HAEY&ALDRICH

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Haley & Aldrich, h1.c.

465 Medford St.Suite 2200Boston, MA 02129-1400

Tel: 617.886.7400Fax: 617.886.7600HaleyA I drich. com

8 August 2008File No. 34368-040

US Environmental Protection AgencyRGP-NOC ProcessingMail Code CMP1 Congress Street, Suite 1100Boston MA 02114-2023

Attention: Mr. Victor Alvarez

Subject: Notice of Intent (NOl)Construction Dewatering175 Wyman StreetWaltham, MA

Dear Mr. Alvarez:

In accordance with the National Pollutant Discharge Elimination System (NPDES) RemediationGeneral Permit (RGP) in Massachusetts, MAG910000, this letter submits a Notice of Intent(NOl) and the applicable documentation as required by the US Environmental ProtectionAgency (EPA) for construction site dewatering under the RGP. Dewatering is planned insupport of the construction activities proposed at the 175 Wyman Street site, located in

Waltham, Massachusetts (Figure 1 - Project Locus).

The property owner, Hobbs Brook Management, LLC, plans to construct two, two storybuildings within the project limits. The proposed below-grade construction wil consist ofexcavation and installation for building footings, utility installations, and for a proposed belowgrade access tunnel leading to an existing groundwater recovery well at one of the buildinglocations. Planned site improvements wil also include construction of a stormwater detentionbasin in the southwestern portion of the property. The storm water basin wil be lined andconstructed above the observed water table. The limits of work wil also include excavationsfor utility installations and landscaping. Excavations wil extend below the range of normalgroundwater levels measured at the site.

The 175 Wyman Street property occupies a 27.5 acre parcel located east of Route 128 , on

Wyman Street in Waltham. The former owner of the property used the building complex from1959 to 1995 for the manufacture of medical equipment and printed circuit boards.

The limits of work include one state disposal site with Release Tracking Number (RTN) 3-13311 issued by the Massachusetts Department of Environmental Protection (MassDEP) andsubject to the Massachusetts Contingency Plan (MCP), 310 CMR 40.0000. A release ofchlorinated volatile organic compounds (CVOC - primarily TCE) possibly from a former sewerline under a portion of the existing buildings is suspected to be the historical source of CVOCsthat have been detected in the groundwater primarily at depth. The groundwater contamination

HAEY&ALDRICH

US Environmental Protection Agency8 August 2008Page 2

extends into the fractured bedrock. The former owner is the party conducting response actionsat the MCP site.

GZA GeoEnvironmental , Inc. (GZA) has been conducting remedial response actions at theproperty to address the CVOCs in groundwater since 1997. The primary purpose of theremedial actions is to contain the CVOC plume and prevent migration of contaminants. Theremedial actions undertaken at the MCP site have involved the installation and operation of aGroundwater Containment and Treatment System (GTCS). The MCP site is currently inRemedy Operation Status (ROS) under the MCP. Construction activities within the limits ofthe MCP site are being conducted under a Release Abatement Measure (RAM) Plan.

ln support of the NOl, a groundwater sample was collected from one groundwater monitoringwell (MW- 101) located within the project site and near locations where proposed constructionmay encounter groundwater. The results of water quality testing conducted for this NOl aresummarized in Table 1. The location of the groundwater monitoring well is shown on Figure 3.

Dewatering wil be conducted from sumps located at the area of local excavations within theproposed foundation limits, and at the proposed stormwater basin excavation location.Dewatering is necessary to control precipitation, surface water runoff and construction-generated water to enable construction in-the-dry. It may also be needed to control groundwaterseepage. Construction dewatering may be needed on-site as soon as 15 September 2008.

Prior to discharge, collected water wil be routed through a sedimentation tank and bag fiter , at

a minimum, to remove suspended solids and undissolved chemical constituents (metals), asshown in the Proposed Treatment System Schematic included in Figure 2 herein. Followingtreatment, the effluent wil be piped and directly discharged to storm drains located within andadjacent to the site. ln general , the storm drains cross Wyman Street and discharge into an off-site detention pond adjacent to Route 128N. The detention pond discharges to the CambridgeReservoir. The proposed discharge route is shown on Figure 3, Proposed Dewatering DischargeRoute.

The completed "Suggested Notice of lntent" (NOl) form as provided in the RGP is enclosed inAppendix A. The site owner is the Hobbs Brook Management, LLC, and the operator isColumbia Construction Company (Columbia). Columbia is the general contractor and wil hirea subcontractor to conduct the Site Work, including the dewatering activities. On behalf of theowner, an environmental consultant wil monitor the Contractor s dewatering activities. Inaccordance with the requirements for this NOl submission, the owner and Contractor are listedas co-permittees for this NPDES RGP and have both signed the NOl form.

Appendix B provides Material Data Safety Sheets (MSDS) and fact sheets for possible chemicaladditives or treatments to be used in the treatment system. A Best Management Practices Plan(BMPP) has been completed and is included in Appendix C. The BMPP outlines the proposeddischarge operations covered under the RGP. Appendix D and E include National Register ofHistoric Places and Endangered Species Act documentation. A copy of the laboratory resultsare provided in Appendix F.

HAEYlALDRICH

US Environmental Protection Agency8 August 2008Page 3

Thank you very much for your prompt consideration of this NOr. Please feel free to contact usshould you wish to discuss the information contained herein or if you need additionalinformation.

Sincerely yours,

HALEY & ALDRICH, lNC

Mark X. Haley, P .Senior Vice President

lliana Alvarado, P.Senior Engineer

Attachments:

Table I - Summary of Water Quality Data

Figure 1 - Site LocusFigure 2 - Proposed Treatment System SchematicFigure 3 - Proposed Dewatering Discharge RouteFigure 4 - Subsurface Exploration Location Plan

Appendix A - Notice of lntent (NOl) for Remediation General Permit (RGP)Appendix B - MSDS and Fact SheetsAppendix C - Best Management Practices Plan (BMPP)Appendix D - National Register of Historic Places and Massachusetts Historical

Commission DocumentationAppendix E - Endangered Species Act DocumentationAppendix F - Laboratory Data Reports

Hobbs Brook Management, LLC; Donald OldmixonColumbia Construction Company; NeilJ. LemieuxMassachusetts Department of Environmental Protection; Division of WatershedManagementCity of Waltham; Health DepartmentWiliam Norman; GZA GeoEnvironmental

G:\34368\040\NPDES RGP Application\Final\2008-0808-HAI-RGP CoverLetterI- doc

Page 1 of2

TABLE ISUMMARY OF GROUNDWATER QUALITY DATA175 WYMAN STREETWALTHAM, MASSACHUSETTSMADEP RTN: 1331134368.040

SAMPLE DESIGNATION MCP NPDES MW-101S

LABORATORY SAMPLE DESIGNATION RCGW- RGP L0803616-

SAMPLING DATE Effuent Limits 14-MAR-

VOCs by 6241504 (ug/I)1, 1-Trichloroethana 4000 200 ND(25)

2- Trichloroethane 900 ND(19)

Dlchloroethane 1000 ND(19)

Dichloroethene ND(12.

Dlchlorobenzene 2000 600 ND(60)

Dichloroethane ND(19)

Djchlorobenzene 2000 320 ND(60)

Dichlorobenzene 200 ND(60)

Dibromoethane ND(0.051)

1 A-Dioxane Monitor Only ND(25000)

Butanone 50000 ND(12.

Acetone Monitor Only ND(125)

Benzene 2000 ND(12.

Carbon tetrachloride 4.4 ND(12.

cis- Dlchloroethylene 100 ND(12.

Ethylbenzene 5000 ND(12.

Methyl tert-butyl ether 5000 ND(250)

Methylene chloride 10000 ND(60)

a-xylene ND(12.

m/p-Xylene ND(25)

Tert-Butyl Alcohol #NIA ND(1250)

Tertiary-Amyl Mathyl Ether #N/A ND(250)

Tetrachloroethylene ND(19)

Toluene 40000 ND(12.

Trichloroethylene 1500

Vinyl chlorida ND(25)

Xylene (Total) #N/A ND(25)

Tolal VOCs 1500

SVOCs by 8270 (ugll)Methylnaphthalene ND(2.

Acenaphthene 6000 ND(2.

Acenaphlhylene ND(2.

Anthracene ND(2.

Benzo(a)anthracene 1000 ND(2.

Benzo(a)pyrene 500 ND(2.

Benzo(b)fluoranthene 400 ND(2.

Benzo(g, i)perylene ND(2.

Benzo(k)fiuoranthene 100 ND(2.

Bis(2-ethylhexyl)phlhalate 50000 ND(2.

Chrysene ND(2.

Dibenzo(a h )anthracene ND(2.

Fluoranthene 200 ND(2.

Fluorene ND(2.

Indeno(1 3-cd)pyrene 100 ND(3.

Naphthalene 1000 ND(2.

Pentachlorophenol 200 ND(5)

Phenanthrene 10000 ND(2.

Phenol 2000 300 ND(3.

Pyrene ND(2.

Tolal SVOCs

PAHs by 81M 8270 (ugll)Methylnaphthalene ND(0.

Acenaphthene 6000 ND(0.

Acenaphthylena ND(0.

Anthracene ND(0.

Benzo(a)anthracene 1000 ND(0.

Benzo(a)pyrene 500 ND(0.

Benzo(b)fluoranthene 400 ND(0.

Benzo(g, i)perylene ND(0.

Benzo(k)fluoranthene 100 ND(O.

Chrysene ND(0.

Dibenzo(a,h )anthracene ND(0.

Fluoranthene 200 ND(0.

Fluorene ND(O.

Indeno(1, 3-cd)Pyrene 100 ND(0.

Naphthalane 1000 ND(0.

Pentachlorophenol 200 ND(OA)

Phenanthrene 10000 ND(0.

Pyrene ND(0.

T alai P AHs

HALEY & ALDRICH , INC.

G :1343681040\NPDES RGP ApplicationIFinaI12008-0324-HAI-GWQualityData-F .xls 8/7/2008

Page 2 of2

TABLE ISUMMARY OF GROUNDWATER QUALITY DATA175 WYMAN STREETWALTHAM, MASSACHUSETTSMADEP RTN: 1331134368-040

SAMPLE DESIGNATION MCP NPDES MW-101SLABORATORY SAMPLE DESIGNATION RCGW- RGP L0803616-SAMPLING DATE Effuent Limtts 14-MAR-

TPH (mgll) ND(2)

Tolal Melals (ug/I)Antimony 8000 ND(0.25)Arsenic 900 ND(0.25)Cadmium ND(0.

Chromium 300 48. ND(0.25)Chromium , Hexavalent 300 11.4 ND(5)

Copper 100000Iron 1000 ND(25)

Lead ND(0.25)Mercury ND(0.

Nickel 200Selenium 100 ND(0.

Silver 1.2 ND(0.

Zinc 900 66.

PCBs by 60B (ugll)Total PCBs 000064'

Generai' ChemislryCyanide, Total (ugll) ND(2.Phenolics, Total (ug/I) 300 ND(15)Chlorine , Total Residual (ugll) ND(10)Total Suspended Solids (U9/1) 30' ND(2.

ABBREVIATIONS:NA: Not applicabla-: Not analyzed

ND(2.5): Not detected: number in parentheses is one-halfthe laboratory detection limit

#: Indicates Effuent limit limitad as ug/L total BTEX: Indicates the compliance limits are equal to the minimum level of the test method used.

+: Indicates Effuent limit limited as ug/L total Group II PAH

NOTES:1. This table includes only those compounds detected on the dates indicated.

HALEY & ALDRICH, INC.G:13436810401NPDES RGP ApplicationIFinal\2008-0324-HAI-GWQualityData-F .xls 8/712008

SITE COORDINATES:42"24' N 71' 15' 24" HALEY&ALDRICH

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B. Suggested Form for Notice of Intent (NO!) for the Remediation General Permit

1. General site information. Please provide the following information about the site:

a) Name of facilty/site: 175 Wyman Street Facility/site address:

Location offacilty/site: Facility SIC code(s): Street:175 Wyman Streetlongitude: 42 24 7 latitude: 71 15 26

b) Name of facility/site owner:Hobbs Brook Management, LLC Town: Waltham

Email address of owner: donald.oldmixon(ghobbsbrook.com State: Zip: County:

Telephone no.offacility/site owner: 781-890-9300 02451 Middlesex

Fax no. of facility/site owner: 781-890-8617 Owner is (check one): 1. Federal 2. State/Tribal

__-

3. private--- 4. other, if so , describe:Address of owner (if different fTom site):

Street: 225 Wyman Street

Town: Waltham State: MA Zip: 02451 County: Middlesex

c) Legal name of operator: Operator telephone no: 978-664-9500

Columbia Construction Company Operator fax no. : 978-664-1563 Operator email:nlemieux(gcolumbiacc.com

Operator contact name and title: Neil J. Lemieux

Address of operator (if different fTom owner): Street: 100 Riverpark Drive PO Box 220

Town: North Reading State: MA Zip: 01864 County: Middlesex

d) Check "yes" or " " for the following:, if "yes " number:1. Has a prior NPDES permit exclusion been granted for the discharge? Yes

2. Has a prior NPDES application (Form 1 & 2C) ever been filed for the discharge? Yes NOL, if "yes " date and tracking #:

3. Is the discharge a "new discharge as defined by 40 CFR 122.2? Yes4. For sites in Massachusetts, is the discharge covered under the MA Contingency Plan (MCP) and exempt from state permitting? Yes ./ No

Remediation General Permit - Notice ofIntent

e) Is site/facility subject to any State permitting or other action which is causing thegeneration of discharge? Yes - NoIf "yes " please list:I. site identification # assigned by the state ofNH or MA:2. pennit or license # assigned:3. state agency contact information: name , location, and telephone number:

f) Is the site/facility covered by any other EP A permit , including:1. multi-sector storm water general permit? Y , ifY , number:

2. phase I or II construction stonn water general permit? Y - N MAR10CQ2ifY , number:3. individual NPDES permit? , ifY , number: MAG91 00024. any other water quality related permit? Y N1, ifY , number:

2. Discharge information. Please provide information about the discharge , (attaching additional sheets as needed) including:

a) Describe the discharge activities for which the owner/applicant is seeking coverage:

Temporary construction dewatering in support of building foundation and subsurface utility construction.

b) Provide the 1) Number of 2) What is the maximum and average flow rate of discharge (in cubic feet per second , ft3/s)? Max. flowAverage flow 0.11 Is maximum flow a design value? Y- N

---

following dischargeinformation points: For average flow , include the units and appropriate notation if this .value is a design value or estimate if not available.

about eachdischarge:

3) Latitude and longitude of each discharge within 100 feet: pt. l:long. lat. ; pt.2: long.

___

lat. ; pt.3: long. lat.

pt.4:10ng. - lat.

___

; pt.5: long.__- lat. ; pt.6:10ng.

__-

lat.

---

; pt.?: long.

___

lat. ; pt.8:long. lat.

___

; etc.

4) If hydrostatic testing, total volume of the discharge (gals): 5) Is the discharge intermittent or seasonalIs discharge ongoing Yes_- No

c) Expected dates of discharge (mm/dd/yy): start 09/01/08 end 08/01/09

d) Please attach a line drawing or flow schematic showing water flow through the facility including:I. sources of intake water , 2. contributing flow from the operation , 3. treatment units , and 4. discharge points and receiving waters(s).

See attached Figure 2 (Proposed Treatment System Schematic)

(Proposed Dewatering Discharge Route) .and Figure 3

Remediation General Permit - Notice of Intent

3. Contaminant information. In order to complete this section, the applicant wil need to take a minimum of one sample of the untreated water and have it analyzed for allof the parameters listed in Appendix III. Historical data , (i. , data taken no more than 2 years prior to the effective date of the permit) may be used if obtained pursuant to:i. Massachusetts ' regulations 310 CMR 40. 0000 , the Massachusetts Contingency Plan ("Chapter 2lE"); ii. New Hampshire s Title 50 RSA 485-A: Water Pollution and

Waste Disposal or Title 50 RSA 485-C: Groundwater Protection Act; or iii. an EP A permit exclusion letter issued pursuant to 40 CFR 122. , provided the data was

analyzed with test methods that meet the requirements of this permit. Otherwise , a new sample shall be taken and analyzed.

a) Based on the analysis of the sample(s) of the untreated influent , the applicant must check the box of the sub-categories that the potential discharge falls within.

Gasoline Only VOC Only Primarily Metals Urban Fill Sites Contaminated Sumps Mixed Contaminants Aquifer Testing

Fuel Oils (and VOC with Other Petroleum with Other Listed Contaminated Contaminated Hydrostatic Testing of Well Development

Other Oils) only Contaminants Contaminants Sites Dredge Condensates Pipelines/T anks or Rehabilitation

b) Based on the analysis ofthe untreated influent , the applicant must indicate whether each listed chemical is believed present or believed absent in the potential

discharge. Attach additional sheets as needed.

PARMETER Believe Believe # of Type of Analytical Minimum Maximum daily value Avg. daily value

Absent Present Samples Sample Method Level (M) of(1 min- (e.g., grab) Used Test Method concentration mass (kg) concentration mass (kg)imum) (method #) (ugll) (ug/I) (ugll)

1. Total Suspended Solids Grab 160.

2. Total Residual Grab 330.Chlorine

3. Total Petroleum Grab 1664Hydrocarbons

4. Cyanide Grab 335.

5. Benzene Grab 624

6. Toluene Grab 624

7. Ethylbenzene Grab 624

8. (m, o) Xylenes Grab 624

9. Total BTEX' Grab 624 25/50

BTEX = Sum of Benzene, Toluene, Ethylbenzene, lolal Xylenes.

Remediation General Permit - Notice of Intent

PARAMETER Believe Believe # of Type of Analytical Minimum Maximum daily value Avg. daily value

Absent Present Samples Sample (e.

g.,

Method Level (M) of(1 min- grab) Used Test Method concentration mass (kg) concentration mass (kg)imum) (method #) (ug/l) (ugll) (ug/l)

10. Ethylene Dibromide Grab 504(1,2- Dibromo-methane)

11. Methyl-tert-Butyl Grab 624 500Ether (MtBE)

12. tert-Butyl AlcOhol Grab 624 2500(TBA)

13. tert-Amyl Methyl Grab 624 500Ether (TAME)

14. Naphthalene Grab 8270

15. Carbon Tetra- Grab 624chloride

16. 1, Dichlorobenzene Grab 624 120

17. Dichlorobenzene Grab 624 120

18. 1 Dichlorobenzene Grab 624 120

19. 1, Dichloroethane Grab 624

20. 1, Dichloroethane Grab 624

21. 1, Dichloroethylene Grab 624

22. cis- Dichloro- Grab 624ethylene

23. Dichloromethane Grab 624 120(Methylene Chloride)

24. Tetrachloroethylene Grab 624

EDB is a groundwaler conlaminanl al fuel spil and pesticide application sites in New England.

Remediation General Permit - Notice ofIntent

PARAMETER Believe Believe # of Type of Analytcal Minimum Level Maximum daily value Avg. daily Value

Absent Present Samples Sample (e. Method Used (M) ofTest(I min- grab) (method #) Method (ug/l) concentration mass (kg) concentration mass (kg)imum) (ug/l) (ug/l)

25. 1 Trichloroethane Grab 624

26. 1, Trichloroethane Grab 624

27. Trichloroethylene Grab 624 1500

28. Vinyl Chloride Grab 624

29. Acetone Grab 624 250

30. 1,4 Dioxane Grab 624 50000

31. Total Phenols Grab 420.

32. Pentachlorophenol Grab 8270

33. Total Phthalates Grab 8270(phthalate esthers)

34. Bis (2-Ethylhexyl)Phthalate lDi- Grab 8270(ethylhexyl) Phthalate)

35. Total Group IPolycyclic AromaticHydrocarbons (P AH)

a. Benzo(a) Anthracene Grab 8270

b. Benzo(a) pyrene Grab 8270

c. Benzo(b)Fluoranthene Grab 8270

d. Benzo(k) Fluoranthene Grab 8270

e. Chrysene Grab 8270

The sum of individual phthalale compounds.

Remediation General Permit - Notice of Intent

PARAMETER Believe Believe # of Type of Analytical Minimum Maximum daily value Average daily value

Absent Present Samples Sample (e. Method Used Level (ML) of

(l min- grab) (method #) Test Method concentration mass (kg) concentration mass (kg)imum) (ug/) (ug/l) (ug/l)

f. Dibenzo(a Grab 8270anthracene

g.

Indeno(1 2,3-cd) Grab 8270Pyrene

36. Total Group IIPolycyclic AromaticHydrocarbons (PAil

h. Acenaphthene Grab 8270

i. Acenaphthylene Grab 8270

j. Anthracene Grab 8270

k. Benzo(ghi) perylene Grab 8270

I. Fluoranthene Grab 8270

m. Fluorene Grab 8270

n. Naphthalene- Grab 8270

o. Phenanthrene Grab 8270

p. Pyrene Grab 8270

37. Total Polychlorinated Grab 3510Biphenyls (PCBs)

38. Antimony Grab 6020

39. Arsenic Grab 6020

40. Cadmium Grab 6020

41. Chromium III Grab 6020

42. Chromium VI Grab 3500

Remediation General Permit - Notice of Intent

PARAMETER Believe Believe # of Type of Analytical Minimum Maximum daily value Avg. daily value

Absent Present Samples Sample (e.

g.,

Method Level (ML) of(I min- grab) Used Test Method concentration mass (kg) concentration mass (kg)imum) (method #) (ug/l) (ug/l) (ug/I)

43. Copper Grab 200.

44. Lead Grab 6020

45. Mercury Grab 245.

46. Nickel Grab 200.

47. Selenium Grab 6020

48. Silver Grab 6020 0.4

49. Zinc Grab 200.

50. Iron Grab 200.

Other (describe):

c) For discharges where metals are believed present, please fill out the following:

Step 1: Do any of the metals in the influent have a reasonable potential to exceed the If yes, which metals?

effuent limits in Appendix II (Le. , the limits set at zero to five dilutions)? Y -- N

Step 2: For any metals which have reasonable potential to exceed the Appendix III limits Look up the limit calculated at the corresponding dilution factor in

calculate the dilution factor (DF) using the formula in Part I.A. c) (step 2) of the NOI Appendix IV. Do any of the metals in the influent have the potential to

instructions or as determined by the State prior to the submission of this NO!. exceed the corresponding effluent limits in Appendix IV (i. , is the

What is the dilution factor for applicable metals? influent concentration above the limit set at the calculated dilution

Metals: factor)?

DF: If "Yes " list which metals:

Remediation General Permit - Notice of Intent

6. Results of C

onsultation with Federal Services: Plcasc providc the follow

ing infonnation according to requircments of Part L

BA

and Appendices II and V

II

a) Are any listed thrcatcncd or endangered species , or designated critical habitat, in proxim

ity to Ihe discharge? YeS

____

Has any consultation w

ith the fedcral serviccs been completed? Y

es_- No "-

or is consultation underway? Y

es -- No

"--

What w

ere the results of the consultation with the U

. S. Fish and Wildlife Service and/or N

ational Marinc Fisheries Service (check one):

a "no jeopardy" opinion? _

or written concurrencc

- on a finding that the discharges are not likely to adversely affect any cndangered species or critical habitat?

b) Are any historic proyerlies listed or eligible for listing on the N

ational Registcr of H

istoric Places located on the facility or site or in proximity to the discharge?

Yes

No

Ji_--- H

ave any state or tribal historic preservation officer becn consultcd in this determination (M

assachusetts only)? Yes

7. Supplem

enlal information. :

Please provide any supplemental inform

ation. Attach any analytical data used to support the application. A

ttach any certification(s) required by the gcncral permit.

8. Signa lure Requirem

enls: The N

otice of Intent must be signed by the operator in accordance w

ith the signatory requircments of 40 C

FR Section 122.

, including thefollowing certification:

I certify under penalty of law that this docum

ent and all attachments w

ere prepared under my direction or supervision in accordance w

ith a system designed to assure

that qualified personnel properly gather and evaluate the information subm

itted. Based on m

y inquiry afthe person or persons who m

anage the system, or those

persons directly responsible for gathering the information

, I certifY that the inform

ation submitted is , to the best of m

y knowledge and belief true

, accurate, andcom

plete. I certify that I am aw

are that there are significant penaltes for submitting false inform

ation, including the possibility affine and im

prisonmentfor know

ingviolations.

Title:

Date:

August 8,

2008

Rem

ediation General Perm

it - Noticc of Intent

6. R

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f C

onsu

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ith F

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Ple

ase

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the

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of

Part

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and

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Yes

W

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):a "no

jeop

ardy

" op

inio

n? _

_or written concurrence

-- on

a f

indi

ng th

at th

e di

scha

rges

are

not

like

ly to

adv

erse

ly a

ffec

t any

end

ange

red

spec

ies

or c

ritic

al h

abita

t?

b) A

re a

ny h

isto

ric

prop

ertie

s lis

ted

or e

ligib

le f

or li

stin

g on

the

Nat

iona

l Reg

iste

r of

His

tori

c Pl

aces

loca

ted

on th

e fa

cilit

y or

site

or

in p

roxi

mity

to th

e di

scha

rge?

Yes No

';

Hav

e an

y st

ate

or tr

ibal

his

tori

c pr

eser

vatio

n of

fice

r be

en c

onsu

lted

in th

is d

eter

min

atio

n (Massachusetts only)? Yes

7. S

uppl

emen

tal i

nfor

mat

ion.

:

Plea

se p

rovi

de a

ny s

uppl

emen

tal i

nfor

mat

ion.

Atta

ch a

ny a

naly

tical

dat

a us

ed to

sup

port

the

appl

icat

ion.

Atta

ch a

ny c

ertif

icat

ion(

s) r

equi

red

by th

e general permit.

8. S

igna

ture

Req

uire

men

ts: T

he N

otic

e of

Inte

nt m

ust b

e si

gned

by

the

oper

ator

in a

ccor

danc

e w

ith th

e si

gnat

ory

requ

irem

ents

of

40 C

fR S

ectio

n 12

2., i

nclu

ding

the

follo

win

g ce

rtif

icat

ion:

I cer

tify

unde

r pe

nalty

of l

aw th

at th

is d

ocum

ent a

nd a

ll at

tach

men

ts w

ere

prep

ared

und

er m

y di

rect

ion

or s

uper

visi

on in

acc

orda

nce

with

a s

yste

m d

esig

ned

to a

ssur

eth

at q

ualif

ed p

erso

nnel

pro

perly

gat

her

and

eval

uate

the

info

rmat

ion

subm

itted

. Bas

ed o

n m

y in

quir

y of

the

pers

on o

r pe

rson

s w

ho m

anag

e th

e sy

stem

, or

thos

epe

rson

s di

rect

ly r

espo

nsib

le f

or g

athe

ring

the

info

rmat

ion

, I c

ertif

y th

at th

e in

form

atio

n su

bmitt

ed is

, to

the

best

of m

y kn

owle

dge

and

belie

f, tr

ue, a

ccur

ate

, and

com

plet

e. I

cert

ifY th

at I

am a

war

e th

at th

ere

are

sign

ifica

nt p

enal

ties

for

subm

ittin

g fa

lse

info

rmat

ion

, inc

ludi

ng th

e po

ssib

ility

off

ine

and

impr

ison

men

t for

kno

win

gvi

olat

ions

.

faci

lity/

Site

Nam

e:

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'\,\V

V

,c,

\OO

'\D-L

-\J '"

62-4

'5(\

Ope

rato

r si

gnat

ure:

Titl

e:

Dat

e:

Rem

edia

tion

Gen

eral

Per

mit

- N

otic

e of

Int

ent