
14815
(check all that apply, for volumes list cumulative amounts)
S15. Removal of Other Contaminated Media:
a.Specify Type and Volume:
100' Flex Hose, 30' PVC Pipe, 13-bags of non-hazardous soils
[vaCtor hose, pads, trash, and poly], and 2245-gal oily water
b.Facility Name:
Cyn Oil Corporation
c. Facility Name:
Town
Stoughton
Town:
fl16. Other Response Actions:
Describe:
State:
MA
State:
___________
El17. Use of innovative Technologies:
Describe:
___________
D. RESPONSE ACION OUTCOME CLASS:
Specify the Class of Response Action Outcome that applies to the disposal site, or site of the Threat of Release.
Select ONLYone Class.
51. Class A-I RAO: Specify one of the following:
-
a. Contamination has been reduced to background levels.
5
b. A Threat of Release has been eliminated.
2. Class A-2 RAO: You MUST provide justification that reducing contamination to or approaching background
levels is
IJinfeasible.
53.contamination
Class A-3 RAO:
You MUST provide an Implemented Activity and Use Limitation (AUL) and justification that
reducing
to or approaching background levels is infeasible.-
fJ
4. Class A-4 RAO: You MUST provide an implemented AUL, Justification that reducing contamination
to or approaching
background levels is infeasible, and justification that reducing contamination to less than Upper Concentration Limits
(UCLs) 15 feet below ground surface or below an engineered barrier is Infeasible. If the permanent solution
relies upon an
engineered barrier, you must also provide a Phase Ill report justifying the selection of the engineered barrier.
Revised: 0612712003
Pae3o
Page 3 of 7
*MassaChusetts Department of Environmental ProteCtion
-- Bureau of Waste Site Cleanup
RESPONSE ACTION OUTCOME (RAO) STATEMENT
-
Pursuant to 310 CMR 40.0580 (Subpart E)& 40.1056 (Subpart J)
BWSC104
Release Tracking Number
li
41
D. RESPONSE ACTION OUTCaME CLASS (cont.):
5
S. Class B-1 RAOl: Specify one of the followinig:
a. Contamination is consistent with background levels
El6.
Elb. Contamination
is NOT consistent with background
levels.
Class B-2 RAO: You MUST provide an implemented AUL.
7. Class B-3 RAO: You MUST provide an implemented AUL and
justification that reducing contamination to less than
ElUpper Concentration Limits (UCLs) 15 feet below ground surface is infeasable.
El8. Class CRAO:Specify one:
Ela. Monitoring ~jb. Passive Operation and Maintenance
Sc. Active Operation and Maintenance (defined at 310 CMR 40.0006)
E. RESPONSE ACTION OUTrCOME INFORMATION:1. Specify the Risk Characterization Method(s) used to achieve the RAO described above:
12a. Method 1 5 b.Method 2
c.Method 3
5d. Method Not Applicable-Contamination reduced to or consistent with background, or Threat of Release abated
2Specify all Soil and Groundwater Categories. More than one Soil Category and more than one Groundwater Category
may
apply at a Site. Be sure to check off all APPLUCABLE categories.
a. Soil Category(ies) Applicable:
i. S-1/GW-1
21 i.S-1/GW-2
iii. S-1/GW-3
E
5
5
b. Groundwater Category(ies)
I. GW-1
iv.S-2/GW-1
v. S-2/GW-2
vi. S-2/GW-3
vii. S-3/GW-i
5
5
viii. S-3/GW-2
ix. S-3/GW-3
Impacted:
I li. GW-2 Iiii.GW-3
5
iv.No Groundwater Impacted
3. Specify remediation conducted.
a. Check here if soil remediation was conducted.
Elb. Check here if groundwater remediation was conducted.
4. Estimate the number of acres this RAO Statement applies to:
Revised: 06/27/2003
0.03 aCres
Pae4o
Page 4 of 7
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
BWSCI104
Release Tracking Number
RESPONSE ACTION OUTCOME (RAO) STATEMENT
2
Pursuant to 310 CMR 40.0580 (Subpdrt E) & 40.1056 (Subpart J)
14815
-
F. LSP SIGNATURE AND STAMP:
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 (i) the standard of care in309 CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and
(lii) the provisions of 309 CMR 4.03(3), to the best of my knowledge, information and belief,
> if SectionSB 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 (i) has (have) been developed and implemented in
accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to
accomplish the purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c.21E and 310 CMR
40.0000, and (iii) comply(ies) with the identified provisions of all orders, permits, and approvals identified inthis submittal.
1lam
aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit
*information which I know to be false, inaccurate or materially incomplete.
1. LSP #:
5121
Philip
2. F~irst Name:
4. Telephone:
McBain
3. Last Name:
(781) 341-1777
5.Ext.:
133
6.rFAX:
(781)304t6246
7. Signature:
8. Date:
24
9. tsp Stamp:
mm/ddyy
G. PERSON MAKING SUBMrrTAL:
fla.change in contact name
1. Check all that apply:
2. Name of Organization:
3. Contact First Name:
5. Street:
Athol Medical CliniC
JOSe / Joseph
4.Last Name:
1467 Main Street
6. Title:
7. City/Town: Athol
10. Telephone:
b. change of address
8. State:
(978) 249-9736
I.Et:NA
uyndertaing response actions
Amparo / Mathew
Owners
Ma
12. FAX:
9. ZiP Code:
01331
-j
(978) 249-9414
Revised: 6/27/2003
Page 5 of 7
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
RESPONSE ACTION OUTCOME (RAO) STATEMENT
BW SC104
Release Tracking Number
Pursuant to 310 CMR 40.0580 (Subpart E) & 40.1056 (Subpart J)
2J-E14815
H. RELATIONSHIP TO RELEASE OR ThREAT OF RELEASE OF PERSON MAKING SUBMIT TAL:
1. RP or PRP
a. Owner
[3b. Operator 3c. Generator
5e. Other RP or PRP
[d.
Transporter
Specify:
~J2. Fiduciary, Secured Lender or Municipality with Exempt Status (as defined by M.G.L. 0. 21 E, s. 2)
fJ3. Agency or Public Utility on a Right of Way (as defined by M.G.L. 0. 21 E, s. 5(J))
El4. Any Other Person Making Submittal Specify Relationship:
I. REQUIRED ATTACHMENT AND SUBMITTALS:
2
1. Check here if the Response Action(s) on which this opinion is based, if any, are (were) subject to any order(s),
permit(s)
and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of
an RAO Statement that relies on the public way/rail right-of-way exemption from the requirements of an AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
RAO Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of
the Disposal Site subject to this RAO Statement. If submitting an RAO Statement for a PORTION of a Disposal
Site, you
IEJmust document the location and boundaries for both the portion subject to this submittal and, to the extent defined,
the entire
Disposal Site.
5. Check here if required to submit one or more AULs. You
submit an AUL Transmlttal Form (BWSC1 13) and a
Eicopy of each implemented AUL related to this RAO Statement.must
Specify the type of AUL(s) below: (required for Class
A-3, A-4, B-2, B-3 RAO Statements)
[3a. Notice of Activity and Use LImitation
[3c. Grant of Environmental RestrictIon
b. Number of Notices submitted:
d. Number of Grants submitted:
___________
_________
6. If an RAO Compliance Fee Isrequired for any of the RTNs listed on this transmittal form, check here to certify that an RAO
Compliance Fee was submItted to DEP, P.O. Box 4062, Boston, MA 02211.7. Check here if any non-updatable Information provided on thIs form is incorrect, e.g. Site Address/Location Aid. Send
corrections to the DEP Regional Office.
8. Check here to certify that the LSP Opinion containing the material facts, d ata, and other information is attached.
Revised: 06/27/2003
Pae6o
Page 6 of 7
MassaChusetts Department of Environmental Protection
Bureau of Waste Site. Cleanup
BWSCI104
RESPONSE ACTION OUTCOME (RAO) STATEMENT
Pursuant to 310 CMR 40.0580 (Subpart E) & 40.1056 (Subpart J)
Release Tracking Number
W
-
14815
J. CERIICATION OF PERSON MAKING SUBMITrTAL:
.1.1i, Jose Amparo / Joseph Mathew
, 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
transmittal form, (ii) that, based on my inquiry of those individuals immediately responsible for obtaining the information, this
the
material Information contained in this submittal is,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, lI/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.
|2. By-
3. Title:
Signature
4. For.
Owners
Athol MediCal CliniC
(Name of person or entity recorded in Section G)
mm/ddyyy
56. Check here if the address of the person providing certification is different from address recorded In Section G.
7. Street: _______________________
8. City/Town:
-
9. State:
11. Telephone:
12. Ext.:
____
10. ZIP Code:
________
13. FAX:
YOU MUST LEGIBLY COMPLETE ALL RELEVANT SECIONS OF THIS FORM OR DEP MAY
RETURN THE DOCUMENT AS INCOMPLETE. IFYOU SUBMIT AN INCOMPLETE FORM, YOU
MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP' USE ONLY:)
Revised: 06/27/2003
Pae7o
Page 7 of 7
APPENDIX C
Site Photographs
CYN Environmental Services
Athol Medical Clinic
Fill and Vent lines
-
Source
Inmpaced
Soil Und er Fill and \Vent ine
June 2004 Reponse F cNeaamon
July 2004 Limits of the Response Excavation
Limits of Response Excavation
APPENDIX D
MADEP Correspondence
CYN Environmental Services
03/23/04
I
f-It. iuu4 1U:00AM
IM,
Ut VItKU
aM
DUU IS? /0li
12i10pm,
I
P.
007
l
COMMaoNWaET OF MASBACHUSETTS
j
OFFICE op ENVIRONMENTAL A FFAIRS
~EXECUTIVE
DEPARTMENTj OF ENVIRoNMErNA PRoTECTION
Central Regional Office. e27 Maim street. Worcester, ifA 01605
I
WTRM!|
M
Ldentanao
ELLEW ROY HERZFLDR
.v.rn.
.
._....---
-
RMT....
URGENT LEGAL MATTER: PROMPT ACTION NECESARY
I
AtholMedical Clinic
1467 Main St.
AthoLMA 01331
RE:~CRWSC - Athol
Atlbol Medical Clinic
1467 Main St.
ATTN: Julie Hockonan,
RTN: 2-14815
Of~c
MangerNOT]CE
OF RSONSIILITY
Dear Ms. Haocman:
I
I
E
The D epartment of Envronmental P rotection (the Department) was notified o
n June 19,
2003, at 11:45 a~m., that a sudden release of an unknown amount of Nb. 2 oil ocared at
the abovereferenced property. Specifically, the release occurred fimm the fil1 pipe of two, two
hundred
and
Seventy-five (275) gallon aboveground storage tanks (AS~s)
located is.
According
to
lnformation available to the Department, rainwater entered the fill pipes of
the
ASTs,
thereby
displacing an unkniown amount of oil from the AST, and releasing the oil from the fil1 pipes to the
toil. Such condition required oral notification to the Department within 2-hours and pefbrmnce
of
an bmondiate Response Acton (IRA). In light of the notifieation and other infbnmation
available,
theDearmet ishs o nsrethat you are awmreoworrgt ad respone-bilitie under
the
adteMassachusetts Contingency Plan (MCP), 310 CMR 40.0000.
~The
Depairment has identified the property, or portions thereof, -a a disposal site that
requires th odc fcenpor other response actions. The cleanup of disposal sites is
governed by Chapter 2lE and the MCP. The Department has assigned Release Tracking Number
(RTN): 2-14815 to this disposal site for the release notification received.
The Department also has reason to believe that you (as used in this Notice, "you" refers
to
Athol Medical Clinic) are a p arty with p otential liability for response
action costs and damages
under Chapter 21B,§i5.
Itrt'WWW~.a~ovalep
QPdnhifede
Phon(50) 70a.76O|i
Paax(50) 792-7521 TDD00(50)?0755
ycledPaper
bO,
0S/2S/04
8. 2004 I0:bS6h
NOTICE OF
DbP?-CtRO
00
I32 /U21
No.-2I
12:10pm
RTSPONS1B4LITYPage 2
Athol Medical Clinici 1467 Main St., Athol; RN-41
.The attached s ummary 1. intended to pmovide you with infbnnation abcut liability under
Chapter21E to assist you in deciding what actions to take iresponse to ts Note.
.You should be aware that you might have claims against third parties for doniages, including
claims for contribution or reimbursement for the coats of cleanup. Such claims do not exist
indefinitely but are govemned by laws that establih the tine allowed for bringir g litigpton. The
DeparDtet encourages you to take any action necessary to protect any such claimns you may have
agamst third parties.
On Jkne 19, 2003, the Department required you to undertake the following actions:
* Engage a Licensed Site Professional (LSP) to assess the impacts that aad ocoutred and.
seek approval for the appropriate IRA to mitigate the impacts. At a mlnmum, oilcontaminated water and soil would need to be removed and properly dispaoed of
On June 19.,2003 at 1:10 a.m. "you" asreed to take the recuired IRA.
You must dispose of any.Remediation Waste as defined by the MCP, includin8, without
limitaion, contaminated soil and/ar debris, generated at the location in accordant e with 310 CMR.
40.0030. Any Bill of Lading accompanying such waste must bear the seal and sIgnature of a
LSP.
NECSSARV RESPONSE ACTIONS AND APPLICABLE DEAD)
P.
P. 4/il
S
Please be advised that ynne 19. 2003 is considered to be the date of release notificadion.
Unless otherwise stated, this date will be the baseie for calculating compliance with
deadlines contained within the MCP.
The MCP requires responsible parties and any other person undertaking ri sponse actions ata disposal site to perform Immediate Response Actions in response to sudden releases, Imndnent
Hazards and Conditions of Substantial Release Migration. Such persons miist continue to evaluate
-the need for Tmmediate Response Actions and notify the Department immediately if such a needexists.
006
02/23/04
51
18.ZU4 10:laIAMt|PCLK
5!
5.
5
__
NOTICE OF RnSPO~sNSII
mU
18
/MI
12i10pm
MOat
vf
Athol Medical Clinic; 1467 Main St., Athol; RTN 2-14815
P'.
P. 4/fl
Pag 3
As an integral part of the zvaponise action(s) for this release, you must aiso comply with the
following:1.
__
_
Submit a completed Release Notifiction & Refrmetion Fonn tu the Departrment in
accordance wit 310 Ci 40.0300 (i.e., within 60 days of the .date of release
notification). You may renrat this notification via the same fim iyoutwhav
Innrmtion that the Incident that ocmrd did not result in a nts~hc
eum
nocato totel
2.
~40.0427),
atent
Submit an IRA Plan (310 CMER 40.0420), or IRA Completion Stiatement (310 CMR
or altesponse Action Outcoms Statement (310 CMR 40.1000) whichever
is applicable to the Department within 60 days of the date of the release notification
or the date of service of this Notice, whichever comes first.
INodiposase
will be de
edto
havehaadall thenecessayand requiedeponsactions
taken for it unless and until all substantial hazards presented by the release and'or thira of
release
~have
been eliminated and a level of no significant risk exists or has been achieved in compliance
with M,3,L. c. 21B and theMCP.
A fee of S1,200.00 is assessed!if an RAO Is fired 120 days after releare notification,
before Tier Classitlcation. Therefore, if all remediation work has been completed, you but
are
encouraged to have the RAC submitted promptly to avoid the fee.-
.
Iinitial
Unless otherwise provided by the Department, responsible parties have one year from the
date notice of a release or threat ofrelease is rovided to the Deparmnt pursuant to 310
cMR 40.0300 or from
the date the-Departmet issues a Notice of Responsibility, whichever occurs
curlier, to file with the Department one of the following submittals: (1) a
completed Tier
Classiffloation Submittal; or (2) a Response Action Outcome Statemnent.
If requ red by the MCP,a
.completed
Tier I Permit Application must also accompany a Tier Classificaton Submittal. The
deadline for these submittals for this disposal site is June 19, 2004.
PROCEDURES TO FOLLOW TO UND9ERTAKCE RESPONSE AfTINS.
IThe
-
~
D epartment encourages parties having liability underM.G.L 0 .2 lE t o t
ake prompt
action in responsecto releases and threats of release of oil and hazardous maisrials.
By taking
pwompt action, liable parties may significantly lower cleanup costs and avoid th
s imposition of, or
reduce the amount of, certain permit and/or annual compliance assurance Lees payable under
310
CMRt 4.00 (e.g., no, annual compliance assurance fee is due for Response Action
Outcome
Statements submitted to the Department within 120 days of the initial date of rele;ase
notification).
.
008
0s/2;/04
18 2004 10:51AMl
NO-BO
DEP-CERO
508 192 7621
'12i10pm
No.2819
ESOSBLT
P 5/iL
Page 4
Athol Medical Clinic; 1467 Main St., AthoI; RTN2-14815
You must emulov or eneage an LSP to manage.
actins which ou intenld to undertake at this disnosal site,sumervise. or actually..noromalrsos
You may obtain a lis of the names and
of LSPa by visiting ww asav/s, iby contacting
the Board >f Registration of
Hazardous Waste Site CLeanup Profesuionals by
telephone at (617) 556-1091, ir in person or by
mail at One Wintr Street,10th Floor, Bdston, Massaohusetts
02108.
Iaddresses
If you have any quastions, please contact this offce at the
letterhead address or at (508) 792'/63.
The
Deartment
reauests
that
vo
nmr
your LSP of this Notice. .All future correspondence
comnmicationsiregarding te disposal site should
referenceRTN: 2-14815.
I
Sincerely,
Juy1.203Sinae
FSNCw
-
[NOMISSUED.ER]
I
nclosures
.cc:
g
Section Chief
Bureau of Waste Sitto Cleanup
AtholFireflepartmentPhil MoBain; LSP; CYN Environmenal, Inc.; 100 Tosca
Dr., Stoughton, MA )2072
Database Entry
2-0014sl3- Atl0-nor
P. 010.
I
02/2S/04
l8. 2004
~
10:57AM
DEP-CERO
508 792 7621
12:10pm
No.2819
P. 011
P.6/f1
SUMMARV dI1UABLIfY UNDERCHATRI21E
IAs
mated Inthe Notce eof Raespo
nsiiiy hccffmpanyln; als Sumnsy, the Depnemt has reast n to believe that you arn
Potenially Responible Pmny ("PRP") with potwtial lifability under M.G.
e,2IE, gtin 5,for tespwe a nan coats and damnaget te
nummi retomnae ad y the rokosM n/or thrnt of release. The Dwptent bas idetified puu
Ps t Pbeue It bellvs you
Al inoe or rmsr of the ftlowing waegoies ofpmrsons made potendally liable by Subsedton 3(a):
- any cwrem owne or operaor orf alte born orsa which ther is or has been a release or thre ofrtlnaof oil
3*
any person wo
a any
5:
nedworoperaeda ste ar thet dme bataidcus rnteral wes stored or disposeof,
peron who mranged
e uesaport, disposal, sinrge or trieane ofhazardous material1 nor atse;
*
y person who rnspoted hazdus mariai to a tranhport, disposal,
therm Isor has bemn arelease or ireat of release or such
material; ad-
magse or tratment site hom which
- any peaon who othewse caused or is legal respousible for aresse or threat of release of all orhmnerdous
For purposes of the MCP', you
are considere * Rlesponsible Party ("RP") with actal liblky unt lr diapter 2II if you Nill
riekes you (I) are entiiled to adeanse. under Section 5 oioter aplicable i' v,and (2)have reasonably
meurred cleanup coats in anon equal to or greater than any applicable cap on ialty
und etir M 5(d).
within
I
one of thes catgo
lls liability is
"se,"meaning illis not based co lauf but solely ren your stames ascar -mer, operator, gnato,
transpoter or dispose. It isalso jont and several/mning t eac person who fhils within one of ihesategonea may be bald
liable for ali responsaractonwossncmdte atta~tegdless ofteeneiswnc fmanyoterhlable partie.
3
Scot. Sprovides a
few naowly drtawn defenses to labilit, Including adefbne for releates and danages caused by an act
. of God, msot oftwr oren aerby sthird party other than an Sinployee, agent or person with whom the party hasn a ormafeal
relationship (. Subsaelion 5(4)); a defenae for rtni n net of reidaisi propenty at whicthe miw er matmaint a ponnanunt
presidence
(sne Submeton 5()) and adeftane for ea~In pulie utilitIes and agenctes ofthec Commonawualth wichi own anght-of~way
thtunmitseessctionS)).
I
You may vohntarily undentake taonse ecdwionmder the MCP wthoul having yomr liability wr de riper 21- fotnafly
uagudicated by the Dertmemr. Ifyou do not take the necessary response acdions, or fil to perform than Inan appropriate and timely
manuner, the Deprtmi is ambronrd by ChapterI 2IBm pertebn the necessary work.
pefomigthese aadons [f you ore asRP end you fhil to perfom necessary response aons at the uIte, yot may
be hold liable fbr tp
to
the 3 ie
l epneato
ot nurdby the Dleparnt and sanctions may be imposed on you ftr Ibiluro to pedorm
by the 14CP.
I ~response aeoerequrd
. Reponise nelln cots iiclde,
I"T
Z
n
so ov
em
ivor
without
lirmtatlon, die
cost
of direct houma-pant by Depatmen' employees marring for
peribrmed by prann other thanthe Depflrwn oris controsxpenenurrenyi h
de'ot, ie Departent may laciens o ad of yourpropertyin the Cormmonwealth imder MG.Le. 212, Siction I3. To recover this
debt, the Commonwealth may foreclose on these Uian orthe Attormey General ray bring legal acton aginsl yoU.
I
In additi on to yourjmetu li iw for response taton cost. and damages to natural resources caused bythe relase, clvil
aneriminal liabilily ma
uo eiposedby a court of enmpetent Jurldction under M.O.L c. 225, Section I I, and civil
~~~adminilrmnya pEnalties mny bewaaeed by' the Dparent under MGL el. 2A Sectdon 26, (hr each via tion of Chapter 1B, the
MCP or any or pemi Or approval Issued thermur
If you are an RPY and you have roason to believe Ohat your perfomance of dhe neceauy responsa amtioa i beyond your tecmeal,
finnocial or legal ability, you should promptly notify the Depstmn in writing of your inabilliy In accodace wilh Chapter 21B,
Subsection 1(e and 330 CMR 4072. If you assert and demontats in compliance therewith that part rmring or paying for such
response action isbeyond your ability, Suhsoedcn $(e) provides you with a limited defoense to an action t y the CoImonWealp for
recver otwolo hreties heDeprtmnts rsposeactoncosts and 310 CMR 40.0172lprovides you wits limited defenistothe
*Departmeta assnt of civil mdmnfrdredve pernulds.
a
-
5?
A~al Id.
LUU4 IU:00AM
-
Ut -~u
t
0S/23/04
uu3
8 /2 il
12.:10pm
- 021
MrmtnOMNZY
-
ELLEN RoY RZRtnnit
opvrnerBacratary
KERY HLt
oaz!rr w. GOLLEDGE rr
H
URGENT LEGAL MATTER: PROMPT ACTION NECESARY
Athol Medical Clinic
1467 Main St.
AtholMA 01331
*
R
ATTN: Julie Hockman,
OffEce Manager
I
.NOTICE
3
~
RE: CRWSC - Ato!
Athol Medical Clinic
14d7 Main St. -
-KRN:
2-14815'
NON-CB-03-3146
OF NONCOMPWLIANCE-
ThNTERI DEADLiBS
MIL 6.21E,.310 CMR 40,0000
FAILURE TO SUBMIT A RELEASE NOTIFICATTON FORM WITH!6 DAYSl
FAIURE TO StJMfT AN IRA PLAN WITHIN 60 DAYS.
I
I
-/ I
COMMONWEALTH OF MASSACHIUSETTrS
-EXECUImVE OFFICE OF ENVIRONMENTAL AFFAIRSDEPARTMENT OF ENVIRONMENTAL PRO'IECTION
Central Regional Office. 411 Main Street, Worcester. MA OLGOS
5
if
A review of infonnation available to the Department demonstrates that you
Ailed to comply
with one or more laws, regulations, orders, licenses, permits, or spprovals enforced by theDepadent.Be advised that the regulations that generally set forth the requirements
of providing
notihcation and conducting Imrnediate
Response Actions are coditled at Subparts C and
D), of the
Massachusetts Contingency Plan, 310 CMR 40.0333'and
310 CMR 40.0420, rea ectively.
The Deparment has included with and specifically incorporated into this writing a NOTICE
OF NONCOMPLIANCE SUMMARY, which includes:
L. the elements and occurrence(s) of the noncompliance necessitating thin issuance
of this
Notice; and-
I
I
P. 002
2. the deadline(s) within which a return to compliance must be acl loved by:£.
coming into compliance with the applicable requirements, or
ii. subtmitting a written pmposai to the Department setting forth how and when
coming ito compliance with the requirements will be achieved
I
Tb Is fnadn i*
ans~ahl, toalferna.
hmar. ca Aprathfcak 1 ADA cordiauoiwu-6I7-Sf5647.
U
Pulntad on n.cyed pape
33/2s/4
04 10:58AMl
DEP-CERD
CB OF NONCOMPLIK. JB
SDB 792 7621
NON-CB-O3-.L44.
iza
No.2819
po . aes
P.8/l
Page 2
An administradve penalty may be
out of compliance with the requirements assessed for every day from now w that you remain
Notwithstanding tis NON, the Dqiarmnent described in this Notice of Noncompliancee (NON).
authority in orde to obtain fll compliance reserves tho tight to exercise the frI extent of Its legal
wit
limited to the assessmnt of civfl namnitrative all applicable legal requiremen s, including but not
penalies, the cormmencement of a civil
court(s) of competent jurisdiction, or tecommencement
action in the
of acriminal prosecutian in the court(s)
competent jurisdiction.-of
mn ambiguity or confision concemning tis-Notice.
Inresponding to this NON, please reference
the NON numiber found on ihe first page
document to ensure proper acknowledgement
of this
of
your
response. ThelwDepartmen requestsht.vo
itbun Vour SP of this Notice.
October 6.2003
Nicholas J. Child
Branch Chief, Emergency Response
Bureau of Waste Site Clesiup
NJC/
EncL
[C&WFNLET C&B/NON
cc:
J
James Moody, CDRO/BWSC Enfortement
Coordinator
Michael Maher, CERO Regional Enforcement
Mary Gardner, CERO/BWSC Deputy ReglonalCoordinator
Director
Datgbase BEtry
0S/2'3/04
. '
DEP-CEHO 508 192 1821
04 10:59AM
CB OF NONCOMPLOE SUMMARY NON-CE-03-$4
3!
I,
U
12:10pm
No. 2819
P. 10/l
Page 2
310 CMR 40.0420(7%t Reouirements. Approvals, and Time Lines for Conductine Imrnediate
7'
(7)Phcept as provided in 310 CMR 40.0420(8), and without regard to whether oral
approval was given by the Department to conduct or initiate Response Ar-ions, Rhs and
other peson~s conducting response actions shall submit t o the Deparment an Innnediate
(a) within 60 days of providing oral notificaion to the Departmientbof -hose"2 Hour" or
*72 Hlour" releases or threats of releases specified in-31C CMR 4O.0311 through
40.0314;
*(b,) within 60 days of orally communicating to the Department kniowli dge.of a
condition of Substantial Release Migration at a disposal site;
(c) within 60 days of the date that the Deparitment issues a Notice of Responsibility
indicating that they are an RP or PRP for a site at which an Immediate Response Action
isrerenidpursuant to 310 CMR 40.0412; or
(d) within a time pediod established bythe Department as an Iterim D~eadlino inaccordance with 310 CUR 40.0167.
DESCRIPTION OF ACT OR OIfSION CONSTITUTING NONCOMPJJINC
.
Based on-lhe above ihformation, the due date for submitting adt IRA Plan to the Department
was August 18, 2003. The Department has yet to receive an iRiA Plan for this rselease~as required
by~l
30dR40.0420(7).
DES CIPTION OF fQUIREMENTS NOT COMPLIED WITH
* 310 CMR 40,042,0(7%: Requirements. Aporovals. and Time Lines for Conduotine Immpediate
*
P. 004I
(8) Except as provided in 310 CMR. 40.0420(8), and without regard to whether oral
approval wvas given by the Departmt to conduct or initiate Response Actions, RPs and
other persons conducting response actions shall submfit to the Departnrent an Itnmediate
Response Action Plan, within the earliest of the foillowing time periods:
(a) wthin 60 days of providing oral notification to the Dleparment of those "2 Hour" or
"72 Hour" releases or threats of releases specified in 310 CMRP 40.0311.through
40.0314; .0dy foal omnctn t h eatetIoLdeo
(b) within 6 aso rlycmuiaigt h eatetkolieo
condition of Substantial Pelease Migration at a disposal site;
(c) with 60 days of the daze that the Depatment issues a Notice ofltessponuibility
indicating That they are an RP or PRP for a site at which en Immediate Redponse Action
is requied pursuant to 310 CMRP 40.0412; or(d) withntieperiod establishedby teDparnentuannerim eadline in
accordance with 310 CMRt 40.0167.
0S/2S/04
*
-04
10:58AM
DEP-CERO
509 792 7621
12:10pm
No 2919
9. 9/li
NOTICE OF NONCOMPLIAlNCE SUMMARY
NON-CE-03-Q4{
-
I
U
3
I
I
1
I
I
3
Athol Medical Clinic
l467 Main St.
fDATE OF NONCOMPLIANCE
AMgust 18, 2003
DESCRIPTION OFRSEOQUIEMENTS NOT COMVPLIED WITH
310 CMR 40.333: How to Notify
(1)
Two Hour and Seventv-Two Hour Notifications. Persona descrit ed in 310 CMR-
40.0331(1) shall:
~
~
(a). notify the Department of arelease orthreat of release specifieS in 310 CMR
40.0311 through 40.0314, inclusive, by calling a telephone number published by the
Department and designated for that purpose and orally notifying die Department the
informarion specified in 310 CMR 46.0334; and
(b) within 60 days thereanter, submit a completed Release Notification Form, as
described in 310 CMR 40.0371, to the Departrnent oeuce looated:n the DEP region
in which the release or threat of release occurd. Where appropri ate, the Release
Notification Fonn may be accompanied by a Response Action Ou tcome Statemnent,
as described in 310CMR 4.1000.
I
DESCRIPTION OF ACT OR OMWISSION CONSTITUTING-NONCOMPLIAJQS-
The Department of Environmental Protection (the Department) was nC tified on June 19,
2003, at 11:45 a.m., that a sudden release of an unb::own amount of No. 2 (il occurred at the
above-reftrenced property. Specifically, the release occurred from the fill pipe of two, two
ansventy-five (275 gation abovegroundsoag tanls(ASTn) kocatedinde
Ihundred
I
I
ASTa, tebydisplacing an unknown amount of oil frmthe AST, and releasing the oil from the
fdll pipes to the soil.
I
P. 006
Based on the above information, the due date for submitting an RNF to tice Department Was
August 18, 2003. The Department has yet to reoeive a Release Notification form for-this release, as
required by310 CMR 40.0333(1)(b);
03/2s/e4
12i10pm
P. 01S8
LOCATION: Central Regional Office
627 Main Street
Worcester, MA
DATE:
March 30, 2004
TIME:;
10:00 am.
The purpose of the enforcement conference is to provide you with the opportunity to
reach a negotiated agreement with the Department to return to compliance and pay a civil
administrative penalty as appropriate. The Department believes that pror apt resolution of this
enforcement case in a manner that ensures your 'expeditious return to compliance and resolves all
penalty issues is beneficial and consistent with the Department's environmental protection goals..
The enforcement conference will provide you with the opportunity to dis';uss the alleged
violations and your return to compliance and/or penalty conditions of a final enforcement
document.. Prompt settlement may also decrease the resources you and the Department might
expend on protracted litigation of the issues.
If you either do not attend the enforcement conference or do not reach a negotiated
settlement, then the Department will initiate appropriate enforcement acti ons and you will have
limited, if any, further opportunity to reach a negotiated settlement of this case.
Please contact Kevin W. Daoust at (508) 767-2815 to confirm your attendance at the
Enforcement Conference or if you have any questions.
Sincerely,
Date:
MazyDG'td
Deputy Regional Director
Bureau of Waste Site Cleantp
Enclosure
Cc:
Robert Brown, Chief Regional Counsel DEP CERO
James Moody, Regional Enforcement Coordinator, DEP CERO
I
~03/2L/04
12:10pm P. 014I
Attachment I
DEPARTMENT 0OF ENVIRONMENTAL PROTECTION
Policy Statement
SETTLING CIVIL ADMINISTRATIVE PENAL TY CASES
The Department's goal Is to encourage settlements In a ppropriate
enforcement cases as early in the administrative penalty process as possible
(iLe.,conducting pre-Issuance enforcement negotiation meetinigs leading to a
consent order with penalty). The Department believes that by encouraging
earlysettlements that meet the Department's environmental jrotection goals,
it will maximize limited resources and benefit the environment through early
-compliance.
Early settlement allows violators to save the potentially great costs
resulting from adjudication of the ease and provides them witha an
opportunity to have more input into the compliance condition;s. Early
settlement provides the violator with a greater opportunity to settle with
more favorable terms and conditions, where later settlement, :f any, with the
Department may result in less flexible conditions depending ona the
circumstances of the case.
The Department will continue to allow violators to pres ent new
factual information concerning the alleged violations at any point in the
settlement process.
0//4.12110pm P. 01E
Attachment 2
Athol Medical Clinic Violations
Violation 1
FACTS:
The Department of Environmental Protection (the Department) w as notified on June 19,
2003, at 11:45 a.m., that a sudden release of an unknown amount of No'. 2 oil occurred at the
above-referenced property. Specifically, the release occurred from the fill pipe of two, two
hundred and seventy-five (275) gallon aboveground storage tanks (A.STs) located inside.
According to information available to the Department, rainwater entere d the fill pipes of theASTs, thereby displacing an unknown amount of oil from the AST, and re leasing the oil from the
fill pipes to the soil.
Based on the above information, the due date for submitting an RNF to the Department
was August 18, 2003. The Department has yet to receive.a Release Notification form for this
release, as required by 310 CMR 40.0333(1)(b).
On October 6, 2003, the Department issued a Notice of Noncompliance (NON-CE-033146) to Athol Medical Clinic, requesting the submittal of the RNF and IFA Plan by November
3, 2003. Athol Medical Clinic has not complied with NON-CE-03-3 146 to date.
LAW:
310 CMvR 40.333: How to Notify
(I) Two Hour and Seventy-Two Hour Notifications. Persons desc:-ibed in 310 CMR
40.0331(1) shall:
(a) notify the Department of a release or threat of release specified in 310 CMIR
40.0311 through 40.03 14, inclusive, by calling a telephone number published by
the Department and designated for that purpose and orally niotifying the
Department the information specified in 31l0:CMR 40.0334; and
(b) within 60 days thereafter, submit a completed Release Noti:ication Form, as
described in 310 CMR 40.0371, to the Department office 1Iccated in the DEP
region in which the release or threat of release occurred. where appropriate, the
Release Notification Form may be accompanied by a Respconse Action Outcome
Statement, as described in 310 CMR 40.1000.
VIOLATION:
-Athol Medical Clinic failed to comply with NON-CE-03-3: 46 by failing to
submit an RNF within established Interim Deadlines.
APPENDIX E
StandardOperationalProcedures
&
Quality Assurance / Quality Control Plan
CYN Environmental Services
Standard Operation Procedures ISOP'sl
IDrilling Procedures (if required)
a)
Overburden:
Test borings are accomplished by using a truck-mounted rig vehicle set-up with both hollow stem augers and
flush jointed casing. Drilling operations will be completed using the procedures outlined in WSC-3 10-91
"Standard Reference for Monitoring Wells", Section 3.3 - 2.2. Hollow stem augers will be advanced to the
groundwater table or contaminated media to allow the collection of soil samples and to allow the documentation
of the subsurface conditions. If required, drilling operations will be converted to flush jointed casing to
minimize potential contaminant transference whibh would occur during auger operations. The casing will be
advance into or through the zone of contamination to allow the installation of the proposed monitoring well or
define the limits of the soil contamination. The casing will be advanced using a 300-pound weight dropping a
distance of 24-inches. Drilling fluids generated during the cleaning of the interior annular casing space will be
containerized on-site for treatment or disposal considerations. A FRAC tank will be used to allow the
separation of the suspended soil from the drilling fluid. Representative samples of these solids and fluids will
be collected and analyzed to determine if treatment or disposal actions are required towards this material. The
collected soil and fluid will be containerized and disposed of as contaminant conditions dictate. Refer to
Section V and VI of this SOP for information regarding soil sampling and decontamination procedures,
respectively.
The soil test borings drilled to the bottom of the aquifer [deep wells] will be located in area of greatest known or
suspected contamination as determine by the Phase II Investigation. These borings will be extended to the
bottom of the aquifer [lower permeability strata] or until refusal is encountered with the flush jointed casing.
The bottom of the aquifer will be determined by field personnel during the drilling operations by identifying
and confirming the presence of a less permeable material than the overlying strata; i.e., clay, silt, glacial till or
bedrock. Based on the present site conditions, the installation of deep test borings does not appear to be
required.
b)
Bedrock Coring:
The installation of bedrock monitoring wells are currently not proposed in this investigation study. If
contaminant conditions are detected which require the installation of bedrock monitoring wells, then the
procedures outlined in WSC-310-91 "Standard Reference for Monitoring Wells", Section 3.6 will be followed.
The installation of the test borings will be completed in a manner to ensure that contaminants from upper laying
locations will not migrate down to the underlying bedrock aquifer, if present.
IISoil Samplin2 Probes
The soil sampling probes will be completed using a 3-inch diameter, hand operated, bucket auger. To complete
this task, a coring machine will be used to allow an egress for the bucket auger. The auger will be advanced
through the soil to obtain a representative soil sample from the soil/water interface. This sample will be placed
in a glass jar, screened for total organic vapor readings, and submitted for laboratory analyses. The constituent
analyzed for will include volatile organic compounds, total petroleum hydrocarbons, and polynuclear aromatic
hydrocarbons. After the sampling collection, the hole will be backfilled with the excavated soils, and the
concrete surface seal installed. Refer to Section V of this SOP for information regarding the sampling
equipment decontamination procedures.
CYN Environmental Services
100 Tosca Ddiver, Stoughton, MA. 02072
Page I or 9
Ill
Monitoring Well Installation (if reauired)
a)
Overburden:
The monitoring wells will be constructed with a 0.5 foot long sediment trap-attached to a 10 foot long section of
threaded 2 inch diameter, 0.010 inch slotted schedule 40 polyvinyl chloride [PVCI wellpoint. The wellpoint
and sediment trap will be extended to the ground surface by a solid 2 inch diameter threaded PVC riser pipe.
Following the installation of the sediment trap, wellpoint and riser pipe, a clean sand filter will be placed around
the sediment trap and wellpoint to approximately I foot above the slotted wellpoint section. A one foot thick
bentonite seal is then placed above the silica sand filter. The remainder of the annular space is filled with native
soil to within a foot of ground surface. At this point a gate box is installed flush to the ground surface and a
concrete seal incorporated. All PVC connections are completed without the use of glues to prevent
contamination.
After installing each monitoring well, the well is developed using one of the procedures outline in Section 4.5 of
the DEP policy WSC-310-9l "Standard Reference for Monitoring Wells". Due to the anticipated depth of the
overburden wells, it appears that an over-pumping technique will be employed to develop these monitoring
wells. Fluids evacuated during the well production will be stored in a container. Samples from the container
will be collected to determine the disposal protocol.
b)
Deep Wells:
Based on the existing information, deep monitoring wells have not been proposed to be installed at the Disposal
Site. However, if conditions generated by the Phase II Investigation, or the schedule remedial measures require,
then deep monitoring wells will be installed using the following protocol. These monitoring wells will be
screened at the bottom of the overburden aquifer to sample for the chlorinated organic compounds detected on
the site. These deep monitoring wells will be constructed of a 0.5 foot long sediment trap attached to a 5 or 10
foot long section of threaded 2 inch diameter, 0.0 10 inch slotted schedule 40 polyvinyl chloride [PVC]
welipoint. The wellpoint and sediment trap will be extended to the ground surface by a solid 2 inch diameter
threaded PVC riser pipe. Following the installation of the sediment trap, wellpoint and riser pipe, a clean sand
filter will be placed around the sediment trap and wellpoint to approximately 1 foot above the slotted wellpoint
section. A one foot thick bentonite seal is then placed above the silica sand filter. The remainder of the annular
space is filled with concrete grout to within a foot of ground surface. At this point a gate box is installed flush
to the ground surface and a concrete seal incorporated. All PVC connections are completed without the use of
glues to prevent contamination.
After the installation of each monitoring well, the well is developed using one of the procedures outline in
Section 4.5 of the DEP policy WSC-310-91 "Standard Reference for Monitoring Wells". Due to the unknown
depth of the deep wells, it appears that a mechanical surging technique with over-pumping will be employed to
develop these monitoring wells. Fluids evacuated during the well production will be containerized and
laboratory analyzed to determine the appropriate and applicable disposal method, if required.
IV Groundwater Samnlina
Prior to the initiation of the groundwater sampling collection, an initial site reconnaissance is performed. The
procedures involve the inspection of each monitoring well to ensure that the protective casing is intact and that
no apparent vandalism has occurred since the monitoring well was constructed.
CYN Environmental Services
100 Tosca Driver, Stoughton, MA. 02072
Page 2of 9
Once the protective cover is removed, a check of the well headspace is performed using a photoionization
detector for total organic vapors (TOys). This instrument is calibrated to benzene in accordance to the
Massachusetts Department Environmental Protection and manufacturing requirements.
In addition, static water levels are measured along with the total well depth. These values are used to determine
the volume of water bailed prior to sample collection; in addition, a check is made with the drilling records to
ensure that the migration of fines into the well screen has not occurred.
Upon the completion of the reconnaissance program, water samples are obtained from each monitoring well.
Prior to purging and sampling the well, a clean bailer and product-water interface probe will be used to check
for the presence of light or deep non-aqueous phase liquid [U.DPAPL] or a petroleum sheen. Additionally, a
sample will be collected from the monitoring well to document the pH, conductivity and temperature of the
groundwater.
After checking for a UJDNAPL layer, a volume of water equivalent to three times the standing water in the well
is evacuated (with a freshly decontaminated submersible pump or bailer) and allowed to stabilize. After the
water level stabilizes, the sampling equipment will be used to collect the require samples for laboratory
analysis. Prior to purging and sampling the next location, the submersible pump or bailer will be cleaned in a
five step process. First, the equipment will be cleaned with a brush and tap water, next an alconox solution will
be used to clean the equipment, followed by a methyl alcohol bath, distilled water rinsing, and finally air drying.
Upon commencement of the purging and sampling at the next location, new product transfer tubing or rope will
be used to ensure against cross contamination.
Each sample is placed in a sample contains and labeled with identification which includes the job name and
number, date, time, sample's name, sampling identification, preservative and analysis to be conducted. All
samples are placed in a cooler, chilled to approximately 4 degrees Centigrade and shipped immediately to a
Commonwealth of Massachusetts, Department of Environmental Protection certified laboratory.
All meters used during the groundwater sampling program [photoionization meter and probes] are calibrated in
accordance with the manufactures specifications to ensure the validity of the collected date. This calibration
program will be completed prior to the arrival at the site.
V
Soil SampnlinE
Soil samples are collected in accordance with ASTM D-1586, "Penetration Test and Split Barrel Sampling of
Soils". Standard Penetration Tests (SPT) are performed in all test boring locations. A continuous sampling
method will be completed in one exploration location to supply additional information on the subsurface
lithology conditions and contaminant characteristics.
Soil samples are collected at five (5) foot intervals or at changes in the subsurface conditions. Soil sampling
operations will be converted to a continuous sampling methodology based upon elevated TOV readings so that
the zone of soil contamination may be defined. Split-spoon soil samples are collected by using a split-spoon
sampler, inserted into the hollow stem auger, and then driving it through undisturbed soil (by means of 30 inch
blow from a 140 pound hammer). These soil samples are placed in precleaned glass jars and capped
immediately to prevent any loss of volatile organic compound or oxidation. A layer of aluminum foil is place
between the jar opening and the screw cap to provide a tight seal.
Soil samples obtained from the split spoon sampler during the test boring program will be analyzed with a direct
reading photoionization detector (HNU or Microtip) for concentrations of total organic vapors. As required by
the MADEP protocol [jar headspace], the collected soil samples are warmed to room temperature (70 degrees
Fahrenheit) prior to screening.
Soil samples chosen for laboratory analyses are selected as the 'worst case' based upon field screening using the
photoionization meter or due to particular or atypical color or odor. The selected soil samples are analyzed for
concentrations of total petroleum hydrocarbons, polynuclear aromatic hydrocarbons and/or volatile organic
CYN Environmental Services
100 Toscn Driver, Stoughton, MA. 02072
Page 3 of 9
compounds. The orientation of this testing is based on previously existing analytical data and the conditions
detected during the exploration program. Revisions to this analytical program may be required based on the
detected subsurface conditions.
Overburden sampling will continue until background levels, as recorded by the field screening or TOVs are
obtained or refusal is encountered during the test boring program.
Samples selected for analysis are placed in the appropriate sample contained and labeled with identification
which includes the job name and number, date, time, sample's name, sampling identification, preservative and
analysis to be conducted. All samples are placed in a cooler, chilled to approximately 4 degrees Centigrade and
shipped immediately to a Commonwealth of Massachusetts, Department of Environmental Protection certified
laboratory.
Soil samples selected for physical property analysis will be stored/preserved in accordance with the procedures
outlinedin ASTM D-4220-89 "Standard Practice for Preserving and Transporting Samples." Cyn's Site Health
and Safety Protocol require that these samples be screened for TOV readings or analyzed for the contaminants
detected at the site. Samples submitted for gradation analysis will be completed using the procedures outlined
in ASTM D422 "Standard Method for Particle Size Analysis for Soils".
VI Decontamination Procedures
Prior to the start of the exploration program, the drilling contractor will completely clean and decontaminate all
equipment to be used at the site. This will ensure that contaminants are not transferred to the site from a
previously completed location.
Between each exploration location, the equipment used during the drilling event will be transferred to a
centralized location for decontamination. The following will serve as the minimum standard for the drilling
process:
1.
2.
3.
4.
Portable water rinse and brushing
Soapy water cleaning
Steam cleaning
Portable water rinse and air drying
.All fluids produced by this process will be containerized for off-site disposal. To confirm the integrity of the
portable water source used by this decontamination process, a sample of the water will be collected from the
location and analyzed for the items listed during the Phase II Investigation.
During soil sampling, the drilling contractor will supply two to three split-spoon samplers to ensure the integrity
of the collected soil samples. This will reduce delays produced during the decontamination of the sampler after
each sampling event. Cyn will require that the split spoon samplers are decontaminated using
the following
process:
1.
2.
3.
4.
5.
Portable water rinse and brushing
Soapy water cleaning
Portable water rinse
Distilled water rinse
Air drying
Prior to purging and sampling the next location, the submersible pump or bailer will be cleaned
in a five step
process. This process will include:
1. Portable water rinse and brushing
2. Soapy water cleaning [alconox solution]
CYN Environmental Services
100 Tosca Driver, Stoughton, MA. 02072
Page 4 orfg
3.
4.
Distilled water rinse
Air drying
Upon commencement of the purging and sampling at the next location, new product transfer tubing or rope will
be used to ensure against cross contamination
VII Hydraulic Conductivity Testing [Slug Testing, if requiredi
Hydraulic conductivity testing will be conducted on select monitoring wells. Hydraulic conductivity is the rate
at which water passes through a permeable medium under unit gradient and the value is generally given in units
of cubic feet [volume] per square foot[area[ per day [time] or simplified as feet per day [ft/day].
The hydraulic conductivity is calculated by removing a volume or slug of groundwater from a well and
recording the rate of recharge of groundwater to the well. To accurately record this rate, a pressure transducer
and data logger are used during the performance of the slug test. The transducer measures pressure differences
and the data logger records and stores the measurements at specific timer increments. Manual calculations
convert the recorded pressure differences into actual groundwater fluctuation depths. The ratio of recorded
changes in water depth (h/h 0 ) are computed and plotted versus time (t) on send-logarithmic graph paper. Data
from the graph is incorporated in an equation to cbmpute the hydraulic conductivity of the aquifer surrounding
the well tested.
A potential groundwater flow rate will be calculated in units of fl/day using the following relationship.
V
=
K (dh/dl)/n
Where:
= flow rate (ft/day)
K =average hydraulic conductivity (ft/day)
dh/dl = hydraulic gradient (ft/ft)
n = porosity of the soil
y
Transmissivity is rate which groundwater is transmitted through a unit width of an aquifer under a unit
hydraulic gradient and the value is generally given in units of cubic feet [volume] per day [time] per foot
[saturate thickness] or simplified square foot per day [ft2/day]. In order to evaluate additional site specific
aquifer flow properties, the hydraulic conductivity value obtained from the monitoring well is multiplied by the
saturated thickness of the aquifer to obtain the transmissivity of the aquifer. The saturated thickness of the
aquifer is measured from the top of the groundwater surface to the bottom of the aquifer.
VIII
Total Organic Vapor Screening Procedures
The following are recommended procedures for conduction analytical screening of petroleumcontaminates soils utilizing a portable photoionization detector (PID) or flame ionization detector (FID).
1. Half-fill two clean glass jars with the sample to he analyzed. Quickly cover each open top with one or two
sheets of clean aluminum foil and subsequently apply screw caps to tightly seal the jars. Sixteen ounce
(16-oz) (approximately 500 ml) soil or "miason" type jars are preferred; jars less than 8 ounces
(approximately 250 ml total capacity may to be used.
CYN Environmental Services
100 Tosca Driver, Stoughton, MA. 02072
Page5of 9
2.
Allow headspace development for a least 10 minutes. Vigorously shake jars for 15 seconds both at the
beginning and end of the headspace development period. Where ambient temperature are below 32 degrees
Fahrenheit (0 degrees Celsius), headspace development should be within a heated vehicle or building.
3.
Subsequently to headspace development, remove screw lid/expose foil seal. Quickly puncture foil seal
with instrument sampling probe, to a point about one-half of the headspace depth. Exercise care to avoid
uptake of water droplets or soil particles.
As an alternative, syringe withdrawal of a headspace sample with subsequent injection to instrument probe,
or septum-fitted inlet is acceptable contingent upon verification of methodology accuracy using a test gas
standard.
4.
Following probe insertion through foil seal and/or sample injection to the probe, record highest meter
response as the jar headspace concentrations. Using foil seal/probe instrument method, maximum response
should occur between 2 and 5 seconds. Erratic meter response may occur at high organic vapor
concentrations or conditions or elevated headspace moisture, in which case headspace data should be
discounted.
5.
The headspace screening data from both jars samples should be recorded and compared;
replicate values should be consistent to plus or minus 20%.
6.
PID and FID filed instruments shall be operated and calibrated to yield "total organic vapors" in parts per
million (v/v) as benzene. This variation in the MADEP protocol and procedures is required to properly
evaluate the horizontal and vertical limits of the release, and to provide field critical information to
terminate the boring, place the monitoring well, and evaluate Site Health and Safety procedures. The PID
instrument is operated with a 10.0 eV (+/-) lamp source. Operation, maintenance, and calibration shall be
performed in accordance with the manufacturer's specifications. For jar headspace analysis, instrument
calibration shall be checked/adjusted no less than once every 10 analyses, or daily, whichever is greater.
7.
Instrument with digital (LED/LCD) display may not be able to discern maximum headspace response
unless equipped with a "maximum hold" feature or strip-chart recorder
generally,
Deviations, departures and/or additions to the above procedures will be considered on a case-by-case basis by
the MADEP on-scene coordinator or project manager. In such cases, compelling technical justification may be
presented and documented by the methodology proponent.
IX -Disposal Soil SamplinR
To comply with off-site disposal requirements, a representative soil sample will be collected from the excavated
soils at a frequency of one per every 500-cubic yards. This soil sample will be laboratory analyzed for
concentrations of RCRA 8 total metals, paint filter test, pH, flash point, reactive cyanide and sulfide, and
polychlorinated biphenyls. In addition, a soil sample will be laboratory analyzed for total petroleum
hydrocarbons at a frequency of one per every one-hundred cubic yards. The results of this testing will be
compared to the limits provided within the contract documents to determine whether off- or on-site disposal is
required. Selection of soil samples for laboratory analysis will be based on field screening results, olfactory,
and/or visual indications.
Samples selected for analysis are placed in the appropriate sample container and labeled with identification
which includes the job name and number, date, time, sample's name, sampling identification, preservative, and
analysis to be conducted. All samples are placed in a cooler, chilled to approximately 4 degrees Centigrade and
shipped immediately to the analytical laboratory.
CYN Environmental Services
100 Tosca Driver, Stoughton, MA. 02072
Page 6of 9
Ouality Assurance/Ouality Control IOA/OC1 Plan
I
Introduction
All information pertinent to field activities including sampling will be recorded in a) a field logbook; and b)
sample labels or tags.
The purpose of the document control is to assure that all documents for a specific project are accounted for
when the project is completed. -Accountable documents include items such as logbook, field data records,
correspondence, sample tags or labels, chain-of-custody records, analytical records and/or photographs.
II
Field Loebook
All information pertinent to a field activity will be entered in a bound book with consecutively numbered pages.
Entries in the logbook will include the following
1. Date and time of entry
2. Name and Address of field contractor
3. Type of process producing waste[if known]
4. Description of sample
5. Number and size of sample collected
6. Date and time of sample collection
7. Reference maps, sketches, photo's
8. Any field measurements
9. Purpose of sampling
10.
11.
12.
13.
14.
15.
Producer of waste and address [if known]
Types of waste [sludge, wastewater, etc.]
Waste component and concentration
Description of sampling location
Collector's sample ID number and/or name
Field observations
III Chain-of-Custody [COCl Procedures
Samples submitted to the analytical laboratory will be accompanied by a Cyn Chain-of-Custody form
completed by Cyn personnel. Each sample will be logged on this COG form with the appropriate data. A copy
of the COG is attached to the end of this QA/QC protocol.
A sample is in someone's "custody" if:
*
*
e
*
A.
it
it
it
it
is one's actual possession; or
is in one's view, after being in one's physical possession; or
is in one's physical possession and then is locked up so that no one can tamper with it; or
is kept in a secure area, restricted to authorize personnel only.
Samnyle Collection.Handlinp and Identification
The number of persons involved in the collection and handling of samples will be kept to a minimum. One
member of the sampling team is to be appointed field custodian. Samples are turned over to the field
custodian by the team member who collected the samples. The field custodian documents each transaction
and the sample remains in his/her custody until it is shipped to the laboratory.
Each sample is identified by affixing a pressure sensitive gummed labels on the container(s) as described in
Section IV of this plan.
The sample container should then be placed in a transportation case [i.e., cooler], along with the chain-ofcustody record. The transportation case will be sealed or locked. The transportation case will be capable
of controlling the temperature of the interior [i.e., ice packages, insulation].
CYN Environmental Services
100 Tosca Driver, Stoughton, MA. 02072
Page 7 of 9
B.
Transfer of Custodv and Shipment
When the samples are transferred, the transferee will sign and record the date and time on the COG record.
Custody transfer made to a sample custodian in the field should account for every sample, although it may
be transferred as a group. Every person who takes custody must fill in the appropriate section of the COG
record.
The field custodian will be responsible for properly packaging and dispatching samples to the appropriate
laboratory. This responsibility includes filling out, dating, and signing the appropriate portion of the COG.
The COG will include the following sampling collection information:
*
*
*
*
*
*
Sampling location as specific as possible
Sampling date and time
Sampling equipment , collection, and decontamination procedures
Sampling container description
Field filtration/preservative procedures
Sample collector's name, title, and affiliation
All packages sent to the laboratory will be accompanied by the COG record and other pertinent information
and forms. A copy of these forms will be retained by Cyn and placed in the Job File as permanent record
of procedure. In addition, a copy of the completed COG record will appear in the final report submitted to
the client or other governing body.
Cyn will use the laboratory carrier service for all project sampling deliveries. In the event of samples
mailed to the laboratory, mailed package can be registered with return receipt request. For packages sent
by common carrier [such as Federal Express, Express Mail], receipts will be retained until the package has
been received by the laboratory. Samples will be packed so as not to break during transit, and will be
sealed or locked so that any tampering can be readily detected.
C.
Sample Collection and Preservation
Samples plus appropriate duplications, field blanks, trip blanks will be collected and preserved in
accordance with procedures defined in 40 CFR 136. Samples requiring preservation shall be treated at the
time collection; holing times begin at this time.
D.
Sample Disposal
Unless otherwise instructed, all samples will be disposed of upon expiration of their holding time or thirty
days after submittal of the Report to the MADEP, whichever is longer. Samples will be disposed of in an
environmentally responsible manner.
CYN Environmental Services
T0O Tosca Driver, Stoughton, MA. 02072
Page
8 of9
IV Samle Labels
Each sample will be sealed immediately after it is collected and labeled using a waterproof ink. Labels are
filled out prior to collection to minimize handling of sample containers. Labels are firmly affixed to the sample
containers.
V
Quality Control
Prior to sampling, rinsate from the cleaning of a sampling bailer(s) shall be collected and analyzed for volatile
organic compounds in accordance with EPA Method 8240. This will ensure some control over what
constituents, if any are being introduced to the well by sampling equipment. In addition, laboratory spike, trip
and equipment samples will be performed as required.
QA/QC procedures and laboratory qualification from the laboratory will be used by Cyn. If deemed necessary,
periodic duplicate samples shall be collected and sent to the laboratory for analysis.
CYN Environmental Services
100 Tosca Driver, Stoughton, MA. 02072
Page 9 of 9
APPENDIX F
Disposal Arrangement Pap envork
And Testing Report
CYN Environmental Services
CY
ED VIRORGE GIRL
Fax Correspondence
iiFax
Number: 781-341-2440
SEGYICES
19 April 2005
Mr. Bill Reinhardt
Aggregate Industries, Inc.
1101 Turnpike Street
Stoughton, MA 02072
RE:
Soil DisposalLetter, TrackingNumber 2-14815
Athoi Medical Clinic - Number 2 Fuel Oil Release
1467 Main Street, Atho, Massachusetts 01331
Dear Mr. Reinhardt:
Cyn Environmental Services (Cyn) has prepared this letter to outline the reason for the
delay in disposal of petroleum-impacted soil associated with the above referenced site.
Initially, Cyn provided you with a completed BOL, analytical results, and the facility prequalification form in 13 July 2004. While response actions were completed in August
2004, unforeseen circumstances limited the removal of the roll-off container containing
the impacted soils. With these conditions being resolved, Cyn is requesting approval to
transport and dispose of the impacted soils at your Stoughton Facility. For you
convenience, I have attached a copy of the July 2004 package. It is my opinion that the
attached results accurately reflect the soils contained within the roll-off container.
Should you have any questions relative to this submittal, please contact the undersigned
at your convenience.
Sincerely,
Cyn Environmental Services
Philip D. McBain, LSP
Senior Project Manager
P.O. BOX 0119 - 100 TOSCA DRIVE - STOUGHTON, MA 02072-0119 TELEPHONE 781-341-1777 - FAX 781-341 -6246
1-800-242-5818 in, MA - 1-800-622-6365 outside MA
100 Tosca Drive, PO Box 119
Stoughton, MA 02072, Phone Number 781-341-1777.
FaxTanImUallia
To:
Bill Reinhardt
From:
Fax:
781-341-2440
Pages: 15 [counting cover page]
Phone: 781-341-5500
Re:
Bill of Lading / Athol Medical Clinic
0 Urgent
0 For Review
Philip McBain
Date:
13 July 2004
CC:
File
0 Please Comment
* Please Reply
0 Please Recycle
Comments: Please review and contact me with approval or questions. Would like to arrange for the
disposal of material sometime this week or next.
Thanks, Phil McBain
Privileged and Confidential information. If transmission problems occur, please contact Cyn at 781-341-1777, Ext
133.
Page I of 3
AGGREGATE INDUSTRIES
1101 TURNPIKE STREET, STOUGHTON, MA 02072
PHONE (781) 341-5500,.. FAX (781) 341-2440
SOIL RECYCLING SUBMITTAL
Site Information:
Name:
Athol Medical Clinic
Street:
1467 Main Street
_Athol,
City/Town:
Contact:
Phone No:
State/Zip:
Generator Information:
Name:
Same
Cityrown:
Contact:
Phone No:
State/Zip:
Consultant Information:
Name:
Cyn Environmental Services
Street:
100 Tosca Drive
Stogton
City/Town:
Contact:
Phone No:
State/Zip:
Street:
______
Estimated Soil Quantity
Tons,
Jose Amparo
978-249-9736
MA 01331
Matt Murphy
781-341-1777
Massachusetts 02072
100
Cubic Yards
NOTE: Water displaced oil out of AST. Soil below fill connection impacted by released oil
Soil Contaminants
(gasoline, diesel fuel, motor oil, etc)
Number 2 Fuel Oil
Analyses Performed (check all that apply)
X TPH,
X VOCs,
_X Flash,
_XpH,
_X Cd,
_X_ As,
X PCBs,X Cr,
TCLP (metals), if required based on total levels
__All the above tests were performed
Other
Laboratory Analytical Data Attached
Screening Data Attached
No
_X Reactivity (S,CN),
XIHg,
Yes
,
Instrument Used and Constituent Found:
Page 2 of 3
Description/Source of Release
X_ Other, Describe, Including date of release
Water entered AST
and displaced oil out of fill line, impacting soils below the fill connection.
__UST,
Soil Description
Physical Description (sand, gravel, silt, etc.)
Coarse to fine sand with 20-30% c-f gravel.
Classification Method:
Visual and Unified Soils Classification System
Check if the following materials are present: None
__construction debris
vegetation matter
ash
___clay
__
___coal
other deleterious materials (list)
___________________
Soil Characterization Methodology
Sampling Method:
Grab,
X_ Composite
_Biased samples (e.g. headspace screening, visually contaminated)
Contaminant of Concern:
Number 2 Fuel Oil Related Compounds
Site History
(
Current Use
___
Past Use
check if extra sheets attached )
Medical Clinic
Medical Clinic
I, the generator, having used due diligence determined that these is no reason to suspect or believe
that the petroleum contaminated soil has been impacted by any release of oil or hazardous materials
other than that of the known source or I have identified that additional oil and hazardous materials
that are suspected or known to be present in the soil, in addition to those associated with the known
release, including any anthropogenetic contaminants.
I, the generator, realize that due diligence shall consist of a search of information and records
reasonably available to the generator of the contaminated soil sufficient to make the determination.
Such records and information may include, but are not limited t, those of the generators, location of
generation (i.e. facility if not the generator), the Department's Bureau of Waste Site Cleanup, and
the municipality (i.e. Board of Health, Fire Department) within which the site is located.
X
Si
eof Generator
Generator
-
Jose Amparo
Printed Name
C
1J/2
ate
Page 3 of 3
A site diagram is required indicating any major structures or roads, excavation areas and stockpile
locations. All sampling locations must be noted.
X
Check if diagram attached
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~Massachusetts Department of Environmental Protection
BWSC-O1 2A
Bureau of Waste Site Cleanup
Ii
Release Tracking Number*
BILL OF LADING Pursuant to 310 CMR 40.0030
2
-
14815
A.
OCAIONOF SITE OR DISPOSAL SITE WHERE REMEDIATION WASTE WAS GENERATED:
lase Name (optional)
Street:
Athol Merlical ('linic
1467 Main Street
Ciztrown:
AthoI,
l.ocation Aid:
MA
AlEI-
Zip Code:
42..
04..
DaeProffGeneration
/
/__
_
Additional Release Tracking Numbers Associated with this Bill of Lading
I
I
47-3 5-75"N / 71-1 ?'-S8"W
*
Not Applicable
Note: If Bill or Lading Isthe result of a Limited Removat Action (LRA) taken prior to
Notification, a Release Tracking Number Is not needed.
B PESONCONDUCTING RESPONSE ACTIONS ASSOCIATED WITH BILL OF LADING
Athol Medical Clinic
Naeof organization:
Name of Contact:
Jose Amparo
Title:
Owner
I
IC.
I(check
I .PRP
Street:
1467 Main Street
Athol
City/Town:
Telephone:
State:
Q78-74Q-Q73%
Ext.:
01331
ZipCode:
MA
______
RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON CONDUCTING RESPONSE ACTIONS
ASSOCIATED WITH BILL OF LADING
one/specify)
RP
o
Specify (circle one):
Owner
Operator
Generator
Transporter
Other RP:
Specify (circle one):
Owner
Operator
Generator
Transporter
Other PRP:
______________
___________
Fiduciary/Secured Lender
oAgency/Public Utility on a Right of Way
In Other-Person:
If an owner and/or operator is not conducting the response action associated with the Bill of Lading, provide on a attachment the
name, contact person, address and telephone number, including any area code and extension, for each, if known.
ID.
I
TRANSPORTER/COMMON CARRIER INFORMATION:
Transporter/Common Carrier Name:Cyn Environmental
Contact Person:
Matt Murphy
100 Tosca Drive
Street:
City/Town:
Stoughton
Telephone:
781-341-1777
Title:
State:
E
Ext.:
Sipervisor
Zip Code:027
MA
______
E. RECEIVING FACILITY/TEMPORARY STORAGE LOCATION:
Aoreote lnuinctriec
Operator/Facility Name:
Contact Person:
Street:
Bill Reinhardt
Environmental Manager
Title:
I1101 Turnpike Street
City/Town:
Telephone:
State:
Stnughtnn
781-341-5500U
Type of Facility
(check one)
U
U
[1
Asphalt Batch/Cold Mix
Asphalt Batch/-ot Mix
Thermal Processing
Division of Hazardous
Waste/Class APermit:
Ext.:
02072
Zip Code:
______
E
C
0
I] Incineration
0 Temporary Storage
0 Other:
Landfill/Disposal
Landfill/Daily Cover
Landfill/Structure Fill
____________________
Division of Solid Waste
S-01-029
Management Permit #:
Actual/Anticipated Period of Temporary Storage (specify dates if applicable):
Reason for Temporary Storage (if applicable):
Revised 10/1/93
MkA
Not Applicable
____ / _____
/
_
to ___/
EPA Identification #:
____ /
MAD-981213531
Not Applicable
Not A pplicaible
Thisform
is printed on recycledpaper
Page
1of 2
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
BWSC-012A
Release Tracking Number
2W-D1481
BILL OF LADING Pursuant to 310 CMR 40.0030
E. RECEIVING FACILITY/TEMPORARY STORAGE LOCATION (continued):
Not Applicable
Temporary Storage Address
State:
City/Town:
Zip Code:
-
__
-
____
F. DESCRIPTION OF REMEDIATION WASTE:
(check
all that apply)
Contaminated Media (check all that apply):
C]Contaminated
I
Debris (circle all that apply):
oiL
Other:
Engineered Impoundments
Jet Fuel
Containers
Drums
Not Applicable
Diesel Fuel
100
#2Ol
4Oil
150
Tons:
I]Transportation Accident
oUnderground Storage Tank
Immediate
Response Actions Associated with Bill of Lading (circle one):
Utility-Related Abatement Measures
Other (specify):
Not Applicable
Other:
Tank Bottoms/Sludges
Waste Oil
#~6Oil
Other:
Cubic Yards:
Contaminant Source (check one/specify):
_____
Vegetation/Organic Materials
Non-aqueous Phase Liquids
Gasoline
Type of Contamination (circle all that apply):
Other:
Nnt Annlienhle
Other:
CINon-hazardous Uncontainerized Waste (circle all that apply):
CiNon-hazardous Containerized Waste (circle all that apply):
Estimate Volume of Materials
Surface Water
Demolition/Construction Waste
Inorganic Absorbant Materials
Kerosene
Groundwater
Response Actions
Limited Removal Actions (LRA)
Other:________
Water entering AST
*Other:
Release Abatement Measures
Comprehensive Response Action
___________________
Remediation Waste Characterization Support Documentation attached:
USite
History Information
U
Sampling and Analytical Method and Procedures
ILaboratory Data
5Field Screening Data
If supporting documentation is not appended, provide an attachment stating the date and in connection with what document such
information was previously submitted to DEP
G. LICENSED SITE PROFESSIONAL (LSP) OPINION:
Name of Organization:
Cyn Environmental Services
Philip D. McBain
LSP Name:
Telephone:
781
341
-
-
1777. Ext.-
Title
Senior Project Manager1/ LSP
133
I have personally examined and am familiar with the information contained on and submitted with this form. Based on this information, it is my
Opinion that the testing and assessment actions undertaken were adequate to characterize the Remediation Waste, in accordance with 310 CMR
40.0030, and that the facility or location can accept remediation wastes with the characteristics described in this submittal. Ilam aware that
significant penalties including, but not limited to, possible fines and imprisonment may result if I willfully submit information which I know to be
false, inaccurate, or materially incomplete.
Seal:
Signature:
Date:
See Attached
Replacement Opinion
______/______/_____
Licensed Number.
5121
H. CERTIFICATION OF PERSON CONDUCTING RESPONSE ACTIONS ASSOCIATED WITH THIS
BILL OF LADING:
I certify under penalties of law that!I have personally examined and anmfamiliar 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. Iam aware that
there are significant penalties, including, but not limited topossible fines and imprisonment, for willfully submitting false, inaccurate, or
Name of Person (print):
Revised 10/1/93
Tnse A mparo
Thisform
isprinted on recyclespaper
Page 2 of 2
USE LSP Replacement Opinion V with the following BWSC Form:
O
Bill of Lading (BWSC-012A)
LSP Replacement Opinion V
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this submittal
including any and all documents accompanying this submittal. In my professional opinion and judgment based
upon application of
(i) the standard of care in 309 CMR 4.02 (1)
(ii) the application provision of 309 CMR 4.02 (2) and (3), and
(iii) the provisions of 309. CMR 3.03 (5).
to the best of my knowledge, information and belief, the assessment actions undertaken to characterize the
Remediation Waste which is (are) the subject of this of acceptance at the facility identified in this submittal comply
with the application provision of 310 CMR 40.O000, and such facility is permitted to accept Remediation Waste
having the characteristics described in this submittal. I am aware that significant penalties may result, including, but
not limited to, possible fines and imprisonment, if submit information which I know to be false, inaccurate or
materially incomplete.
*Release Tracking Number:
___ -
2-14815
LSP Name:
Philip D Mcein
Title: Senior Pmject Mnager /ITSP'
LSP Organization:
Cyni Environmental Services
Date:
781-341-1777 Ext 133
Telephone/Ext.:
Signature:-
.4~
Seal:
/3
2oo
'
iF
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
--
-
BWSC-012B
Release Tracking Number
BILL OF LADINQpursuant to 310 CMR 4O.0030)
-
LOG SHEET
[2l-
OF
L LOAD INFORMATION:
LOAD 1: Signature of Transporter Representative:
Date of Shipment:
Receiving Facility/Temporary Storage Representative:
Time of Shipment (circle one) am/pm
/
/
___
_
Truck/Tractor Registration:
Trailer Registration (if any):
I
Date of Receipt:
Time of Receipt:
/_
__/_
I(circle
one) am/pm
Load Size (cu. yds./tons):
LOAD 2: Signature of Transporter Representative:
Date of Shipmet:
:ime
_
_
Truck/Tractor Registration:
/_
_I_
Trailer Registration (if any):
:ime
_
_
_
Truck/Tractor Registration:
Time of Receipt:
/__
/_
I(circle
ILoad Size (cu. ydsitons):
one) am/pm
________
Receiving Facility/Temporary Storage Representative:
of Shipment (circle one) am/pm
/
Date of Receipt:
___
LOAD 3: Signature of Transporter Representative:
Date of Sbipnent:
________
Receiving Facility/Temporary Storage Representative:
of Shipment (circle one) am/pm
/
/_
14815
_
Trailer Registration (if any):
IDate
I_
of Receipt:
_
Time of Receipt:
_
I(circle
ILoad
one) ant/pm
Size (cu. ydsitons):
_________
LOAD 4: Signature of Transporter Representative:
Receiving Facility/Temporary Storage Representative:
Date of Shipmet:
Date of Receipt:
:ime
of Shipment (circle one) am/pm
I
Truck/Tractor Registration:
Time of Shipment (circle one) am/pm
/
/
_
_
_
Truck/Tractor Registration:
_
_
/
/__
Time of Receipt:
/_
_
_
Truck/Tractor Registration:
(circle one) am/pm
Load Size (cu. ydsitons):
__________
Receiving Facility/Temporary Storage Representative:
Time of Shipment (circle one) am/pm
/
Facility/Temporary Storage Representative:
Trailer Registration (if any):
LOAD 6: Signature of Transporter Representative:
__
________
Date of Receipt:
_
_______________________________
Date of Shipment:
(circle one) nm/pm
Load Size (cu. yds./tons):
IReceiving
LOADS5 Signature of Transporter Representative:
__
/_
Trailer Registration (if any):
____________________________
Date of Shipment:
/__
Time of Receipt:
_
Date of Receipt:
_I__/
Time of Receipt:
_
Trailer Registration (if any):
___________________________
I(circle
ILoad
one) am/pm
Size (cu. yds./tons):
________
LOAD 7: Signature of Transporter Representative:
Receiving Facility/Temporary Storage Representative:
Date of Shipment:
Date of Receipt:
__
/
Time of Shipment (circle one) am/ pm
Truck/Tractor Registration:
U
I
/I
_/_
Time of Receipt:
/
Trailer Registration (if any):
(circle one) an/pm
Load Size (cui. yds./tons):
________
HiJ. LOG SHEET VOLUME INFORMATION:
Total Volume This Page (cu. yds./tons):
Total Carried Forward (cu. yds./tons):
Total Carried Forward and This Page (cu. yds.Itons):
10/1l/93
Thisform is printed on recycled paper
Page I of I
|I
I II 7Massachusetts Department of Environmental Protection
Bureau of Waste Site CleanupI
IIJ.
BILL OF LADIN~pursuant to 310 CMR 40.0030)
SUMMARY SHEET_____OF____
SUMMARY OF SHIPMENT:
DATE OF SHIPMENT:1
DATE OF RECEIPT:
SUMMARY SHEET OF SHIPPED:
BILL OF LADING TOTAL SHIPPED (only of different):
I
NUMBER OF LOADS Sil
eWSC-012C
Release Tracking Number
2- 14815
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
-
BWSC-012C
Release Tracking Number
-
BILL OF LADIN~pursuant to 310 CMR 40.0030)
SUMMARY SHEET
[J
41
L. ACKNOWLEDGEMENT OF RECEIPT OF REMEDIATION WASTE AT RECEIVING FACILITY OR
TEMPORARY STORAGE LOCATION:
Receiving Facility/Temporary
Location Representative (Print):
Aggregate Industries / Bill Rienihardt
Signature: ____________________________________
Title:
Date:
Environmental Manager
_____/
_____/
___
M. ACKNOWLEDGEMENT OF SHIPMENT AND RECEIPT OF REMEDIATION WASTE BY PERSON
CONDUCTING RESPONSE ACTIONS ASSOCIATED WITH THIS BILL OF LADING:
I certify under penalty of law that I personally examined and am familiar with the information contained inthis 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 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 willfully submitting false, inaccurate, or incomplete
information.
C.
VT~J
gipnnenire
Name of Person (print):
Ujy'hifomiprneonrccepaePae2f2
i 10/
Rc~c
3/93
evsed
2 2 c--
Date:
07
/ /2.-
/ O-
Jose Amparo
This form is printed on recycled paper
Page 2 of 2
EIIBIUEI1TRL
SERV1ICES
Client:
Date:
Project Manager:
Job #
Athol Medical Clinic
1467 Main St.
Athol, MA
7/2/04
Phil McBain
201-882-00-TS
Sample Information
Laboratory ID Number
2043138
Sample ID Number
Soil disposal
-
1
Analysis
Aggregate Parameters
-Massachusetts certification number: M-MA904
P.O. BOX 0119
+
1771 WASHINGTON STREET - STOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
/
Cyn Environmental Services Analytical Laboratory
Eli VIROmE'IIE iRL.
SERV ICE S
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043138
Sample ID: Sail disposal - 1
Sampled By: Sylvia Kirsch
Sample Matrix: Soil
Job Number:
Waste Code:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
201 -882-00-TS
NA
06/25/04
06/28 /0 4
07/01/04
07/02/04
Inorpanics
Method
EPA 1010
EPA 9095
EPA 9045
SWS46 7.2
SW846 7.2
Analyte
Flashpoint
Paint Filter
pH
Reactive Cyanide
Reactive Sulfide
Result
RL
>140
Pass
6.2
ND
ND
140
5
5
NA
S.U.
mg/Kg
mg/Kg
Result
RL
Units
ND
4,300
0,5
170
mg/Kg
Result
RL
Unrits
120
30
5
5
ND
810
ND
ND
3
7
3
2
3
15
1
3
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
0.3
0.3
mg/L
Orqjanics
Method
EPA 600/4-8-04 5
EPA 8100M
Analyte
Total PCBs
Total Petroleum
Hydrocarbons
mg/Kg
Metals
Method
Analyte
EDXRF
EDXRF
EDXRF
EDXRF
EDXRF
EDXRF
EDXRF
EDXRF
Total
Total
Total
Total
Total
Total
Total
Total
Lead
Chromium
Arsenic
Cadmium
Mercury
Barium
Selenium
Silver
TCLP/EDXRF
TCLP Lead
NA = Not Applicable
ND = Not Detected above Reporting Limit (RL).
Metals tested by energy dispersive x-ray fluorescence spectrometry.
Submitted By:
Approved By:
ministratoremplae\18a
C:\Winnt\Priles
P.O. BOX 0119'* 1771 WASHINGTON STREET - STOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 * 1-800-899-1038 - FAX 781-344-3318
2.-
Cyn Environmental Services Analytical Laboratory
Customer:
Location:
Lab Number:
Sample ID:
Sampled By:
Sample Matrix:
EDYVIBRO RfiE 11181l
SEA VICES
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
Athol Medical Clinic
Athol, MA
2043138
Soil disposal - 1
Sylvia Kirsch
Soil
201-882-00-TS
V28572.D
06/25/04
06/28/04
06/30/04
07/07/04
Orgianics
Date Extracted: 06/25/04
Dilution Factor:
Sample Preservation: Methanol
Container Condition: Satisfactory
% Moisture: 18.3%
Soil Weight (g): 15.2
Method
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
Result
Analyte
Acetone
Benzene
Bromobenzene
Bro mochloro me th ane
Bromodichloromethane
Bromoform
Bromomethane
2-Butanone (MEK)
n-Butylbenzene
sec-Butylbenzene
tert-Butylbenzene
Carbon tetrachloride
Carbon Disulfide
Chlorobenzene
Chloroethane
Chloroform
Chloromnethane
2-Chlorototuene
4-Chlorotoluene
1,2-Dibromo-3-chloropropane
Dibromochloromethane
1,2-Dibromoethane (EDB)
Dibromomethane
1,2-Dichlorobenzene
1,3-Dichlorobenzene
1 ,4-Dichlorobenzene
Dichiorodifluoromethane
1,1 -Dichloroethane
1,2-Dichloroethane
1,1-Dichloroethene
cis-1,2-Dichloroethene
trans-i,2-Dichloroethene
1,2-Dichloropropane
1,3-Dichloropropane
2,2-Dichloropropane
1,1-Dichloropropene
RL
U!nits
1400
300
300
300
300
300
600
1400
300
300
300
300
300
300
600
300
600
300
300
300
300
300
300
300
300
300
600
300
300
300
300
300
300
300
300
300
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ugKg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/K(g
ug/Kg
ug/Kg
ug/Kg
ug/K~g
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
3
P.O. BOX
0119 - 1771 WASHINGTON STREET - STOUGHTON,
MA
02072-0119
TELEPHONE 781-341 -5108 * 1-800-899-1038 * FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
Job Number:
Waste Code:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043138
Sample ID: Soil disposal - 1
Sampled By: Sylvia Kirsch
Sample Matrix: Soil
* ERV IREnTAL
201-882-00-TS
V28572.D
06/25/04
06/28/04
06/30/04
07/07/04
Organics
Date Extracted: 06/25/04
Dilution Factor: 1
Sample Preservation: Methanol
Container Condition: Satisfactory
% Moisture: 18.3%
Soil Weight (g): 15.2
Method
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 503518260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 503518260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA
EPA
EPA
EPA
50 35/8260
5035/8260
5035/8260
503 5/82 60
Result
Analyte
cis-1,3-Dichloropropene
trans-i,3-Dichioropropene
Ethylbenzene
Hex ach lorob uta dilen e
2-Hexanone
lsopropylbenzene
4-isopropyitoluene
Methyl tert-butyl ether (MTBE)
4-Methyl-2-pentanone (MIBK)
Methylene chloride
Naphthalene
n-Propylbenzene
Styrene
1,2,3-Trichloropropane
1,1,1,2-Tetrachloroethane
1,1,2,2-Tetrachloroethane
Tetrachioroethene (PCE)
Toluene
1,.2,3-Trichlorobenzene
1,2,4-Trichlorobenzene
1,1,1-Trichloroethane
1,1,2-Trichloroethane
Trichioroethene (TCE)
Trichlorofl uoromethane
1,2,4-Trimethylbenzene
1,3,5-Trimethylbenzene
Vinyl chloride
Total Xylenes
Surroaates
Dibromofl uoromethane
1,2-Dichloroethane-d4
Totuene-d8
4-B romnof luo robe nzene
Result
97%
96%
77%
91%
RL
its
300
300
300
300
1400
300
300
300
1400
300
300
300
300
300
300
300
300
300
300
300
300
300
300
600
300
300
600
600
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ugKg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
Recovery Limits
70-130
70-1 30
70-1 30
70-130
ND = Not Detected above Reporting Limit (RL).
Approved By:
Submitted By:
P.O. BOX 0119 - 1771 WASHINGTON STREET - STOUGHTON, MA
02072-0119
6
s.~I
TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
*
NVOSZVR
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siAuewdig PeleuIioItJDKIod
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CD
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11fl1 'loalas
a
02
(coLa) HdJ.
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X~L8
SINHAlOS 1VIHISflONI
(0
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9
_____________________
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SJeu!eIUoO SS2~ J2919 #
SJeu!e~Uo3 o!lSeId #
I-
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SIB!A bOA IW-OV #
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2
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N-
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(0
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0)
CD
Nt
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w
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(DC
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5
CY
EOYIIROOiEGIITALI
Fax Correspondence
iiFax
Number: 781-341-2440
SERBV ICE S
27 April 2005
Mr. Bill Reinhardt
Aggregate Industries, Inc.
1101 Turnpike Street
Stoughton, MA 02072
RE:
Soil DisposalLetter, Tracking Number 2-14815
Athrot Medical Clinic - Number 2 Fuel Oil Release
1467 Main Street, Athol, Massachusetts 01331
Dear Mr. Reinhardt:
Cyn Environmental Services (Cyn) has prepared this letter to confirm that the release,
which occurred at the above noted location consisted of Number 2 fuel oil. The source of
the Methylene Chloride, which was reported within the testing results is unknown but
may be a laboratory contaminant.
Should you have any questions relative to this submittal, please contact the undersigned
at your convenience.
Sincerely,
Cyn Environmental Services
Philip D. McBain, LSP
Senior Project Manager
P.O. BOX 0119 - 100 TOSCA DRIVE - STOUGHTON. MA 02072-0119 TELEPHONE 781-341-1777 - FAX 781-341-6246
1-800-242-5818 in MA - 1-800-622-6365 outside MA
01/07/2004 08:58 FAX
17213443318
WASHINGYON-STREET
' TSO
@j002/006I
EN IN
VI OE AIU I
SER VICE S
Client:
Athol Medical Clinic
1467 Main St.
Athol, MA
Date:
712104
Project Manager:
Job #
Phil Mc~aini
201-882-00-Ts
Sample Information
Laboratory ID Number
2043138
Sample ID Number
Soil disposal
-
1
Analysis
Aggregate Parameters
Massevchusetts certification number: M-MA904
P.O. BOX
0119 -1771
WASH(NGTON STREET'- STOUGHTON, MAC0272-OI1G
TELEPHONE 781-MI1-IC 5 + 1-60-991038.- FAX( 71-344-3316
/
07/01/2004 08:56 FAX
17813443318
WASTTN-STREET
+
T&D
@j003/0068
Cyn Environmental Services Analytical Laboratory
Customer:
Location:
Lab Number
Sample ID:
Sampled By:
Sample Matrix:
SES YIlC ES
Athol Medical Clinic
Athol, MA
.
2043138
Soil disposal -i1
Sylvia Kirsch
Soill
Job Number
Wante Code:
Sample Date:
Recuipt Date:
Anal3 sis Date:
Rerort Date:
201 -882.-0O-TS
NA
06/25/04
06/28/0 4
07/01/04
07/02/04
Inorpanics
Method
Analyte
EPA 1010
EPA 9095
EPA 9045
SWS46 7.2
SW846 7.2
Flashpoint
Paint Filter
pH
Reactive Cyanide
Reactive Sulfide
Result
RL
>140
14C
Pass
6.2
ND -
NA
5S
5
mg/Kg
mg/Kg
Result
RL
Units
ND
0.5
170
mg/Kg
ND
Oroanics
Method
Anlalye
EPA 600/4-8-045
EPA 810DM
Total PCBs
Total Petroleum
Hydrocarbons
4,300
mg/Kg
Metals
Method
EDXRF
EDXRF
EDXRF
EDXRF
Analyte
Result
RL
Units
Total Lead
Total Chromium
Total Arsenic
120
30
5S
5
ND
mg/Kg
610
3
7
-3
2
3
15
ND
ND
1
3
0.3
0.3
EDXRF
EDXRF
ED XR F
EDXRF
Total
Total
Total
Total
Total
TCLP/EDXRF
TCLP Lead
Cadmium
Mercu-y
Baium
Selenium
Siver
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/L
NA = Not Applicable
ND = Not Detected above Reporting Limit (RL).
Metals tested by energy dispersive x-ray fluorescence spectrometry.
Submitted By:
P.O Ois
BO
Approved By:
1 WA*N~N~ETS-JUGH1ON, MA 02072-0119 TELEPHONE 781-341-5101
* 1-E0-Hl9O-103O + FAX 781'344-3318
2-
01/01/2004 08:51 FAX
11813443318
gASHINGTON-STREET
+
TSD
@004/006
.Cyn Environmental Services Analytical Laboratory
A |
Customer
Location:
Lab Number;
Sample ID:
Sampled By:
Sample Matrix:
[NYI ROGWnl1 TR1L
E
[[ES
Athol Medical Clinic
Alhol, MA
2043138
Soil disposal - 1
Sylva Kirsch
Soil
Job Nu nbqr
Data Filie:
Sample Date:
Receipt Date:
AnalysiS Date:
Report Date:
201-882-00-TS
V28572.0
06/25/04
06/28/04
08/20/04
07/07/04
Oruanics
Container Condidon: Satisfactory
% Moisture: 1.3%
Soil Weight (g): 15.2
Method
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8280
EPA 5035/8260
EPA 6035/80
EPA 503518260
EPA 5035/8260
EPA 5035/8280
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5038/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8280
EPA 5035/8260
EPA 5035/6260
EPA 6035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/B260
EPA 5035/8280
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8280
EPA 5035/8260
P.O. BOX
0119 - 1771
Analyte
Acetone
Benzene
Rromnobenzene
Bromochioromethane
Brmonldclromethane
Bromoformn
Brmomethaene
2-flutanone (MEK)
n-Butylbenzene
sec- utylbenzene
lert-Butylbenzene
Carbon tebrdchoulde
Crbon Disulfide
Chlorobenzeneo.
Chlorceihane
Chlorofonnm
Chlornmethane
2-Ch lortolue ne
4-Chlorotoluene
1,2-Dlbromio-3-chtoroprgpane
Dibromodloqomethane
1,2-Dibromoethane (EDB)
Di brom-omnethane.
1,2-Dichlorabenzene
1.3-Dichlorobenzene
1.4-Dlchobenzene
Dichlorodlfluoromethane
1,1-Dichloroethane
I,2-Didloroethane
1,1-Dlchloroethene
cis-1,.2-Dichloroethene
lrans-1,2-Olchloroelhene
1.2-Dlchloropropane
1.3-ODilorpropane
2,2-aidlioropropane
1,1l-Diclropropene
WASHINGTON SThEET - STOUGHTON, MA 02072-v11g
Date Extacted: 00/25/04
Dllution Fiactor 1
Sample Presernation: Methanol
Result
RL
Units
.1400
300
300
300
300
300
600
1400 *
300
300
300
300
300
300
600
300
800
300
300
300
300 300
~300
300
300
300
600
300
300
300
300
300
300
300
300
200
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kgo
ug/Kg
ug/K~g
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug
ug/Kg
g
g
TELEPHONE 7O1-341-510i * 1-00-69-1038 - FAX 7B1-344-3318
.3
I
07/07/2004 08:57 FAX
17813443318
WASHINGTON--STREET
T&Dj005/008
16
Cyn Environmental Services Analytical Laboratory
cy ii
Customer. Athol Medical Clinic
Location! Ath, MA
Lab Number 2043138
Sample ID: Soil disposal - 1I
Sampled By: Sylvia Kirsch
Sample Matrix: Soili
EFIYIROOFI1ENTIII
SERVICES
Job Number:
Waste (:ode:
Sample Jate:
Receipt 2ate:
Analysi Jate:
Report isle:
201-802-00-TS
V28572.D
06/25/04
06/28/04
06/30/04
07/07/04
Organics
Container Condition: Satsfactory
% Moisture: 16.3%
Soil Weight (9J: 15.2
Method
Anaivte
EPA 5035/8260
EPA 5035/8260
EPA 5030/820
EPA 5035/8260
EPA 5035/8260
EPA 5035/6260
EPA 5035/6260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/680
EPA 5035/8260
EPA 503ti/8280
EPA 5035/80
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8260
EPA 5035/8280
EPA 5035/8260
EPA 5035/8260
EPA 5035u/80
EPA 5035/6260
EPA 5035/8280
EPA 5035/8260
EPA 5035/8260
1,2,3-Trdhlarobenzene
1.2,4-Tridilomobenzene
1,1,1-Trlihoroeihane
1,1,2-Trlihoroethane
Trlchloraethene (TCE)
Trdhlorofluoromethiane
1.2.4-Trirnethytbenzene
1.3,5-Timethylbenzone
Vinyl chloride
Total Xylenes
EPA
EPA
EPA
EPA
Surroates
Dibrvnmofluvrgnmelhane
1,.2-Dichloroethane44
Toluene46B
4-B rom~oluorobenzene
5035/620
50350/8260
5035/8260
5035/8260
Date Exin
c: 06/25/04
Dilution Fictor: 1
Sample Preservation: Methanol
Result
Un!;it~s
-
cis-1.3a-Dichloropropene
trns-1,.3-Didchloropropene
Ethylbenzene
Hexadcroutadiene
2-Hanone
lsopropytbenlzeneC
4-tsopropylleluwee
Methy4 tart-butyl ether (MTBE)
4-Meihyl-2-penlanonie (MIBK)
Methlylene chloride
Naphthalene
ni-Propylbenzene
Styrene
1,2,3-Trdhlormpropanie
1,1,.1,2-Telrachloroethane
1.1.,2-Tetrlroethano.
Tetrachlcoothens (PCE) -
300
300
300
300
1400
300
300
300
1400
300
300
300
300
300
300
300
300
300
300
300
300
300
300
600
300
300
600
800
Toluene
ug/Kg
ug/Kg
ug/Kcg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/Kg
ug/K<g
ug/Kg
ug/Kg~
ug/Kg
ug/Kg
ug/Kg
1g/Kg
ug/Kgg
ug/Kg
ug/Kg
ug/Kg
ugMg
ug/K~g
Rewcvry Umnils
70-130
70-130
70-130
70-130
Resut
97%
96%
77%
91%
ND = Not Detected above Reporting LUmit (RL).
Submittted By:
P.O.
BOX 0tis9+1771
2D/
WASHINGTONI STREET e STOUGHTON, MA 02072-0119
Approved
By:
TELEPHONE 781-341-510)
*
1-800-h9-1O38 - FAX 781-344-3316
V
01/07/2004 08:57 FAX
17813443312
!WASHINGTON-STREET
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APPENDIX G
July 2004 LaboratoryReport
Soil Testing Services
CYN Environmental Services
Eyi VIi iEiTA
SES V1CES
Client:
Athol Medical Clinic
1467 Main St.
Athol, MA
Date:
7/28/04
Project Manager:
Job#
Phil McBain
20276600SP
Sample Information
Laboratory ID Number
Sample ID Number
Analysis
2043524
2043525
2043526
2043527
2043528
2043529
Comp 1
Comp 2
Comp 3
Comp 4
Field Blank
Trip Blank
EPH/ VP H
EPH/VPH
EPH/VPH
EPH/VPH
VPH
VP H
Massachusetts certification number: M-MA904
P.O. BOX 0119 - 1771 WASHINGTON STREET - STOUGH-TON, MA 02072.-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
/
Analytical Report Certification and Narrative Form
E IN IRi DiiE IllT 1
SEA VICES
Date:
July 28, 2004
Client:
Athol Medical Clinic
1467 Main St.
Athol, MA
Job Number:
20276600SF
Project Manager:
Phil Mcflain
Laboratory Project No's.:
2043524-2043529
8260B ( )
MCP SW-846 Methods
VPH (X)
EPH (X)
8082 ( )
Other:
Were all samples received by laboratory in a condition consistent with that described
on the Chain-of Custody documentation for the data set?
YsXN
Yesl No nwrO
utb adesdblw
Were all QA/QC procedures required for the specified analytical method(s) included
in this report followed, including the requirement to note and discuss in a narrative
QC data that did not meet appropriate performance standards or guidelines?
Ys
o
YeslX No nwrO
oasesms
(l
utb adesdblw
eadesdblw
Does the analytical data included in this report meet all the requirements for
"Presumptive Certainty", as described ini section 2.0 of the MADEP document CAM
VII A, "Quality Assurance and Quality Control Guidelines for the Acquisition and
Reporting of Analytical Data"?
Yes X No O
(All No answers must be addressed below)
Was the VPH or EPH method nmn without significant modifications, as specified in
Section 11.3?
Yes C No X
(All No answers must be addressed below)
Were all QA/QC performance standards and recommendations for the specified
method(s) achieved?
Yes X No O
(All No answers must be addressed below)
Were results for all analyte-list compounds/elements for the specified method(s)
reported?
Yes C No X
(All No answers must be addressed below)
VPH!Analysis:
The VPH analysis perform ed on this sample delivety group, andpresented in this report wsas modified to include the use of a Mass
Spectrometerfor the identification and quantitationof the MPH targets as welt as the ranges. All the calibrationand quality control
aspects of the Mass DEP'MPH method were satisfied. The approachfollowed is consistent with the DEP'APH method. The aliphatic
manges were quantitated using the total ion chromatogram response within the chromatogrmphic windows defined by the Mass DEP'VPH
method. The aromatic range 1was quantitatedusing the sum of mass ions 91, 105, 120 and 1 34, within the chromatogmophic window,
defined by the Mass DEP VPH method. The aromatic range calibrmtion was performed using the sum of the responsesfor the above
mentioned ions for isopropylbenzene, n-propylbenzene, L.3.5-trimethylbenzene, tert-butylbenzene, 1,2,4-trimethylbenzene, secbutylbenzene, p-isopropyltoluene, and n-b utylbenzene.
EPH!Analysis:
The percent dgerence for naphthatene in the closing CC was 23%
low. This is outside the 20% criteriafor the method.
No modi4fication was made to the RPM method.
Analytes reportedper attachedchain of custody.
I, the undersigned,attest under the pains and penalties ofperjury that, based upon my personalinquiry of those responsiblefor
obtaining the information, the
'to
'ned in this analytical reportis, to the best of my knowledge and belief, accurateand
cmee.
Signature:
->Date:
Woratory
Ire
or
Dave Dickinson
P.O. BOX 0119- 1771 WASHINGTON STREET - STOUGHTON, MA 02072-0119
TELEPHONE 781-341-5108 - 1-80(-899-1038 - FAX 781-344-3318
2-
Cyn Environmental Services Analytical Laboratory
Customer: 1467 Main St.
Location: Athol, MA
Lab Number: 2043524
Sample ID: Camp 1I
Sampled By: Chris McKenna
Sample Matrix: Sail
EGiI ROG IlEGITA .
SERVI[ES
Job Number: 20276600SP
Batch ID: ES0413
Sample Date: 07/22/04
Receipt Date: 07/22/04
Analysis Date: 07/27/04
Report Date: 07/28/04
ExtraCtable Petroleum Hvdrocarbons by MADEP EPH 04-1
Sample Temperature: Received @ 4'C0
Container Condition: Satisfactory
Percent Moisture: 13.1
Frac. Column Lot #: 01 24603
Method
Analyte
GO/F ID
GC/F ID
C9-C18 Aliphatics
019-C36 Aliphatics
C11-C22 Aromatics
C11-C22 Aromatics*t
2-Methylnaphthalene
Acenaphthene
Naphthalene
Phenanthrene
GC/F ID
GO/F ID
GC/MS
GC/MS
GC/MS
GC/MS
Method
Surrogate
GC/F ID
2-Bromonaphthalene
2-Fluorobiphenyl
Chl orooctadeca ne
Orthoterphenyl
GC/FID
GO/FID
GC/F ID
Date Extracted: 07/22/04
AROC ALl
Dilution Factor:
1
1
Extraction Method: EPA 3546
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
23
23
23
23
0.2
0.2
0.2
0.2
mg/Kg
Result
AR
_Units
93
115
93
121
40- 140
40- 140
40-1 40
40-1 40
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments: *Unadjusted, Concentrations based on dry weight.
Submitted By:
P8 '3iflf'R
rsC--t
Approved By:
IS~
RNIN
Wti'lIid
&i
ON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-103
+
FAX 781 -344-3318
S
Cyn Environmental Services Analytical Laboratory
cy0
*
RTRL
IInYA
E
!~v~
Customer: Athol Medical Clinic
Location: Athol, M~A
Lab Number: 2043524
Sample ID: Comp i
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28656.D
0 7/22/04
07/22/04
07/26/04
07/27/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
Received @ 4* C
Satisfactory
13.1%
18.3
Analvte
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MAD EP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
Method
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics*
C9-C12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogate
MADEP-VPH-04-1 .1
2,5-Dibromotoluene
Date Extracted: 07/22/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
2.4
2.4
2.4
2.4
2.4
0.24
0.24
0.09
0.24
0.47
0.47
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
122
70-1 30
%/
ND
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
Submitted By:
A~
C:\VPH-fcomnputer\Fina Data\3524-3529VPH.xis
Approved By:
(2,4km
P.O. BOX 0119 - 1771 WASHINGTON STREET - STOUGHTON, MA 02072-0119 TELEPHONE 781 - ~4I-5I08
A
*
1-800-899-1038- FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
SEY RD
Customer:
Locatidn:
Lab Number:
Sample ID:
Sampled By:
Sample Matrix:
D10EDIRL
1467 Main St.
Athol, MA
2043525
Camp 2
Chris McKenna
Soil
Job Number: 20276600SP
Batch ID: ESO413
Sample Date: 07/22/04
Receipt Date: 07/22/04
Analysis Date: 07/27/04
Report Date: 07/28/04
Extractable Petroleum Hydrocarbons by MADEP EPH 04-1
Sample Temperature: Received @ 4C
Container Condition: Satisfactory
Percent Moisture: 20.7
Frac. Column Lot #: 0124603
Method
Analyte
GC/FID
C9-C18 Aliphatics
C19-C36 Aliphatics
C11-C22 Aromatics
C11-C22 Aromatics*
2-Methyl naphthalene
Acenaphthene
Naphthalene
Phenanth rene
GC/F ID
GC/F ID
GC/FID
GC/MS
GC/MS
GC/MS
GO/MS
Surrogate
Method
GC/F ID
GC/FID
2-Bromonaphthalene
2-Fl uorobiphenyl
Chlorooctadecane
Orthoterphenyl
GC/FID
GC/FID
Date Extracted: 07/22/04
ARO
ALl
Dilution Factor:
1
1
Extraction Method: EPA 3546
Result
RL
Units
170
25
mg/Kg
96
39
39
ND
ND
ND
ND
25
25
25
0.3
0.3
0.3
0.3
mg/Kg
mg/Kg
mg/Kg
Result
AR
85
98
70
96
40- 140
40- 140
40-1 40
40-1 40
mg/Kg
mg/Kg
mg/Kg
mg/Kg
_Units
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments: *Unadjusted, Concentrations based on dry weight.
Submitted By:
zi
t
Approved By:
/ pW
P.OBOX0119fY
11
A
YHIGTON STET + STOGHTON, MA 02072-0119
TELEPHONE 781-341-5108 - 1-800-899-1038+*FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
EllYVI ROifEGIARL
SE[R VIt ES
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043525
Sample ID: Comp 2
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V286 57. D
07/22/04
07/22/04
07/26/04
07/27/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
Received @ 4* C
Satisfactory
20.7%
23.2
Analyte
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
Method
C5-C8 Aliphatics
C9-C12 Aliphatics
09-Ci0 Aromatics
C5-C8 Aliphatics*
CS-Cl12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogate
MADEP-VPH-04-1 .1
2,5-Dibromotoluene
Date Extracted: 07/22/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Ujnits
ND
ND
ND
ND
ND
ND
ND
2.0
2.0
2.0
2.0
2.0
ND
0.20
0.20
0.08
0.20
0.41
0.41
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
121
70-130
ND
ND
ND
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* = Unadjusted
Submitted By:
t~
&
Approved By:
C:\vPH\fComputer\FinaI Data\3524-3529vPH.xIs
P.O. BOX 0119 - 1771 WASHINGTON STREET - STOUGHTON. MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
Cyn Environmentai Services Analytical Laboratory
Customer: 1467 Main St.
Location: Athol, MA
Lab Number: 2043526
Sample ID: Comp 3
Sampled By: Chris McKenna
Sample Matrix: Soil
[HE VIODE DIA
Job Number: 20276600SF
Batch ID: ES0413
Sample Date: 07/22/04
Receipt Date: 07/22/04
Analysis Date: 07/27/04
Report Date: 07/2 8/0 4
Extractable Petroleum Hydrocarbons by MADEP EPH 04-1
Sample Temperature: Received @ 4*C
Container Condition: Satisfactory
Percent Moisture: 14.9
Frac. Column Lot #: 0124603
Date Extracted: 07/22/04
ARO
ALl
Dilution Factor:
1
1
Extraction Method: EPA 3546
Method
Result
GC/FID
GO/FID
GC/FID
GC/FID
GC/MS
GC/MS
GC/MS
GC/MS
Method
GC/FID
GC/FID
GC/FID
GC/F ID
Analyte
C9-C18 Aliphatics
C19-C36 Aliphatics
C11-C22 Aromatics
C1 1-C22 Aromnatics*
2-Methylnaphthalene
Acenaphthene
Na phthalene
Phenanthrene
Surrogate
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
R
RL4
Units
990
360
360
360
ND
ND
ND
ND
24
24
24
02
0.2
0.2
0.2
mg/Kg
Result
AR
104
106
63
78
40-140
40-1 40
40-1 40
40-140
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Units
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments: *Unadjusted, Concentrations based on dry weight.
Submitted By:
Pu BX019*171WAHNGT!ITEE-rSTU
Approved By:
TON, MA 02072-0119 TELEPHONE 781-341 -5108 - 1-800-899-1038 - FAX 781 -344-3318
7
Cyn Environmental Services Analytical Laboratory
Customer:
Location:
Lab Number:
Sample ID:
Sampled By:
Sample Matrix:
SESRYIC ES
Athol Medical Clinic
Athol, MA
2043526
Camp 3
Chris McKenna
Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28658.D
07/22/04
07/22/04
07/26/04
07/27/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Received @ 40 C
Satisfactory
14.9%
20.8
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
Method
MADEP-VPH-04-1 .1
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics*
09-Cl12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogate
2,5-Dibromotoluene
Date Extracted: 07/22/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Units
ND
20
2.3
ND
22
ND
ND
ND
ND
ND
ND
2.1
2.1
2.1
2.1
2.1
0.21
0.21
0.08
0.21
0.42
0.42
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
102
70- 130
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
Submitted By: ~
C:\vPH\fComputer\inal Data\3524-3529vPH.xls
Approved By:
P.O. BOX 0119 - 1771 WASHINGTON STREET - STOUIGHTON, MA 02072-0119 TELEPHONE 781-341-5108
I-800-899-1038
1
- FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
IEDAf~GR
SEYIE
Customer:
Location:
Lab Number:
Sample ID:
1467 Main St.
Athol, MA
2043527
Comp 4
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number: 20276600SP
Batch ID: ES0413
Sample Date: 07/22/04
Receipt Date: 07/22/04
Analysis Date: 07/27/04
Report Date: 07/28/04
ExtraCtable Petroleum Hydrocarbons by MADEP EPH 04-1
Sample Temperature: Received @ 4C
Container Condition: Satisfactory
Percent Moisture: 22.0
Frac. Column Lot #: 0124603
Date Extracted: 07/2 2/04
ARO
ALl
Dilution Factor:
1
1
Extraction Method: EPA 3546
Method
Result
RL
Units
440
160
180
180
ND
ND
ND
0.9
26
26
26
26
0.3
0.3
0.3
0.3
mg/Kg
Result
AR
Units
90
40-140
40- 140
40- 140
40- 140
GC/FID
GC/FID
GC/FID
GC/FID
GC/MS
GC/MS
GC/MS
GC/MS
Analyte
C9-C18 Aliphatics
C19-C36 Aliphatics
C11 -C22 Aromatics
C11-C22 Aromatics*
2-Methylna phthalene
Acenaphthene
Naphthalene
Phenanthrene
Method
GC/FID
GC/FID
GC/FID
GC/FID
Surrogate
2-Bromonaphthalene
2-Fl uorobiphenyl
Chlo rooctadecane
Orthoterphenyl
99
53
73
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments: *Unadjusted, Concentrations based on dry weight.
Submitted By:
zZ~21~,
-
Approved By:
C:\Winnt\ProfesAdministaorTemplate\324.3527EPH
P.O. BOX 0119 + 1771 WASHINGTON STREET + STOUGHTON, MA 02072-0119 TELEPHONE 781-341-.5108 * 1-800-899-1038
+
FAX 781-344-3318
7%
Cyn Environmental Services Analytical Laboratory
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043527
Sample ID: Comp 4
Sampled By: Chris McKenna
Sample Matrix: Soil
SERYICE S
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28659.D
07/22/04
07/22/04
07127104
07/27/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Received
@ 4"
C
Satisfactory
22.0%
19.2
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
Method
MADEP-VPH-04-1 .1
05-CS Aliphatics
C9-C12 Aliphatics
09-C 10 Aromatics
C5-CS Aliphatics*
C9-C12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogate
2,5-Dibromotoluene
Date Extracted: 07/22/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Units
ND
4.2
ND
ND
4.2
ND
ND
ND
ND
ND
ND
2.5
2.5
2.5
2.5
2.5
0.25
0.25
0.10
0.25
0.50
0.50
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
112
70-130
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
Submitted By:
A~~
4~
C:\vPH-\Computer\Final Data\3524-3529vPH xis
Approved By:
P.O. BOX 0119 - 1771 WAsHINGTON STREET - sTOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038
- FAX 781-344-3318
/0
Cyn Environmental Services Analytical Laboratory
SEABV
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043528
Sample ID: Field Blank
Sampled By: Chris McKenna
Sample Matrix: Soil
I C~Ff_
ES
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28654.D
07/22/04
07/22/04
07126/04
07/27/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH--04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Received @ 4" C
Satisfactory
0.0%
15.0
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
Method
MADEP-VPH-04-1 .1
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics*
C9--C1 2 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogate
2,5-Dibromotoluene
Date Extracted: 07/22/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
2.5
2.5
2.5
2.5
2.5
0.25
0.25
0.10
0.25
0.50
0.50
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
122
70-1 30
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
Submitted By:__
Approved By:
C:\vPH4computer\Final Data\352435S29vPHxls
P.O. BOX 0119 - 1771 WASHINGTON STREET * STOUJGHTON, MA 02072-0119 TELEPHONE 781- 341-5108
e
1-800-899-1038 - FAX 781-344-3318
/
Cyn Environmental Services Analytical Laboratory
EIlYI ROOUEI1RLR .
SE[RVICES$
Customer:
Location:
Lab Number:
Sample ID:
Sampled By:
Sample Matrix:
Athol Medical Clinic
Athol, MA
2043529
Trip Blank
Chris McKenna
Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28655.D
07/22/04
07/22/04
07/26/04
07/27/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04--1.1
MADEP-VPH-04-1 .1
Method
MADEP-VPH-04-1 .1
Received @ 4* C
Satisfactory
0.0%
15.0
Analyte
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aiiphatics*
C9-C12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylente (total)
Surrogate
2,5-Dibromotoluene
Date Extracted: 07/22/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
_Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
2.5
2.5
2.5
2.5
2.5
0.25
0.25
0.10
0.25
0.50
0.50
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
117
70- 130
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
*
= Unadjusted
Submitted By:
A ~Z -
Approved By:
Vt
C:\vPH\Computer\Final Data\3524-3529vPH.xIs
P.O. BOX 0119 - 1771 WASHINGTON STREET.- STOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108
*
1-800-899-1038 - FAX 781-344-3318
/2-
Cyn Environmental Services Analytical Laboratory
EDYVINRO IIl EO1ARL
SERVICES
Quality Control Report
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil Method Blank
Lab Number: ESO41 3BLK
Batch ID: ESO413
Extract Date: 07/12/04
Method
Analyte
GC/F ID
GO/F ID
GC/FiD
GC/MS
GO/MS
GO/MS
GC/MS
C9-C18 Aliphatics
019-036 Aliphatics
011-C22 Aromatics
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Anthracene
Benzo(a)anthracene
Benzo(a)pyrene
Benzo(b)fl uora nthene
Benzo(g,h,i)perylene
Be nzo(k)fluoranthene
Chrysene
Dibenz(a h)anth racene
Fluoranthene
Fluorene
Indeno(1 ,2,3-cd)pyrene
Naphthalene
Phena nthrene
Pyrene
GO/MS
GO/MS
GC/MS
GO/MS
GO/MS
GO/MS
GO/MS
GO/MS
GC/MS
GO/MS
GO/MS
GC/MS
GO/MS
Method
Surrogate
GC/FID
2-B romonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GO/F ID
GO/F ID
GO/F ID
Extraction Method: EPA 3546
Frac. Column Lot #: 0124603
Percent Moisture: 0.0%
Extraction Weight: 10 gins
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
20
20
20
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
69
81
52
69
40-140
40-140
40-140
40-1 40
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
RL = Reporting Limit
AR = Acceptance Range
ND = Not Detected
Submitted By
:_
PEN~f$*9m~gg~tV9rS
__
NY
Approved By:
Th4 r 8GHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
'-3
Cyn Environmentai Services Analytical Laboratory
Quality Control Report
EDYVI RO Ai HIEf ITA 1.
ERVuIrC
U L II I
I I, L U
-EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample BD:
Soil Range LCS
Lab Number: ESO413LCS
Batch ID: ESO413
Extract Date: 07/12/04
Method
Extraction Method: EPA 3546
Frac. Column Lot #: 0124603
Percent Moisture: 0.0%
Extraction Weight: 10 gins
AnaMe
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GC/FIDB
GC/FIDB
GC/FIDB
GC/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GO/FID
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GC/FIDB
Naphthalene
2-Methy~lnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fiuoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
tndeno(1,2,3-od)pyrene
Dibenz(a, h)anthracene
Benzo(ghiperylene
Non ane
Decane
Dodecane
Tetradecane
Hexadecane
Octadecane
Nonadecane
Eicosane
Docsane
Tetracosane
Hexacosane
Octacosane
Tricontane
Hexatriacontane
Method
Surrogate
GO/FIDB
GO/FIDB
GC/FIDB
GC/FIDB
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorcoctadecane
Orthoterphenyl
IResult
AR
42
44
49
50
48
52
46
54
54
53
56
53
55
52
45
45
44
46
42
46
51
55
66
55
58
60
59
59
56
55
43
40-140
40-140
40-14 0
40-140
40-14 0
40-140
40-140
40-140
40-140
40-140
40-140
40-1 40
40-1 40
40-1 40
40-140
40-140
40-14 0
40-140
40-140
40-140
40-1 40
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
Result
AR
65
77
51
61
40-140
40-140
40-140
40-140
Unijts
%Naphthatene Breakthrough = <1.0%
%42-Methytnaphthalene Breakthrough = 1.0%
AR = Acceptance Range
Submitted By:
P.O
:t 4
ao~i*177
~
WAT~
H
C --
Approved By:
*
de
STOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
cyn
EFOV IBRO Sll 11T111l
Quality Control Report
SERVYICE S
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID:
Lab Number:
Batch ID:
Extract Date:
Method
GO/MS
GO/MS
GC/Ms
GC/MS
GO/Ms
GC/MS
GC/MS
GO/MS
GC/MS
GO/MS
GC/MS
GO/MS
GO/MS
GO/MS
GC/MS
GO/MS
GO/MS
Method
GO/MS
GC/MS
GC/MS
AR
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Weight:
Soil PAH LCS
ESO41 3LCS
ES0413
07112/04
Analyte
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
B enzo (a)a nthra cene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
lndeno(1 ,2,3-cd)pyrene
Dibenz(ah)anthracene
Benzo(ghi)perylene
Surrogate
2-Bromonaphthialene
2-Fluorobiphenyl
Orthoterphenyl
Resujt
AR
53
54
57
59
59
57
57
58
60
58
56
48
53
49
50
50
50
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
Result
AR
60
82
62
40-140
40-1 40
40-1 40
EPA 3546
0124603
0.0%
10 gins
Units
Units
= Acceptance Range
Submitted By:
P.O BOX 0-9 171 WAHNGTN STREE
Approved By:
SOUGH-TON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-99-103
*AX
781-344-3318
/5
It
Cyn Environmental Services Analytical Laboratory
ED INRIiOilE IA
TL
Quality Control Report
SEAYIl[ES
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil LCSD
Lab Number: ES041 3LCSD
Batch ID: ES0413
Extract Date: 07/12/04
Method
GC/FID
GC/F ID
GC/FID
GC/MS
GC/MS
GC/MS
GO/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GO/MS
GO/MS
GO/MS
GO/MS
GO/MS
GC/MS
GO/MS
GC/MS
Extraction Method: EPA 3546
Frac. Column Lot #: 0124603
Percent Moisture: 0.0%
Extraction Weight: 10 gins
Result
Analyte
09-Ci8 Aliphatics
019-036 Aliphatics
011-022 Aromatics
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
Indeno(1 ,2,3-cd)pyrene
Dibenz~a,h)anthracene
Benzo(g,h,i)perylene
AR
Unit~s
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
% Naphthalene Breakthrough = 2.8%
% 2-Methylnaphthalene Breakthrough = 2.2%
AR = Acceptance Range
Submitted By:
P.S
/&2dAl?
... .~~E2
t-t
RO
§?
..
Approved By:
3
if)ff-1
S9SUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
'6
Cyn Environmental Services Analytical Laboratory
EIlYIBOOmHE oIilL
SEAVICES
Quality Control Report
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Fractionation Check Sample
Fractionation Date: 07/13/04
Method
GCIFID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FlD
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GCIFID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
Method
GC/FID
GC/FID
GC/FID
GC/FID
Analyte
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthiracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b )fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
lndeno(1 ,2,3-cd)pyrene
Di benz( a,h)anthracene
Benzo(g,h,i)perylenie
Nonane
Decane
Dodecane
Tetradecane
Hexadecane
Octadecane
Nonadecane
Eicosane
Docosane
Tetracosane
Hexacosane
Octacosane
Tricontane
Hexatriacontane
Surrogate
2-Bro monap hthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
Lot Number: 0124603
Result
AIR
73
76
82
83
78
83
76
65
85
85
88
87
85
87
83
76
78
78
81
82
87
88
106
89
96
94
93
93
91
87
67
40- 140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40- 140
40-140
40-140
40-140
40-140
40-140
40-14 0
40-140
40-140
40-140
40-140
40-140
40-140
40- 140
40- 140
40- 140
40- 140
40-140
40-140
40-140
40-140
Result
AR
53
82
80
88
40-140
40-140
40-140
40-140
Units
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
Unt
%
%/
AR = Acceptance Range
Submitted By:
Pd a
Z- CC-t.t . 3
0119 171 WsHINTO
TREE
*TOUGHTON.
Approved By:
MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 * FAX 781-344-3318
/7
N
Cyn Environmental Services Analytical Laboratory
Quality Control Report
SERVICES
VOLATILE PETROLEUM HYDROCARBONS (VPH)
Sample ID: Soil Method Blank
Lab Number: VPHBLKSO72604
Associated Data Files: V28648-V28663
Data File: V28653.D
Analysis Date: 7/2 6/04
Method
Analyte
MADEP-VPH-04-1. A
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MAD EP-VPH-04-1 .1
MADEP-VPH..04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH4)4-1 .1
MADEP-VPH-04-l1.1
Method
C5-08 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-08 Aliphatics*t
09-Cl12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogiate
MADEP-VPH-04-1 .1
2,5-Dibromotoluene
Extract Date:
Sample Preservation:
Percent Moisture:
Extraction Weight(g):
Dilution Factor:
Result
7/26/04
Methanol
0.0%
15.0
1
IRL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
2.5
2.5
2.5
2.5
2.5
0.25
0.25
0.10
0.25
0.25
0.50
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
_Units
113
70-1 30
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
Submitted By:
c:\VPH\Computer\Final
Approved By:
Data\QCVPHO72604.xIs
P.O. BOX 0119 - 1771 WASHINGTON STREET * STOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038
+
FAX 781-344-3318
I
Cyn Environmental Services Analyticai Laboratory
IIE
VICO1E
Quality Control Report
.
VOLATILE PETROLEUM HYDROCARBONS (VPH)
Sample ID: Soil LCS/LCSDUP
Lab Number: VPHLC072604
Associated Data Files: V28648-V28663
Data File: V28651 .DN28652.DO
Analysis Date: 7/26/04
Method
MADEP-VPH-04-l1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MAD EP-VPH-04-1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
Ana lyte
n-Pentane
2-Methylpentane
Methyl t-butyl ether
2,2,4-Trimethylpentane
Benzene
Toluene
Ethylbenzene
m,p-Xylene
o-Xylene
n-Decane
n-Butylcyclohexane
1,2,4-Trimethylbenzene
Naphthalene
Extract Date:
Sample Preservation:
Percent Moisture
Extraction Weight(g):
Dilution Factor:
Recovery
LOS
LCSDUP
111
86
80
93
88
82
92
95
98
94
95
103
85
RPD
115
90
85
100
91
79
91
93
96
99
104
103
87
7/26/04
Methanol
0.0
15.0
1
AR
Units
70-1 30
70-1 30
70-130
70-1 30
70-130
70-130
70-1 30
70-130
70- 130
70-130
70-1 30
70-1 30
70-130
LOS = Laboratory Control Sample
LCSDUP = Laboratory Control Sample Duplicate
RPD = Relative Percent Difference
AR = Acceptance Range
Submitted By:
c:WPH-fcomputr\Final Data\QcVPH072604.xIs
Approved By:
62~ 244
P.O. BOX 0119 - 1771 WAsHrNGTON STREET - STOUGHTON. MA 02072-0119 TELEPHONE 781-341-5108 * 1-800-899-1038 FAX 781-344-3318
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APPENDIX HI
August 2004 LaboratoryReport
Soil and Groundwater Testing Services
CYN Environmental Services
Eli VIADlO
Im
Eli TR I.
SERVICES
Client:
Athol Medical Clinic
1469 Main St.
Athol, MA
Date:
8/19/04
Project Manager:
Job#
Phil McBain
20276600SP
Sample Information
Laboratory ID Number
Sample ID Number
Analysis
2043835
2043836
2043837
2043838
2043839
2043840
SS 1
SS2
Comp 5
WS 1
Trip Blank
Field Blank
EPH/VPH
EPH/VPH
EPH/VPH
EPH/ VP H
VPH
VPH
~
Massachusetts certification number: M-MA904
P.O. BOX O119 - 1771 WASHINGTON STREET - STOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
Analytical Report Certification and Narrative Form
EflVIROflmEi1Ll
SERVICES
Date:
August 19, 2004
Client:
Athol Medical Clinic
1469 Main St.
Athol, MA
Job Number:
20276600SP
Project Manager:
Phil Mc~ain
Laboratory Project No's.:
2043835-2043840
8260B
MCP SW-846 Methods
( )
EPH (X)
VPH (X)
8082
()
Other:
Were all samples received by laboratory in a condition consistent with that described
on the Chain-of Custody documentation for the data set?
Yes X No C
(All No answers must be addressed below)
Were all QA/QC procedures required for the specified analytical method(s) included
in this report followed, including the requirement to note and discuss in a narrative
QC data that did not meet appropriate performance standards or guidelines?
YsXN
Yell Notsesmstb]drssdblw
eadesdblw
(l
oasesms
Does the analytical data included in this report meet all the requirements for
"Presumptive Certainty", as described in section 2.0 of the MADEP document CAM
Vll A, "Quality Assurance and Quality Control Guidelines for the Acquisition and
Reporting of Analytical Data"?
Yes X No O
(All No answers must be addressed below)
Was the VPH or EPH method run without significant modifications, as specified in
Section 11.3?
Yes C No X
(All No answers must be addressed below)
Were all QA/QC performance standards and recommendations for the specified
method(s) achieved?
Yes C No X
(All No answers must be addressed below)
Wee reuts for all analyte-list compounds/elements for the specified method(s)
Yesl No swr
utbIddesdblw
VPH'l Analysis:
The V'PH analysispeifonned on this sample delively group, andpresented in this report, was mnodgied to include the use of a Mass
Spectrometerfor the identification and quantitationof the PH'targets as well as the ranges.All the calibrationand quality control
aspects of the Mass DEP VPH method were satisfied. The approachfollowed is consistent with the DEP'APH!method. The aliphatic
ranges were quantitated using the total ion chromatogram response within the chromatographicwindows defined by the Mass DEP VPH
method. The aromatic range was quantitatedusing the sum of mass ions 91, l05, 120 and 134, within the chromnatographic window,
defined by the Mass DEP VPH method. The aromatic range calibmation was performed using the sum of the responsesfor the above
mentioned ionsfor isopmopylbenzene, n-propylbenzene, 1.3.5-trimethylbenzene, tert-butylbenzene, 1,.2,4-trimethylbenzene, secbutylbenzene, p-isopropyltoluene,and n-butylbenzene.
EPHlAnalysis:
The closing calibrationstandardiforthe GC/MS runfor samples "SS-2" and "Comp 5" had two compounds outside the 20% acceptance
criteria. 2-methylnaphthalenehad a recovery of 24% high and acenaphihene was 21% high.
No mod
(imction was made to the ERR method.
Analytas reportedper attachedchain of custody.
I, the undersigned,attest under thepains andpenalties ofperjury that, bused upon my personalinquiry of those responsiblefor
obtaining the information, the mt'lc
andin this analytical reportis, to the best of my knowledge and belief; accurateand
cmet.
Signature:
j
*k
.. ~
4
Date:/
Dave Dickinson
P.O. BOX 0119 - 1771 WASHINGTON STREET e STOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 * 1-800-899-1038 e FAX 781 -344-3318
Cyn Environmental Services Analytical Laboratory
Eli
VIA 0DITERlI.L
SEA YIicES
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043835
Sample ID: SS1
Sampled By: Chris McKenna
Sample Matrix: Sail
Job Number: 20276600SP
Batch ID: ES0415
Sample Date: 08/09/04
Receipt Date: 08/09/04
Analysis Date:. 08/18/04
Report Date: 08/19/04
Extractable Petroleum Hvdrocarbons by MADEP EPH 04-1
Sample Temperature: Received @ 4*C0
Container Condition: Satisfactory
Percent Moisture: 69.2
Frac. Column Lot #: 0114004
Date Extracted: 08/16/04
ALl
ARO
Dilution Factor:
1
1
Extraction Method: EPA 3546
Method
Result
GC/FID
GC/FID
GC/FID
GC/FID
GC/MS
GC/MS
GC/MS
GC/MS
Method
Analvte
C9-Cl18 Aliphatics
C19-C36 Aliphatics
C11-C22 Aromatics
C11-C22 Aromatics*
2-Methylnaphthalene
Acenaphthene
Naphthalene
Phenanth rene
Surroqate
GC/FID
GC/'FID
GC/FID
GC/FID
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
ND
ND
ND
ND
ND
ND
ND
ND
Units
65
65
65
65
0.6
0.6
0.6
0.6
mg/Kg
mg/Kg
Result
AR
_Units
72
97
42
69
40-1 40
40-1 40
40-140
40-1 40
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments: *Unadjusted, Concentrations based on dry weight.
Submitted By:
7Z S O A
-
Approved By:-
/ p;
MA 02072-0119
TELEPHONE 781-341-5108 e 1-800-899-1038 - FAX 781-344-3318
3
Cyn Environmental Services Analytical Laboratory
SEVIC ERT8L
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043835
Sample ID: SS1
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28771 .0
08/09/04
08/09/04
08/11/04
08/16/04
volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Received @ 4* C
Satisfactory
69.2%
18.1
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
Method
MADEP-VPH-04-1 .1
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics'
C9-C12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surroqate
2.5-Dibromotoluene
Date Extracted: 08/09/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
_RL
_Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
6.7
6.7
6.7
6.7
6.7
0.67
0.67
0.27
0.67
1.35
1.35
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
117
70-1 30
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
Submitted By:
Approved By:
C:\vPH\Computer\Final Data\3835.3837vph.xls
P.O. Box 0119 - 1771 WASHrNGTON STREET . sTOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
V
Cyn Environmental Services Analytical Laboratory
CyI1
EDYVIBROI WmE
DIALI.
SEGRIV1 ES
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043836
Sample ID: SS2
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number: 20276600SP'
Batch ID: ESO414
Sample Date: 08/09/04
Receipt Date: 08/09/04
Analysis Date: 08/12/04
Report Date: 08/19/04
Extractable Petroleum Hydrocarbons by MADEP EPH 04-1
Sample Temperature: Received @ 4*C0
Container Condition: Satisfactory
Percent Moisture: 60.5
Frac. Column Lot #: 0124603
Date Extracted: 08/11/04
ARO
ALl
1
Dilution Factor:
1
Extraction Method: EPA 3546
Method
Result
RL
Units
200
120
ND
ND
ND
ND
ND
ND
51
51
51
51
0.5
0.5
0.5
0.5
mg/Kg
Result
AR
_Units
89
101
78
76
40-140
40-140
40-140
40-140
Analyte
C9-C18 Aliphatics
019-C36 Aliphatics
C11-C22 Aromatics
C11-C22 Aromatics*
2-Methylnaphthalene
Acenaphthene
Naphthalene
Phenanthrene
GO/FID
GC/FID
GC/FID
GC/FID
GC/MS
GC/MS
GO/MS
GC/MS
Surrogate
Method
GC/F ID
GC/F ID
GC/F ID
GC/F ID
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments: *Unadjusted, Concentrations based on dry weight.
Submitted By:
%~tP
~
-
Approved By:
aQ-4K
ONMA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038.*FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
Efi VlAG Iil ID11I.1
T
SERVI0 ES
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043836
Sample ID: SS2
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28772.D
08/09/04
08/09/04
08/11/04
08/16/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
Received @ 4* C
Satisfactory
60.5%
19.1
Analyte
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
Method
05-08 Aliphatics
09-012 Aliphatics
C9-C10 Aromatics
05-08 Aiiphatics*
C9-C12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surroqate
MADEP-VPH-04-1 .1
2,5-Dibromotoluene
Date Extracted: 08/09/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
5.0
5.0
5.0
5.0
5.0
0.50
0.50
0.20
0.50
0.99
0.99
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
107
70-130
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* = Unadjusted
Submitted By:
$
c:WvP\Computer\Final
e
Approved By:
Data\3835-3837vph.xls
P.O. BOX 0119 *1771 WASHINGTON STREET +STOUGHTON, MA 02072-0119 TELEPHONE 781-: 341-5108 e 1-800-899-1038
- FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
Ey iVOim
SERYVI CE S
.
Customer:
Location:
Lab Number:
Sample ID:
Sampled By:
Sample Matrix:
Athol Medical Clinic
Athol, MA
2043837
Camp 5
Chris McKenna
Soil
Job Number: 20276600SP
Batch ID: ES0414
Sample Date: 08/09/04
Receipt Date: 08/09/04
Analysis Date: 08/13/04
Report Date: 08/19/04
Extractable Petroleum Hvdrocarbons by MADEP EPH 04-1
Sample Temperature: Received @ 4"C
Container Condition: Satisfactory
Percent Moisture: 21.2
Frac. Column Lot #: 0124603
Method
Result
Analyte
09-C18 Aliphatics
C19-C36 Aliphatics
C1 1-C22 Aromatics
C11-C22 Aromatics*
2-Methylnaphthalene
Acenaphthene
Naphthalene
Phenanth rene
GC/FID
GC/FID
GC/FID
GC/FID
GC/MS
GC/MS
GC/MS
GC/MS
Surrogate
Method
GC/F ID
2-Bromonaphtha lene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GC/FID
GC/FID
GC/F ID
Date Extracted: 08/11/04
ARO ALl
Dilution Factor:
1
1
Extraction Method: EPA 3546
_RL
LUnits
77
25
mg/Kg
49
ND
25
25
25
0.3
0.3
0.3
0.3
mg/Kg
mg/Kg
Result
AR
Units
92
40- 140
112
70
91
40- 140
40- 140
ND
ND
ND
ND
ND
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
40-140
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments: *Unadjusted, Concentrations based on dry weight.
Submitted By:
,
.4~-
Approved By:
cfa
/
~
PREN
hthidT-
6
ONMA 02072-0119
TELEPHONE 781-341-5108
+
11
1-800-899-1038 e FAX 781-344-3318
9
Cyn Environmental Services Analytical Laboratory
[OI RO
AA
SERVICES
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043837
Sample ID: Comp5
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP'
V28773.D
08/09/04
08/09/04
08/11104
08/16/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Received @ 4* C
Satisfactory
21.2%
20.9
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
Method
MADEP-VPH-04-1 .1
C5-C8 Aliphatics
09-C12 Aliphatics
C9-CI0 Aromatics
C5-C8 Aliphatics*
C9-C1 2 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogate
2,5-Dibromotoluene
Date Extracted: 08/09/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
2.3
2.3
2.3
2.3
2.3
0.23
0.23
0.09
0.23
0.46
0.46
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
129
70-1 30
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
*= Unadjusted
Submitted By:_
C:\vPHAComputer\Final Data\3835-3837vph xis
Approved By:
4224;
P.O. Box 0119 - 1771 WAsHINGTON STREET - STOUGHTON. MA 02072-0119 TELEPHONE 781-341 -5108 - 1-800-899-1038 - FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
cyII
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043838
Sample ID: WS 1I
Sampled By: Chris McKenna
Sample Matrix: Aqueous
SESRY ICE S
Job Number:
Batch ID :
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
EA0405
08/09/04
08/09/04
08/11/04
08/19/04
Extractable Petroleum Hvdrocarbons bv MADEP EPH 04-1
Sample Temperature:
Container Condition:
Sample Volume (ml):
Frac. Column Lot #:
Received @ 4*C0
Satisfactory
400
0124603
Method
Analyte
C9-Ci8 Aliphatics
019-036 Aliphatics
C11-022 Aromatics
011-C22 Aromatics*
2-Methylnaphthalene
Acenaphthene
Naphthalene
Phenanthrene
GO/F ID
GO/FlID
GO/F ID
GC/FID
GO/MS
GC/MS
GO/MS
GC/MS
Surrogate
Method
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GC/FID
GC/FID
GC/FID
GC/FID
Date Extracted: 08/11/04
Aro
Ali
1
1
Dilution Factor:
Extraction Method: EPA 3510
Result
RL
ND
ND
ND
ND
ND
ND
ND
ND
1300
1300
250
250
2.5
2.5
2.5
2.5
Result
AR
70
103
77
82
40- 140
40-140
40-1 40
40-140
Unijts
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
Un)its
AR = Acceptance Range
RL = Reporting Limit
ND = Not Detected
Comments: *Unadjusted
Io
Submitted By:
fNNalliIEW
PREN
M
Approved By:
UGHONMA 02072-0119
,
4
TELEPHONE 781-341-5108 . 1 800-899-1038 - FAX 781-344-3318
5'
Cyn Environmental Services Analytical Laboratory
cyli
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043838
Sample ID: WS1
Sampled By: Chris McKenna
Sample Matrix: Aqueous
EOYVI ROGDllEflTI.
SERV ICE S
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28774.D
08109/04
08/09/04
08/12/04
08/16/04
Volatile Petroleum Hydrocarbons
Sample Temperature: Received @ 4* C0
Container Condition: Satisfactory
pH: <2
Method
Analyte
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics*
C9-C12 Aliphatics*
Benzene
Ethylbenzene
Methyl t-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Method
Surrogate
MAD EP-VPH-04-1 .1
2,5-Dibromotoluene
Date Extracted: 08/12/04
Dilution Factor:
Sample Preservation: HCL
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
50
50
50
50
50
5.0
5.0
5.0
5.0
10
10
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
Result
AR
Units
113
70-130
ND = Not Detected, below Reporting Limit (RL).
AR = Acceptance Range, defined by the method.
* = Unadjusted
Submitted By:
)te
.r/
C:\VPH\computer\Final Data\3838VPH1 xis
2/ -
Approved By:
P.O. BOX 0119 - 1771 WASHINGTON STREET +STOUGHTON. MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038
*FAX
781-344-3318
/
Cyn Environmental Services Analytical Laboratory
Customer:
Location:
Lab Number:
Sample ID:
Sampled By:
Sample Matrix:
IIVIRO IlImE ATR I.
SERYICE S
Athol Medical Clinic
Athol, MA
2043839
Trip Blank
Chris McKenna
Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28766.D
08/09/04
08/09/04
08/11/04
08/16/04
Volatile Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Received @ 400C
Satisfactory
0.0%
15.0
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics*
C9-C 12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Method
Surrogate
MADEP-VPH-04-1 .1
2,5-Dibromotoluene
Date Extracted: 08/09/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
JUnits
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
2.5
2.5
2.5
2.5
2.5
0.25
0.25
0.10
0.25
0.50
0.50
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
118
70-130
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* = Unadjusted
Submitted By: ,$
r
At c
Approved By:
C:WPHicomputer\Final Data\3835-3837vph.xts
P.O. BOX 0119 - 1771 WASHrNGTON STREET + STOUGHTON, MA 02072-0119 TELEPHONE 781 -341-5108 * 1-800-899-1038 e FAX 781-344-3318
'I
Cyn Environmental Services Analytical Laboratory
ERY IA0 IIIlE llT I.
SERVI CES
Customer: Athol Medical Clinic
Location: Athol, MA
Lab Number: 2043840
Sample ID: Fld Blank
Sampled By: Chris McKenna
Sample Matrix: Soil
Job Number:
Data File:
Sample Date:
Receipt Date:
Analysis Date:
Report Date:
20276600SP
V28767.D
08/09/04
08/09/04
08/11/04
08/16/04
volatlie Petroleum Hydrocarbons
Sample Temperature:
Container Condition:
Percent Moisture:
Extraction Weight(g):
Method
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Received @ 4* C
Satisfactory
0.0%
15.0
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
Method
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics*
CS-C 12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Surrogate
MADEP-VPH-04-1 .1
2,5-Dibromotoluene
Date Extracted: 08/09/04
Dilution Factor: 1
Sample Preservation: 1:1 Methanol Covering Sample
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
2.5
mg/Kg
mg/Kg
ND
ND
2.5
2.5
2.5
2.5
0.25
0.25
0.10
0.25
0.50
0.50
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
_Units
121
70- 130
ND
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
Submitted By:
64
Approved By:
C:\vPH~computer\FinaI Data\33-3837vph.xls
P.O. BOX 0119 - 1771 WASHINGTON STREET
+
STOUGHTON, MA 02072-0119 TELEPHONE 781-341-51038 - 1-800-899-1038 - FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
Eli VIAD O I1TR L
SERVICES
Quality Control Report
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil Method Blank
Lab Number: ESO414BLK
Batch ID: ES0414
Extract Date: 08/02/04
Method
Analyte
GC/FID
GC/FID
GC/FID
GC/MS
09-C18 Aliphatics
C1 9-C36 Aliphatics
011-022 Aromatics
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Anthracene
Benzo(a)anth racene
Benzo(a)pyrene
Benzo(b)fluoranthene
Benzo(g,h,i)perylene
Benzo(k)fluoranthene
Chrysene
Dibenz(a,h)anthracene
Fluoranthene
Fluorene
lndeno(1 ,2,3-cd)pyrene
Naphthalene
Phenanthrene
Pyrene
GO/MS
GC/MS
GC/MS
GO/MS
GC/MS
GO/MS
GC/MS
GC/MS
GO/MS
GC/MS
GO/MS
GO/MS
GO/MS
GO/MS
GC/MS
GO/MS
Method
Surrogate
GC/F ID
2-Bromonaphthaiene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GC/FID
GC/FID
GC/FID
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Weight:
EPA 3546
0124603
0.0%
10 gins
Result
RL
_Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
20
20
20
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
mg/Kg
mg/Kg
Result
AR
Units
83
96
67
78
40-1 40
40-140
40-140
40-140
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
RL = Reporting Limit
AR = Acceptance Range
ND = Not Detected
Submitted By:
-~r-
,gggt
ge
-
Approved By:
GTONMA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038
e
FAX 781-344-3318
/3
Cyn Environmental Services Analytical Laboratory
Quality Control Report
EDVIROfmEI1T
SER VICE S
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil Range LOS
Lab Number: ESO414LCS
Batch ID: ESO414
Extract Date: 08/02/04
Method
Analyte
GC/FID
GC/FID
GC/F ID
GC/FID
GC/FID
GO/F ID
GC/FID
GC/FID
GC/FRD
GC/FID
GC/FID
GC/FID
GC/FID
GC/F ID
GC/F ID
GC/F ID
GC/F ID
GC/F ID
GC/F ID
GO/FID
GO/FID
GC/FID
GC/FID
GC/FID
GO/FID
GO/F ID
GO/FRD
GC/F ID
GO/FID
GO/FID
GO/FID
Naphthalene
2-M ethylna pht halene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anithracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
Indeno(1 ,2,3-cd)pyrene
Dibenz(a~h)anthracene
Benzo(g,h,i)perylene
Nonane
Decane
Dodecane
Tetradecane
Hexadecane
Octadecane
Nonadecane
Eicosane
Docosane
Tetracosane
Hexacosane
Octacosane
Tricontane
Hexatriacontane
Method
Surrogate
GC/FID
GO/FRD
GO/FRD
GC/FID
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
Extraction Method: EPA 3546
Frac. Column Lot #: 0124603
Percent Moisture: 0.0%
Extraction Weight: 10 gins
Result
AR
68
73
84
86
89
103
93
109
108
115
120
119
116
116
120
106
107
46
60
66
76
82
97
82
84
86
83
86
85
85
78
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-1 40
40-140
40-140
40-140
40-1 40
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
Result
AR
107
108
59
93
40-1 40
40-140
40-140
40-1 40
Unit~s
%G
Unt
% Naphthalene Breakthrough =<10
% 2-Methylnaphthalene Breakthrough = <1.0%
AR = Acceptance Range
Submitted By:
Approved By:
e48%
WM#2 eW*MET -STOUGHTON,
MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAx 781-344-3318
'VI
Cyn Environmental Services Analytical Laboratory
cyV i
EI1VYI ADOIA
THL
Quality Control Report
SERVICES
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil PAH LCS
Lab Number: ESO41 4LCS
Batch ID: ESO41 4LCS
Extract Date: 08/02/04
Method
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GO/MS
GC/MS
GO/MS
GC/MS
GO/MS
GC/MS
GO/MS
GC/MS
GO/MS
GO/MS
GO/MS
Method
GC/MS
GC/MS
GC/MS
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Weight:
Result
Analyte
Naphth-alene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
Indeno(1 ,2,3-cd)pyrene
Dibenz(a,h)anthracene
Benzo(g,h,i)perylene
Surrogate
2-Bromonaphthalene
2-Fluorobiphenyl
Orthoterphenyl
AR
EPA 3546
0124603
0.0%
10 gins
Units
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-140
40-140
40-1 40
40-140
40-140
40-140
40-140
40-1 40
40-1 40
40-1 40
Result
AR
71
77
67
40-1 40
40-1 40
40-140
Units
AR = Acceptance Range
Submitted By: ±~~t
8:\
',X
- -
Approved By:
a2~7
QC
P.O BO rofles\Adninstratoi\Temrolates\ES0414
0119 - 1771 WASHINGTON STREET * STOUGHTON, MIA
02072-0119 TELEPHONE 781-341-5108
-
1-800-899-1038 - FAX 781-344-3318
/3-
Cyn Environmental Services Analytical Laboratory
CY Dl
Quality Control Report
SER YICES
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Extraction Method:
Frac, Column Lot #:
Percent Moisture:
Extraction Weight:
Sample ID: Soil LCSD
Lab Number: ESO414LCSD
Batch ID: ESO414LCSD
Extract Date: 08/02/04
Method
GC/FID
GC/FID
GC/FID
GC/MS
GC/MS
GO/MS
GC/MS
GO/MS
GO/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GO/MS
GC/MS
GC/MS
Anlalye
Result
EPA 3546
0124603
0.0%
10 gins
Units
AR
C9-C18 Aliphatics
019-C36 Aliphatics
C11 -C22 Aromatics
Naphthialene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
Indeno(1 ,2,3-cd)pyrene
Dibenz(a,h)anthracene
Benzo(g,h,1)perylene
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
% Naphthalene Breakthrough = <1.0%
% 2-Methylnaphthalene Breakthrough = 1.7%
AR = Acceptance Range
Submitted By: ~
Approved By:
~
MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038
*FAX
781-344-3318
it
Cyn Environmental ServiCes AnalytiCal Laboratory
EDVlROOHE i TIREL
Quality Control Report
SERVICES
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil Method Blank
Lab Number: ES041 5BLK
Batch ID: ESO415
Extract Date: 05/16/04
Method
Analyte
GC/FID
GC/FID
GC/FID
C9-Ol8 Aliphatics
C1 9-C36 Aliphatics
C11-C22 Aromatics
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Anthracene
Benzo(a)anthracene
Benzo(a)pyrene
Benzo(b)fluoranthene
Benzo(g,h,i)perylene
Benzo(k)fl uoranthene
Chrysene
Dibenz(a,h)anthracene
Fluoranthene
Fluorene
lndeno(l1,2,3-cd)pyrene
Naphthalene
Phenanthrene
Pyrene
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GO/MS
GO/MS
GC/MS
GC/MS
GO/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
Method
Surrogate
GO/FID
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GC/FlD
GC/FID
GC/F ID
Extraction Method: EPA 3546
Frac. Column Lot #: 0114004
Percent Moisture: 0.0%
Extraction Weight: 10 gins
Result
RL
Units
ND
20
20
20
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
mg/Kg
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
Result
AR
U~nits
85
110
71
86
40-1 40
40-140
40- 140
40-140
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
RL = Reporting Limit
AR = Acceptance Range
ND = Not Detected
Submitted By: /S
PE9
r
7WASHINGTO
C
t
SWEET-
Approved By:
42A~4
TOUGHTON, MA 0207240119 TELEPHONE 781-341-5108 * 1-800-899-1038 * FAX 781-344-3318
'9
ICyn
Environmental Services Analytical Laboratory
Quality Control Report
SERVICES
-EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil Range LCS
Lab Number: ESO415LCS
Batch ID: ESO415S
Extract Date: 08/16f04
Method
Analyte
GC/FIDU
GC/FlD
GC/FlD
GC/FID
GC/FID
GC/FID
GC/FlDU
GC/FlD
GC/FIDU
GO/FlD
GC/FID
GC/FLDU
GC/FIDU
GC/FID
GC/FID
GC/FIDo
GC/FIDU
GC/F ID
GC/FID
GO/F ID
GC/FID
GO/FID
GC/FID
GC/FlDU
GC/FID
GO/FID
GO/FLDU
GO/FLDU
GO/FID
GO/FlDU
GO/FlD
Extraction Method: EPA 3546
Frac. Column Lot #: 0114004
Percent Moisture: 0.0%
Extraction Weight: 10 gins
Result
AR
40-140
40-140
40-1 40
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-1 40
40-1 40
40-1 40
40-1 40
40-1 40
40-140
40-140
40-1 40
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
Indeno(1 ,2,3-cd)pyrene
Dibenz(a,h)anthracene
Benzo(g,h~i)perylene
Nonane
Decane
Dodecane
Tetradecane
Hexadecane
Octadecanie
Nonadecane
Eicosane
Docosane
Tetracosane
Hexacosane
Octacosane
Triconitane
Hexatriacontane
Method
Surrogate
GC/F ID
GO/FlDU
GO/FlDU
GO/FLDU
2-B romona phth ale ne
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
%6Naphthalene Breakthrough = 1.6%
%62-Methylnaphthalene Breakthrough
=
Result
AR
89
114
82
85
40-1 40
40-140
40-1 40
40-140
Units
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
%6
Unt
%6
%6
%6
%6
<1.0%
AR = Acceptance Range
Submitted By:.~r>
PO O
Approved By:
11
*1
WASHIGTON STRET - STOUGHTON, MA
02072-0119
TELEPHONE 781-341-5108 + 1-800-899-1038 - FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
C
E
SERVI[ES
Quality Control Report
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil PAH LCS
Lab Number: ESO41SLCS
Batch ID: ESO415
Extract Date: 08116/04
Method
Analyte
GC/MS
GC/MS
GC/MS
GC/MS
GO/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
Naphthalene
2-Methytnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
Indeno(1 ,2,3-cd)pyrene
Dibenz(a,h)anthracene
Benzo(g,h,i)perylene
Method
Surrogate
GC/MS
2-Bromonaphthalene
2-Fluorobiphenyl
Orthoterphenyl
GC/MS
GC/MS
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Weight:
Result
AR
61
74
77
78
40-1 40
40-140
40-1 40
40-140
40-140
40-140
80
83
78
78
85
86
85
84
81
40-140
40-140
40-140
40-140
40-1 40
40-140
40-1 40
40-140
40-140
40-140
40-140
Result
AR
70
95
71
40-140
84
81
77
83
EPA 3546
0114004
0.0%
10 gins
Units
%/
Unt
%/
40-140
40-140
AR = Acceptance Range
Submitted By:
P.
Approved By:
9
/2244
STETFI
TOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
m
Ey iVIOi
.
Quality Control Report
SER VICE S
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Soil LCSDO
Lab Number: ESO41 5LCSD
Batch ID: ES0415
Extract Date: 08/16/04
Method
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Weight:
Result
Anlalye
GC/FIDO
GC/FID
EPA 3546
0114004
0.0%
10 gins
AlR
C9-Cl18 Aliphatics
C19-C36 Aiiphatics
C11-C22 Aromatics
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fiuoranthene
Benzo(a)pyrene
Indeno(1 ,2,3-cd)pyrene
Dibenz~a,h)anthracene
Benzo(g,h,i)perylene
GC/FID
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GO/MS
GO/MS
GO/MS
Units
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
% Naphthalene Breakthrough = 3.1%
% 2-Methylnaphthalene Breakthrough = <1 .0%
AR = Acceptance Range
Submitted By:
PA
60
s,
ezz, 2L-1 .
ImET
OGTN
Approved By:
MA 02072-0119
(I2
TELEPHONE 781-341-5108
*1-800-899-1038
- FAX 781-344-3318
2~0
Cyn Environmental ServiCes AnalytiCal Laboratory
Ji
EDi VIROD [DHIEA L
Quality Control Report
SER VICE S
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Water Method Blank
Lab Number: EAO405BLK
Batch ID: EA0405
Extract Date: 07/16/04
Method
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Volume:
Analyte
Result
RL
Unit~s
ug/L
ND
500
500
100
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
Result
AR
Units
58
78
52
72
40-140
40- 140
40- 140
40- 140
GC/FID
GC/FID
C9-C18 Aliphatics
ND
C19-C38 Aliphatics
GC/FID
C11-022 Aromatics
GC/MS
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Anthracene
Benzo(a)anthracene
Benzo(a)pyrene
ND
ND
ND
ND
GC/MS
GC/MS
GC/MS
GO/MS
GO/MS
GO/MS
GC/MS
GO/MS
GO/MS
GO/MS
GO/MS
GO/MS
Benzo(b)fluoranthene
Benzo(g,h,i)perylene
Benzo(k)fluoranthene
Chrysene
Dibenz(a,h)anthracene
Fluoranthene
Fluorene
GO/MS
GC/MS
Indeno(1 ,2,3-cd)pyrene
Naphthalene
GO/MS
GO/MS
Phenanthrene
Pyrene
Method
Surrogate
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GC/F ID
GO/F ID
GC/FID
GC/FID
EPA 3510
0124603
NA
1000 mls
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
RL = Reporting Limit
AR = Acceptance Range
ND = Not Detected
Submitted By:
-Tr
X
Approved By:
/ !)1
PE~40
7$$$stEET
*SOUGHTON,
MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
EfiVROD~GIALQualhy Control Report
SEARYICES E=XTRTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID:
Lab Number:
Batch ID:
Extract Date:
Water Range LOS
EAO4O5LCS
EAO405S
07116/04
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Volume:
Analyte
Method
GC/FIDB
GO/FID
GO/F ID
GO/FIDB
GC/F ID
GC/F ID
GC/F ID
GO/F ID
GO/FIDB
GO/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GC/FIDB
GC/F ID
GO/FIDB
GC/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GO/FIDB
GC/FIDB
GO/FIDB
GO/FIDB
R_esult
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phienanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
Indeno(1,2.3-cd)pyren~e
Dibenz(a,h)anthracene
Benzo(g~hi)perylene
Nonane
Decane
Dodecane
Tetradecane
Hexadecane
Octadecane
Nonadecane
Eicosane
Docosane
Tetracosane
Hexacosane
Octacosane
Tricontane
Hexatriacontane
Surroaate
Method
2-Bromonaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GO/FIB
GC/FIB
GO/FIB
GC/FIB
AR
51I
55
61
63
62
686
63
70
70
71
74
72
70
71
67
61
64
41
45
48
55
61
75
69
68
72
70
70
67
66
53
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-440
40-140
40-140
40-140
40-140
40-140
Result
AR
77
92
55
72
40-140
40-140
40-140
40-140
EPA 3510
0124603
0.0%
1000 mis
Unjts
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
%4
Units
%4
%4
%4
%4
%4Naphthalene Breakthrough = <1.0%
%42-Methylnaphthalene Breakthrough = 1.1%
AR = Acceptance Range
Submitted By:
Approved By:
P990T
-STOUGHTON, MA 02072-0119 TELEPHONE 781 -341-5108 * 1-800-899-1038 - FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
Quality Control Report
SERVYIHOffEIS
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH- 04-1
Sample ID:
Lab Number:
Batch ID:
Extract Date:
Method
Analyte
GO/MS
GC/MS
GC/MS
GO/MS
GO/MS
GO/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
GC/MS
Extraction Method: EPA 3510
Frac. Column Lot #: 0124603
Percent Moisture: NA
Extraction Weight: 1000 mls
Water PAH LOS
EA0405LCS
EA0405
07/16/04
Result
40-140
40-140
40-140
40-140
40-140
40-1 40
40-140
40-140
40-140
40-140
40- 140
40-140
40-1 40
40-1 40
40-140
40-140
40-140
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a) anthracene
Chrysene
Benzo(b)fluoranthiene
Benzo(k)fluoranthene
Benzo(a)pyrene
lndeno(1 ,2,3-cd)pyrene
Dibenz(a,h)anthracene
Benzo(gh,i)perylene
Method
Surrogate
GC/MS
GC/MS
GC/MS
2-Bromonaphth-alene
2-Fluorobiphenyl
Orthoterphenyl
AR
Result
AR
61
84
68
40-140
40-140
40-140
Units
%
%
%
%
%
%
%
%
Unt
%/
%
%/
AR = Acceptance Range
Submitted By: ~>$.-P.O BO
*771WSNGN
-1
Approved By:
-TE~
SOUGHTON, MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 . FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
Quality C6ntrcl Report
SEAYIC[S
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Water LCSD
Lab Number: EA0405LCSD
Batch ID: EA0405
Extract Date: 07/16/04
Method
Extraction Method:
Frac. Column Lot #:
Percent Moisture:
Extraction Weight:
Result
Analyte
GC/FID
GC/FID
GC/FID
GC/MS
GO/MS
GC/Ms
GO/MS
GC/MS
GO/MS
GC/MS
GC/MS
GC/MS
GO/Ms
GO/MS
GC/MS
GC/MS
GO/MS
GO/MS
GO/MS
GC/MS
EPA 3510
0124603
NA
1000 mls
AR
C9-C18 Aliphatics
019-036 Aliphatics
011-C22 Aromatics
Naphthalene
2-Methylnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)flucranthene
Benzo(a)pyrene
Indeno(1,2,3-cd)pyrene
Dibenz(a,h)anthracene
Benzo(gh,i)perylene
Units
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
RPD
% Naphthalene Breakthrough = <1.0%
% 2-Methylnaphthalene Breakthrough = 1.3%
AR = Acceptance Range
Submitted By:
PEE
Z r-(to
~
C
dil
M
-,.
WOUGHTON,
Approved By:
MA 02072-0119 TELEPHONE 781-341-5108 - 1-800-899-1038
e
FAX 781-344-3318
Cyn Environmental Services Analytical Laboratory
C_
EI VIRO 0lll E ITRL
SEARVICES
Quality Control Report
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Fractionation Check Sample
Fractionation Date: 07/13/04
Method
Analyte
GC/FID
GO/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FID
GC/FIDC
GC/F ID
GC/FID
GC/FID
GC/FIDC
GC/FID
GC/FID
GC/F ID
GO/F ID
GO/F ID
GC/FIDC
GO/F ID
GC/FID
GC/FID
GC/FID
GC/F ID
GC/FIDC
GC/FID
GC/F ID
GO/FID
GC/FID
GC/FID
GO/F ID
GC/FID
Method
Naphthalene
2-Methytnaphthalene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranthene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo( k)fluoranthene
Benzo(a)pyrene
lndeno(1 ,2,3-cd)pyrene
Dib enz~a,h) anthracene
Benzo(g,h,i)perylene
Nonane
Decane
Dodecane
Tetradecane
Hexadecane
Octadecane
Nonadecane
Eicosane
Docosane
Tetracosane
Hexacosane
Octacosane
Tricontane
Hexatriacontane
Surrogate
GC/FID
GC/FIDC
GO/F ID
GC/F ID
2-Braomonaphthalene
2-Fluorobiphenyl
Chlorcoctadecane
Orthoterphenyi
Lot Number: 0124603
Result
AR
73
76
40-14 0
40-14 0
40-1 40
40-1 40
40-140
40-140
40-1 40
82
83
78
83
76
65
85
85
88
87
85
87
83
91
87
67
40-140
40-140
40-140
40-14 0
40-140
40-14 0
40-140
40-14 0
40-14 0
40-140
40-140
4 0-140
40-140
40-14 0
4 0-14 0
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
Result
AR
53
40-140
40-140
40-140
40-14 0
768
78
786
81
82
87
88
106
89
96
94
93
93
82
80
88
Units
%6
%6
%6
%6
%6
%6
%6
%6
Unt
AR = Acceptance Range
Submitted By:
C\WinnWoliles\Adminisrtor\TemplatsFractontion Chocks
P.O. BOX
Approved By:
.
0119 -
1771 WASHINGTON STRET- STOUGHTON, MA
02072-0119
TELEPHONE 781-341-5108 - 1-800-899-1038 + FAX 781-344-3318
if
.111
Cyn Environmental Services Analytical Laboratory
Quality Control Report
ED IN IOimFE ITR L
SERVICES
EXTRACTABLE PETROLEUM HYDROCARBONS (EPH)
By MADEP EPH 04-1
Sample ID: Fractionation Check Sample
Fractonaton Date: 08/12/04
Method
Analyte
GC/FID
Naphthalene
2-Methylnaphthaiene
Acenaphthylene
Acenaphthene
Fluorene
Phenanthrene
Anthracene
Fluoranithene
Pyrene
Benzo(a)anthracene
Chrysene
Benzo(b)fluoranthene
Benzo(k)fluoranthene
Benzo(a)pyrene
lndeno(1,2,3-cd)pyrene
Dibenz(a, h)anthracene
Benzo(g,h,i)perylene
Nonane
Decanie
Dodecane
Tetradecane
Hexadecane
Octadecane
Nonadecane
Eicosane
Docosane
Tetracosane
Hexacosane
Octacosane
Tuicontanie
Hexatuiacontane
GC/F ID
GC/F ID
GC/FID
GC/F ID
GC/F ID
GC/FID
GC/FID
GC/IFID
GC/F ID
GC/FID
GC/FID
GC/FID
GC/F ID
GC/F ID
GO/FID
GC/F ID
GC/FID
GC/FID
GC/F ID
GC/F ID
GC/FID
GC/FID
GO/FID
GC/FID
GC/F ID
GC/FiD
GC/FID
GC/F ID
GO/FlD
GC/F ID
Method
Surrogate
GO/FID
GC/FID
2-Brom onaphthalene
2-Fluorobiphenyl
Chlorooctadecane
Orthoterphenyl
GO/FlDU
GC/F ID
AR
= Acceptance
Submitted By:
/
Lot Number: 0114004
Resuft
AR
85
82
89
90
90
95
88
101
105
100
105
102
104
103
99
91
96
94
94
95
101
101
117
99
103
103
104
103
101
100
88
40-140
40-140
40-140
40-14 0
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-140
40-14 0
40-140
40-14 0
40-140
40-14 0
40-140
40-140
40-140
Result
AR
66
87
94
96
40-140
40-140
40-140
40-140
_Uni
%6
%6
%6
%6
%6
%6
%6
%6
$6
$6
%6
%,
%6
%6
$6
%6
%6
%6
$6
$6
$6
$6
$6
Un%
$6
$6
%6
%6
Range
--
0
X Z
P95MM~de
oW
~m
Approved By:
"-786HTN.MA02o72-0119 TELEPHONE 781-341-5108 - 1-800-899-1038 - FAX 781-344-3318
04
Cyn Environmental Services Analytical Laboratory
Quality Control Report
SERVYICE S
VOLATILE PETROLEUM HYDROCARBONS (VPH)
Sample ID: Soil Method Blank
Lab Number: VPHBLKS081 104
Associated Data Files: V28761-V28777
Data File: V28765.D
Analysis Date: 8/11/04
Method
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
MADEP-VPH-04-1
Analyte
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
.1
C5-C8 Aliphatics
C9-C12 Aliphatics
C9-C10 Aromatics
C5-C8 Aliphatics*t
C9-Cl12 Aliphatics*
Benzene
Ethylbenzene
Methyl tert-Butyl Ether
Naphthalene
Toluene
Xylene (total)
Method
Surrogate
MADEP-VPH-04-1 .1
2,5-Dibromotoluene
Extract Date:
Sample Preservation:
Percent Moisture:
Extraction Weight(g):
Dilution Factor:
8/11/04
Methanol
0.0%
15.0
1
Result
RL
Units
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
2.5
2.5
2.5
2.5
2.5
0.25
0.25
0.10
0.25
0.25
0.50
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Result
AR
Units
104
70-130
AR = Acceptance Range
RL = Method Reporting Limit
ND = Not Detected
Comments:
* =
Unadjusted
.
Submitted By:_
c:\VPH\compute,\FInal Data\QcVPHO811 04.xls
Approved By:
42244
P.O. BOX 0119 - 1771 WASHINGTON STREET*- STOUGHTON, MA 02072-0119 TEL.EPHONE 781-341-5108 - 1-800-899-1038 . FAX 781-344-3318
a?
Cyn Environmental Services Analytical Laboratory
C? II
E
EGYVISRO fl I1AT1L
SE~Il[IES
Quality Control Report
VOLATILE PETROLEUM HYDROCARBONS (VPH)
Sample ID: Soil LCS/LCSDUP
Lab Number: VPHLCO81 104
Associated Data Files: V28761-V28777
Data File: V28763.DN28764.D
Analysis Date: 8/11/04
Method
MADEP-VPH-04-i1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-i1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1.1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
MADEP-VPH-04-1 .1
Extract Date:
Sample Preservation:
Percent Moisture
Extraction Weight(g):
Dilution Factor:
Recovery
LCS
LCSDUP
Analyte
n-Pentane
2-Methylpentane
Methyl t-butyl ether
2,2,4-Trimethylpentane
Benzene
Toluene
Ethylbenzene
m,p-Xylene
o-Xylene
n-Decane
n-Butylcyclohexane
1,2,4-Trimiethylbenzene
Naphthalene
88
87
81
101
89
99
96
93
96
125
104
99
86
_RPD
91
87
81
104
92
107
99
100
101
120
105
99
87
ARl!
8/11/04
Methanol
0.0
15.0
1
Units
70- 130
70-130
70-1 30
70-1 30
70-1 30
70- 130
70- 130
70-1 30
70-1 30
70-1 30
70-1 30
70-130
70-130
LCS = Laboratory Control Sample
LCSDUP = Laboratory Control Sample Duplicate
RPD = Relative Percent Difference
AR = Acceptance Range
Submitted By:
x
§t
2
c<
Approved By:
C:\vPH\ComputAer\Final Data\QCvPH081 104.xis
P.O. BOX 0119 * 1771 WASHINGTON STREET * STOUJGHTON. MA 02072-0119 TELEPHONE 781-341-5108
+
1-400-899-1038 - FAX 781-344-3318
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I
APPENDIX I
Bill-of-Lading and
Uniformn Hazardous Waste Manifests
CYN Environmental Services
16312r
I1771
CYN
aIL iW04lNOT
NEGOTIABLE
SHIPPER NO.
WSHINGTON
STRIET 02072
-CARRIERyMNj.~
CARRIER NO.
(781)341-5108
0001
Lj /es-Or
DATE:
COSIGNEE
I
C7A'
OIL
CoaLP
I77
wkt
'-6'CAs
ATHOL
t-1CO/(
)JtI
y4
AT~oLI
/
ii7,44
EMERGENCY
RESPONSE PHONE NO.
cn33 /
VEHICLE
NUMBER
T1
ma
Wium - rat. to d.p.nd.ut on whi., .ttp."
This Is to csrtily bat ha inbovaflamed matarlata at.
hi stataapcJfloatty hi witting tha agrnd or rxopw~ chadhd. dortcd. pac*a~adnu4u~widhb.Iad.
take oft.. prcpa4
and - hi propatonoultontuiu~icftataaooo.dnghiCu
A4raador dflmd rahie of it pnpatty to fly
.c#ott. egtdator. of Cu GapeMutt ofThapoaUorL
way
bd bylit t#
- -
Ez±zzz~w___
CHRGES: $
FREIGHT CHARGES
acfl~
umidh ihcatadabhotswed
eademnlatr(uh
re4nd
ri
-
* &*d hi Seodon?
of can.
#5* t*flaA to to ho
d.twd tots ccrnlgnawmw4 tcana a, tia cOttloriOr.
WI.
tel 4i Cu hmo.,g statamat
ma ranier tad - roaMdattary of Id. shtomatt
a~.t
p.tM~attof Ira~ - sCout, bald tiMW.
oiatrbatingedstood
UyougontesCuonrta -
PREPAID
(Strati. ofCorofgno4
eunhganyp*rsonor
corpetn
o----efropertymrdre
ocead
crs
S pivpwg
iit ery earitpa be h
e lbyfrllCthea
parlrmd hersiunder aha edelt t Vi SNheO of Llaw ers anid a ulln hitie geomflg
on t Cu data of tshrime.
tmilar shalt Cu I~ tof ngfr ande-noilona hi Vipgor*igds ,-a Cunandhsatrm atandcninareherebyMasd
toby lischtpar ndaccapiad
Reigramovigerils.Sor0 tldnilsiSofto CudaeaSban
nh Miy Sad
aheci
u ,idaiseo5*1
of
eLadng.
nan.
dosaesde
aidnrwgtseny clhaimedatadeor
aaormdetrmnfn barueentheiaperile shreaahailafrmlve~ecpfehieutofanywrlncntmetdhicasibt
craoceilaga
mandisl4ned
byaulhiorizad
HIPPER
CYN aIL coRPION
represantavof
CAR RIt
PER
If~lMA~fERALS
SMRK WITHT TODESIGNATE
HAZARDOlUS
M&AERAL
ASREFERENCED
IN4S0FRS172.202.-
tocalny
hi
-
umuialplac.erderwery
-rhlreeadhisaan.
sanrlderalerr ta arad.
Cortact
oseropartiaahi
COLL.ECT
aa
promlea,
OIL CORPORATION
~DATE
cfj
'7'
<t)W
*
ORIGINAL
-
14512
NOT NEGOTIABLE
SHIPPER No.
CYN .OIL CORPORATION
WASHINGTON STREE
STOUGHTON
MA 02072
(781)341-5108
s202'74 -00o-sp
CARRE 7 71
/
1:CYN OIL CORPORATIONC~SGEE 1771 WASHINGTON ST.
STOUGHTON
(781) 341-5108
CARRIER NO.
/'-R /-oaP0 BOX 119
HA 02072
/V/6c7
,1i4/4
AThOL rli-
'7)
&ntfr
o 33/
'73(
eNg9
EMERGENCY
RESPONSE PHONE NO.
VEHICLE -anj
NUMBER
1-800-899-1038
HAZARDOUS SOLID, NON DOT REGULATED
)N
LiTERIA
th34-Tyyt
7abS
$4osV)
EE~c.o~mnOADRESS:
T'W5ll, 9
-
C.O.D. EE:
CODUI
NOE
era
.r.datqn
c.ud
flO~jMSSndt
yle*it
win -r
-
b.
--
p tui
orf
esnty
nuecmtmiraeau.
AMr: $
euSeg
eamens.nra
in.e'a
p.
Mr___________
$
se
pdpedeten
EBaafmnd
at -ao
nmoeea nwwn ein s-inoanny
e--aa
T7OTALm
t b
.*
----
_P EmoO
.
CHARG ES: $
FREIGHT CHARGES
Signoen......---"RAI
-- CO.ECT
4 si .td - ades a . vbo dflehaktentenir(1hwonrde
e~l.qm arsoixchote.otrta-smefanig
twnn st t maoat,4.missdd..erbnih
.
mo crpordooi
possealtndplptym wderUt crla
tearrottlsoutM b aedes gt tleuaQyage4dagre.it
sny bb
sesMitedieseryS al
itachst Mdirateydeldpepfl -e crestyordn
panS
wa~..y..wtw t pfliutud f..dr~anare.M*
titnSul ad-ehadon~atnd ite S te pw~nyalare
nayisdated
hiayen S bs aisima a Se PuC - Lflng nfrm Siden iSn it a 5t,- ha a is..n~ns ieto p.Wkm e oteieto. CW~e.
.
gowcrhg
d
-slso
r f. sa -em und conailans
Ai inmderfl
taageM
t by to tlpe and .osid tor~me M nd h! am*m
isati
endisl
li 1y 5 tdaarn to~eten edi PuEflenetdng:TD*.nOfsileeiad. * halby.pd
==rmdabai.esc. one Lfl
ps,
a .. wa bs to
egaossanydhldSm i gderand crtadegeaitunt nitflomi*
Ws~t *WIWeet SWe~neartudeled
0*suemwed u<.nan it aaed ty' etedesn
enn* c bcomgo',st.med.
d$C/pQs
~.\1mTmutswftq.
-- U---
ORPOTION
HAZARDOUS
AWEMAJ.AS REnW'CED II 480FR I 172
-(
-~
C
*~'~U r~4
9
..
DATE~-zV4.O
-
~
1t.~fl.tJt,
'r
t'~j4K.
Cl.)
'
~71
S-
COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
DMSION OF HAZARDOUS MATERIALS
One Winter Street Boston, Massachusetts 02108
UNIFORM HAZARDOUS -
WASTE MANIFEST
1.Generatorts US EPA IDNo.
1fP9?819979L1,
3. Generators Name and Mailing Addressq
Please print or type. Form designed for use on elite (12-pitch)
typewriter)
Manifest Document No. 2. Page 1 jInformation in the shaded areas
of
is not required by Federa law.
12
x ~~e~SaeManfst
~
j/Io
Documen Nur
B
4. Generators Phone (AJ)
5. Transporter 1 Company Name
Iii
-6.
US EPA
CYN' OIL OQFRPATK'
MA
7. Transporter?2 Company Name
IDNumber
-C
Dr10i8I2I3I0I3I7I7[7
STtCnrf
, MA
02072
AlO10182)33Q
a.p.,
ID Number)
PEWOLELM OIL. CCMUSTBLE LIQUID, NA1270,
III (WASTE OIL &JWATER)
Is
Ii
IL
Vr
'
~7~~~1
D
34 1 io
71
F..TransporesPhone (
G2iate Facilyys iD'
ST. PO EoX 119I
G
N
%
10. US EPA ID Number
11. US DOT Description (Including Proper Shipping Namne,
Hazard Class and
C
t
.
en. D
D lTahsporters Phone
E. Sate Trans. D-
CYN OIL (XRPAT ICt
1'771 WA)S-I1NTCf'
Stale
State Trans ID.'
8. US EPA ID Number
9. Designated Facility Name and Site Address
fi
7n7h7lI
N.
T
W~*a.iiysPhone
oalOant
)
NOTREQULIRED 6K
&S)341 5109~
NO.
.WsT
FG.
1
'
T
-IOIQ
G
X
A
9____
c)
Ii
-
-
-
T
O0
R
d.
aJArdiional
Is
Descriptions for Materials Ustedb
Aloe(include physicalsate
and hazard cdde)s
-2
K:Handling poes fonWastes Listed Above
I5. Special Handling Instrucions and Additional Information---
E~izv CALL 800 899
iN CS
c'Ts
1a38 4c LCRE
16. GENERATOR*S CERTIFICATION: I hereby declare that~the contents
-2O
of thIs consignment are fully end accurately described above by proper
pocked, matked, sad labeled, end are in all respects In proper condition
shippIng name and are classfied
for transport by highway according to applIcable IntemnatIonal
nationial government regulatIons.
pricblean
t
nerae
seece
thpacal mehopo
atcent torage, the vpoa crety aalle toere whnc
mn m es the prsent and futur treat to huma
hltha
evrnt;OI
eah
am a small quantty generator, Ihave made a good faith effort to minImize my waste generatldn
and select the best waste management
PrintedlTypediName
-
.
rT, d/
Aor
Date.
Si ntur
181. Transporter 2 Acknowledgement of Receipt of Materials
APrinted/Typed Name
.
-
.1.Tansporer
o9&'O
and
-
S
ldgemao
etfctRecept
of
of aterardus mael
aine
.d
.Day
Month
-.
i-
Month
Year
'Date.
-.
Day
Year
ay
Ya
coee byt smnietDxepastoednee1,
Sig
tureu
.
WrcvedOMBNo~OWa~
COMMONWEALTH OF MASSACHUSETTS
-DEPARTMENT OF ENVIRONMENTAL PROTECTIONDIVISION OF HAZARDOUS MATERIALS
One Winter Street Boston, Massachusetts 02108
'ii
UNIFORM HAZARDOUS
Please print or type. (Form designed for use on elite
(12-pitch) typewriter)
Manifest Document No. 2. Page 1
Information in the shaded areas
1i Generator s US EPA IDNo.
WASTE MANIFEST
a4
IIP?7~2
12 ~
~
9Coc4s~A
3. Generator's Name and Mailing Address,
1ZSZ.of
isnot required by Federalilaw.
.
State Manifest Document Numbe
DB/,3ateGen
I
4. Generators Phone (
)_______________________
5. Transporter 1 Company Name
c'
6. US EPA IDNumber
C512 OlLtOXPf'ATTCNJ
7. Transporter 2 Company Name
a.US
CYN' OIL OYJT.RCATTGtV
177 WASH-NnnCu ST.
STCantW,
MA
D 082
EPA ID Number
I
9. Designated Facility Name and Site Address
IiC
D
Stat Trans. ID'..
-C
30 37'7 7
T',~
:I[
[bS4,~I
C
D Transporters Phone
iiiill
Ii
10. US EPA IDNumber
Ete-Trar
I
ID
'I"
FO EiX 119
G State Facilitj.s ID
ilA ID[0 8 2 31Q0117[717 HFacIImt
h
04207'2
11., US DOT Description (Including Proper Shipping
Namo, Hazard C/ass andfl Number)
'
T
TtJsN
F
i
~tt
F ransporters Pone
E
.
NOT REQUIRED ;
.
9S. 9St
41,510
-WAENO
PFL8.ay OIL,
C
OMUSTIBLE LIQUjID, NA1270, FG
(WASTE OIL & WATER)
II
E
oW LT
.
«4>-
G
b-
Iag
N-
-.
,*
E
T
'I
4
C.
d.4
i.Aelditional*Ddscriptions forMaterlals Uisted Above
inlude physicaltari o azadeP
5.S
eia4adin:ntrcin
an4diinl.nom
4.4;'4~
IE
to
4 t.
4
.
.
-
r1
.
.
-
l
.
-
:'
K Handling Codes for Wastes Lsted Above'>
-".
-,
--.
-4
,
-
-
ISc.
Speciala
d Hanndlringa
Instrucitpionsondtin
aghnydcorinddoitlionalntmatonlInnnforommmation
ortrilpot b
aios...
If l am a large quatt generator, I certify thiat Ihave
program in place to reduce the volume and toxinity
of waste generated the degree I have determIned
WpNe'"o dithave selected the practicable amethod
to beoeconomically,
of treatment storage. or disposal currently avaIlable to me whichtominImizes
mem
e e,"viaone;O.fI
"aa
the present -Snd future tireat to human
s::ldquantityenertor I haemde a good
fa"t efott minm-z''' wat genraton and
select hetwsemngmn
Prined/Tped'me
-
.
r
t
Siglna
ure
.jE-
17. Transporter1 Acknowledgement ofReceIptof
Materials
Printed/Typed Name
IC
.9O3~to a
- Mont
Day
-Year
18. Transporter-2 Acknowledgement of Receipt of
Materials
Printed/Typed Name,
F
A
-
.i. O-iscrepancy Indication Space-
-
ll~ate-
.
44Moth
20. Facilty Owner or Operator: Cert fcation
of receipt of hazardous rnaterials covered by
this manifest except as noted in item19O
t-c-
Day.
Year
----
signature
.
_______
-_
y4
May 3, 2005
AGG REGATE
INDUSTRIES
PAT MCCARTHY
CYN ENVIRONMENTAL
100 TOSCA DRIVE
P.O. BOX 119
STOUGHTON, MA 02072
Re: Soil,
Athol Medical Clinic
1467 Main Street
Athol, MA
Release Tracking #: 2-148 15
The recyclable soil from the above address was received at our facility on April 29,
2005. Attached are the shipper's log of soil receipts which total 22.64 tons along with
the Bill of Lading and other receipt documentation.
We will issue a "Certificate of Recycling" upon request after processing.
Thank you for recycling soil at our Stoughton facility.
Yours truly,
William R. Reinhardt
Manager, Soil Division
AGGREGATE INDUSTRIESNortheast Region, Inc.
1101 Turnpike Street
Stoughton, Massachusetts 02072
Telephone 781-344-1100
Facsimile 781-341-5523
07/13/04
12:14 FAX 1 781 341 6246
LYN ENIVIRUNMENTAL
.tgj
uuo
~ NMassachiusetts Department of Environmental Protection
BWSC-012A
Bureau of Waste Sire Cleanup
I
-
Release Tracking Number*
2
BILL OF LADING Pursuant to 310 CMR 40.0030
LOCATION OF SITE OR DISPOSAL SITE WHERE REMEDIATION WASTE WAS GENERATED:
R1 einme (opnionan A thn1 Mperl1 Clinie
*A.
Stret:
1467 M2Itain Streer
Location Aid:
Citrwn
AhlMAZip
DdtProGnaionl_04_ A2.
___/__
_
AdiinlRelease Tracking Numbers Associated with This Bil of Lading .
Code:
14815
-
47-3'-25"NJ / 71?--"W
Aifli
Not Applicable
*Note: If Bill ofrLading ithe result ofta Limiked Removal Action (LRA) taken prior to
Notificationi, a Reease Tracidng Number is not needed.
*
*B. PERSON CONDUCTING RESPONSE ACTIONS ASSOCIATED WITH BILL OF LADING
Nae of organitation:
Athol Medical Clinic
NaeofContact
Jose Amparo
ma
flwr
Main Street
Su-oer1467
City/Town:
Telephone:
Athiol
Ste:
O97-407%f
pxt:
01331
Zip Codc:
MA
____
C. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON CONDUCTING
RESPONSE ACTIONS
ASSOCIATED WITH DILL OF LADING
(check one/specify)
o
RP
Specify (circle one):
Owner
Operator
Generator
Transporter
Other RP:
*
PRP
Specify (circle one):
wnr
Operator
Generator
o
Transporter
Other PRP:__________
Fiduciary/Secured Lender
ioo
_
_______
Agency/Public Utility on a Right of Way
Other Person:
______________
If an owner and/or operator is not conducting the response action associated with the Bill of Lading, provide
on a attachment the
name, contact person, address and telephone number, including any area code and extension, for each, if known.
D). TRANSPORTER/COMMON CARRIER INFORMATION:
Transportwr/ommnon CarrierNarnr
Cyn Enivironmental
Contact Person: Matt Murphy
snee:
100 Tosca Drive
S Ctyrow~n:
Telephone:
'Tide
Stn:
Stouhton
781-341-1777
.ipervicr
Zip Code: -02072
.
X4
pxL
E. RECEIVING FACfLTYTEMORARY STORAGE LOCATION:
Openor/Fscility Narne
A foregnt Inrinie
Contact Person: Bill Reinhardt
Street
1101 Turnpike Street
ICiyrrown:
Telephone:
|TypeofFacility
Tie:
Se:
Snnhnn
781-341-5500
(cheek one).
U
U
0
Ext.:
MA
Zip Code:
..
02072
-
_____
AsphalrBarthCojdMix
0
Batch/Rot Mix
Thernal Processing
C Indfilt/Daily Cover
Asphalt
Environmntal Manaaer
0
Landfill/Disposal
Landfill/ncur
Oncination
Fill
D Temnporary Storage
O Oter:
____________
Division of Hazardous
Division of Solid Waste
Mangement rennit #: Not Applicable
S-01-029
A PermitActual/nticiptvd
Period of Temporary Storage (specify dates if applicable):
/
/
to
Reason for Temporary Storage (if applicable):
NotApnlicble
IWmst/Class
EPA
/
/
Identification #: MAD-9812 13531
Nor Applicable
7
07/13/04
12:15 FAX 1 781 341 8246
I.
i
CYN ENVIRUNMENT7AL
WglU U
Massachusetts Departmant oflEnvironmental Protection
ReaeBWSC-.012A
BILL OF LADING Pursuant to 310 CMR 40,0030
14815
2-
*E- RECEIVINJG FACILITY/TEMPORARY STORAGE LOCATION (continued):
Temowy Storage Address
Not Applicable
Eweet.-
City/Tewn:
State:
Zip Cede:-
P, DESCRIPTION OP REMEDIATION WASTE:
edia (check all that apply):
(ehe Coamintate
p
O
Si
Contaminated Debis (circ all that apply):
Groundwater
Surface Water
Demoliton/Constveuion Waste
Other:_______________
Vegetaton/Organic Materials
o
N
Inorganic Absorbant Macrials
Other:
Not Applicahle
.O Non-hanrdou: Utierized
t(irle all thtapply): Non-aqueus Phase Lquids
Other
Tyeof Contmnation (circle all that apply):
Kerosene
Gaoie
Jet Fuel
EsdimateVolumcofMuterals
#
i
4Ol#
i
at
i
Other:______________________________
100
CubicYards:
Contaminant Source (check onespecify):
Diesel Fuel
NtAnlal
__NotApplicable_
O
Tons:
0
Thansportaion Accident
Response Actions Associated with Bill1 of Lading (cirede
cone):
U~tility-Related Abatemnt Measures
150
Other:
undergmund Storage Tank
nediate ResponseActions
Limited Removal Actions (LRA)
Other (specify):
U
Oher:
_
_______
Water entering AST
Release Abatement Measures
Comnprehensive Reponse Action
.
Remdiation Waste Chsarcriwaion Support Documentation attached:
* Site
History lnfomraion
U Sampling and Anlyticaj Method and Procedures
U Laboratory Data
Ifsupporting documentaion is not appended, provide an attachment stating the date and in eonnection with what document such
informaion was previously submitted to DEP
C
Field Screening Data
G- LICENSED SITE PROFESSIONAL (LSP) OPINION:
1Name
Cyn
Environmental Services
of Organinion:
ISP Name:
Philip D. Mcflain
Title
jmjnioT Project Manaeer / LSP
Telephone: 781
~
341 ~
1777 Ext.
133
I have personatly examined and am famriliar
withr the infcmuntion contained on and submitted with this forn. Based on this information. itismy
Opinion that the !estng and assessmentC actions undertaken were adequste to characterite the Remetditioni Wslte,ini accordance with 310 CMR
40.0030, and that the facility or location can accept remediauion wastes with the characteristics described inthis
submittal, Ilam await that
signifiant peaies including, but nor limited In,possible fines and imprisonment may resulh ifI willfully submit lnformauion which I kniow to
be
incomplete.
matrially
or
inaccurate,
ase,
I
Signature:
Seal:
____________________
at.
,
,__/___
121Replacement
LicesedNumbr:
See Attached
Opinion
H. CERTIFICATION OF PERSON CONDUCTING RESPONSE ACTIONS ASSOCIATED) WITH THIS
BILL OF LADING;
I certify under penalties oflaw that!I have personally examined and am familiar with the information contained in this submittal, including
any.
and all
documents accompanying iscetification, and that,
based on my inquiry of those indivduals immediately responsible for obtaining the
informatin the maternal information contained herein is, to the best of my knowledge and belief, true, accurate and
complete. Ilam aware that
there are significant penalties, including, but not limited to, possible fines and imprisonmn tfr willfuilly submitting false.
inaccurate, or
iName
of lrson (print):
rne Ampanr
evised 10/1/93
Thisform Irprinred on recydnapne
Pagc 2 of 2
12:15 FAX 1 781 341 6246
07/13/04
I
CYN ENYIRO0NMNTAL
IgJoUIs
USE LSP Replacement Opinion V with the following BWSC Form:
()
Bill of Lading (BWSC-012A)
LSRplc
enOiioV
Iincluding
I attest under the pains and penalties ofperjury that I have personally examined and am familiar 'with this submittal
any and all documents accompanying this submittal. In my professional opinion and judgment based
upon application of
(i) the standard of care in 309 CMIR 4.02 (1)
(ii) the application provision of 309 CMR 4.02 (2) and (3), and
(iii) the provisions of 309 CMR 3.03 (5).
totebest of my knowledge, information and belief, the assessment actions undertaken to characterize the
Remediation Waste which is (are) the subject of this of acceptance at the facility identified in this submittal comply
Ihaving
I
with the application provision of 3l0 CMR 40.0000, and such facility is permitted to acceptiRemediation Waste
the characteristics described in this submittal. I am aware that significant penalties may result, including, but
not limited to, possible fines and imprisonment, if submit infonnation which I know to be false, inaccurate or
* materially incomplete.
ReloaselTracking Number:
LSP Name:
* LSP Organization: -
I
Telephone/Ext.:
Signature:
___ -
2-14815
Phitlipfl Menhin
Title:
Cvn Bnvironental Services
Date:
781-341-1777 Ext 133
s21 /
Seal:
Seninr Pmjer Mannor /IT RP
'3
.2.
Q
I
Massachusetts
Bureau of Waste Department
Site-Cleanupof Environmental Protection
*
B ILL OF LADING (pursuant to 310 CMR 40.0030)
/ OF
SUMMARY SHEET
Release Tracking Number
-/ /f
K. SUMMARY OF SHIPMENTS:
Date of Shipment:
Date of Receipt:
Summary Sheet Total Shipped:
BWSC-012C
Number of Loads Shipped:
/22
Daily VolumeShipped
(cu. yds.dns
6~
Bill of Lading Total Shipped
(only if different):
Revised 1&3 94
Page 1 of 2
Q
Massachusetts
Bureau of Waste Department
Site Cleanupof Environmental Protection
BILL OF LADING (pursuant to 310 CMR 40.0030
BWSC-012C
Release Tracking Nunber
W-
SUMMARY SHEET
/ /c<
ONLY COMPLETE ONE COPY OF THIS PAGE AND ATTACH TO THE FINAL COPY OF THE SUMMARY SHEET.
L. ACKNOWLEDGMENT OF RECEIPT OF REMEDIATION WASTE AT RECEIVING FACILITY OR TEMPORARY
STORAGE:
Receiving FacilityTemporary Storage Representative (print):
William
. Reinhardt
Signature:
Title:
Date:
Manager
,6
~
M. ACKNOWLEDGMENT OF SHIPMENT AND RECEIPT OF REMEDI
ION WASTE BY PERSON
CONDUJCTiNG RESPONSE ACTION ASSOCIATED WITH THIS Bl
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 thuis certification, and that, based on my inquiry of those indivduats immediately responsible for
the information, the
material information contained inherein is, to the best of my knowledge and belief, true, accurate and compqlete, I am awareobtaining
that there are significant.
penalties, including, but not limited to, possible fines and imprisonment, for wilifuilly submitting false, inaccurate, or incomplete information.
Signature:
Date:
Name of Person (print):
RviJ
'OOPae2o2
evised 1&3/94
Page 2 of 2
INQULIY
TICKET
042905
RT BY:
0139
LOCN
147311
IN
Aggregate
-
042//L5
to
CI4/&:9/05
Industries-NE Region
-Page
1
CUSTOMER
10LAIN:
311
TONER: 675183
RDER:
33253
ICKET
pm
RV
EPORT
STOUGHTON
CYN ENVIROMENTftL
PD #602754 ATHOL
DATE
84/29 08:05
ENVIROMENTAL TOTALS
PORT TOTALS
TInE
IN
10 311
TO 675183
TO 33253
CUSIONlER
67'5183
ORDER
STOUGSHTON
CYN ENVIROMENTAL
P0 #602754 ATHDL
PRODUCT
LYN ENViIRO P0 #602754 RECY SOIL
HAULER
TRUCK
FOB ONLY
CYN811
ST BIN
DISP
0
QTY
22.64 TON
1 TICKETS
22.64 TON
1 TICKETS
22.64 TON
Massachusetts Departnient of Environmental Protection
Bureau of'Waste Site Cleanup
U
BWSC-012B
BILL OF LADING(pursuant to 310 CMR 40.0030)
LOG SHEET
OF
Release Tracking Number
14815
2-
L. LOAD INFORMATION:
LOAD
~
i
p~r
Representative:
Dat hi
entTime
Truck/Tyt
Rec~ Facility/Temporary Storage Representative:
of Shipment (circle one(fgfpm
ratn
ID
eofReit
1
S/(ze
Trailer Registration (if any):
ds
Tmo~c
t
tons): OS2 icle one)
im
LOAD 2: Signature of Transporter Representative:
Receiving Facility/Temporary Storage Representative:
Date of Shipment:
Date of Receipt:
-Time
of Shipment (circle one) am/pm
*Truck/Tractor Registration:
Date of Shipment:
/
'Time
ITruck/Tractor
_
_
_
Registration:
_
_
IDate of Receipt:
_I_
I(circle
Trailer Registration (if any):
4: Signature of Transporter Reprcsentative:
SDate of Shipment:
LOAD 5: Signature of Transporter Representative:
IReceiving
Time of Shipment (circle one) am/pm
_
Truck/Tractor Registration:
_
Trailer Registration (if any):
5
-(circle
LOAD 6: Signature of Transporter Representative:
- Date of Shipment:
__
Facility/Temporary Storage Representative:
/
ILoad Size (cu.
Time of Receipt:
/
one) am/pm
yds./tons):
_________
Receiving Facility/Temporary Storage Representative:
Time of Shipment (circle one) am/pm
/ /__
_________
Date of Receipt:
____________________________
Truck/Tractor Registration:
one)m/pm
~~~~Load
Size (cu. yds./tons):
/
Time of Receipt:
i(circle
Trailer Registration (if any):
Date of Shipment:
_________
jDate of Receipt:
*
/
one) am/pm
Load Size (cu. yds./tons):
IReceiving Facility/Temporary Storage Representative:
Time of Shipment (circle one) am/pm
Truck/Tractor Registration:
Time of Receipt:
_/_
_____________________________
LOAD
one) arm/pm
-
Receiving Facility/Temporary Storage Representative:
of Shipment (circle one) atm/pm
/
Time of Receipt:
I(circle
jLoad Size (cu. yds./tons):
Trailer Registration (if any):
* LOAD 3: Signature of Transporter Representative:
.
-
___
Date of Receipt:
_
__/___
Trailer Registration (if any):
Time of Receipt:
/__
I(circle
ILoad Size (cu. yds./tons):
_
one) am/pm
_________
LOAD 7: Signature of Transporter Representative.
Receiving Facility/Temporary Storage Representative:
Date of Shipment:
Date of Receipt:
Time of Shipment (circle one) am/pm
Truck/Tractor Registration:
Trailer Registration (if any):
_____________________________
Time of Receipt:
j(circle
one am/pm
Load Size (cu. yds./tons):
_________
J. 0G SHEET VOLUME INFORMATION:
A
~~~~~~~~~Total
Volume Thiis Page (cu.
II
yds./tons):
________________
Total Carried Forward (cu. yds./tons):
________________
~~~~~~~~~Total
Carried Forward
and This Page (cu. yds./tons):
________________
o
se
1i0rite/n1/yce9ppe3ag
dsJo
Ievi
This form is printed on recycled paper
Page
1o f i

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