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Transcription
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 l P'outnti Respnsible/ P'artiPR P/)~ & Prper' I Awner Site ootrmates LongitudeI Lattud Reter to Fi;tire I Aihol AMedical ClI/nit /467 /ain Streez, Athtol,\!tassaem>uts B / i Attn Jose Amprqaro Joep r Maltheni/ii Phione Numbear 978-2'49-9 736 I-ax XNmber: 9785-249- 94/4 42> 35 125"A 7! I2 .58Y 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 -J 0 I .2 .2 N .2 N N fl CO N :1 fl.2.2.2.2 Sn 00000 0 I - - -C r, C I* C C vv vvvv - vvvvvvvv - -__ _ __ _ _ _ _ _ -- C C,, 4) -vvv v v vv vv~ 00 CA 0) -o H addS oo 0 C- I r;n o 0 - vvv v v vvvvv - - g - 0000 C-s vv v -_ - -- 0000 0000 -- vv v v v a v 'A8 E Ef E E ot ~flIflfl 000-ON- 000000 .0 _____E_____ *0 U & S 8 *2t& 2 - U 4 I *0 C 0 ~u ri = (40 AU) <It 0-H 0- .1.1 ~ dU,U S 0 ZE- =42 42 0. = .S-.~ S U.0 U (flu 0. C22 too. -C 0- I 8m - Si x t z FIGURES 1. 2. 3. 4. 5. Site Loctis Map General Site Layout Plan MASS/GIS Map Soil Sampling Location Plan Conceptual Site Model Diagram CYN Environmental Services r z cJ 0 Cs Ce k/. ol 0I C 4- Cr N N trsaL / 7 Cs Cs - I Z C A -- N v 4-3 0 4-f 5>h C - C -Te N ~52-,- N K V - VV p / Cl C Ni C- (4 <a Nt (4 S Li, -c t 0 z 0) N @4 N \ \ \N 6> -J(tO L F K 0 V. @4 C U E U U - U 1 1 Cs Cs tr~ z Cs C C C x I C tC LN U S C. t N - c, < 2 - Q <C 2 CN 0 0 - C-, Li 0 - Ct C" C" C.,,, -c C c-c C.,-,'. c~t C C 4: 0 Uo a -- o - a en C HU U 2 4,--, N Uo <e 3 I E 40 - 6 -o- I o n O 00 In C z 4) I- Co 0 2 " - -l On ~ Cu ~~ - C) (A ~4 Ca- t9~ 0< ~ U C~ AM E-- o CJoO -, ZE~ CJ)z< -U. Cu - U In C) ~ 00 '1* GaO) u~.S ~ - r4 0~ CA .0 z .t to C-) F0 0V U ^^ 0) CA C, o E 0) 4) 6 .^ c '1~ 0 -- 5 . 2 2o 0 eN 6.) C 0< a 4).. 8I -4) I- 0 coO ON 3C 0 eN 0 - - - - - - - - - - - - - - A - - CaIn 0 U - 0 4)00 0 H CA Us 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 -C"" ~ 6 Z ~ C C cuZ~ ~ ~o< U N C.) U * p ~ -N ~ ~n - H 4) 4) C 4) 00~ 04 0 U, 0) Q - 4)0 - to V ~ (N 0.)** 04 eN I0 eN 0 0~ Mi 4) 4)', C 4, I -~ ES :0 *~ ~ ~0 I ~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 I, g-OBdS fr3~dS siAuewdig PeleuIioItJDKIod 0) - lUlOd 14621d k!A!1oeo~ :Jeq;~ S ~d 6i-i i3 P3 CD 0) a E CD (0 o .9 11fl1 'loalas a 02 (coLa) HdJ. :sia6rn± Hd8 'GUON IIfld 'josies 'euoj.j :siebie± HdA X~L8 SINHAlOS 1VIHISflONI (0 C) CD 0. :~3j S~2~9~AJ CD .~ S'~ 9 V~3~ dlOJ. sieie~j 9 Yd3~ 18101 C (0 ~v 8~ SINflAlOS O~1VNfti01H3 0 0 (±NrIAIno~ 30 Jo O9~9) SOQA 9 _____________________ 2 SJeu!eIUoO SS2~ J2919 # SJeu!e~Uo3 o!lSeId # I- 0) C S U __________ s~er sseio aeqw~ ~ a C-, SIB!A bOA IW-OV # 0) I- a 0) o 0) C 2 z0 Z Is N- - 0) r H a C _________ 0) - oII E (0 0 C CD 0) CD Nt I-N 0(9 w In a - 0 II a X 0 Cr- o r -- ..- -~ X n 0 C CD '- ~ t~c0) II r II _______ (DC 0 E _ -k II LOCON ao2~ 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 vdfjIaPflfl ,i#oojrni :JOLAMJX N, 'C iia N * T&D j006/006 I ______vtt~ N ZVI.ILII] NVOS 1-OidS a t'-32d9 %IAJOtIdIg PG18UU0ILJ~AI0d JLMOd LfSBd N N uslijo Qd 6w J3 PD 2~ Cv sv:dni SI81~VJ B VU3~i 6131 sje~arj ~ vuou rew± s I I I 'I IL 0 C _ 0 0. -~ Em 'U (0 o E 0 oil C 0 a, _ S I- .5 E 'U 0 COOLS) Hdl --- 'alsOON:~e Hd AC .= 02 0. 0 a. 'U lil 'U8:om ;Oe I-d O~1 a 0 (±N~1Inno3 09 Jo O9?6) ~OOA _ C, smiii~iuoo ssuj~i fob r ~ SSGUtWIUOO ~i~Id # S K sanj' sse~ .seqw~ U SI8~ VOA IUJ-OV Vt C, (3 "p w C C I'3 - K 0 .0 2 II a, z 0; aC, 0. I N)I a C 'U C S C) J II In (S 2 tm S C C., 0 z z * P IAI S Ii V .0 NE S a a- C~ -is 0 C C 0 K S C a. E 'C II p'1El. o N N a, S a, U, N p j C.- Cu / a S 03 S SE *1 CR N 4., a ho qt 'a z a I, A- 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 t I 0 U SfljOUSild IL(3 snsQwumJ- iiU ii 4a- 0 0 d 0 U, 'A 0 S r 4 I fj )tm)flflO~J A~opj (1 liz it -I - S VX~)1 Is Cd -1 ____________________________________________________________ - 0 0 00 dial AZ, pOAJOSSIG *1 z 'RIO' (sEI!mrj otj) sw~mj ANd LI HdH z (swmrJosyis~XnJA1vdkHaa i a (smuv ojuj StflSUOpIWVHdH U, I 2 S13 1B.L (surnv O1~Jj ~ ~ ~~11 AIM AMA XaAA AMA -- 7x------------ - Sq)SUOLUThlrJHdA )UlJdfl2UkJQ 01±1/300 0 ildI 2 ICA LI N Iii 7 *1 In ID Ij1g~ i a 0 4* a e ---- 4!MSUPII4JUM o I IA - - - OA1~'~S 'I C C) 0 C o U H' sz; ssqQ iaqu~ fi F-. 0 fr - - - - - - - - - - - -- 0, C 4 - SflUWlflO3 ~ '~L2 f~ Snululuos opsuId is SMAVOAIIThVt'# - - - VVTh7) - I z C 0 0 II a. - - *1 - uIdI'JL.JI'~j $ Cr, ~0 I U d U, U) 4, C K 0 U "Ii" I- II 'nj 4) Cs a Cl S 4) E 0 C,, r~i 01311 U; II Cl UhIii~ a 0) 00 PC 0 Ii U I t I C, I8t *1 I S I! C j5 Co cC II I -C' 7 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 a? .4 I 0 I. 'I Is S 1fl smsunued CI ent '9 r-9 o o d a I- 'I a 00~ P e 0 I a su DON s2eI Xe Ii I. A CA nud-EuMO Ind A3UU a A XO Hd -cain . 0 Sw 0 '4< K El U U U. B -4 oo sHU SWAVO seDAgUifl#y H I b z 0 0* a. II '0 C, 4h 'U UC I I,, C el N0 0 a a CA' A' Ii 4. In MI, II E 4) II C, 11 11 ~2 )4 ) A A N '3 6 V 4 08* 9) i-fl t LI -0~ I; i '8 3 bO cc EJE~ SW ~~1 ~uI Ejt ii 4- S U, ii PROXldaU& U II I U It U kP A, CA 0 en 'I) I -I S 'I 5 C- 5- 23V.-' V rK. I I 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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