355 Highland Avenue 1-22-18 COOPERSTOWN
environmental
January 22,2018 RECEIVED
Mr. Paul Kirby,chair JAN 2 9 2013
Salem Board of Health CITY OF SALEM
Salem City Hall BOARD OF HEALTH
93 Washington Street
Salem, MA 01970
Re: Notice of Submittal of Release Notification Form under
the Massachusetts Contingency Plan (MCP,310 CMR 40.0000)
355 Highland Avenue/Salem, Massachusetts
RTN 3-34643
Dear Mr. Kirby:
The property at 355 Highland Avenue (which includes 2 and 3 Cedar Road) in Salem is a "site" under the
Massachusetts Contingency Plan(MCP,310 CMR 40.0000)at which a release of asbestos has occurred
in the past. The Massachusetts Department of Environmental Protection(MassDEP) has assigned
Release Tracking Number(RTN) 3-34643 to the site. The MCP stipulates at 40.1400 that the chief
municipal and health officers of the municipality(s) in which a site is located be notified of the submittal
to the MassDEP of a Release Notification Form (RNF,which informs MassDEP of the release). An
electronic RNF for 355 Highland Avenue has been submitted to MassDEP through the Department's
"eDEP"web page. A copy is attached.
The site file can be viewed at the following web site:
http7//public.dep.state.ma.us/SearchableSites2/Search.aspx
by entering"3" in the first RTN search box,and"34643" in the second RTN search box. No other search
parameters are required. Additional opportunities for public involvement are available under the MCP
at 310 CMR 40.1403 and 40.1404.
Should you have any questions,you may contact me at the letterhead address.
Very sincerely yours,
Cooperstown Environmental LLC
James S.Young, PG, LSP
-'3 Main Strccl Anduccr, Al 01810•'I'978-470-47J.;• K)'1F.Sslitpl'I'9Iu�4ril'ilVal�Al
Massachusetts Department of Environmental Protection BWSC 103
Bureau of Waste Site Cleanup
1 RELEASE NOTIFICATION&NOTIFICATION Release Tracking Number
RETRACTION FORM j 3 - 34643 J'
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: PROPERTY
2.Street Address: 355 HIGHLAND AVENUE
3.City/rown: SALEM 4.ZIP Code:
5.Coordinates: a.Latitude:N 42.49832 b.Longitude:W 71.92965
B.THIS FORM IS BEING USED TO: (check one)
W, 1.Submit a Release Notification
r 2.Submit a Revised Release Notification
r 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 (TOR):
I.Date and time of Oral Notification,if applicable: 11127/2017 Tone: 01:40 r A M r PM
mm/dd/yyyy hh:mm
2.Date and time you obtained knowledge of the Release or TOR: 9/82017 Tune: 12:00 r AM ro PM
mm/ddlyyyy hh:mm
3.Date and time release or TOR occurred,if known: Tune: r AM rpm
mm/dd/yyyy hh:mm
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 5.72 HOUR REPORTING CONDITIONS 6.120 DAY REPORTING CONDITIONS
C a. Sudden Release r a. Subsurface Non-Aqueous Phase r a.Release of Hazardous Material(s)to
Liquid(NAPL)Equal to or Greater than Soil or Groundwater Exceeding
1/2 Inch(.04 feet) Reportable Concentration(s)
r b.Threat of Sudden Release r b.Underground Storage Tank(UST) r b.Release of Oil to Soil Exceeding
Release Reportable Concentration(s)and
Affecting More than 2 Cubic Yards
r c.Oil Sheen on Surface Water r c.Threat of UST Release r c.Release of Oil to Groundwater
Exceeding Reportable Concentration(s)
r d.Poses Imminent Hazard r d.Release to Groundwater new Water r d.Subsurface Non-Aqueous Phase
Supply Liquid(NAPL)Equal to or Greater than
1/8 Inch(.01 feet)and Less than 1/2 Inch
(.04 feet)
r e.Could Pose Imminent Hazard r e.Substantial Release Migration
r f.Release Detected in Private Well
r g.Release to Storm Drain
r h.Sanitary Sewer Release
(Imminent Hazard Only)
Revised:07/18/2013 Pagel of3
Massachusetts Department of Environmental Protection BWSC 103
Bureau of Waste Site Cleanup
RELEASE NOTIFICATION&NOTIFICATION Release Tracking Number
RETRACTION FORM
LIN
3 34643
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.
r Check here if an amount or concentration is unknown or less than detectable.
O or HM Released CAS Number, O or HM Amount or Units RCs Exceeded,if Applicable
if known Concentration (RCSI,RCS-2,RCGW-1,
RCGW-2)
ASBESTOS Hv1 1 LBS N/A
r Check here if a list of additional Oil and Hazardous Materials subject to reporting,or any other documentation relating to this notification
is attached.
D.PERSON REQUIRED TO NOTIFY:
1.Check all that apply: r a.change in contact name r b.change of address r c.change in the person notifying
2.Name of Organization: CINEM4NpRLD OF FLORIDA INC
3.Contact First Name: RICHARD 4.Last Name: STARR
5.Street: 97016TH PLACE 6.Title:
7.CityfFown: VERO BEACH 8.State: FL 9.ZIP Code: 329600000
10.Telephone: 772-978-7188 11.Ext: 12.Email:
I— 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: r Check here to change relationship
WO I.RP or PRP r a.Owner r b.Operator r c.Generator r d.Transporter
!✓e.Other RP or PRP Specify: NON-SPECIFED PRP
r 2.Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21E,s.2)
r 3.Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50))
r 4.Any Other Person Otherwise Required to Notify Specify Relationship:
Revised:07/18/2013 Page 2 of 3
Massachusetts Department of Environmental Protection BWSC 103
Bureau of Waste Site Cleanup
- RELEASE NOTIFICATION&NOTIFICATION Release Tracking Number
RETRACTION FORM 3 I - 34643
Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpar C)
F.CERTIFICATION OF PERSON REQUIRED TO NOTIFY:
L I,RICK STARR ,attest under the pains and penalties of perjury(i)that I have personally
examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal
form,(ii)that,based on my 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 1 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: RICKSFARR 3.Title:
Signature
4.For: CNEMANORLD OF FLORIDA INC 5.Date: 1/25/2018
(Name of person or entity recorded in Section D) mm/dd/yyyy
r 6.Check here if the address of the person providing certification is different from address recorded in Section D.
7.Street:
8.Cityfrown: 9.State: 10.ZIP Code:
11.Telephone: 12.ExL: 13.Email:
YOU ARE SUBJECT TO ANNUAL COMPLIANCE ASSURANCE FEES FOR EACH RELIABLE YEAR FOR TIER
CLASSIFIED DISPOSAL SITES.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
MAYBE PENALIZED FOR MISSING A REQUIRED DEADLINE
Date Stamp(DEP USE ONLY:)
Received by DEP on 1/25/2018 1:47:01 PM
1
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Revised:07/18/2013 Page 3 of 3