71 LORING AVENUE BIANNUAL THIRD-PARTY LANDFILL INSPECTION • RECEIVED
TETRATECH SEP 04 2024
CITY OF SALEM
BOARD OF HEALTH
August 26, 2024
Project Number 143-3794-24002
MassDEP—Northeast Regional Office
Attention: Solid Waste Management
150 Presidential Way
Woburn, MA 01801
Subject: Biannual Third-Party Landfill Inspection
Former GTE/Sylvania Landfill
71 Loring Avenue
Salem, Massachusetts
On behalf of Salem State University, Tetra Tech has conducted a third-party landfill inspection of the closed
former GTE/Sylvania Landfill at 71 Loring Avenue in Salem,Massachusetts on 08/08/24. The attached Third-
Party Inspection Report and photograph log document the findings of the semi-annual landfill inspection.
The attached has been provided to you(hardcopy)and to the parties identified in the distribution list, as
noted below.
If you have any questions regarding this submittal, please do not hesitate to contact me at 781-526-1484 or
brandon.smith@tetratech.com.
Very truly yours,
Brandon E. Smith, PE, CHMM
Third-Party Inspector SW48-0000155
Enclosures
Third-Party Inspection Report
Photograph Log
c: Salem Board of Health (w/encl. -hardcopy)
T. Gallagher, Salem State University (w/encl.-electronic)
W. Phelps, Tetra Tech (w/encl. -electronic)
File 143-3794-24002-3.2 (1 hardcopy)
Tetra Tech
5 Industrial Way,Suite 2B,Salem,New Hampshire 03079
603.328.1558 603.870.0802 www.tetratech.com
RECEIVED
SEP 04 2024
CITY OF SALF-M
Massachusetts Department of Environm 1Fftt*6tT& important:Whencompleting
Bureau of Waste Prevention /Solid Waste Management this form on a computer,use
g only the Tab key to move your
Third-Party Inspection Report-310 CMR 19.018(8) cursor-not the Return key.
Operation &Maintenance
Instructions
Use this form to record and report the results of a Third-Party Operation and Maintenance MassDEP Use Only
Inspection conducted pursuant to 310 CMR 19.018. Be sure to obtain the most recent version Rec'd Date:
of this form. All applicable sections of the submitted form must be completed to be accepted by
MassDEP.
Pursuant to 310 CMR 19.018(8)(a),the third-party inspector and facility owner/operator must sign FMF#:
this Third-Party Inspection Report form and submit the completed report to the appropriate RO#:
MassDEP regional office and one copy of each completed report to the board of health of the
municipality in which the facility is located. Reviewer:
In the event that this inspection report contains a recommendation for corrective action(s),the Comments:
owner/operator shall also submit the information required by 310 CMR 19.018(8)(c)2.
Forms and instructions are available online:
http•//www mass gov/eea/agencies/massdep/recycle/approvals/solid-waste-applications-and-forms.htm1#8
Note:This form does not identify all of the requirements applicable to each solid waste
management facility;other requirements and/or policies may apply to the operation,maintenance
and monitoring for each facility.
1. Facility Information
Facility Type(check one):
❑Transfer Station/Handling Facility ❑ C&D Waste Processor or C&D Waste Transfer Station ❑ Municipal Waste Combustor
❑Active Landfill ®Closed Landfill ❑Other:
Specify
Facility:
Salem State College Assistance Corp.
Facility Name
Salem MA 01970
City/Town State ZIP Code
978-542-3073 314305 NA
Telephone Number Regulated Object Account Number FMF Number
Operator:
NA
Operator Name(Doing Business As/Company Name)
Telephone Number Email Address
Mailing Address
City/Town State ZIP Code
Permittee:
NA
Permittee Name(Entity Identified on Facility Permit)
Mailing Address
City/Town State ZIP Code
Responsible Official for the Facility:
Tara Gallagher tgallagher@salemstate.edu
Responsible Official Name(Individual) Responsible Official Email Address
Salem State University 978-542-3073
Responsible Official Company Name Responsible Official Telephone Number
Third-Party Inspection Report(0&M)-Rev.12/4/14 Page 1 of 13
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention/Solid Waste Management
Third-Party Inspection Report—310 CMR 19.018(8)
Operation &Maintenance
II. Third-Party Inspector
Brandon E. Smith Tetra Tech, Inc.
Third-Party Inspector Name Company Name
SW48-0000155 08/16/2026
MassDEP Third-Party Inspector Identification Number MassDEP Third-Party Inspector Expiration Date(MM/DD/YYYY)
603-328-1470 brand on.smith@tetratech.com
Telephone Number Email Address
5 Industrial Way, Suite 2B
Mailing Address
Salem NH 03079
City/Town State ZIP Code
Construction and Demolition Waste(C&D Waste)Processing Facility or C&D Waste Transfer Station Only:
Identify the qualified individual that conducted the observation of incoming waste loads and collection of samples of suspect asbestos-
containing materials during the inspection [pursuant to 310 CMR 19.018(6)(f)]. If the entire inspection was conducted by the third-party
inspector listed above,then check the box and enter only the Asbestos Inspector Certification Number.
❑ Same as above. Provide Asbestos Certification Number► MA Dept.of Labor Standards Asbestos Inspector Certification Number
Asbestos Inspector Name Company Name
Telephone Number Email Address
Mailing Address
City/Town State ZIP Code
III. Inspection Details
A. FREQUENCY
Indicate the scheduled inspection frequency for this facility as required by 310 CMR 19.018(6)(b),or a more frequent schedule set forth
in the Facility Permit/Other Approval:
❑ Bi-Monthly ❑ Quarterly ® Semi-Annual ❑ Annual ❑ Biennial
❑ Other(include permittapproval type and date of issuance):
B. DATE,TIME&PERSONNEL
Inspection Date(MM/DD/YYYY):08/08/2024
Inspection Start Time: 09:00 ®AM ❑PM
Facility Representatives in Attendance During Inspection:None
C. CONDITIONS
Air Temperature: Approximately 67 degrees F. Wind Direction(direction from which the wind is blowing):
Weather: ❑ Clear ❑ Partly Cloudy ® Cloudy ❑NW ❑N ®NE
® Dry ❑ Rain ❑ Snow ❑W Wind ®E
Wind Speed: ❑ Calm ® Breeze ❑ Moderate ❑ Strong ❑SW ❑S ❑SE
Third-Party Inspection Report(0&M) Page 2 of 13
' Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report—310 CMR 19.018(8)
Operation& Maintenance
IV. Pre-Inspection Preparation _
A. FACILITY-SPECIFIC O&M REQUIREMENTS
During each third-party inspection,the third-party inspector shall examine and evaluate the facility's solid waste activities,equipment,
operations,practices,procedures,and records relevant to the type of third-party inspection being conducted in order to determine the
facility's compliance with all applicable requirements as set forth in 310 CMR 19.018(6)(a)l.
Therefore,pursuant to 310 CMR 19.018(6)(a)l,prior to conducting a third-party facility operation and maintenance
inspection,the third-party inspector shall,without limitation,complete all of the following:
® Review and become familiar with the regulations set forth at 310 CMR 19.000—Massachusetts Solid Waste Regulations.
® Identify,review and become familiar with all solid waste permits,plans,approvals,and orders(or other enforcement documents
issued to the facility by the Department),and the solid waste requirements applicable to the operation and maintenance of the
facility.
Relevant requirements may include,without limitation,specific practices and procedures for the operation,maintenance and
monitoring of the facility,waste acceptance/storage limits,and other requirements related to the facility's solid waste activities.
Without limitation,these facility-specific requirements may be contained in the Facility Permit,Authorization to Construct,
Authorization to Operate,Operation and Maintenance Plan,Closure/Post-Closure Plans and Approvals,Facility Modification
Approvals, Beneficial Use Determinations,Administrative Consent Orders,and other determinations,authorizations or
enforcement actions issued by the Department.
I, Brandon E. Smith,have identified,reviewed and understand all of the aforementioned requirements that op-
are applicable to this facility and the following are my observations and recommendations related to the Inspector Initials
facility-specific requirements.
B. SOLID WASTE PERMITS, PLANS,APPROVALS&ORDERS
List all relevant solid waste permits,plans,approvals,orders or other enforcement actions issued to the facility by the Department that
contain specific practices,procedures and other requirements still in effect for the operation,maintenance and monitoring or
closure/post-closure of the facility. Where applicable,provide the plan or issue date for each item. For enforcement actions,include
the document number,effective date,and status of implementation by the facility.
Discussion:None.
Third-Party Inspection Report(0&M) Page 3 of 13
` y Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation&Maintenance
V. Performance Standards
Examine and evaluate the facility's solid waste activities,equipment,operations,practices,procedures and records relevant to the type
of solid waste facility.
Using the tables below,identify all areas evaluated by the inspector during the inspection by checking the box in the first column.
Describe all deviations noted during the inspection in the third column. Provide recommendations for corrective action to return to
compliance with the applicable performance standard in the fourth column.
Facility Type Performance Standards
Transfer Station/Handling Facility --Co-_mplete Section A.
(Including C&D Facility) If C&D Handling/Processing Facility,then also complete Section B.
Municipal Waste Combustor Complete Section A.
Active Landfill Complete Sections C.and F.
If active ash landfill,then also complete Section D.
Closed Landfill Complete Sections E.and F.
A. TRANSFER STATION,HANDLING FACILITY,OR MUNICIPAL WASTE COMBUSTOR(INCLUDING C&D FACILITY)
Comments/Observations and
Evaluated Performance Standard Deviation(s) Recommended Corrective
Action(s)
E] 19.205(1)
Storm Water Controls.
El 19.205(2)
Equipment.
19.205(3)
Weighing Facilities.
El 19.207(1) Discuss in Section VI. Discuss in Section VI.
General.
❑ 19.207(2)
Supervision of Operation.
❑ 19.207(3)
Access to Facilities.
❑ 19.207(4)
Security.
El 19.207(5)
Posting of Handling Facility.
❑ 19.207(6)
Unloading of Refuse.
El 19.207(7)
Special Wastes.
19.207(8)
Banned/Restricted Wastes.
El 19.207(9) — —
Hazardous Waste.
El 19.207(10)
Household Hazardous Waste
and Waste Oil Collections.
19.207(11)
Bulky Waste.
19.207(12)
El Liquid Wastes. _
Third-Party Inspection Report(0&M) Page 4 of 13
LlMassachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation&Maintenance
Comments/Observations and
Evaluated Performance Standard Deviation(s) Recommended Corrective
Action(s)
❑ 19.207(13)
Bird Hazards.
❑ 19.207(14)
Dust Control.
❑ 19.207(15)
Vector Control.
❑ 19.207(16)
Control of Wind-blown Litter.
❑ 19.207(17)
Staffing.
❑ 19.207(18)
Employee Facilities.
❑ 19.207(19)
Accident Prevention/Safety.
❑ 19.207(20)
Fire Protection.
❑ 19.207(21)
Recycling Operations.
❑ 19.207(22)
Records for Operational and
Plan Execution.
❑ 19.207(23)
Screening and/or Fencing.
❑ 19.207(24)
Open Burning.
❑ 19.207(25)
Inspections.
❑ 19.207(26)
End-of-Life Mercury-added
Products.
B. CONSTRUCTION AND DEMOLITION(C&D)WASTE PROCESSING FACILITY OR C&D WASTE TRANSFER STATION
Comments/Observations and
Evaluated Performance Standard Deviation(s) Recommended Corrective
Action(s)
❑ 19.206(1)
Enclosed Operations.
❑ 19.206(2)
Storage.
❑ 19.206(3)
Contact Water.
❑ Suspect Asbestos-Containing
Material(ACM)Inspection and
--Management Protocol.
Sample collection of suspect
❑ ACM from incoming loads. Discuss sample results:
► ❑Attach analytical reports.
Third-Party Inspection Report(0&M) Page 5 of 13
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
1 Operation &Maintenance
C. ACTIVE LANDFILL
Evaluated Performance Standard Deviation(s) Comments/Observations and
Recommended Corrective Action(s)
19.130(l) Discuss in Section VI. Discuss in Section VI.
General.
E] 19.130(2) — -
Operator Supervision.
19.130(3)
Special Wastes.
19.130(4)
Banned/Restricted Wastes.
❑ 19.130(5)
Hazardous Waste.
❑ 19.130(6)
Bulky Wastes.
i� 19.130(7)
Liquid Wastes.
❑ 19.130(8)
Solid Waste Handling.
❑ 19.130(9) --
Bird Hazards.
101 19.130(10)
Equipment and Shelter
19.130(11)
El Staffing.
El 19.130(12)
Employee Facilities.
❑ 19.130(13)
Accident Prevention/Safety.
❑ 19.130(14)
Spreading and Compacting of
Solid Waste.
❑ 19.130(15)
Cover Material.
❑ 19.130(16)
Vector,Dust and Odor Control.
❑ 19.130(17)
Litter Control.
19.130(18)
Top Slope and Side Slopes.
19.130(19)
Storm Water Drainage.
❑ 19.130(20)
Erosion Control.
19.130(21)
Boundary/Elevation Markers.
El 19.130(22)
Access Roads.
❑ 19.130(23)
Security.
19.130(24)
Posting of the Landfill.
Third-Party Inspection Report(0&M) Page 6 of 13
Massachusetts Department of Environmental Protection
LBureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation&Maintenance
Evaluated Performance Standard Deviation(s) Comments/Observations and
Recommended Corrective Action(s)
El 19.130(25)
Open Burning.
El 19.130(26)
Fire Protection and Control.
19.130(27)
Convenience and Recycling
Drop-off Areas at Landfills.
19.130(28)
Waste Oil Collections at
Landfills.El _
19.130(29)
Household Hazardous Waste
Collections at Landfills.
El 19.130(30)
Leachate Collection,
Treatment and Disposal.
El 19.130(31)
Phase Completion of the
Landfill.
El 19.130(32)
Disruption of Landfilled Areas.
El 19.130(33)
Construction of Buildings.
El 19.130(34)
Records for Operational and
Plan Execution.
El 19.130(35)
Inspections.
El 19.130(36)
Re-circulation of Leachate.
El 19.130(37) End-of-Life
Mercury-added Products.
D. ASH LANDFILL
Evaluated Performance Standard Deviation(s) Comments/Observations and
Recommended Corrective Action(s)
19.131(1) Discuss in Section VI. Discuss in Section VI.
General.
19.131(2)
Fugitive Emissions.
El 19.131(3)
Ash Moisture Content.
19.131(4)
Spreading/Compacting of Ash.
19.131(5)
Vehicle Washdown/
Wheelwash/Other Measures.
Third-Party Inspection Report(0&M) Page 7 of 13
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention 1 Solid Waste Management
t1 Third-Party Inspection Report—310 CMR 19.018(8)
L )m Operation& Maintenance
E. CLOSED LANDFILL
Evaluated Performance Standard Deviation(s) Recommended corn Comments/Observations and
Recommended Corrective Action(s)
19.016
Post-closure Use. None.
19.142(1) Discuss in Section VI. Discuss in Section VI.
General.
19.142(2)
Post-closure monitoring period runs through Dec 2026.
Post-closure Period. None.
19.142(3)
Post-closure Period Waiver. None. No waiver requested.
19.142(4)
Post-closure Period Extension. None. Post-closure monitoring period runs through Dec 2026.
19.142(5)
Post-closure Requirements. None. All post-closure requirements currently being met.
19.142(6)
Inspection Requirements. None. Third-party inspection occur biannually.
19.142(7)
Additional Measures. None.
® 19.142(8)
Termination of the Post-
Closure Period. None. Post-closure monitoring period runs through Dec 2026.
19.143(1)
Applicability. None. see Note 1 below
19.143(2)
Submission of Post-closure
Use Plans. None. Post-closure use plans previously submitted.
19.143,(3) �I
Criteria for Approval of Post-
None. Post-closure use plans previously approved.
closure Use.
19.143(4)
Post-closure Construction. None. see Noce 2 below
Note 1: Post-closure use as an athleticfield and access ways constructed in 2007 was approved.
Note 2:The baseball field and associated structures and access ways constructed in 2007 occupy the majority of the landfill area.The gas vents formerly located on the
landfill were removed as part of the construction of the baseball field in 2007.Replacement vents were installed during the construction.Monitoring wells P-203U-R&
P-203L-R were installed at the Site in January 2009 under the oversight of Woodard and Curran,Inc.to replace monitoring wells P-203U and P-203L which were located
within the footprint of the new baseball field and subsequently closed in 2007 as part of the baseball field construction on the closed landfill.The closure of the wells was
approved by the MassDEP.
Third-Party Inspection Report(0&M) Page 8 of 13
` Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report—310 CMR 19.018(8)
Operation&Maintenance
F. ADDITIONAL LANDFILL REQUIREMENTS
Comments/Observations and
Evaluated Performance Standard Recommended Corrective Action(s)
19.132
Environmental Monitoring Requirements.
Is the monitoring of surface water,ground water,landfill
gas and any other media as determined by the
Department,including without limitation,soil and
sediment,being conducted on the schedule established in
the permit or as otherwise required by the Department?
®YES ❑NO
Are the analytical results of the environmental monitoring
submitted to the Department within 60 days after the date
of sample collection or as otherwise specified by the
Department?
®YES ❑NO
19.133
Maintenance of Environmental Control and Monitoring
Systems.
Are the facility operations conducted in a manner which
protects all environmental control systems as approved in
the Operation and Maintenance plan and monitoring
systems as approved in the Operation and Maintenance
plan or permit?
®YES ❑NO
Is regular maintenance of all landfill environmental control
systems performed as approved in the Operation and
Maintenance plan or permit?
®YES ❑NO
Has the Department been notified of the existence and
extent of damaged or destroyed environmental control
systems,monitoring devices,or surface water sampling
location markers in accordance with 310 CMR
19.133(1)(c)and/or 19.133(1)(e)?
® N/A(if no damage to report) ❑YES. ❑NO
Continue to Next Page►
Third-Party Inspection Report(OW) Page 9 of 13
Massachusetts Department of Environmental Protection
VBureau of Waste Prevention / Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
F. ADDITIONAL LANDFILL REQUIREMENTS—Continued
Comments/Observations and
Evaluated Performance Standard Recommended Corrective Action(s)
® 19.121(4) No landfill gas recovery operations occur at the
Landfill Gas Recovery Operation and Maintenance closed landfill.
Requirements.
Is condensate generation kept to a minimum and
condensate recirculation, if proposed,performed in
accordance with the permit?
❑YES ❑NO
Are the sampling and analysis of condensate conducted
on the schedule established in the permit or as otherwise
required by the Department?
❑YES ❑NO
Are the analytical results of condensate monitoring .
reported to the Department as established in the permit or
as otherwise required by the Department?
❑YES ❑NO
Is an annual report on the operation of the landfill gas
recovery facility submitted to the Department as specified
in the permit?
❑YES ❑NO
Third-Party Inspection Report(0&M) Page 10 of 13
lMassachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report—310 CMR 19.018(8)
Operation&Maintenance
VI. Inspection Observations
A. FACILITY CONDITION AND OPERATIONS
Examine and evaluate the facility condition and operations as observed during the inspection,including the following:
® Describe any evidence of the following conditions observed at the time of the inspection:
• Unpermitted discharges to air,water,land or other natural resources of the Commonwealth;and
• Dust,odors,litter,and/or other nuisance conditions.
® Document and discuss all deviations from any specific requirements for the facility that are not addressed in the previous section
(Section V.—Performance Standards),including without limitation,the requirements set forth in the facility's operation and
maintenance plan,orders or other enforcement documents,and other solid waste permits,approvals,and authorizations issued to
the facility by MassDEP.
❑ List the types and estimated quantities of all waste and materials stored at the facility at the time of the inspection.
® Provide a narrative that describes the overall status of the general condition,operation and performance of the facility as
observed at the time of the inspection.
Attach photographs taken during the inspection that depict the general condition and operation of the facility. At a minimum,include
photographs,as applicable,of the waste unloading(tipping)area,waste storage areas,recyclable material storage and,for transfer
stations,the waste reloading activity.
Discussion:
The landfill was closed in 1993. No unpermitted discharges or deficiencies to the cap were observed.The cap is in good condition.
B. RECORD REVIEW
Examine and evaluate the facility's record-keeping. Without limitation,document the status of the facility's compliance with,and any
deviations from,the record-keeping required by 310 MCR 19.0b0;the facility's operation and maintenance plan;orders or other
enforcement documents issued to the facility;and other solid waste permits,approvals,determinations and authorizations issued to the
facility by the Department,including the following:
❑Discuss the evaluation of the Facility's"daily log"such as,daily tonnage records.
❑List and discuss any special incidents that have occurred since the previous inspection such as exceedances of the facility's
permitted waste acceptance limits,nature and outcome of complaints reported to the facility operator(including the identity of the
complainant,if known),fires,emergencies,or other disruptions to the routine operation of the facility.
Dcus ission: 1
The landfill was closed in 1993 and does not accept any waste.
Third-Party Inspection Report(0&M) Page 11 of 13
Massachusetts Department of Environmental Protection
VBureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation&Maintenance
VII. Summary and Recommendations
Pursuant to 310 CMR 19.018(6)(a)4.,where a third-party inspector observes that the operation or maintenance of the facility deviates
from the aforementioned applicable requirements,he or she shall document all such deviations and recommend corrective actions for
the facility to take to return to compliance.
A. INSPECTION RESULTS
Based on the examinations and evaluations conducted in Sections V.and VI.,please summarize the inspection results by checking one
of the following determinations:
No deviations from the applicable performance standards or additional requirements listed at 310 CMR 19.018(6)
were identified during this inspection.
If no deviations were identified during the inspection,check this box and proceed to Section VII.B.
Deviations from the applicable performance standards or additional requirements listed at 310 CMR 19.018(6)were
identified during this inspection and are discussed further in this report.
If deviations were identified during the inspection,check this box and ensure that each deviation and the recommended
corrective actions are discussed in the applicable section(s)below.
B. STATUS OF PREVIOUS RECOMMENDATIONS FOR CORRECTIVE ACTION
If a previous inspection report identified deviations with recommendations for corrective action, please describe the action(s)taken
since the last inspection to return the facility to compliance with the applicable requirements.
Discussion:
NA, no previous corrective actions.
C. RECOMMENDATIONS FOR CORRECTIVE ACTION
Based on the results of this inspection,please list all deviations noted during the inspection and provide recommendations for corrective
action to return to compliance with the applicable requirement.
Recommendations:
No corrective actions required.
D. ADD
ITIONAL COMMENTS
Comments:
Vill. Additional Information Checklist
Attach the following additional information,as applicable,to complete the inspection report.*
® Attach photographs taken during the inspection that depict the general condition and operation of the facility,as required in
Section VI.A.
❑ For C&D Waste facilities only,attach the analytical results,as required in Section V.B.
*Note:Pursuant to 310 CMR 19.018(8), MassDEP may request additional information.
Continue to Certification Statement on Next Page►
Third-Party Inspection Report(OW) Page 12 of 13
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention / Solid Waste Management
L�
Third-Party Inspection Report—310 CMR 19.018(8)
Operation&Maintenance
IX. Certification—THIRD-PARTY INSPECTOR
"I attest under the pains and penalty of perjury that: ,
Signature of Third-Party Inspector
1. I have personally examined and am familiar with the information
contained in this submittal,including any and all documents Brandon E. Smith, PE
accompanying this certification statement;
2. Based on my inquiry of those persons responsible for obtaining the Print Full Name
information,the information contained in this submittal is,to the best of
my knowledge,true,accurate and complete; Tetra Tech, Inc.
3. 1 have been able to conduct the third-party inspection and prepare the Company Name
third-party inspection report without being influenced by the facility
owner or operator and,(if I am a municipal employee)without being 08/16/2024
influenced by my municipal employer,by any coworker or by any
elected or appointed official of the municipality;and Date(MM/DD/YYYY)
4. 1 am aware that there are significant penalties,including,but not limited
to,possible administrative and civil penalties for submitting false,
inaccurate,or incomplete information and possible fines and
imprisonment for knowingly submitting false,inaccurate,or incomplete
information."
X. Certification—FACILITY OWNER/OPERATOR
Does the facility maintain a Financial Assurance Mechanism(FAM)pursuant to 310 CMR 19.051? ❑YES ®NO
If yes: . Enter the amount of the current FAM: $
Enter the date of the last revision of the FAM amount,pursuant to 310 CMR 19.051(6):
As a reminder,pursuant to 310 CMR 19.051(6),the estimate of the cost of closure and post-closure
maintenance must be revised every year,and every second year shall be submitted to the Department.
"I certify under the penalty of law: 7-4o, `&Lj
1. That I have personally examined and am familiar with the information Signature of Responsible Official
submitted in this third-party inspection report,including but not limited to
the statements above concerning the financial assurance mechanism in Tara Gallagher
place in accordance with any facility permit and 310 CMR 19.051,and Print Full Name
all attachments and that,based on my inquiry of those individuals
immediately responsible for obtaining the information,I believe that the Sustainability and EH&S Coordinator
information is true,accurate and complete.I am aware that there are Title
significant penalties both civil and criminal for submitting false
information including possible fines and imprisonment. 08/22/2024
2. That,in the event that this inspection report contains a recommendation Date(MM/DD/YYYY)
for corrective action(s),I have completed and attached to this report a
Corrective Action Plan and Schedule*,pursuant to 310 CMR No.Pursuant to 310 CMR 19.018(8)(c),a copy of each third-
19.018(8)(c)2." party inspection report shall be maintained at the facility in
accordance with the requirements of 310 CMR 19,000. The
`Note:The owner or operator may elect to correct deviations identified in the Third- owner and operator shall make third-party inspection reports
Party Inspection Report in a manner that is different than that recommended by the available to personnel or authorized representatives of the
Third-Party Inspector,so long as the facility is brought back into compliance with Department for review at the facility upon request.
applicable requirements.
Within 30 days of the a Mail this completed form to the MassDEP Regional A list of municipalities and MassDEP Regional
inspection date: Office that serves the municipality in which the facility Offices is available online at:
is located.(Attention:Solid Waste Management) httr,://www.mass.gov/eea/agencies/massdep/about/
contacts/find-the-massdeo-regional-office-for-you r-
• Send one copy to the local board of health for the city-or-town.html
municipality in which the facility is located.
Third-Party Inspection Report(0&M) Page 13 of 13
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