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%(YearID):%(Description1) %(Description2) %(Description3) %(Description4)IES,INC. ENVIRONMENTAL CONSULTANTS 5 Middlesex Avenue • Suite 307 :Somerville, MA 02145 617-623-8880 • Fax: 617-629-2920 WWW.IESINC-ENVIRONMENTAL.COM '=-'IESINC'©AOL.'COte "" " ' July 3,f2009 Salem Fire Department Office of Fire Prevention 29 Fort Avenue Salem, MA 01970 To Whom It May Concern: 4.� . Melissa Randolph: ' Kevin'G'. Schwabe` FILEC Re: Environmental Site Assessment 92 North Street Salem. MA This letter is to request a freedom of information review, of Fire Prevention Office records relative to the above referenced address in'accordance with the provisions of the General Laws, Chapter 66, Section .10, Chapter `4S,_Section 7,' for the purpose of preparing a professional site assessment report in regard to M.G.L. Chapter 21E. ,f Please provide a listing of all permits issued -relative to underground and above ground storage of oil or hazardous materials for the above referenced address, as well we the following address ranges. 1� �`75-125North.Street, Salem; MA. 2. 50-100, Franklin Street, ,Salem, MA. 3. Mason Street at North Street; Salem,,MA • Enclosed is a $50.00 check to cover the cost of the review services. Thank you for your time and attention in this matter. If you have any questions, or need further information, please contact me at 617-776-1950. Respectfully, IES, In David Brincheiro Senior Hydrogeologist Connecticut: 72 Country View Drive • South Windsor, CT 06074 • (860) 724-1020 Florida: 433 Cerromar Lane • Venice, FL 34293 • (941) 493-7167 Maine: 7 Camp Road • West Newfield, ME 04095 • (207) 636-2034 Direct Dial Numbers David P. Borans: (617) 776-8549 Daniel G. Jaffe: (617) 776-2715 Kerry R. Asetta: (617) 776-0578 John Beck: (617) 623-9813 David Brincheiro: (617) 776-1950 Christopher D. Buchanan: (617) 623-5168 Mary Oliveira: (617) 776-4405 (617) 776-0829 (860) 724-4420 y4-3117 William F. Weld Governor Trudy S. Coxe Secretary, EOEA Thomas B. Powers Acting Commissioner Name of Permiftoc: Mailing Address: Contact Person: Telephone Number: ' 83 NORTH STREET - ——SALEM,-•NASSA-CHiJBET`31S 0197e DENNIS ALETTER (508) 745-7166 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Metro Boston/Northeast Regional Office RECYCLING PERMIT WERNER a S AUTO SALES , INC . Effective Date: /a - a f _ C74 Expiration Date: Class: A, LEVEL I Permit Number: NE-9 4 — 0 5 7 This is to certify that the above named company is authorized to manage regueecy materials pursuant to Regulation 310 CUR 30.200 and General Laws, Chapter 21 C. This permit authorizes recycling of the following materials onlic: Material Description WASTE OIL Description of Recycling Operations EPA Waste Code MA01 Amount 1,200 GAL/YR WASTE OIL TO BE BURNED FOR ENERGY RECOVERY IN A CLEAN ENERGY, INC., SPACE HEATER, MODEL NO. CB1400. Location of Recycling Operations WERNER'S AUTO SALES, INC. 83 NORTH STREET SALEM, MASSACHUSETTS 01970 MAV000017744 10 Commerce Way 0 Woburn, Massachusetts 01801 ® FAX (617) 932-7615 0 Telephone (617) 932-7600 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Metro Boston/Northeast Regional Office William F. Weld Governor Trudy S. Coxe Secretary, EOEA Thomas B. Powers Acting Commissioner Mr. Werner W. Aletter .:.rner's Auto Sales, Inc. 63 North Street Salem, Massachusetts 01970 Dear Ms. Aletter DEC 211994 RE: Recycling Permit NE-94-057 Transmittal #39085 Enclosed please find a Class A recycling permit issued to: Werner's Auto Sales, Inc. 83 North Street, Salem,_ Massachusetts which authorizes the management of regulated recyclable materials. This permit is issued pursuant to G.L. c. 21C and 310 CMR 30.200. Please read this document carefully as it stipulates the particular activity for which this permit is issued as well as the general and specific conditions governing that activity. Please note that all future correspondence should be directed to the Northeast Regional office of the Department of Environmental Protection. Should you have any questions concerning this matter, please contact Martha Bolis at (617) 932-7644. Very truly yours, Martha J. Bolls / Environmental Analyst ��/.mes E:' Bels y (Chief, Permit ing `Bureau of Wast Preve2ition JEB/mjb cc: DEP, Boston - Steve Bergstrom Fire Headquarters, 48 Lafayette St., Salem, MA 01970 Board of Health, 9 North Street, Salem, MA 01970 10 Commerce Way e Woburn; Massachusetts 01801 e FAX (617) 932-7615 e Telephone (617) 932-7600 GENERAL CONDITIONS OF RECYCLING PERMIT, 1. The permittee shall have all equipment installed in accordance with all applicable federal, state and local regulations. The equipment site must have proper fire and explosion protection features, must have proper ventilation and provide easy access to all significant parts of the equipment. 2. The permittee shall install, operate and maintain recycling equipment in accordance with all recommendations provided by the manufacturer. 3. Permittee shall not alter the recycling device. Permittee shall not allow materials to be introduced into the recycling device, other than those which have been specifically enumerated by the manufacturers or that would result in inadequate performance of the device. 5. The permittee shall satisfy all applicable conditions of 30.200. They include but are not limited to the following: a. Duty to Comply. The permittee shall comply at all times with the terms .and conditions of the permit, 310 CMR 30.000, MGL c. 21C, MGL c. 21E, and all other applicable state and federal statutes and.regulations. b. Duty to Maintain. The permittee' shall always properly operate and maintain all facilities, equipment, control systems, and vehicles which the permittee installs or uses. c. Duty to Halt or Reduce Activity. The permittee shall halt or reduce activity whenever necessary to maintain compliance with 310 CMR 30.200 or the permit conditions, or to prevent an actual or potential threat to public health, safety, or welfare, or the environment. d. Duty to Mitiaate. The permittee shall remedy and shall act to prevent all potential and actual adverse impacts to persons and the environment resulting from noncompliance with the terms and conditions of the permit. The permittee shall repair at his own expense all damages caused by such noncompliance. e.' Duty tb Provide Information.. The permittee shall General Conditions -Page 2- provide the Department, within a reasonable time, any information which the Department may request and which is deemed by the Department to be relevant in determining whether a cause exists to modify, revoke, or suspend a permit, or to determine whether the permittee is complying with the terms and conditions of the permit. f. Entries and Inspections. The permittee shall allow personnel or other authorized agents of the Department or authorized EPA representatives upon presentation of credentials or other documents as may be required by law, to: (1) Enter at all reasonable times any premises, public ---or private ---for- - the- --purposes - of investigating, sampling or inspecting any records, conditions, equipment, practice; or property relating to activities subject to MGL c. 21C, MGL c. 21E, or RCRA, as amended; and (2) Enter at any time such premises for the purpose of protecting the public health, safety or welfare, or the environment; and (3) Have access to and copy at all reasonable times all records that are required to be kept pursuant to the conditions of the permit, and all other records relevant to the permittee's hazardous waste activity or to the permittee's activity involving regulated recyclable material. g. Records. All records and copies of all applications, reports, and other documents required by 310 CMR 30.200 shall be kept by the permittee for at least three (3) years from the expiration of the permit. This period shall be automatically extended fcr the duration of any enforcement action. This period may be extended by order of the Department. All record -keeping shall be in compliance with 310 CMR 30.007. h. Continuincr Duty to Inform. The permittee shall have a continuing duty to immediately: (1) correct any incorrect facts in an application; and General Conditions -Page 3- (2) report or provide any omitted facts which should have been submitted; and (3) in advance, report to the Department each planned change in the permitted facility or activity which might result in noncompliance with 310 CMR 30.200 or with a term or condition of the permit; and (4) report to the Department any cessation of the permitted activity. 1. Preventing and Reporting Releases into the Environment. No materials that are to be recycled shall be --intentionally £ eleased---in-to--the-- environment — or otherwise disposed of within Massachusetts except in full compliance with all applicable provisions of 310 CMR 30.000 and c. 21C. All accidental releases of recyclable material shall be immediately reported to the Department and to all other persons to whom such releases must be reported pursuant to state or federal laws or regulations. j. Compliance with the Application and the Terms of the Permit. Except where 310 CMR 30.200 or other conditions of the permit provide otherwise, the materials that are to be recycled shall be recycled in the manner described in the application for the permit and in no other manner, and in compliance with all conditions of the permit. There shall be no change in the procedure of recycling without the prior express written approval of the Department. k. Transportation of Recyclable Material. Unless otherwise specified, all transportation of recyclable material, and preparation of all recyclable material for transportation, shall be in full compliance with U.S. Department of Transportation and other federal regulations, and all state regulations, governing the transportation of hazardous materials. 1. Annual Reporting. All permittees shall submit to the Department an annual report covering all recyclable material they handle. Each annual report shall be submitted to the Department no later than March 1 for the General Conditions -Page 4- preceding calendar year. The permittee shall use the form prescribed by the Department for Annual Reports submitted in compliance with 310 CMR 30.205(12). All annual reports shall include at least the following information. (1) The EPA identification number of the generator; and (2) The name, address, and EPA identification number of the facility to which recyclable material was sent; and (3) Identification of all recyclable material recycled at the site of generation. Such identification shall include the EPA listed name or description, the EPA hazardous waste number, the DOT hazard-C ass; -the" amount"of recyclable -material -- transported, and the facility to which it was transported; and (4) Identification of all recyclable material shipped to off -site facilities. Such identification shall include the EPA listed name or description, the EPA hazardous waste number, the DOT hazard class, the amount of recyclable material transported, and the facility to which it was transported; and (5) The name and EPA identification number of the transporters used. m. Dust Suppression and Road Treatment. The use of regulated recyclable material for dust suppression or road treatment is prohibited. The provisions set forth in 310 CMR 30.205(9) shall apply to such activity. n. Speculative Accumulation. Speculative accumulation is prohibited. The permittee shall make and keep records that will adequately demonstrate that there has occurred no speculative accumulation. Such records shall include, but not be limited to, the following: (1) records showing the amount of material being accumulated or stored at the beginning of the calendar year. (2) records showing the amount of material received or generated during the calendar year, and General Conditions -Page 5- (3) records showing the amount of materials being accumulated or stored'at the end of the calendar year. o. Personnel Training. The permittee shall instruct, or give on-the-job training to, personnel involved in any activity authorized by the permit, so that such instruction or on-the-job training teaches such personnel how to comply with the conditions of the permit and to carry out the authorized activity in a manner that is not hazardous to public health, safety or welfare, or the environment. p. Emergency Prevention and Response. The permittee shall plan and prepare for fires, explosions, or other occurrences that might result in release of oil or hazardous materials to the environment or otherwise constitute a potential hazard to public health, safety, or welfare, or the environment. Without limiting the generality of the foregoing, if the permit authorizes the operation of a recycling facility, the design and operation of the recycling facility shall be in compliance with the requirements set forth in 310 CMR 30.524 (1) . q. Storage and Accumulation in Tanks and Containers. Regulated recyclable materials shall be stored or accumulated only in tanks or containers. If the permittee stores or accumulates the regulated recyclable material in tanks, such tanks shall be in compliance with the requirements set forth or referred to in 310 CMR 30.692. If the permittee stores or accumulates the regulated recyclable material in containers, such containers shall be in compliance with the requirements set forth or referred to in 310 CMR 30.683 through 3,0.685. 6. All hazardous waste generated from recycling activities shall be subject to all applicable regulations including 310 CMR 30.000. 7. All residues or by-products of recycling will be considered hazardous waste unless demonstrated otherwise. General Conditions -Page 6- 8. Failure to comply shall be grounds for enforcement action including without limitation, permit suspension and revocation. 9. Within 6 months prior to the expiration of this permit, the permittee shall re -apply to the Department. In accordance with General Law Chapter 30A Section 13 re -application will allow the continued operation of the approved recycling activity until a new permit is issued or denied. Failure to re -apply will result in immediate suspension of all approved recycling activities on the expiration date of this permit. Z0 . --Ap15ea1TRiahfis - and Time Limits . "- This permit is ari action of the Department. If you are aggrieved by this action you may request an adjudicatory hearing. A request for a hearing must be made in writing within 21 days of the date on which the permittee receives the permit. 11. Contents of Hearina Reauest. Under 310 CMR 1.01(6)(b), the request must state clearly and concisely the facts which are the grounds for the request and the relief sought. Additionally, the request must state why the penult is not consistent with applicable laws and regulations. 12. Filinct Fee and Address. The hearing request along with a valid check payable to the Commonwealth of Massachusetts in the amount of $100 must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston, MA 02211 The request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. 13. Exemptions. The filing fee is not required if the appellant is a city or town (or municipal agency), county, or district of the Commonwealth of Massachusetts, or a municipal housing authority. General Conditions -page 7- 14. Waiver, The Department may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file, together with the hearing request as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship. SPECIAL CONDITIONS (1) The permittee is authorized to handle waste oil only under the provisions for a Class A Regulated Recyclable Material. The Department must be notified immediately of any changes or modifications in equipment type, material composition or amount, or operation of recycling equipment. (2) Each tank or container in which regulated recyclable material is being accumulated or stored and each outside container into which small containers are packed shall be clearly marked and labelled throughout the period of accumulation or storage in accordance with 310 CMR 30.206(1). (3) The permittee is authorized to burn waste oil only during the time period between September 2 through May 31. Waste oil may not be burned between June 1 and September 1. (4) All waste oil not burned in the space heater and Speculatively Accumulatd- must— be Handled as ds s —waste. Those materials exceeding the Speculative Accumulation requirements are no longer considered Regulated Recyclable Materials under this permit and must be handled as a hazardous waste. Shipment of waste oil to any facility for recycling requires prior authorization of this Department. Without prior authorization those materials must be handled as hazardous waste pursuant to 310 CMR 30.000 and therefore are no longer considered Regulated Recyclable Materials under this permit. (5) (6) Please note that the Department reserves the right to revoke or suspend this permit if the above special conditions are not met. THIS PERMIT AUTHORIZES ONLY THE NAMED PERMITTEE TO ENGAGE IN THE ACTIVITIES DESCRIBED ABOVE. THIS PERMIT DOES NOT GRANT ANY RIGHTS NOT OTHERWISE GRANTED BY FEDERAL, STATE OR LOCAL STATUTES, ORDINANCES, OR REGULATIONS. THE PERMITTEE SHALL COMPLY AT ALL TIMES WITH ALL STATE AND FEDERAL REGULATIONS AND STATUTES APPLICABLE TO THE MANAGEMENT OF REGULATED RECYCLABLE MATERIALS. Janes E. Belsky Date L' Chief of Permitt g hireau of Waste P ven '`ion • 527 CMR: BOARD OF FIRE PREVENTION REGULATIONS 4.03: continued The Commonwealth of Massachusetts Department of Public Safety 527 CMR 4.00 - Form 1 Application for Permit, Permit, and Certificate of completion for the Installation or Alteration of Fuel Oil Burning Equipment and the Storage of Fuel Oil SALEM /'3 // /ic, (City or Town) (Date) #5cya11 Permit #'s: FD I,? C? 2 Elec. FDID#: U 92.5- 8 Fee Paid: /0 Owner/Occupant Name: frt✓ A/-e/f'S .¢i/o 54fle 5 Tel #: 17 e.N H 15 A-c- elle -- _ Installation Address: 1 Snrr Ti,, ,J s� n7'., 5 #- Serviced Floor or Unit #: . % L It/Heating Unit ❑ Domestic Water Heater ❑ Power Vent ❑ Other Burner: trZNew ❑ Existing Location: Trade Name: C- , f' «/ Ae Mfg: C / P .1-Aszf3Gt0'(/V G.lS ofOD Type: /-t%i ( 4' Model # or Size: C �t 0-D75----0Nozzle Size: f • D 4/0/4 ❑ Fuel Oil 0 Kerosene )(Waste oil Storage Tank: Jr New ❑ Existing Location: Type: S -Le Capacity: / r gals. No. of Tanks: 1 Special requirement (or additional safety devices) ❑OSV Valve ❑Oil line protected •❑Sheet Rock ❑Sprinkler AFUE: Oyes Ono EF: Dyes Ono (Furnace and boilers) (Water heater) Co. Name:,.' I/1 irl /✓4-t-Y .liV C) Tel # 6-3 / °'i 59 Address: P O. 604Z- 1/G "/ City: f� - fre 7) t( tilr¢- Zip: 0/q40" 4'7 7 Completion Date: a Combustion Test: Gross Stack Temp.: k.Jr -)C-1 t- Net Stack Temp.: /D � CO2 Test: `/7 Z Breech Draft: a a,1 . Smoke: / Overfire Draft: Efficiency rating %: 8 2 1. the undersigned certify that the installation of fuel burning equipment has been made in accordance with M.G.L. c. 148 and 527 CMR 4.00 currently in effect. Furthermore. this mstallauon has been tested in accordance with such requirements, is now in proper operating condition and complete uutrucuoas as to its use and mamtenance have been furnished to the person for whom the installation (or alteration) was made. Installer: {2i 14/1M -+t r�/YC7 Print Name Address: J 0- ! ' gtri /O Lei Cert ofC# 42. Signature (no Stamp) City: ttlifvi) . a/9 Once signed by the fire department, this is a PERMIT for the storag and use of oil burning equipment. Approved by: &I lh Date: Keep Ongrnal as application. Issue duplicate as permit. This form may be photocopied.. 4 .1• 12/15/95 527 CMR - 45 FORM #90140 (7/91) CHECK ONE OF THE FOLLOWING: CITY OF SALEM FIRE DEPARTMENT - FIRE PREVENTION BUREAU 48 Lafayette St., Salem, Massachusetts 01970 APPLICATI[ N F S PE To: HEAD OF FIRE DEPARTMENT FEE DUE $10.00 CK# c02`i CASH 3//a 199G Mato) MIT In accordance with the provisions of Chapter 148, G. L. as provided in Sec., application is hereby made for permission to install a WASTE OTL RETENTTON P I'Tr.TTV in accordance with 527CMR9.27, 9.28. 9.29. N 1- Permanent Storac_0 aside a Building= 2- Permanent Storage Inside a Building= l/ 3__,.p1 hm Si-nrago Tnci rla a Riii 1 ai ntt= 4- Automotive Lubrication Service Center= Name: I/li-.0444-V-e->;29 47to 5, AddrtoSs: (Glue location by stroet gad no., or describe lrs snob a manner as to provi a adoquate idantlfioation of location) Date issued - Date of expiration ti foal osc leo % 28 , ' "4" "-• ..,.DEPARTMENT,'Of4 1/3.•A DA.0478: ' ONE AShBURTONPilACE', RO'1301. I• •BOSTON,tf../V'.02108L•1618. AUG 2-31995 • ‹. OII4-aURNER TECHNICIAN CERTIFICATE Nuiiibep: Expires: -. Birthdat BU t. -020077 09/07/1997 09/07/1943 Restricted To:00 NORMAN.: BURNETT PO BOX 409 PEABODY, MA 01960 -,-- - kep top for receipt and change -E74•6.-r address notification. .1.44 ealitM011Weaa .oadeldeerd - DEPARTMENT OF PUBLIC SAFETY OIL BURNER TECBNICIAN CERTIFICATE _ Number: • • Expires : Birthdate: BU 020077 09/07/1997 09/07/1943 Restricted:To: 00 LL.3m b. Saft.0 COMMISSIONER NORMAN S BURNETT 00 BOX 409 PEABODY, NA 01960 V;:tt 4AeAch•bottom,- fold-, sign on ' 774' back, and laminate license caid. Restricted To: 00 00 - None 10 - Gravity feed - 15 - 1 & 2 Oil 10478 FORM 24 POWER BURNERS Date December 28,1977 Name Salem Paint Co .Inc Location 75 North St No. of Tanks 1 Name of Burner Gals. Stored Texac o Co Mass. Approval No. 969 Kind of Heat Location of Tank Outside Rear B1dg<Kind of Oil #2 Installed by StephenC Slawnwhite C. of C. # 14890 D .0 .Sosnowski Inspected by Date Approved 12-24�77 Form 24 Date Power Burners January 22.19 .1 Name Werner Ale tter Location 83..85 V orti^ St No. of Tanks a_ Name of Burner Kroll W .O .Heater Mass. Approval No. W .0 . .4.2 Unit Atta.cIed tank H.A. Gals. Stored 6 Gals CaD . Kind of Heat Waste 041 Location of Tank Boiler Room ' Enc , Kind of Oil Waste 0w1 Installed by Pe ter Hrub`s . C. of C. # 161127 Inspected by R .Dansreau Date Approved 01-22-81 Form 24 Power Burners Date 12-23-82 Name Werner Ale tter Location 83 North St Name of Burner Gals. Stored 55 Location of Tank Garage P Installed by Peter Hrubis Inspected by R .Dansre a u FORM 24 Lanair No. of Tanks 1 W .0 .1-T . A . Mass. Approval No. 7A H .A .Waste Oil Kind of Heat Kind of Oil Waste Oil C. of C. 16427 # Date Approved 12-22-82 POWER BURNERS Date Sept. 9, 1972 Name Werner Auto Seriice 1,Tor t h St re e t Location Name of Burner No. of Tanks °1-3-r American Standar6.. -mass. Approval No. Gals. Stored 2:100 Out s i de, 1dcr Location of Tank Ci°11e're t.e Shed. use® riooert Li -ravel. Installed by JeCs Oil co. Inspected by ADC Go in Kind of Heat Kind of of Oil 7/2 C. of C. # 121003 Date Approved 21/c)/72 IMMEDIATE RESPONSE ACTION PLAN MODIFICATION CITGO SERVICE STATION 105 NORTH STREET SALEM, MASSACHUSETTS, 01970 RTN # 3-19632 AND 3-20329 May 14, 2002 Prepared f Shehab Real Estate Trust Route 114 Citgo 105 North Street Salem, Massachusetts 01970 Prep: red by: Global. BioSciences, Inc. 91 George Leven Drive North Attleborough, MA 02760 91 George Leven Drive, North Attteborough, Massachusetts 02760 • Tel (508) 643-7122 August 22, 2002 Lt. Charles Latulippe Fire Prevention Bureau Salem Fire Department 29 Fort Avenue Salem, MA 01970 RE: Application for Permit to Store Butane 105 North Street Salem, Massachusetts, 01970 Dear Lt. Latulippe: The attached approved Immediate Response Action Plan Modification (IRA) for the Route 114 Citgo Station at 105 North Street in Salem, Massachusetts is submitted to you in support of the application for a permit required to store butane on -site. Our process, which is discussed in the IRA, uses butane gas in its process and would require that we maintain two 28.5-gallon butane cylinders on -site. Also included is an example of a completed application that has been approved and is in effect at a site in Canton, Massachusetts where our process was used to remediate petroleum contamination. If you have any questions, please call me at (508) 643-7122. Sincerely, ,c) George A. DiCesare Vice President of Operations 91 George Leven Drive, North Attleborough, Massachusetts 02760 e Tel (508) 643-7122 May 14, 2002 Ms. Jennifer Wang Department of Environmental Protection - NERO 205A Lowell Street Wilmington, Massachusetts 01887 Re: IRA Plan Modification Route 114 Citgo Service Station (the Site) 105 North Street and 2 Mason Street Salem, Massachusetts Release Tracking Numbers 3-19632 and 3-20329 Dear Ms. Wang: Global Biosciences, Inc. (GB1) of North Attleborough, Massachusetts has prepared the attached Immediate Response Action (IRA) Plan Modification and IRA Transmittal Form (BWSC-105) on behalf of Shehab Real Estate Trust for the above referenced Site. This IRA Plan Modification identifies proposed modifications to ongoing response actions at the Site. This Report has been prepared in accordance with the provisions of the Massachusetts Contingency Plan (MCP) 310 CMR 40.0000. The IRA Plan Modification addresses the implementation of Butane Biostimulation Technologiesrm to remediate contaminated groundwater and soil source areas at the Site for further abatement of potential source of volatile organic compounds previously detected in the basement of the adjacent house located at 2 Mason Street. Please call me if you have any questions. Very truly yours, Felix A. Perriello, CHMM, CPG, LSP President and CEO CC: Mr. Mohamed Shehab Shehab Real Estate Trust Route 114 Citgo 105 North Street Salem, Massachusetts 01970 TABLE OF CONTENTS 1.0 INTRODUCTION 1 2.0 SITE BACKGROUND 1 3.0 DESCRIPTION OF IRA ACTIVITIES 2 4.0 IRA PLAN MODIFICATION 2 4.1 Process Overview 2 4.2 Butane and Air Injection 3 4.3 Biofeasibility Study 3 4.4 Butane and Air Injection Well Construction and Operation 5 4.5 Environmental Monitoring Plan 5 4.5.1 System Operation Monitoring 5 4.5.2 Groundwater Quality Monitoring 6 4.5.3 General Provision for the Management of Remedial Additives 6 4.6 Implementation Schedule 6 4.7 Permits 7 4.8 Reporting 7 5.0 FURTHER INFORMATION7 LIST OF FIGURES Figure 1 Locus Map Figure 2 Site Plan Map APPENDICES Appendix 1 April 2001 IRA Plan -Addendum Appendix 2 Statement of Limitations and Conditions Appendix 3 DEP IRA Transmittal Form (BWSC-105) Global BioSciences, Inc. 1 IMMEDIATE RESPONSE ACTION PLAN MODIFICATION CITGO SERVICE STATION 105 NORTH STREET SALEM, MASSACHUSETTS, 01970 RTN # 3-19632 AND 3-20329 1.0 Introduction This Immediate Response Action (I A) Plan Modification has been prepared by Global Biosciences, Inc. (GBI) _ on behalf of Shehab Real Estate Trust to document the proposed implementation of Butane Biostimulation TechnologiesTM to control gasoline vapors in soil gas and remediate soil and groundwater contamination source areas at the Site. The Site is identified by the Massachusetts Department of Environmental Protection (DEP) as Release Tracking Numbers (RTN) # 3-19632 AND 3-20329. The party conducting this response action is: Mr. Mohamed Shehab Shehab Real Estate Trust Route 114 Citgo 105 North Street Salem, Massachusetts 01970 GBI will oversee implementation of the IRA. The principal contact at GBI is: Felix A. Perriello, CHMM, CPG, LSP 91 George Leven Drive North Attleborough, Massachusetts 02760 Telephone No.: (508) 643-7122 2.0 Site Background The Site includes the Citgo Service Station located at 105 North Street Salem and residential , property at 2 Mason Street. A Site Locus Plan is included as Figure 1 and a Site Plan is included as Figure 2 of this report. This plan contains proposed modifications for the ongoing IRA activities in response to a release identified and reported to the Department of Environmental Protection in June 2000. The IRA Plan was last amended in April 2001 (see IRA Plan -Addendum prepared by Lincoln Environmental included in Appendix 1). IRA actions at the Site have included repair of a leaking fuel delivery line, indoor air monitoring and basement foundation sealing at 2 Mason Street, installation of one soil vapor extraction well and an extraction and off -gas treatment system designed to intercept gasoline vapors between the source area and the house at 2 Mason Street. Investigations at the Site have included soil gas, soil, and groundwater contamination assessments. A detailed description of past response actions, a site description and background information is included in the attached April 2001 IRA Plan -Addendum (Appendix 1). Sovereign Consulting Inc. 9 Research Drive, Suite 2 Amherst, MA 01002 -2775 Telephone: (413) 253 -2100 Fax: (413) 253 -160 4 LETTER OF TRANSMITTAL From: Leni-Sarah Boucher Date: 11/28/06 Attn: Chief David W. Cody Company: City of Salem Fire Department Address: 48 Lafayette Street Salem, MA 01970 Project: Former Shell -branded Service Station, 111 North Street, Salem, MA No. Date Description Instructions 1 11/26/06 Immediate Response Action Plan / Underground Storage As Requested Tank Closure Report Review and Comment Your Information Approval Signature Return X Your Files Other Comments: F Dear Chief Cody, In accordance with the Commonwealth of Massachusetts Underground Storage Tank Closure Assessment Manual (Massachusetts Department of Environmental Protection Policy #WSC-402-96), and in accordance with the Massachusetts Fire Prevention Regulations (527 CMR 9.00), underground storage tank closure activities were conducted at the Site between September 25 and October 3, 2006. A summary of the activities conducted are presented in the enclosed document. Please do not hesitate to contact the undersigned if you have any questions on the enclosed. Signature: Title: %cur& ect Manager November 26, 2006 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup 205B Lowell Street Wilmington, Massachusetts 01887 Re: Immediate Response Action Plan / Underground Storage Tank Closure Report Fowler Shell -Branded Service Station No. 137838 111 North Street, Salem, Massachusetts RTN 3-26256 To whom it may concern: On behalf of Motiva Enterprises LLC (Motiva) and in accordance with the Massachusetts Contingency Plan (MCP) 310 CMR 40.0000, Sovereign Consulting Inc. (Sovereign) has prepared this Immediate Response Action (IRA) Plan/Underground Storage Tank Closure Report for the above -referenced location. IRA Transmittal Form BWSC-105 accompanies this document, as well as Release Notification Form BWSC-103. If you have any questions regarding this submittal, please feel free to contact either of the undersigned at (413) 253-2100, or Mr. David B. Weeks of Motiva at (845) 462-5225. Sincerely, SOVEREIGN CONSULTING INC. i-Sarah Boucher Project Manager cc: Mr. David B. Weeks, PE - Motiva Enterprises LLC P. I.ProjectslSOPUSISaIem MA -11I North StlReportsURA FolderURA Plan 11-06.doc sek, Ph.D., LSP anager 9 Research Drive, Suite 2 • Amherst, MA 01002-2774 • Tel: 413-253-2100 • Fax: 413-253-1604 Massachusetts Department of Environmental Protection Trans. ction Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: LSBOUCHER Transaction ID: 99580 Document: BWSC Release Notification & Retraction Form 103 Size of File: 111.332 K Status of Transaction: SUBMITTED Date and Time Created: 11/27/2006::3:12:19 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC103 RELEASE NOTIFICATION & NOTIFICATION Release Tracking Number RETRACTION FORM 3 - '26256 Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C) A. RELEASE OR THREAT OF RELEASE LOCATION: 1. Release Name/Location Aid: iGASOLINE STATION 111 NORTH ST 2. Street Address: 3. CitylTown: jLSALEM __. _._..__-_-__...____....-___..... ._.._..__,_ _ .._.___.__.' 4. ZIP Code: 5. UTM Coordinates: a. UTM N: 47°9759 b. UTM E: 1343795 B. THIS FORM IS BEING USED TO: (check one) L✓i 1. Submit a Release Notification j 2. Submit a Revised Release Notification f i 3. Submit a Retraction of a Previously Reported Notification of a release or threat of release including supporting documentation required pursuant to 310 CMR 40.0335 (Section C is not required) (All sections of this transmittal form must be filled out unless otherwise noted above) C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE (TORT: 19/26/2006 — 1. Date and time of Oral Notification, if applicable: _ Time: mm/dd/yyyy 2. Date and time you obtained knowledge of the Release or TOR: i9/26/2006 Time: mm/dd/yyyy iw 1 3. Date and time release or TOR occurred, if known: Time: mmlddlyyyy Check all Notification Thresholds that apply to the Release or Threat of Release: (for more information see 310 CMR 40.0310 - 40.0315) 4. 2 HOUR REPORTING CONDITIONS a. Sudden Release b. Threat of Sudden Release c. Oil Sheen on Surface Water d. Poses Imminent Hazard e. Could Pose Imminent Hazard f. Release Detected in Private Well g. Release to Storm Drain h. Sanitary Sewer Release (Imminent Hazard Only) 5. 72 HOUR REPORTING CONDITIONS a. Subsurface Non -Aqueous Phase Liquid (NAPL) Equal to or Greater than 1/2 Inch b. Underground Storage Tank ._✓_J (UST) Release c. Threat of UST Release d. Release to Groundwater near Water Supply e. Release to Groundwater near School or Residence f. Substantial Release Migration 101.45 hh:mm hh:mm ii3 PM a ✓ PM 7 j AM ; PM hh:mm 6. 120 DAY REPORTING CONDITIONS a. Release of Hazardous Material(s) to Soil or Groundwater Exceeding Reportable Concentration(s) b. Release of Oil to Soil Exceeding Reportable Concentration(s) and Affecting More than 2 Cubic Yards c. Release of Oil to Groundwater Exceeding Reportable Concentration(s) d. Subsurface Non -Aqueous 3 Phase Liquid (NAPL) Equal to or Greater than 1/8 Inch and Less than 1/2 inch Revised: 02/10/2006 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup RELEASE NOTIFICATION & NOTIFICATION RETRACTION FORM Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C) C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE (TOR): (cont) 7. List below the Oils (0) or Hazardous Materials (HM) that exceed their Reportable Concentration (RC) or Reportable Quantity (RQ) by the greatest amount. BWSC103 Release Tracking Number 3 - `26256 0 or HM Released iPID READING CAS Number, 0 or HM Amount or Units RCs Exceeded, if if known Concentration Applicable (RCS-1, RCS-2, RCGW-1, RCGW-2) i®_._..._._.206 .,�___..._._.. { IPPM Ii ►�_�_ I j 8. Check here if a list of additional Oil and Hazardous Materials subject to reporting is attached. D. PERSON REQUIRED TO NOTIFY: 1. Check all that apply: _-1 a. change in contact name El b. change of address 2. Name of Organization: MOTIVA ENTERPRISES LLC 3. Contact First Name: IL)AVID 5. Street IPaMB 301 1830 SOUTH RD UNIT 24 7. City/Town: 1WAPPINGERS FALLS 10. Telephone: !8454625225 4. Last Name: (WEEKS 6. Title:l I (OWNER 8. State: ! NY 11. Ext.: i 12. -FAX: c. change in the person notifying 9. ZIP Code: 12590-0000 13. Check here if attaching names and addresses of owners of properties affected by the Release or Threat of Release, • other than an owner who is submitting this Release Notification (required). E. RELATIONSHIP OF PERSON TO RELEASE OR THREAT OF RELEASE: A 1. RP or PRP a. Owner b. Operator c. Generator »d. Transporter n e. Other RP or PRP Specify: PRP GENERIC OR NON -SPECIFIED 2. Fiduciary, Secured Lender or Municipality with Exempt Status (as defined by M.G.L. c. 21E, s. 2) 3. 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 Otherwise Required to Notify Specify Relationship: Revised: 02/10/2006 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup RELEASE NOTIFICATION & NOTIFICATION RETRACTION FORM Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C) BWSC103 Release Tracking Number 13 - 12625.6.. _ .... . F. CERTIFICATION OF PERSON REQUIRED TO NOTIFY: 1. IDAVID WEEKS I , attest under the pains and penalties of perjury (i) that 1 have personally examined and am familiar with the information contained in this submittal, including any and all documents accompanying this transmittal form, (ii) that, based on my inquiry of 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. I/the person or entity on whose behalf this submittal is made am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false, inaccurate, or incomplete information. 2. By: 1DAVID WEEKS 3. Title: [OWNER ^_. .__ -.._--- Signature 4. For: ;MOTIVA ENTERPRISES LLC (Name of person or entity recorded in Section D) 5. Date:1 1/27/2006 mm/dd/yyyy 6. Check here if the address of the person providing certification is different from address recorded in Section D. 7. Street: 8. City/Town: 9. State: 10. ZIP Code: 11. Telephone: 12. Ext.: 13. FAX: YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER BILLABLE YEAR FOR THIS DISPOSAL SITE. 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 DEADLINE. Date Stamp (DEP USE ONLY:) Received by DEP on 11/27/2006 3:09:29 PM Revised: 02/10/2006 Page 3 of 3 Massachusetts Department of Environmental Protection i rans opy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: LSBOUCHER Transaction ID: 102670 Document: BWSC 105 IRA Size of File: 140.477 K Status of Transaction: SUBMITTED Date and Time Created: 11127/2006::3:13:36 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. 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) A. RELEASE OR THREAT OF RELEASE LOCATION: {GASOLINE STATION 1. Release Name/Location Aid: 2. Street Address: 1111 NORTH ST .- 3. City/Town: !SALEM 4. ZIP Code: _ ..... _�—_ � -_-_—�- 5. UTM Coordinates: a. UTM N: 4709759 _ ,___..m b. UTM E: [343795 y 6. Check here if a Tier Classification Submittal has been provided to DEP for this disposal site. a. Tier IA I I b. Tier IB U c. Tier IC (n d. Tier It L..J {I BWSCI 05 Release Tracking Number 3 ' - 26256 7. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.0110-0114. Specify Program (check one): n a. CERCLA I I b. HSWA Corrective Action n c. Solid Waste Management d. RCRA State Program (21C Facilities) B. THIS FORM IS BEING USED TO: (check all that apply) 1. List Submittal Date of Initial IRA Written Plan (if previously submitted): ✓I, 2. Submit an Initial IRA Plan. 3. Submit a Modified IRA Plan of a previously submitted written IRA Plan. €_µ7 4. Submit an Imminent Hazard Evaluation. (check one) a. An Imminent Hazard exists in connection with this Release or Threat of Release. b. An Imminent Hazard does not exist in connection with this Release or Threat of Release. (mm/dd/yyyy) n c. It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release, and further assessment activities will be undertaken. n d. 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. 5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent L-1 Hazard . 6. Submit an IRA Status Report. 7. Submit a Remedial Monitoring Report. (This report can only be submitted through eDEP.) a. Type of Report: (check one) i. Initial Report fn ii. Interim Report fn iii. Final Report b. Frequency of Submittal: (check all that apply) n i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard. (n ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration. n iii. A Remedial Monitoring Report(s) submitted concurrent with a IRA Status Report. c. Number of Remedial Systems and/or Monitoring Programs: A separate BWSC105A, IRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Program addressed by this transmittal form. Revised: 2/9/2005 Page 1 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) B. THIS FORM 1S BEING USED TO (cont.): (check all that apply) 8. Submit an IRA Completion Statement. BWSC105 Release Tracking Number ! 3 ; - 26256 a. Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as part of the Response Actions planned or ongoing at a Site that has already been Tier Classified under a I 1 different Release Tracking Number (RTN) . When linking RTNs, rescoring via the NRS is required if there is a 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): LJ - These additional response actions must 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. 9. Submit a Revised IRA Completion Statement. (All sections of this transmittal form must be filled out unless otherwise noted above) 1 C. RELEASE OR THREAT OF RELEASE CONDITIONS THAT WARRANT IRA: 1. Identify Media Impacted and Receptors Affected: (check all that apply) 1 0 a. Air ri b. Basement 71 c. Critical Exposure Pathway ! _1 d. Groundwater e. Residence li f. Paved Surface E _ I g. Private Well D h. Public Water Supply 0. i. School 0 j. Sediments k. Soil r I. Storm Drain q. Others Specify: m. Surface Water r n. Unknown _..! o. Wetland ; . p. Zone 2 2. Identify Oils and Hazardous Materials Released: (check all that apply) ✓{ a. Oils 111 b. Chlorinated Solvents L d. Others Specify: c. Heavy Metals D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply, for volumes list cumulative amounts) 1. Assessment and/or Monitoring Only 3. Deployment of Absorbent or Containment Materials 5. Structure Venting System 7. Product or NAPL Recovery 9. Groundwater Treatment Systems 11. Bioremediation ri 2. Temporary Covers or Caps 4. Temporary Water Supplies r 6. Temporary Evacuation or Relocation of Residents H 8. Fencing and Sign Posting 10. Soil Vapor Extraction 12. Air Sparging Revised: 2/9/2005 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) .3 1 - 26256 BWSC1 05 Release Tracking Number D. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply, for volumes list cumulative amounts) ✓ 13. Excavation of Contaminated Soils I+ f a. Re -use, Recycling or Treatment iia. Receiving Facility: iib. Receiving Facility: iii. Describe: b. Store iia. Receiving Facility: iib. Receiving Facility: n c. Landfill Receiving Facility: MTS n i. On Site Estimated volume in cubic yards ✓I n ii. Off Site Estimated volume in cubic yards 600 Town: CHICHESTER State: NH Town: State: i. On Site Estimated volume in cubic yards ii. Off Site Estimated volume in cubic yards Town: Town: State: State: n i. Cover Estimated volume in cubic yards Town: State: 11 Receiving Facility: I I 14. Removal of Drums, Tanks or Containers: a. Describe Quantity and Amount: ii. Disposal Estimated volume in cubic yards Town: State: b. Receiving Facility: Town: State: c. Receiving Facility: Town: State: 15. Removal of Other Contaminated Media: a. Specify Type and Volume: b. Receiving Facility: C. Receiving Facility: 16. Other Response Actions: Describe: i 17. Use of Innovative Technologies: Describe: Town: State: Town: State: Revised: 2/9/2005 Page 3 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) BWS C 105 Release Tracking Number - 26256 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 in accordance with the applicable provisions of M.G.L. c. 21 E and 310 CMR 40.0000, (ii) is(are) appropriate and reasonable to accomplish the purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000 and (iii) complies(y) with the identified provisions of all orders, permits, and approvals identified in this submittal; > if Section B of this form indicates that an Imminent Hazard Evaluation is being submitted, this Imminent Hazard Evaluation was developed in accordance with the applicable provisions of M.G.L. c. 21 E 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 Action Status Report and/or a Remedial Monitoring Report is(are) being submitted, the response action(s) that is (are) the subject of this submittal (i) is (are) being 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. 21 E and 310 CMR 40.0000 and (iii) comply(ies) with the identified provisions of all orders, permits, and approvals identified in this submittal; > if Section B of this form indicates that an Immediate Response Action Completion Statement or a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard is being submitted, 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. 21 E and 310 CMR 40.0000 and (iii) comply(ies) with the identified provisions of all orders, permits, and approvals identified in this submittal. I am 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 #: (5428 2. First Name: {JOHN P !4132530048 4. Telephone: 5. Ext.: 7. Signature: JOHN P JEMSEK 8. Date: 11/27/2006 (mm/dd/yyyy) 3. Last Name: }JEMSEK 6. FAX: ... _._. 9. LSP Stamp: Revised: 2/9/2005 Page 4 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) F. PERSON UNDERTAKING IRA: a. change in contact name ! I b. change of address 1. Check all that apply: 2. Name of Organization: aMOTIVA ENTERPRISES LLC 3. Contact First Name: iDAVID 5. Street: {PMB 301 1830 SOUTH RD UNIT 24 1 6. Title:,OWNER 7. CitylTown: IWAPPINGERS FALLS- - 10. Telephone• 18454625225 11. Ext.: I G 8. State: 1 (' NY E 12. FAX: G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA: BWSC105 Release Tracking Number 3 ( - 26256 c. change in the person undertaking response actions 4. Last Name: L,iWEEKS 9. ZIP Code: 112590-0000 171 1. RP or PRP n a. Owner b. Operator n c. Generator d. Transporter 0 e. Other RP or PRP Specify: PRP GENERIC OR NON -SPECIFIED 2. Fiduciary, Secured Lender or Municipality with Exempt Status (as defined by M.G.L. c. 21E, s. 2) Li 3. Agency or Public Utility on a Right of Way (as defined by M.G.L. c. 21 E, s. 5(j)) k j 4. Any Other Person Undertaking IRA Specify Relationship: H. REQUIRED ATTACHMENT AND SUBMITTALS: 1. Check here if any Remediation Waste, generated as a result of this IRA, will be stored, treated, managed, recycled or 1 reused 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. n a. A Release Abatement Measure (RAM) Plan (BWSC106) , ( b. Phase IV Remedy Implementation Plan (BWSC108) 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 were notified of the implementation 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 were 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: 2/9/2005 Page 5 of 6 December 8, 2004 Mayor Stanley J. Usovicz, Jr. City of Salem 2 Botts Court Salem, Massachusetts 01970 91 George Leven Drive, North Attleborough, Massachuse . 60 a Tie 643- 8A OF SALEM NtAYOR t AYY 'S3 OFFtCl . Re: Phase IV — Final Inspection Report and Completion Statement Route 114 Citgo Service Station (the Site) 105 North Street and 2 Mason Street Salem, Massachusetts RTNs 3-19632 & 3-20329 Dear Mayor Usovicz: A Phase IV — Final Inspection Report and Completion Statement (Phase IV) has been submitted to the Massachusetts Department of Environmental Protection (DEP), Northeast Region Office, located at One Winter Street in Boston, Massachusetts, for the above referenced Site. All Site documents are available for review at the DEP office under Release Tracking Number (RTN) 3-19632 and 3-20329. If you have any questions regarding this notification, or the Phase IV report, please call me. Very truly yours, Felix A. Perriello, CHMM, CPG, LSP President & CEO C:l(MJFP\Citgo_Salem\PN rpa ma',uoedd - g pia ��jj # sae la eAianu�YZPiref,-o/c e C� 26ve.ced, e�recuCriue �j af9u c CJ150/- 9,19°-'—Re a 7 po17VancMce iti' Notification for Storage Tanks Regulated Under 527 CMR 9.00 Forward completed form, signed by local fire department, to: Mass. UST Program, Dept. of Fire Services, P.O. Box 1025 - State Road, Stow, MA 01775 Use Form FP-290R to notify of tank removals or closures in place. Telephone (978) 567-3710 (Fire Department retains one copy of FP-290) A. New Facility (see instructions, #1) Ei B. Amended g C. Renewal INSTRUCTIONS: Form FP-290 (Notification tor Aboveground and Underground Storage Tanks) is to be completed for each location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. If more than five tanks are owned at this location. photocopy the following pages and staple continuation sheets to the form. The FP-290 must be completed in duplicate. Although the form may be photocopied, the facility owner or owner's representative must sign each copy separately; photocopied signatures are not sufficient. Both copies of the FP-290 are to be forwarded to the local fire department, who will check all information and certify the forms. The fire department will retain one copy of the FP-290 for its records, and the facility owner shall be responsible for forwarding the other copy to the Dept. of Fire Services at the addres_ above. The local fire department will issue the permit portion of the FP-290; however, registration is not complete until the FP-290 is received and checked by the UST Regulatory Compliance Unit. All questions on this form are to be answered. Incomplete forms will be returned. 1 'New Facility" means a tank or tanks located at a site where tanks have not been previously located. 2-Facility street address" must include both a street number and a street name. Post office box numbers are not acceptable, and will cause a registration to be returned. If geographic location of facility is not provided, please indicate distance and direction from closest intersection, e.g., (facility at 199 North Street is located) 400 yards southeast of Commons Road (intersection). Notification Required Fire Prevention Form FP-290 is to be used as Notification, Registration, and Permit for aboveground and underground storage tanks and tank facilities regulated under 527 Code of Massachusetts Regulations 9.00. No regulated aboveground or underground storage tank facility shall be installed, maintained, replaced, substantially modified or removed without a permit (FP- 290) issued by the head of the local fire department. The owner of any storage facility shall within seven working days notify the head of the local fire department and the Dept. of Fire Services of any change in thename, address, or telephone number of the owner or operator of a storage facility subject to regulation by Chapter 148, Mass. General Law and by 527 CMR 9.00. Underground Storage Tanks Each owner of an underground tank first put into operation on or after Jan. 1, 1991, shall, within thirty days after the tank is first put into operation, notify the Department of Fire Services (the department) of the existence of such tank, specifying, to the extent known, the owner of the tank, date of installation, capacity, type, location, and uses of such tank. By no later than Jan. 31, 1991, each owner of an underground storage tank that was in operation at any time after Jan. 1, 1974, regardless of whether or not such tank was removed from beneath the surface of the ground at any time, shall notify the department of the existence of such tank, specifying, to the extent known, the owner of the tank, date of installation, capacity, type, and location of the tank, and the type and quantity of substances stored in such tank, or which were stored in such tank before the tank ceased being in operation if the tank was removed from beneath the surface of the ground prior to the submittal of such notice to the department. Such notice shall also specify, to the extent known, the date the tank was removed from beneath the surface of the ground prior to the submittal of such notice to the department. The operator of any tank that has no owner or whose owner cannot be definitely ascertained, shall notify the department of the existence of such tank, specifying, to the extent known, any information relating to ownership of the tank, and date of installation, capacity, type, and location of the tank, and the type and quantity of substances stored in such tank, or which were stored in such tank before the tank ceased being in operation if the tank was removed from beneath the surface of the ground prior to the submittal of such notice to the department. If the tank was abandoned beneath the surface of the ground prior to the submittal of such notice to the department, such notice shall also specify, to the extent known to the owner or operator, the date the tank was abandoned in the ground and all methods used to stabilize the tank after the tank ceased being in operation. L OWNERSHIP OF TANK(S) Owner Name (Corporation, Individual, Public Agency, or OtherOtEntity) ti S/ a� ,1C g [,i_ L I f/ o c J �(< ) 1�) i h J7 / Street Address — #L1/7 f1 City County" - 48- c Phone Numoer (Include Area Code) , State Zip Code co' ' 9 .-5 k.� Owners Employer Federal IDp Date Received: 3 ..fWC% Fire Dept. ID# 0 8' Fire Dept. Sig./' A. Facility Number B. Date Entered C. Clerk's Initials D. Comments Exception. (a) a farm or residential tank of 1,100 gallons or less capacity used for storing motor fuel for noncommercial purposes, or(b) a tank used for storing heating oil for consumptive use on the premises where stored are not required to be registered under 527 CMR 9.00. Penalties' Any owner who knowingly faits to notify or submits false information shall be subject to a civil penalty not to exceed $25,000 for each tank for which notification is not given or tor which false information is submitted. (MGL Chapter 148, section 38H, 527 CMR 9.00) Aboveground Storage Tanks 527 CMR 9.00 requires the registration of any aboveground storage tank which meets the following definition: a horizontal or vertical tank, equal to or less than 10,000 gallons capacity, that is intended for fixed installation without back fill above or below grade, and is used for the storage of Hazardous Substances, Hazardous Wastes, or Flammable or Combustible Liquids. Exception el: Aboveground tanks of more than 10,000 gallons capacity regulated by 520 CMR 12.00 (Requirements for the Installation of Tanks Containing Fluids Other Than Water in Excess of 10.000 Gallons) are not required to be registered under 527 CMR 9.00. EXCeotion #2. (a) a farm or residential tank of 1,100 gallons or less capacity used for storing motor fuel for noncommercial purposes, or (b) a tank used tor storing heating oil for consumptive use on the premises where stored are not required to be registered under 527 CMR 9.00. Penalties; Any person who knowingly violates any rule or regulation made by the Board of Fire Prevention Regulations shall, except as otherwise provided, be punished by a Sine of not less tnan one hundred dollars nor more than one thousand dollars. (MGL, Chapter 148, section 10B, and 527 CMR 9.00) Where to Notify? Two completed notification forms should be signed by both the tank owner and the local fire department. One copy will be retained by the fire department, and the tank owner shall send a separate copy to the address at the top of this page. When to Notify? 1. Owners of storage tanks in use or that have been taken out of operation must notify within thirty days. Owners and Operators of Regulated Storage Tank Systems must maintain records certifying that all leak detection, inventory control and tightness testing requirements for the Regulated Storage Tank System are current. These records must be readily ' available for inspection. IL LOCATION OF TANK(S) If known, give the geographic location of tanks by degrees, minutes, and seconds. Example: Lat. 42, 36, 12 N Long. 85, 24, 17W Latitude Longitude Distance and direction from closest intersection (see instructions A2j Facility Name or Company Site identifier, as applicable Street Address (P.O. Box not acceptable - see instructions k2) City State Zip Code County . co.00q fravico,-(i yogi ISI. TYPE OF OWNER IV© INDIAN LANDS ❑ Federal Government ❑ State Government ❑ Local Government Commercial (storage and sale) E Private (storage and use) ❑ Tanks are located on land within an Indian Reservation or on other trust lands. ❑ Tanks are owned by native American nation, tribe, or individual. V. TYPE OF FACILITY Select the Appropriate Facility Description: (check all that apply) ` Gas Station Marina Trucking/Transport Petroleum Distributor Railroad Utilities Airport Federal - Military Residential Aircraft Owner Industrial Farm Vehicle Dealership Contractor Other (explain) VI. CONTACT PERSON IN CHARGE OF TANKS Name: ( ,if4i' -i i) K4i' i ✓-t Address: Phone Number (include area code): Job Title: 6..3 /? / i Ai it i 1( g eqc r°-r S T ret, AX, A fi- Home: 9 $- -ti_ (f9 `f i h i ?/,/Ur /i% Pi 4 of Edi(( Business: !'. F )l_ O fa 4; VII. FINANCIAL RESPONSIBILITY C I have met the financial responsibility requirements in accordance with 527 CMR 9.00. Check all that apply: ❑ Self Insurance Commercial Insurance Risk Retention Group ❑ Guarantee • Surety Bond State Fund Letter of Credit E Trust Fund := Other Method Allowed - Specify VIIL ENVIRONMENTAL SITE INFORMATION This information should be available from local health agent, conservation commission, or planning department. 1. Tank site located in wellhead protection area Yes No a Unknown 2. Tank site located in surface drinking water supply protection area C Yes No 0 Unknown 3. Tank site located within 100 feet of a wetland E Yes , No 0 Unknown 4. Tank site located within 300 feet of a stream or water body ❑ Yes No 0 Unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number Tank No. 1 Tank No. a2 Tank No. 3 Tank No. Tank No. 1. Tank status . a. Tank mfr's serial # (if known) b. Currently in Use I s/t'I I 'des) I I i'es I I I I .1 c. Temporarily Out of Use (Start Date) I I I 1 I I 1 I I I d. Permanently Out of Use I I I I I 1 I I I e. Aboveground storage tank (AST) or 0 AST GUST a AST UST r2, AST BUST C. AST 0 UST 0 AST G UST Underground storage tank (UST) 2. Date of Installation (mo./day/yr.) 3. Estimated Total Capacity (gallons) F9.990 (rAvk ri 1196) /cooc' /4 ©o f"0 4.00‘). Tank Identification Number (cont.) Tank No. t Tank No. Tank No. 3 Tank No. Tank No. 4_ Substance Currently or Last Stored Motor vehicle or other use b. Diesel Motor vehicle or other use 'a. Gasoline I I MV ❑ Marina ❑ other I I ❑ MV ❑ Marina 0 other c. Kerosene I d. Fuei Oil* "Consumptive Use" tanks need not be registered. "Consumptive Use" fuel used exclusively for area heating and/or hot water. e. Waste Oil I f. Other, Please specify o MV ❑ Marina C other 1 I MV ❑ Marina ❑ other Hazardous Substance (other than 4a thru 4e above) CERCLA name and/or CAS number I G� MV 0 Marina 0 other 1 1 0 MV ❑ Marina ❑ MV ` Manna _, other C other 0 MV 0 Marina 0 MV 0 Marina 0 MV 0 Manna ❑ other other �, other I I I I I 1 I I I I I I Mixture of Substances Please specify 5. Material of Construction - Tank (mark only on( ) Bare steel (includes asphalt, galvanized and epoxy coated) Cathodically protected steel Composite (steel with fiberglass) Fiberglass reinforced plastic (FRP) Concrete Unknown Other Please specify 6. Type of Construction -Tank (mark only one) Single walled I Double walled I Unknown I Other I Please specify Is tank lined? &Yes C No Does tank have excavation liner? o Yes 4-No .Yes C No 0 Yes PorNo 8. Yes 0 No C Yes ❑ No 0 Yes 0 No 0 Yes WNo C Yes 0 No o Yes 0 No FP-290(revised 11/96) Page 3 Tank Identification Number (cont.) Tank No. Tank No. /- Tank No. j, Tank No. Tank No. 7. Material of Construction - Piping (mark only one Bare steel (includes asphalt; galvanized and epoxy coated) I I 1 1 Cathodically protected steel 1 1 1 Fiberglass reinforced plastic (FRP) 1 I 1 I Flexible Copper Unknown Other Please specify 8. Type of Construction - Piping (mark only one) Single walled I I I I I I I I I Double wailed I 1L I I 1 I I X I I I I I Unknown I I I I I I I I I 1 Other I I 1 i I I I I I I Please specify Has piping been repaired? . 0 Yes 3: No 0 Yes g No C Yes 004\10 C Yes 0 No G' Yes 0 No Is piping gravity feed? 0 Yes 6 No 0 Yes No = Yes '•-No G Yes C No G Yes = No Date X. CERTIFICATION OF COMPLIANCE 1. Installation A. Installer certified by tank and piping manufacturers B. Installer certified or licensed by the implementing agency C. Installation inspected by a registered engineer D. Installation inspected and approved by the implementing agency E. Manufacturers' installation checklists have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2. Tank Leak Detection (mark only one) A. Double -wall tank - Interstitial monitoring B. Approved in -tank monitor C. Soil vapor monitoring (check one below) C Monthly.. C) Continuous E. Inventory record -keeping and tank testing 0-- �1 I I I I I 1 1 I I I ( Tank F. Other method allowed by 527 CMR 9.00. Please specify FP-290 (revised 11/96) Page 4 Tank Identification Number (cont.) 3. Piping Leak Detection (mark only one) A. Pressurized a. Interstitial space monitor b. Product line leak detector (mark all that apply below) Er Automatic flow restrictortr ❑ Automatic shut-off device* , E Continuous alarm* • Also requires annual test of device and piping tightness test or monthly vapor monitoring of soil. B. Suction: Check valve at tank only (Requires interstitial space monitor or line tightness test every three years) C Interstitial space monitor Line tightness test C. Suction: Check valve at dispenser only (No monitor required) D. Other method allowed by 527 CMR 9.00. Please specify 4. Date of last tightness test (tank & piping) 5. Gravity feed piping 6. Spill containment and overfill protection A. Spill containment device installed B. Overfill prevention device installed 7. Daily Inventory Control (mark only one) A. Manual gauging by stick and records reconciliation B. Mechanical tank gauge and records reconciliation C. Automatic gauging system 8. Cathodic Protection (if applicable) A. Sacrificial Anode Type B. Impressed Current Type C. Date of Last Test Tank No. Piping Tank Piping Tank No. Tank No. Tank Tank 4, Tank Piping Tank Piping Tank No. Tank No. Tank Piping Certification of Compliance No.: K C si z Tank r Tank j Piping XL CERTIFICATION (Read and sign after completing all sections) NOTE: Both the copy being sent to the Dept. of Fire Services and the copy retained by the local fire department must be signed separately. A photocopied signature will not be accepted on either document. I declare under penalty of perjury that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. Name and official title of owner or owner's authorized representative (Print) Signature: Date: FP-290 (revised 11/96) Page 5 Edit: COM1 111 North Street - Shell Oil Company < 12/9/54 < License - for the storage & use of City Council gasoline and inflammables. Total amount granted < 12,420 gals.; this includes 550 gals. fuel oil; < 550 gals. waste oil. < 1/28/57 < Permit issued for installation of 2-3,000 gal. < tanks and 1-4,000 gal. tank for the storage of < gasoline. Permit issued in the name of Donald < R. Gilbert. < 10/22/70 < License to increase storage of gasoline by 10,000 < gals. making a total of 22,420 gals. permitted. < Edit: COM1 111 North Street - Shell Oil Company < 12/9/54 < License - for the storage and use of gasoline and inflammables. Total amount granted 12,420 gals. < This includes 550 gals. fuel oil; 550 gals. waste oil. 1/28/57 < Permit issued for installation of 2-3,000 gal. tanks and 1-4,000 gals. tank for the storage of gasoline. Permit issued in the name of Donald R. Gilbert. < 10/22/70 License to increase storage of gasoline by 10,000 gals. making a total of 22,420 gals. permitted. 8/25/72 < Permit to remove (2) tanks (500 gal. each); one < waste oil tank and one fuel oil tank. < 6/16/72 Permit - installed two 6,000 gal. and one 8,000 < Edit: COM1 Permit to remove (2) tanks (500 gal. each); one waste oil tank and one fuel oil tank. 6/16/72 Permit - installed two 6,000 gal. and one 8,000 gal. fiberglass tanks for storage of gasoline. 6/16/72 Permit - installed one 500 gal. tank for waste oil. Plan on file for above. 6/72 Permit - fire code service station permit. 7/25/72 < Permit - remove (2) 3,000 gal. tanks - Whitney Barrel, Woburn, MA. 7/25/72 Permit - remove (2) 4,000 gal. tank to Whitney Barrel, Woburn, MA. < Business name: NORTH STREET SHELL Tank data: Tank size: (in gallons) 550 Product: (G) asoline W (D)iesel fuel (F)uel oil for heating (W)aste oil (0)ther regulated substance (U)nknown substance Tank type: (S)teel (F) iberglass S Date of removal: 01/18/1994 Contractor: LAMOUNTEIN BROS. INC. Additional details: memo 1 Wpoir incvnateai; a orP. l zdaackeze d- ✓JOwiteinexeo/ hies aiev e Wx,ecutriue &Ace Pegic &/et- ger a y �PomAktmee %u- Noteflcation for Storage `hanks Regulated Under 527 CMR 9a00 Forward completed form, signed by local fire department, to: Mass. UST Program, Dept Fire .Qei t Use Onirr of Fire Services, P.O. Box 1025 - State Road, Stow, MA 01775 Use Form FP-290R to notify of tank removals or closures in place. Telephone (978) 567.3710 (Fire Department retains one copy of FP-290) ❑ A. New Facility (see instructions, #1) ❑ B. Amended 14 C. Renewal INSTRUCTIONS: Form FP-290 (Notification for Aboveground and Underground Storage Tanks) Is to be completed for each location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. If more than five tanks are owned at this location, photocopy the following pages and staple continuation sheets to the form. The FP-290 must be completed in duplicate. Although the form may be photocopied, the facility owner or owner's representative must sign each copy separately; photocopled signatures are not sufficient. Both coples off the FP-290 are to be forwarded to the local fire department, who wili check all Infomiaton and certify the forme. The fire department will retain one copy of the FP-290 for its records, and the facility owner shalt be responsible for forwarding the other copy to the Dept. of Fire Services at the address above. The local fire department will issue the permit portion of the FP-290; however, registration Is not complete until the FP-290 Is received and checked by the UST Regulatory Compliance Unit All questions on this form are to be answered. Incomplete forms will be returned. 1'New Fatuity' means a tank or tanks located at a site where tanks have not been previously located. 2`Facility street address' must include both a street number and a street name. Post office box numbers are not acceptable, and will cause a registration to be returned. tf geographic location of facility Is not provided; please indicate distance and direction from closest intersection, e.g., (facility at 199 North Street Is located) 400 yards southeai ommona Road (intersection). Date Received: 1 -)!1.! 4 Fire Dept. ID# ARjj 1( Fire Dept. Sig. A. B. C. D. Facility Number Date Entered Clerk's Initials Comments ENERAL FOR( Ali Notification Required Flre Prevention Form FP-290 Is to be used as Notification, Registration, and Permit for aboveground and underground storage tanks and tank facilities regulated under 527 Code of Massachusetts Regulations 9.00. No regulated aboveground or underground storage tank facility shall be installed, maintained, replaced, substantially modified or removed without a permit (FP- 290) issued by the head of the local fire department The owner of any storage facility shall within seven working days notify the head of the local fire department and the Dept. of Fire Services of any change In the name, address, or telephone number of the owner or operator of a storage facility subject to regulation by Chapter 148, Mass. General Law and by 527 CMR 9.00. Underground Storage Tanks Each owner of an underground tank first put into operation on or der Jan. 1,1991, shall, within thirty days after the tank Is first put into operation, notify the Department of Fire Services (the department) of the existence of such tank, specifying, to the extent known, the owner of the tank, date of Installation, capacity, type, location, and uses of such tank. By no later than Jan. 31,1991, each owner of an underground storage tank that was in operation at any time after Jan. 1, 1974, regardless of whether or not such tank was removed from beneath the surface of the ground at any time, shall notify the department of the existence of such tank, specifying, to the extent known, the owner of the tank, date of installation, capacity, type, and location of the tank, and the type and quantity of substances stored In such tank, or which were stored In such tank before the tank ceased being in operation if the tank yeas removed from beneath the surface of the ground prior to the submittal of such notice to the department Such notice shall also specify, to the extent known, the date the tank was removed from beneath the surface of the ground prior to the submittal of such notice to the department. The operator of any tank that has no owner or whose owner cannot be detinitely ascertained, shall notify the department of the existence of such tank, specifying, to the extent known, any Information relating to ownership of the tank, and date of Installation, capadty, type, and location of the tank, and the type and quantity of substances stored In such tank, or which were stored In such tank before the tank ceased being in operation if the tank was removed from beneath the surface of the ground prior to the submittal of such notice to the department if the tank was abandoned beneath the surface of the ground prior to the submittal of such notice to the department, such notice shall also specify, to the extent known to the owner or operator, the date the tank was abandoned In the ground and all methods used to stabilize the tank after the tank ceased being In operation. )(caption: (a) afarm or residential tank of 1,100 gallons orless capacity used forstoring motor fuel for nonmmmerdalpurposes, or(b)atankused for storing heating oilforconsumptive use on the premises where stored are not required to be registered under527 CMR 9,00. Penalties' Any ownerwho knowingly fails to notify or submits false information shall be subject to a dvl penalty not to exceed $25,000 for each tank for which notification Is not given of for which false information is submitted. (MGL Chapter 148, section 38H, 527 CMR 9.00) Aboveground Storage Tanks 527 CMR 9.00 requires the registration of any aboveground storage tank which meets the following definition: a horizontal or vertical tank, equal to or less than 10,000 gallons capacity: that is intended for fixed !rsi:ilafon without back tut Nova or below grade, and is used far the storage of Hazardous ;Substances, Hazardous Wastes, or Flammable or Combustible Liquids. ).",?rception #1: Aboveground tanks of more than 10,000 gallons capacity regulated by520 CMR 12.00 (Requirements for the Installation of Tanks Containing Fluids Other Than Water In Excess of 10,000 Gallons) are not required to be registered under 527 CMR 9.00. Exception #2• (a) a farm or residential tank of 1,100 gallons or less capacity used for storing motor fuel for noncommercial purposes, or (b) a tank used for storing heating di for consumptive use on the premises where stored are not required to be registered under 527 CMR 9.00. Per0lties'Any person who knowingly violates any rule orreguta;ion made by the I;oard o, Fire Prevention Regulations shall, except as otherwise provided, be punished by afine of not less than one hundred dollar; nor more than one thousand dollars. (MGL, Chapter 148, section 10B, and 627 CMR 9.00) Where to Notify? Two completed notification forms should be signed by both the tank owner and the local fire department One copy will be retained by the fire department, and the tank owner shall sand a separate copy to the address at the top of this page. When to Notify? 1. Owners of storage tanks in use or that have been taken out of operation must notify within thirty days. • Owners and Operators of Regulated Storage Tank Systems must maintain records certifying that all leak detection, inventory control and tightness testing requirements for the Regulated Storage Tank System are current. These records must be readily available for inspection. ® OwNERS9 p OF `BAN: (s) Owner Name (Corporation, Individual, Public Agency, or Other Entity) k eys \CV2.0./ F\anet#'! Street Address u o Ae City tt County trul olcAT Ssote Zip Cods ',I- oatVia IL LOCATO. N ,F T , I K( ) I`; known, give the geographic location of tanks by degrees, minutes, and seconds. Example: Lat. 42, 36, 12 N Long. 85.24,'nv Latitude Longitude 0/stance cro direction from dosest Intersection (see Instructions #2) \ess ‘5tq F: :!ty .:.E-,.," mil r )Si:sldzntfis . aS'pplica Street Address (P.O. Box net acceptable - see Instructions #2) n Miti City ,r-) Stets 0 ;r1-1(5 Zip Cade Phone Number (Include Area Coda) CtgreS Emrtoyer Fssdee !D County, FP-290 (revised 11/96) Page 1 1111. TYPE 0 Federal Government 0 State Government 0 Local Government F OWNER gCommerciai (storage and sale) 0 Private (storage and use) Wu INDIAN LANDS 0 Tanks are located on land within an Indian Reservation or on other trust lands. 0 Tanks are owned by native American nation, tribe, or individual. V TYPE OF FACILITY Select the Appropriate Facility Description: (check all that apply) vt" Gas Station Petroleum Distributor Airport Aircraft Owner Vehicle Dealership Name; Job Title: ‘s-Nowo.v.a Marina Railroad Federal - Military Industrial Contractor Trucking/Transport Utilities Residential Farm Other (explain) VI. CONTACT PE SO IN CW,ROE ,,,sF TANKS Address: Phone Number (include area code): Home: V300&Ovtatle% firS CYVIS Business: 1" 6=0 kliess VL FINA CI RESPONSIBILITY dl have met the financial responsibility requirements in accordance with 527 CMR 9.00. Check all that apply: RrSelf Insurance 0 Commercial Insurance 0 Risk Retention Group 7 0 Guarantee 0 Surety Bond i• 0 State Fund Ville ENV5A6NMEINT 5. SITE INFORM 0 Letter of Credit 0 Trust Fund 0 Other Method Allowed - Specify This information should be available from local health agent, conservation commission, or planning department. 1. Tank site located in wellhead protection area 2. Tank site located in surface drinking water supply protection area 3. Tank site located within 100 feet of a wetland 4. Tank site located within 300 feet of a stream or water body 0 Yes O Yes 0 Yes o Yes 0 No fflinknown 0 No aitlnknown 0 No !Unknown 0 No [2-Unknown DESCRIPTION OF STO GE TIANKS AND PEPINO (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number 1. Tank status a. Tank mfr's serial # (if known) Tarik No. k Tank No. P‘ Tank No. 5 Tank No. Tank No. • b. Currently in Use I vr I c. Temporarily Out of Use (Start Date) I I I d. Permanently Out of Use I I I e. Aboveground storage tank (AST) or Underground storage tank (UST) 2. Date of Installation (mo./day/yr.) I 3. Estimated Total Capacity (gallons) FP-290 (revised 11/96) fr 1 OAST 031:1ST OAST all-ST DAST DiT DAST DUST OAST OUST /0,(200 /0 000• /0,000 Page 2 Tank Identification Number (cont.) 4. Substance Currently or Last Stored a. Gasoline Motor vehicle or other use b. Diesel Motor vehicle or other use c. Kerosene d. Fuel Oil* * `Consumptive Use' tanks need not be registered. "Consumptive Use° fuel used exclusively for area heating and/or hot water. e. Waste Oil f. Other, Please specify Tank No. �I/ I al/MV MV 0 Marina ❑ other I I ❑ MV ❑ Marina ❑ other l ! Tank No, Tank No, 3 Tank No. Tank No.____ I B7 I I V I I I I I 'MMV 0 Marina E✓1 MV 0 Marina 0 MV 0 Marina 0 MV 0 Marina ❑ other 0 other 0 other 0 other I I I I I I I I 0 MV 0 Marina 0 MV 0 Marina 0 MV 0 Marina 0 MV 0 Marina ❑ other 0 other 0 other 0 other I I I.-: I I I 1 I { I 1 I 11 I Hazardous Substance (other than 4a thru 4e above) CERCLA name and/or CAS number Mixture of Substances Please specify 5. Material of Construction - Tank (mark only one) Bare steel (includes asphalt, galvanized and epoxy coated) Cathodically protected steel 1 Composite (steel with fiberglass) 1 Fiberglass reinforced plastic (FRP) I Concrete 1 Unknown 1 Other 1 Please specify 6. Type of Construction -Tank (mark only one) Single wailed 1 I Double walled 1 Unknown Other 1 I Please specify Is tank lined? 0 Yes Clio Does tank have excavation liner? 0 Yes ER"N0 FP-290 (revised 11/96) I I i V 1 1 1 1 I i ! 1 I I 1 1 ! I ❑ Yes CE(No 0 Yes 0,-No 0 Yes 0 No 0 Yes 0 No ❑ Yes g4 o 0 Yes 0,14o 0 Yes 0 No 0 Yes 0 No Page 3 ITank Identification Number (cont.) Tank No. ( Tank No. a Tank No. 3 Tank No._ Tank No. 7. Material of Construction - Piping (mark only one Bare steel (includes asphalt, galvanized 1 I I I 1 I I I I and epoxy coated) Cathodically protected steel I 1 1 1 1 1 1 I I 1 Fiberglass reinforced plastic (FRP) I ✓ 1 1 ✓ 1 I ✓ I 1 I I I Flexible Copper Unknown Other Please specify 8. Type of Construction - Piping (mark only one) 1 I I I I I 1 1 1 1 I I I i t I 1 1 1 1 Single walled 1. I I I I I I I I I Double wailed I✓ I I I 1 I I I I I Unknown 1 I I I I I I I I I Other I I I I 1 I I I I I Please specify Has piping been repaired? ❑ Yes 0 No 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No Is piping gravity feed? 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No Date - 1. Installation A. Installer certified by tank and piping manufacturers B. Installer certified or licensed by the implementing agency C. Installation inspected by a registered engineer D. Installation inspected and approved by the implementing agency E. Manufacturers' installation checklists have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2. Tank Leak Detection (mark only one) A. Double -wall tank - Interstitial monitoring B. Approved in -tank monitor C. Soil vapor monitoring (check one below) 0 Monthly ❑ Continuous E. inventory record -keeping and tank testing F. Other method allowed by 527 CMR 9.00. Please specify FP-290 (revised 11/98) CEli TIFIcATi N OF Crn P ,IANCB 1 1 1 1. I I I 11 I I 1 I 1 1 I I I I 1 I I I 1 1 I I 11 I I 1 1 I I I I 1 I 1 I 1 I I I I Tank Tank Tank Tank Tank Page 4 Tank Identification Number (cont.) 3. Piping Leak Detection (mark only one) A. Pressurized a. Interstitial space monitor b. Product line leak detector (mark all that apply below) 0 Automatic flow restrictor* ❑ Automatic shut-off device* ❑ Continuous alarm* * Also requires annual test of device and piping tightness test or monthly vapor monitoring of soil. B. Suction: Check valve at tank only (Requires interstitial space monitor or line tightness test every three years) ❑ Interstitial space monitor ❑ Line tightness test C. Suction: Check valve at dispenser only (No monitor required) D. Other method allowed by 527 CMR 9.00. Please specify 4. Date of last tightness test (tank & piping) 5. Gravity feed piping 6. Spill containment and overfill protection A. Spill containment device installed B. Overfill prevention device installed 7. Daily Inventory Control (mark only one) A. Manual gauging by stick and records reconciliation B. Mechanical tank gauge and records reconciliation C. Automatic gauging system 8. Cathodic Protection (if applicable) A. Sacrificial Anode Type B. Impressed Current Type C. Date of Last Test Certification of Compliance No.: Tank No. L Tank No. g Tank No. 3 Tank No. Piping Piping Tank No. Piping Piping Piping FA // Tank jr 1 Tank X ' Tank ://///// Tank '%// Tank Piping [ 1 Tank rL. I Piping Tank Piping Tank Piping Tank 7 XL CERTIFICATION (Read and sign after completing all sectons) NOTE: Both the copy being sent to the Dept. of Fire Services and the copy retained by the local fire department must be signed separately. A photocopied signature will not be accepted on either document. • I declare under penalty of perjury that I have personally examined and am familiar with the information submitted In this and at attached documents, and that based on my inquiry of those Individuals Immediately responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. Name and official title of owner or owner's authorized representative (Print) Signature: e Vikei t,,,,, CeOrids FP-290 (revised 11/96) Date: Page 5 Environmental Services February 20, 2004 Honorable Stanley Usovicz Mayor, City of Salem 93 Washington Street Salem, Massachusetts 01970 Ms. Joanne Scott Health Agent, City of Salem 120 Washington Street Salem, Massachusetts 01970 Re: Availability of Class A-2 Response Action Outcome Amerada Hess Station # 21519 90 North Street Salem, Massachusetts 01970 MADEP Release Tracking Number 3-23271 Dear Mayor and Ms. Scott: In accordance with the Massachusetts Contingency Plan (MCP) 310 CMR 40.0000, notification is hereby made that a Class A-2 Response Action Outcome (RAO) has been completed for the above -referenced site. The report concludes that additional response actions are not necessary at the subject property in relation to Massachusetts Department of Environmental Protection (MADEP) Release Tracking Number (RTN) 3-23271. Copies of the RAO can be reviewed or obtained at the Massachusetts Department of Environmental Protection's Northeast Regional Office, located at One Winter Street in Boston, Massachusetts. If you have any questions, please contact the undersigned at (781) 769-5005. Sincerely, EnviroTrac Ltd. —S"usan Cahalan -Roach, P.G. Project Manager cc: Massachusetts Department of Environmental Protection, Northeast Regional Office Donald Bull, Amerada Hess Corporation 1400 Providence Highway, Suite 2100, Norwood, MA 02062 (781) 769-5005 Fax: (781) 769-9345 Permit # P Street Address & City or Town: Signature of applicant: Applicants name printed: FORM F.P. 292 (rev. 9/90) POSTE iJI (Ju,nrn nim att1 ufr anottriptortts Department of Public Safety Division of Fire Prevention and Regulation APPLICATION FOR PERMIT, AND PERMIT, FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YAM FDID#OCacr L1'0 City, Town or District c.82 S.40 R4.G.L. Fee aid: S 25.00 -We0LelL Date 7 1s DIG SAFE NUM8ER q.3 31-023? start date -2? In accordance with the provisions of Chapter 148, Sec. 38A, M.G.L., 527 CMR 9.00 application is hereby made by: 4164.67,1-Db an, 44,w72).--4 / 2.6 ZA-174-4-7.g-9e For permission to remove and transport one un e ground storage tank from. Owner: /1442-ge27- eMP Street Address: An'-9-17-7e • Firm transporting waste: .4C----..:P-e"-02&- a'Af- State Lic'.# /1.4' 2e Hazardous waste manifest # F E.P.A.# Approved tank yard: 7N4- 51)^,) Tank yard Address: Type of inert gas: `-ra. 64-. e-rd-54- UL tank #: Tank capacity: .50() Substance last stored: 14g6:L. Date of issue: 7h.7/ 199 3 Date of expAration: 7/0? / 19 93 I, Signature/Title of Officer granting permit: KEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE AS PERMIT Form 90V (9/90) u rc b I 3 L FORM E.P. 292 (rev. 9/90) alp Tottintinuntult4 of filassultusetto Department of Public Safety Division of Fire Prevention and eguiation APPLICATION FOR PERMIT, AND PERMIT, FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK VAR! FDID# 09z, t CL1/14 City, Town or District Fee Pai Permit # 9 Z.4 7 Date 10zz C.82 S.40 M.G.L. 19'I DIG SAFE NUMBER 933/o233 1 start date 7- 2?'-=13 In accordance with the provisions of Chapter 148, Sec. 38A, M.G.L., 527 CMR 9.00 application is hereby made by: /ode c O / & /' Street Address & City or Town: /aa�7- s Signature of applicant! Applicants name printed: For permission to remove and transport one ound storage tank from. Owner: / 7-- er L- Street Address: Non—u Firm transporting waste: / 'd — OIL State Lic.# / 2DO Hazardous waste manifest # C-i F ODSc ocia E.P,A.# Approved tank yard: / 6c.?S .4---4 $'o-' # / Tank yard Address: Type of inert gas: Oar Tank capacity: 0 UL tank #: Substance last stored: Date of issue: 7/ 2 %/ 19 ('-3 Date of exp ation: Signature/Titre of Officer granting permit: 7/ 2 9� f�; 19 9 3 -�?. i KEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE AS PERMIT Fo ni 90V (9/90) Certified Installer F.D. #322 (603) 926-8683 (603) 474-3166 STATE OF MAINE BOARD OF UNDERGROUND STORAGE TANK INSTALLERS CLASS 2 OIL INSTALLER Leslie Smith, Chairman Date First Issued: (; Expiration Date: 7 /I / MORGADO BROTHERS CONSTRUCTION, INC. EXCAVATING 126 LAFAYETTE ROAD P.O. BOX 157 HAMPTON FALLS, NEW HAMPSHIRE 03844 .1 I 13Yf3()N lhvc,,rrn M,u ,ulrr ft„tirrn fbv,aur 4 :'rois nn of S,„, r):' Comp.tly c' !inns Pfv,tr�;.i P O BOX 988, FRAMINGHAM, MASS. 01701 (617) 875-1371 Licensing Commission Fire Chief._.. - Town of -� Gentlemen: The Sunoco Station located at MA in your municipality is temporarily closed. .The product was removed from underground storage tanks on , and tanks will be gas freed upon notification by the Fire Chief as to the method desired, as spelled out in FPR-9, Rule 24, preferably in inert gas Trichlorothane III. Sincerely, SUNMARK INDUSTRIES • R. E. Laubinger Maintenance Manager /caw be: Territory Manager H. Carr U. Brothers , -°\-1\1`\(' SALEM FIRE DEPARTMENT FIRE PREVENTION BUREAU Location of Complaint or Hazard cotaapitthat:by Nature of OeTm151Vrrt Received by /14 Co a Investigated by Action Taken "V-- . Cr77/ i'e4 a Pe .,&-/ ) Other Department Notified FORM #58 COMPLAINT FORM Address ,e-r249, • DATE z,) ."4 TME M. ; DATE 19 TIME M. 5-5" 42 nntei ct_ 'Prenttan QElie! Name: Address: xt trf k rc, C4inc3sacITu etts Igirr. lepartm?nt lit,ttilquartery 46 afa ptt-p ! ,trept Sunoco Service Station 105 North Street, Salem Date: June 6, 1979 Re: Tires at dispensing isle As a result of an inspection this date of the premises, structure, open land area or vehicle owned, occupied or otherwise under your control, the following recommendations are submitted and shall serve as a notice of violation of fire laws. ,These recommendations are made in the interest of fire prevention. and to correct conditions that are or may become dangerous as a fire hazard or are in violation of law. - You are hereby notified to 'remedy said violations named below within three days , of above date. Such further action will be taken as the law requires, for failure to comply with the above requirements within the stipulated time. (Reference: General Laws of Commonwealth of Massachusetts, Chapter 14 Section 30; and the 'Salem Fire Code Article 1.) to Fire Chief James F. Brennan, has determined that the use of old rubber tires as a dispensing area blockage method, is likely to be a fire hazard; and has ordered these tires to be removed, 28 The Salem Fire Department has a policy of no more than. 25 tires to be kept on the premises of any service station, before they are discarded. Form {`25A(9/75) A .- L COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL P ;` OTECTION Metropolitan Boston — Northeast Regional Office ARGEO PAUL CELLUCCI Governor JANE SWIFT Lieutenant Governor Shehab Realty Trust 105 North Street Salem, MA 01970 Attention: Mr. Mohamed Shehab (Trustee) Dear Mr. Shehab: BOB DURAND Secretary LAUREN A. LISS Commissioner RE:. Salem 105 North Street RTN # 3-20329 NOTICE OF RESPONSIBILITY; M.G.L. c. 21E & 310 CMR 40.0000 On January 19, 2001 at 1:10 PM, .the Department of Environmental Protection (the Department or DEP) received oral notification that there is or has been a release of oil and/or hazardous material (OHM) at the above -referenced property which requires one or more response actions. Based on this information, the Department has reason to believe that the subject property or portion(s) thereof is a "disposal site" as defined in the Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c. 21E, and the Massachusetts Contingency Plan, 310 CMR 40.0000 (the MCP). The assessment and cleanup of disposal sites is governed by M.G.L. c. 21E and the MCP. The purpose of this notice is to inform you of your legal responsibilities under state law for assessing and/or remediating the subject release. For purposes of this notice, the terms and phrases used herein shall have the meaning ascribed to them by the MCP unless the text clearly indicates otherwise. STATUTORY LIABILITIES The Department has reason to believe that you (as used in this letter, "you" refers to Shehab Realty Trust) are a Potentially Responsible Party (a PRP) with liability under M.G.L. c. 21E, § 5, for response action costs. Section 5 makes the following parties liable to the Comrnonwealth of Massachusetts: current owners or operators of a site from or at which there is or has been a release/threat of release of oil or hazardous material; any person who owned or operated a site at the time, hazardous material was stored or disposed of; any person who arranged for the transport, This information is available in alternate format by calling our ADA Coordinator at (617) 574-6872. 205A Lowell St. Wilmington, MA 01887 , Phone (978) 661-7600 , Fax (978) 661-7615 a TTD# (978) 661-7679 0 Printei on Recycled Paper Salem-105 North Street Page - 2 - disposal, storage or treatment of hazardous material to or at a site; any person who transported hazardous material to a transport, disposal, storage or treatment site from which there is or has been a release/threat of release of such material; and any person who otherwise caused or is legally responsible for a release/threat of release of oil or hazardous material at a site. This liability is "strict", meaning it is not based on fault, but solely on your status as an owner, operator, generator, transporter or disposer. It is also joint and several, meaning that you may be liable for all response action costs incurred at the site, regardless of the existence of any other liable parties. The MCP requires responsible parties to take necessary response actions at properties where there is or has been a release or threat of release of oil and/or hazardous material. If you do not take the necessary response actions, or fail to perform them in an appropriate and timely manner, the Department is authorized by M.G.L. c. 21E to have the work performed by its contractors. By taking such actions, you can avoid liability for response action costs incurred by the Department and its contractors in perfotniing these actions, and any sanctions which may be imposed for failure to perfoiui response actions under the MCP. You may be liable for up to three (3) times all response action costs incurred by the Department. Response action costs include, without lirnitation, the cost of direct hours spent by Department employees arranging for response actions or overseeing work performed by persons other than the Department or their contractors, expenses incurred by the Department in support of those direct hours, and payments to the Department's contractors. (For more detail on cost liability, see 310 CMR 40.1200.) The Department may also assess interest on costs incurred at the rate of twelve percent (12%), compounded annually. To secure payment of this debt, the Commonwealth may place liens on all of your property in the Commonwealth. To recover the debt, the Commonwealth may foreclose on these liens or the Attorney General may bring legal action against you. In addition to your liability for up to three (3) times all response action costs incurred by the Department, you may also be liable to the Commonwealth for damages to natural resources caused by the release. Civil and criminal_ liability may also be imposed under M.G.L. c. 21E, § 11, and civil administrative penalties may be imposed under M.G.L. c. 21A, § 16 for each violation of M.G.L. c. 21E, the MCP, or any order, permit or approval issued thereunder. NECESSARY RESPONSE ACTIONS The Department has determined that an IRA is necessary at the subject site to respond to this Imminent Hazard. You are also reminded that at the time of oral notification to DEP, you were advised by the Department that the following response actions were approved as an L.A.: 1) install a vent fan in the basement of the residence located at 2 Mason Street, 2) conduct an additional round of indoor air sampling on 1/22/2001 and 3) seal basement floors and walls if appropriate. You are authorized to conduct only the specific response actions for which you received approval from the Department at the time notification was provided. All additional Immediate Response Actions require DEP approval in accordance with 310 CMR 40.0420. Salem-105 North Street Page - 3 - GENERAL RESP NSE ACTION REQUIREMENTS The subject site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the site have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c. 21E and the MCP. In addition, the MCP requires persons undertaking response actions at disposal sites to perform Immediate Response Actions (IRAs) in response to "sudden releases'`, Imminent Hazards and Substantial Release Migration. Such persons must continue to evaluate the need for IRAs and notify the Department immediately if such a need exists.; You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at the subject site. In addition, the MCP requires persons undertaking response actions at a disposal site to submit to the. Department a Response Action Outcome Statement (RAO) prepared by an LSP in accordance with 310 CMR 40.1000 upon deterrni_ning that a level of No Significant Risk already exists or has been achieved at a disposal site or portion thereof. [You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1091.] There are several other submittals required by the MCP which are related to release notification and/or response actions that may be conducted at the subject site in addition to an RAO, that, unless otherwise specified by the Department, must be provided to DEP within specific regulatory tirneframes. The submittals are as follows: (1) if infontnation is obtained after making an oral or written notification to indicate that the release or threat _of release didn't occur, failed to meet the reporting criteria at 310 CMR 40.0311 through 40.0315, or is exempt from notification pursuant to 310 CivLR 40.0317, a Notification Retraction may be submitted within 60 days of initial notification p2_suant to 310 CMR 40.0335; otherwise, (2) if one has not been submitted, a Release Notification Form (RNF) [copy attached] must be submitted to DEP pursuant to section 310 CMR 40.0333 within 60 calendar days of the initial date of oral notification to DEP of a release pursi»nt to 310 CMR 40.0300 or from the date the Department issues a Notice of Responsibility (NOR), whichever occurs earlier; (3) unless an RAO or Downgradient Property Status Submittal is provided to DEP earlier, an Immediate Response Action (IRA) Plan prepared in accordance with 310 CMR 40.0420, or an IRA Completion Statement (310 CMR 40.0427) must be submitted to DEP within 60 calendar days of the initial date of oral notification to DEP of a release pursuant to 310 CMR 40.0300 or from the date the Department issues an NOR, whichever occurs earlier; and (4) unless an RAO or Downgradient Properly Status Submittal is provided to DEP earlier, a completed Tier Classification Submittal pursuant to 310 CMR 40.0510, and, if appropriate, a completed Tier I Pettibit Appli ration pursuant to 310 CMR 40.0700, must be submitted to DEP within one year of the initial date of oral notification to DEP of a release pursuant to 310 CMR 40.0300 or from the date the DepamtiEment issues an NOR, whichever occurs earlier_ Salem-105 North Street Page - 4 - (5) pursuant to the Department's "Timely Action Schedule and Fee Provisions", 310 CMR 4.00, a fee of $750 must be included with an RAO statement that is submitted to the Department more than 120 calendar days after the initial date of oral notification to DEP of a release pursuant to 310 CMR 40.0300 or after the date the Department issues an NOR, whichever occurs earlier, and before Tier Classification. A fee is not required for an RAO submitted to the Department within 120 days of the date of oral notification to the Department, or the date the Department issues an NOR, whichever date occurs earlier, or after Tier Classification. It is important to note that you must dispose of any Remediation Waste generated at the subject location in accordance with 310 CMR 40.0030 including, without limitation, contaminated soil and/or debris. Any Bill of Lading accompanying such waste must bear the seal and signature of an LSP or, if the response action is performed under the direct supervision of he Department, the signature of an authorized representative of the Department. The Department encourages parties with liabilities under M.G.L. c. 21E to take prompt action in response to releases and threats of release of oil and/or hazardous material. By taking prompt action, you may significantly lower your assessment and cleanup costs and avoid the imposition of, or reduce the amount of, certain permit and annual compliance fees for response actions payable tinder 310 CMR 4.00. If you have any questions relative to this notice, you should contact Jennifer Wang at the letterhead address or (978) 661-7737. All future communications regarding this release must reference the Release Tracking Number (RTN # 3-20329) contained in the subject block of this letter. Very truly yours, JJennifer Wang U Environmental Engineer Iris Davis Section Chief cc Salem Board of Health Salem Fire Department Mr. Steve Kurz, Kurz Environmental, Inc., 31 Fremont Street, Needham, MA 02494 DEP data entry/file Attachment: Release Notification & Release Retraction Foil', BWSC-103 Fire Department retains original application and issues duplicate as Permit. "C-69cv7)- weal/A. o/P,/ (czO/Jac/c: e ._ ici0aa4, 2- t2,e- c,ue c-Jea6vccea — �3ea,cc/o( care ✓ Jce/6teiZCG0,2?. Check 1) 6 APPLICATION and PERMIT Fee: it nn_n0 for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: an Tank Owner Name (please print) CJhf . ��L— �• Address 52-O Mew\ Street emoraon,,tre Pt- a u6 Lo iv C. Company Name 4C -SSt._ -- - ' L prim Address C- Pn,it tur e(if applying ❑ IFC1 Certified Tankanformatior v'1e\rA , ;-i l4 Other Tank Location s �f ,uu S1i- a I•D>-� Tank Capacity (gallons Tank Dimensions (diameter x length) Remarks: Shall measure for presence of contaminants. All documentation shall be forwarded to this office, i.ee any copies of remediatione City Signature (it apllying for permit) In ammabon Assessment' State lip Co. or Individual SVCCrk•• \ Print Address Pont Signature (if applying for permit) IFCI Certified 0 LSP # 111 k�0A-71 - . .r\rr Steel Address 'City Substance Last Stored �0 Other asal infarmab Firm transporting waste Hazardous waste manifest# - Approved tank disposal yard 'pi - Type of inert gas 4 royals Tank yard address City or TownALEM rd Date of issue Dig safe approval number: 7-00L93boo , Signature / Title of Officer granting permit I State Lic. # E.P.A. # T- vD 2.63� Tank yard # FDID# 09258 Permit# .Date of expiration -o( Dig Safe Toll Free Tel. Number - 800-322-4844 Atter removal(s) send Form FP-290R signed by Local F1ire Dept. to UST Regulatory Compliance Unit, One Ashburton Place, Room 1310, Boston, MA 02108.1618. FP-292 (revised 9i961 a a •,ct it , Ctaia to original appiicaoon and issues issues duplicate as Permit. CLY,Y 7Y Loecda /Q/Yc&cYL LGlea, 'rteAa4Onsemta `a4ce ve1,vcced. a/C coca 7iteii)enecaon APPLICATION and PERMIT Check # Fee: J for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: TankOwner Tank Owner Name (please print) SHELL , O.S. t- C• Address 5-2-0 tiSs' e/vA5 Of3- Street mova! Contrac Company Name ktrzSS1_ 44 1 Pnnt Address 6- Itr's • Pnnt ture (if applying fo pee 0 IFCI Certified Other ;formation 4�au10 Z(•Lg-- City „ e ezGL-L, Signature (n apllying for perms) 2_` i Co. or Individual Print Address Print Signature (if applying for permit) DZ�05 State Zip LD PAS u ` 1' I !u r IFCI Certified LSP # Other Tank Location S SSA- j 042-71 - IAA-, Steet Address City Tank Capacity allons -� Tr !� ' ' `r Oil p y (g �-�t�.� � Substance Last Stored _��, - � -�t,J}.?t-� i 1 Tank Dimensions (diameter x length) Remarks: Shall measure for presence of contaminants. All documentation shall be forwarded to this office, i.ee any copies of remediation, osai nformatoi Firm transporting waste tZQ 140,k-`<1-f-t kc Hazardous waste manifest# • Approved tank disposal yard 6 f` Type of inert gas rovas� City or Town Date of issue Tank yard address SALEM 6ic- -4 - Dig safe approval number: 7-00 '2)00 Signature / Title of Officer granting permit State Lic. # m`1 j E.P.A. # lf\AL Do%(7Z-ro�� -i Tank yard # FDID# 09258 Date of expiration Pe mit# t12/ [)) Dig Safe Toll Free Tel. Number - 800-322-4844 After re.moval(s) send Form FP-290R signed by Local(Fire DeWit. to UST Regulatory Compliance Unit, One Ashburton Place, Room 1310, Boston, MA 02108-1618. FP-292 (revised 9/96) Fire Department retains original application and issues duplicate as Permit. o�rri�um oecda o cDyA7c&i<z4cX c6:se i- eha9 en a/ 6-2re Cleouutce6- — �vaa)cci re 7,rP/1entto APPLICATION and PERMIT Check #35 Fee: $tnn.n0 for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Name (please print) cJ('(EU , E. Address 52-0 eAns Street Company Name i&SS\.S-&Z.. \ etk, T Z Print Address `3 qk S W 1 TZG(r fsc`E i ture (if applying fo pe, O IFCI Certified 'anktnfor Pnnt Other Tank Location 5 E-LU S UIr 1 TO I \ 1 - Steer Address trio L City �l�naf�a Signature (if aptlying for permit) Co. or IndividualvR Print Address Ynnt Signature (if applying for permit) IFCI Certified LSP # 002- i l-f-W. Gilg " alfons) �h �.._ :� � Substance Last Stared . Tank CaPacity�(9 Tank Dimensions (diameter x length) t \ Stare zip Cs) tskS Other Remarks: Shall measure for presence of contaminants. All documentation shall be forwarded to this office, i.e. any copies of remediatione So t format Firm transporting waste 2 1`'t O tR'f kcPc� Hazardous waste manifest# • Approved tank disposal yard Type of inert gas Tank yard address Approvals`' City or Town SALEM Date of issue Dig safe approval number: 7-00Le -�?%00 Signature / Title of Officer granting permit After removal(s) send Form FP-290R signed by Local Fire Dept. to UST Regulatory Compliance Unit, One Ashburton Plaice, Room 1310, Boston, MA 02108-1618. State Lic. # m E.P.A. n MI. ooDU Tank yard FDID# 09258 Date of expiration Permit# Jo(;r Dig Safe Toll Free Tel. Number - 800-322-4844 FP-292 (revised 9/96) 1 tvtdrtC dyylic;dtlon 10 Local i`1re uepartmenn. Fire Department retains original application and issues duplicate as Permit. c67 Yi�/12weald of /l��Cr/.k1-CGdGG:leaS c-fAxe as ,a/a&Aace �)ce', eya�ca�ra Check # 15V 70 0 APPLICATION and PERMIT Fee: 100_00 for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Tank Owner Name (please print) SH . 03,1 • Address 52o cN5„ Street emoval Contrac _.mow . , w...._.. Company Name CzSS� "R S\ ikl-k, -"6- 6C4 prof Address W\-U \Z U t IE • Print ture (if applying fo pe it) -D�'1+r'1, '� itu.),J\ ij\9 01LL ❑ 1FC1 Certified Other nforma- Tank Location S€U- SSA ► Z� Signature (,t ad/lying for permit) City ontaminafron Assessment State Zip Co. or Individual SOV f,ILS�� Pnnt Address Print Signature (if applying for permit) )FCI Certified C LSP # Other 1 \ \ ad),-T1-#- �T . ��t�) NAA- Steel Address City Tank Capacity (gallons) Substance Last Stored 5 T- Tank Dimensions (diameter x length) �'' >( 0 Remarks: Shall measure for presence of contaminants. All documentation shall be forwarded to this office, i.e. any copies of remediation. osal lntorrnatio=5 Firm transporting waste 7---O. 1`F0ikl".1-VE c Hazardous waste manifest# • Approved tank disposal yard "" r Type of inert gas royals; City or Town Date of issue \)1 ( Tank yard address ' SALEM Dig safe approval number: 7_-0OL/3 O c 2 Signature / Title of Officer granting permit D�✓ ..After removal(s) send Form FP-290R signed by Local Fire apt. to US I Regulatory Compliance Unit, One Ashburton Place, 'Room 1310, Boston, MA 02108-1618. State Lic. # MeN E.P.A. # .L- D 2._� i Tank yard # FDID# 09258 Permit# Date of expiration . 9 0 b Dig Safe Toll Free Tel. Number - 800-322-4844 FP-292 (revised 9/96) HOOVER OU , INC CONTAINMENT SYSTEMS DIVISION P.O. BOX 396 SEVERNA PARK, MARYLAND 21146 WasteEvac SPECIFICATIONS tAt.aia 410-987-3800 800-777-2823 FAX 410-987-3890 WasteEvac storage systems are built, tested and labeled per U/L 142 (steel aboveground tanks for flammable and combustible liquids.) by HOOVER GROUP, INC. A 25-30 PST hydro test was performed on our tank design to test its structural integrity. The double wall tank design passes a hydro test of 15 PSI, between the inner and outer shell. WasteEvac storage tanks meets all requirements of N.F.P.A. 30. Each tank is individually tested at 2-3 PSI with an air and soap suds solution to detect pinhole leaks before leaving the factory. WasteEvac storage system are equipped with the following equipment; U/L listed air operated double diaphragm pump, U/L listed 6' x 3/4" suction hose with shut off valve and quick connect, manual air inlet shut-off valve, air regulator, air lubricator, air filter, drop tube with Kamlock and dust cap (for pump out by waste hauler), dry break, in tank level gauge, high gloss enamel finish. Optional equipment available; Environmental (weatherproof) cover, Automatic high level air operated shut off, with whistle alarm, 6" fill hatch, Additional waste oil receiver adapter kit. Remote installation equipment` package is also available. HOOVER GROUP, INC. Containment Systems Division PO Box 396 Severna Park, MD 21146 800-777-2823 WasteEvac Systems Featuring All U/L Listed Components Capacity 240 300 360 480 500 1000 Standard Equipment • U/L Listed air operated diaphragm pump • U/L Listed double wall tank • U/L Listed 8' x 3/4" suction hose with shutoff valve and quick connect • Adapter kit for waste oil receiver • Manual air inlet shut-off valve • Air regulator • Lubricator • Air filter • Drop tube with camlock and dust cap for pumpout by waste hauler -Dry break • In tank level gauge • High gloss enamel finish (color choice) Horizontal Model Overall Dimensions 55"L x 37"W x 38"H 69"L x 37"W x 38"H 80"L x 37"W x 38"H 105"L x 37"W x 38"H 87"L x 47"W x 42"H 108"L x 52"W x 50"H Optional Equipment Distributed by: • Environmental (weatherproof) cover (standard on vertical model) • Automatic high level air operated shutoff • Air operated whistle alarm • 6" Fill Hatch • Additional waste oil receiver adapter kit Separate equipment package available for remote installations. Facilities located in: Pennsylvania, Indiana, Kansas, Maryland. North Carolina, and California. Vertical Model Overall Dimensions 42"L x 38"W x 74"H ✓ N/A N/A N/A 58"L x 54"W x 74"H N/A * including cover Fe:Anii FP: 292, (rev. 9/90) Ofir (outtanntimattil vf Altiosatfruutto Department of Public Safety Division of Fire Prevention and Regulation AppuCAT1ON FOR PERMIT, AND PERMIT, FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD FDID# 9,5a; ,A)-11.097 /71144-4-) City, Town or District 1 Oi3 Fee Paid:S SOn p6rrnit # 30 1 Date 1/3, nail C.82 S.40 M.G.L. DIG SAFE NUMBER q?-1-3309no start date .1 In accordance with the provisions of Chapter 148, Sec. 38A, M.G.L., 527 CMR 9.00 application is hereby made by ._ e"-c. Street Address & City or T 111114. K%X.Te.nd 1/44.64_ cf7 - Applicants name•printed4_,," 7—Ari • For permission to remove Owner At_eloif Firm transporting waste: Hazardous waste manifest Signature of applicant: soS-57?;----327 and transport one underground storage tank from. Street Address!)/(iNTiASTre.iiL ..7.7_-__(W-5509/27c774.476tate Lic.t DU('4k!ji #11,111 i# Approved tank yard: 'whif&p.4.Q..A0 Tank yard Address: rnetit-6 krAl Type of inert Tank.capacity: Date of issue! / Date of expiration! SignatUre/Title of Officer granting permit! 01,oviA ) UL tank #: Substance last stored tc_1(9 101( KEEP ORIGINAL AS APALICATION 4440 ISSUE DUPLICATE AS PERMIT Date of expiratior CHECK ONE OF THE OLLOWMIG FORM # 9 OWO (7/91) CITY OF SA. M FIRE DEPARTMENT - FIRE PREVENTION BUREAU 48 Lafayette Si., Salem, Massachusetts01970 FEE DUE $10.00 CK# .fl°573 CASH (Dcde) AP LICATI To: HEAD OF FIRE DEPARTIv1ENT N IF 11) te,4 FERMI In accordance with the provisions of Chapter 148, G. L. as provided in Sec.. application is hereby made for permission to install a WASTE OIL RETENTION PAr-rr,r-ry in accordance with 527CMR9.27, 9.28, 9.29. 1Reaanent. Storage Outside a Buildincr= 2- Permanent Storace Inside a Buildina= 3.pLh Tnzir 1:21-ril1ing= 4- Automotive Lubrication Service Center= Name: (5 I-) 1 u wk.) 0 Address /1/21 A,A4/c7/ (Give loccrtion by street caul no., or describe in such a manner arotoprovidel.pdii.pgd/aem ( Date issued- / /3 /91 t77 1 3 19 28 Form F.P. 6. 40M-4-65-939%3 IK Gantt I bat ttss"eb btts DEPARTMENT OF PUBLIC SAFETY — DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUEo BOSTON/ Gee./�r (Date) PER r; IT APPLIATI To: HEAD OE2 FI1E DEPARTMENT City or Town In accordance with the provisions of Chapter 148, G. L. as provided in Sec. application is hereby made State clearly purpose for which permit is requested for permissipn Restrictions. at 11 / f( (Give location by street t/v 0 0 0 /-ci ±0-11 J .( A Date issued —re, �ed b ! 14' 19 9°.< B ( ✓� m ' nature of licant Date of expiration_2 //� � 19 (B $ ra.., aid —Due _ �_ � �✓t ;� -r L� v (Address) 1 J r� 19,7eR 44 Form F.P. 6. 40M-4-65-939963 00, 4 / (�.GP,rrf tao., or describe in such a manner as to pF n e id-vatic:aim of location) 1�.vzci DEPARTMENT OF PUBLIC SAFETY ® DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH Ado BOST.N APPLICA ION F Date) PER IT To: HEAD OF FIRE DEPARTMENT City or Town In accordance with the provisions of Chapter 148, G. L. as provided in Ser application is hereby shade State clearly purpose for which permit is requested for permission t r- Restrictions: rrt (Give location by street td no., or describe in such a mantle � to. provi / 1- Date issued 1 / 6' 19' By1,4 /0A' 67.474,/,/e_ uat identification of locations) (Signp `re of applicant)j,.� 7 C2 / ��l n �' -/pw F)/ A ! / PARTMENT OF PUBLIC SAFETY—DIV/SION OF FIRE PREVENT A 1010 COMMONWEALTH AVENUE. '''''OSPTON (City orTovsu) LICATiON FOR LICENSE • FOr tli* ',Awffl use of the herein described bn1dingor other stroeture...., application is hereby nakedein .• glee with the provisions of aspter 148 of the General Laws, for a license to use the land on which such building.— et cram' .•• . • Xrueture.... isfare or ./a.re to be situated, and only to such eictent as siaown on plot plan which is Mad with arid. =Ws a • •;. Pltrt of this apprscatiaa. kaa111-113 North Street MASON STREET 1.k,. • • • t .OWNtreet ea Number) ,JZ.WeSt 52no. z.lt„, New York, W: Or 'of hut Adese& Wil Foe.teirddre 11.3 .North Street Sale% Number Wiling or other structures to which this application applies. ...calfe „. .0to.ges4.yerefedeutdibuildings Gasoline Serv1ge.5tatim =•.-4,4. •'-• 4; r Totkevaist. y at tanks in gailans•----Ahoveground 're s - t 110170 IT'lli Ir Gasoline nal A. A. abi attaki w be stored is talgts SHELL OIL COM' TY hy \ ; / 1r,,it's Att ey , A' ' • /1 / „,71050 7=-,?ft,David T .(mg.t..d y e , 81 Washington reet Siaem ••• , • aka. Ago- am. a.. 1.4,41s. scia c4co +eke 4S.. mum. OW @OW Imp ore dzigp DEPARTMENT OF PUBLIC SAFETY --DIVISION OF FIRE PREVENTION toio COMMONWEALTH AVZIVUE. OST ft (City or Toene) (tute/ amerce with tits provisions of Chapter 148 of the General Laws, a lice is hereby granted to use the land kerena" described for the lawful use of the building. or other structure.... which is/are or is/are to be situated thereon, gad as described on the plot plan file' d With the application for this license. LementIon of land Nearest cross street (atrwt Nub) Owner of land kddress Number of buildings or other structures to which this license applies Occupancy or Use of such buildings Total capacity of tanks. in gallons :—Aboveground "Underground ........ ....• Kind of fluid to be stored in tanks Restrietions—lf any: (Siguethre of tiocosiu; authority) THIS LICEN$E OR A PHOTOSTATIC pR CEFVT@FI ED COPY TNEEO.F.' EE cONMSALQUW. POSTED iN A PROTECTED PLACE ON THE LAND FOR WHICH IT IS GRANTED . . , . Ifirp Oiniumenanatt4 of fila,earl tto DEPARTMENT OF PUBLIC SAFETY --DIVISION OF FIRE PREVENTION 101U COMMONWEALTH AVENUE. BOSTON 7 APPLICATION FO LICENSE —c" (tity or Town) (i}atk)" -196, For the lawful use o the herein described building ... or other structure...., application is hereby made ,.in• accord- ance with the provisions of Chapter 148 of the General Laws, for n license to use the land on which such building.... or other Structure.... is/are or is/are to be situated, and only to such utent as shown on plot plan which is filed with and made a part of this application. Location of land Nearest cross street i . •^fh• tej4)-'" O ornlei Street, S '(S�Yc�tt' R,'' hli�'e'rY ; Owner of land..,F•.-, • . { ,.....`�'i�:9Tuw?txldress �v�b��,...�f 9 172i��'tl �� 1'.i� 1 Ode .ii?�iCE v.,�,,... ..� ir'da of Kto b Number of buildings or other structures to which this application applies One Occupancy or use of such buildings SGr,1.o6 sta:t"i.©n Total capacity of tanks in gallons: —Aboveground ;3®� Underground Ad.. . ~J _.a 55' 4G. Total _ j Kind of fluid to be stored in tanks Gam:: OT:ae Approved— p ./ova:1 }�7 19 u i' •..�%�^ X-:c '::�Z....;;, , .,,!..:!,-.`c'6.' / 1 (Head of Fire Dept.) i '/ ✓'_ (Signature of Applicant) (Address) 2-7-727 (Eartuttenturatth of Atzwariptlapitg DEPARTMENT OF PUBLIC SAFETY —DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUE. BOSTON lA (City or Town) .(Data) In accordance with the provisions of Chapter 14S of the General Laws, a license is her ®by granted to use the land herein described for the lawful use of the building.... or other structure.... which is/are or is/are to be situated thereon, and as described on the plot plan filed with the application for this license. Location of land Nearest cross street (Street & Number) OWner of land Address Number of buildings or other structures to which this license applies Occupancy or use of such buildings Total capacity of tanks in gallons: —Aboveground Underground Kind of fluid to be stored iu tanks Restrictions —If any: (Signature of licensing, authority) THIS LICENSE OR A PHOTOSTATIC OR CERTIFIED COPY THEREOF MUST BE CONSPICUOUSLY, POSTED IN A PROTECTED P[_AC.g' t1h1 Z^sir a nwor' JO N OE & SONS, INCH PETROLEUM EQUIP: ENT SPECIALISTS 26 PROCTOR ROAD TELEPHONE 256-5397 SOUTH CHELMSFORD, MASS. 01824 BOSTON LINE. 729-3230 March 27, 1981 Salem Fire Prevention 1.8 Lafayette Street Salem, Mao 01970 Attn: Captain David Coggin 0n March 26, 1981,' we, John D. Hallberg & Sons, Inc., air tested four (4+) 4+000 gallon tanks for Sunoco 0il Co., at 105 North Street Salem, Ma. We put a 5 pound air test on all the tanks. Pressure staved at 5 pounds for one hour without dropping. Also, a Salem Fire Prevention officer was on the location to varifv. Charlie Gillingham 6!'1 r `r M1 "S1,6..66-re 9/1 6-kfi IR CPPV/OrP DIMENSIONS Tank Removed From (no. stre Width Length Tank 1 Tank 2 X Tank 3 X Tank 4 X Tank 5: X (feet) (feet) DIMENSIONS Width Length Tank 1 X -- Tank 2 X Tank 3 X Tank 4 X Tank 5 X (feet) (feet) Tank 1 DIMENSIONS Width Length (city or town) Fire Department Permit # ;7E73 (if applicable) Tank Removed From 9t /04/ (no. street_ (city or town) Fire Department Permit # (if applicable) Tank Removed From (no. s,treet) Tank 2 ----- X (city or town) Tank 3 X Tank 4 X Tank 5 X (feet) (feet) Fire Department Permit # (if applicable) Tank 1 DIMENSIONS Width Length Tank Removed From Tank 2 ----- X (city or town) Tank 3 X Tank 4 X Tank : X (feet) (feet) "--NSIONS Width Length Tank 1 -` °- I X 5 Tank 2 ----- X Tank 3 X Tank 4 X Tank 5 X (feet) (feet) D1ivENSIONS Width Length Tank 1 (e' X `'-'S- r, Tank 2 - X Tank 3 X Tank 4 X Tank 5 X (feet) (feet) s TO Fire Department Permit # (if applicable) Tank Removed from (no. street) (city or town) Fire Department Permit # (if applicable) Tank Removed :From Q7Crr A (no. street) {city or town) Fire Department Permit # ZcoJ (if applicable) SALEM FIRE DEPARTMENT FIRE PREVENTION BUREAU Location of Complaint or Hazard ct b ?- T1A i Complaint by �..-' Q-�� '" Address Nature.of Complaint. �� ' Cde • Received by �� l Investigated by la , J(P4,' Action Taken COMPLAINT FORM Dp L 3 S 3 c ®Agz . 8C TIME , peJiu,ea.4 Ut)--0,e 00 k _.4 ANA,4, IL. 1 -,4AA s,_ fe“, p j •..l ii/ r? 1 f_! fi-. ` .L.%ir'8�� ...�.. ,Y _ ..3 I_ 1,4 6- ak-zeck • ®ATE oz4hy 1114 ei,v$24( fr 0 ,+ Other Department Notified r_cif-) (Street k: \umber) (14 F TurmmnuwiattI of fliassarfittuttn DEPARTMENT OF PUBLIC SAFETY —DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUE. BOSTON Salem, March 19, 19 75 (City or Town). (051) APPLICATION FOR LICE For the lawful use of the herein described building ante with the provisions of Chapter I4`'; of the (;enernl l.ri\cs, structure . is/are or is/are to be situated, and only to such part of this application. Location of land.. -!7.91 North.,.>Street SE or other structure . , application is hereby matte in accord - lot a license to use the land on which such building. or other extent as shown on plot plan which is filed with and made a Nearest cross street Mason Street Owner of landAt.lantn'a i6Ni''ileld Comp'. Address 140 Lee Burbank Highway9Revere,Ma Number of buildings or other structures to which this application applies ....one Occupancy or use of such buildings Gasoline .Service Station Total capacity of tanks in gallons: —Aboveground . ., .. . Kind of fluid to be stored in tanks Gasoline Appro, ed--Disappraue4- ,proposed mf Undergrounuexj sting.. F, Total —2 )fit -iiL-t G 4 '2 4 19p .... ............. (Head of Fire Dept.) 00G Gals, 000 Gals 000 Gals ,, v. V: L o o (Signature of Applicant) lactic-�Pien.i ' e yi Com any R...O...Le?....Bur:n.a ay evere, Masdreaei' I D , M° Tantninnunaltil Palinfiatilitgatil DEPARTMENT OF PUBLIC SAFETY —DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUE, BOSTON (City or Town) (Date) 19 • In accordance with the provisions of Chapter 14S of the General Laws, a license is hereby granted to use the land herein described for the lawful use of the building . or other structure ... which is/are or is/are to be situated thereon, and as described on the plot plan filed with the application for this license. Location of land Owner of land . Number of buildings or other structures to which this license Occupancy or use of such buildings Total capacity of tanks in gallons:—Abovegrouncl. Underground ..... Rini of fluid to be stored in tanks Iicstrictions—If any: Nearest cross street Address .... applies (Signature of licensing authority) THIS LICENSE _OR A PHOTOSTATIC OR CERTIFIED COPY THEREOF MUST SE CONSPICUOUSLY • POWER BURNERS Date Sept. 27, 1961 Name Charles Lee Location 8 5 North St. Name of Burner Gals. Stored Timken 275 Kind of Heat Steam Cap. of Tank 275 Gals. Location of Tank Outside enclosed Kind of Oil Installed by J® C . Oil COe #• 11881 Inspected 9-27-61 Approved 9-27-61 ,P071447..EItillattNER.5g1-,.- • oh, Address 87 Korth Street Mite Of Burner Lennox .725 Kind of Heat • Gars: Stored 275 Cap. of Tank Gals. Location of Tank Underground Kind of Oil #2 A. Belanger & Son 1241 Inspected 1-3-49• Approved •1-3-49. FORM 24 Date Name Location POWER BURNERS 03-03-77 Merit ,Di l Co. 36-90 North 3t Name of Burner Gals. Stored 500 Crown No. of Tanks 1 Mass. Approval No. 1452 Kind of Heat F_IJ_,Q . Location of Tank Underground Kind of Oil Installed by Alvin Boudrow C. of C. # 018203 Inspected by D.C.Sosnowski Date Approved 08-02-77 Form 24. Power Burners Date January 30, 1985 UNIT #1 Name Salvation Army Location 93 NorthStreet No. of Tanks Three(875aa1s) Name of Burner Williamson Mass. Approval No. 969 Gaffs. Stored 875 Kind of Heat FHA Location of Tank Basement Kind of Oil #2 Installed by Pickering Oil Co. C. of C. # 014031 Inspected by DC Goggin Date Approved 12/21/84 Form 24 Power Burners Date January 30, 1985 Name Salvation Army Location 93 North Street Name of Burner Willlamsnn Gals. Stored 875 Location of Tank Basement Installed by Pickering Oil Co. Inspected by DC Goggin FORM 24 Date Name Location 1 ft- Name of Burner Gals. Stored Location of Tank Installed by Inspected by UNIT #2 No. of Tanks Three Mass. Approval No. 969 Kind of Heat FHA Kind of Oil #2 C. of C. # 014031 Date Approved 12/21/84 POWER BURNERS it rr-7round No. of Tanks Z. Mass. Approval No. 200 v 4: Kind of Heat Kind of Oil C. of C. # Date Approved Form 24 Power Burners Date January 9, 1985 Name Henry Nazzaro/North Street Sunoco Location 105 North Street No. of Tanks 1 Name of Burner Beckett Mass. Approval No. g6g Gals. Stored 500 Kind of Heat FN4 Location of Tank R,PmPnt Kind of Oil 49 Installed by Reardon & Sons C. of C. # 21511 Inspected by D.C. Goggin Date Approved 5/30/85