70-92 Boston STreet - Supplemental Site Investigation Summary Report - Appendix B - November 2005 I
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APPENDIX B
} IMMEDIATE RESPONSE ACTION
TRANSMITTAL FORM
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Supplemental Site Investigation Summary Report November 2005
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�assachusetts Department of Environmental Protection
ureau of Waste Site Cleanup BWSCi05
IMMEDIATE RESPONSE ACTION (IRA) TRANSMITTAL Release Tracking Number
FORM (Subpart Pursuant to 310 CMR 40.0424-40.0427 Sub art D) a - 24618
A. RELEASE OR THREAT OF RELEASE LOCATION:
1. Release Name/Location Aid: Former.Flynntan Site
2. street Address: 70-92 Boston Street
3. City(Town: Salem 4. ZIP Code: 01970-0000
❑ 5. Check here if a Tier Classification Submittal has been provided to DEP for this disposal site-
Fla. Tier IA ❑ b. Tier IB ❑ c. Tier IC ❑ d. Tier II
❑ 6. Check here if this location is Adequately Regulated,pursuant to 310 CMR 40.0110-0114. Specify Program(check one):
❑ a. CERCLA ❑ b. HSWA Corrective Action ❑ 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): 02/28/2005'
❑ 2. Submit an Initial IRA Plan. (mm/dd/yyyy)
❑ 3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.
❑ 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.
❑ c.- It is unknown whether are Imminent Hazard exists in connection with this Release or Threat of Release,and further
assessment activities will be undertaken.
❑ 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.
Ei5. Submit a request to Terminate an Active Remedial System or Response Action(s)Taken to Address an Imminent
Hazard.
0 6.-Submit an IRA Status Report.
❑ 7. Submit an IRA Completion Statement.
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
. 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):
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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.
❑ 8. Submit a Revised IRA Completion Statement.'
(All sections of this transmittal form must.be filled out unless otherwise noted above)
Revised: 11/04/2003 Page 1 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup BWSC1.05
IMMEDIATE RESPONSE ACTION (IRA) TRANSMITTAL Release Tracking Number
FORM pursuant to 310 CMR 40.0424-40.0427(Subpart D) 3❑ _ 24618
D. DESCRIPTION OF RESPONSE ACTIONS(cunt): (check all that apply,for volumes list cumulative amounts)
❑ c. Landfill
❑ i.Cover Estimated volume in cubic yards
Receiving Facility: Town: State:
❑ ii.Disposal Estimated volume in cubic yards
Receiving Facility: Town: State:
❑ 14. Removal of Drums,Tanks or Containers:
a. Describe Quantity and Amount:
b. Receiving Facility: Town: State:
c. Receiving Facility: Town:
State:
❑ 15. Removal of Other Contaminated Media:
a.Specify Type and Volume:
b.Receiving Facility: Town: State:.
c.Receiving Facility: Town: State:
❑ 16. Other Response Actions:
Describe:
❑ 17. Use of Innovative Technologies:
Describe:
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Revised: 11/04./2003 Page 3 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup 13WSC105
IMMEDIATE RESPONSE ACTION (IRA) TRANSMITTAL Release Tracking Number
FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) 3❑ _ 24618
F. PERSON UNDERTA UNG IRA:
1. Check all that apply: ❑ a.change in contact name ❑ b.change of address ❑ c. change in the person
undertaking response actions
2. Name of Organization: City Of Salem, Massachusetts
3. Contact First Name: Lynn 4.Last Name: Duncan
5. Street: ..City Hall Annex- 120 Washington Street 6.Title: Director of Planning
7. City/Town: Salem 8. State: MA 9. ZIP Code: 01970-0000
10. Telephone: (978) 745-9595 11.Ext.: 311 12 FAX (978) 740-0404
G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAI KING IRA--
1. RP or PRP a. Owner ❑ b. Operator ❑ c. Generator ❑ d. Transporter
❑ e. Other RP or PRP Specify:
0 2. Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s..2)
❑ 3. Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.56))
❑ 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
❑ :reused at the site following submission of the IRA Completion Statement. If this box is checked,you must submit one of the
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following plans,along with the appropriate transmittal form.
❑ a. A Release Abatement Measure(RAM)Plan(BWSC106) ❑ b.Phase IV Remedy Implementation Plan(BWSC108)
i 2. Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s)
❑ 'and/or approval(s)issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable
provisions thereof.
❑ 3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the
implementation of an Immediate Response Action taken to control,prevent,abate or eliminate an Imminent Hazard.
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❑ 4. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Completion Statement for an Immediate Response Action taken to control,prevent.abate or eliminate an Imminent Hazard.
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i ❑ 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.
Q 6. Check here to certify that the LSP Opinion containing the material facts,data,and other information is attached.
Revised: 11/04/2003 Page 5 of 6
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