SECTION II: SOURCE

 INFORMATION

 (continued)

 CR-ERNS Number:

Name of Source:

Part B: Specific Information on the Source

For the source identified above, provide the following information. Please provide a SEPARATE sheet for

EACH source.

AFFECTED MEDIUM. Identify the environmental medium (i.e., air, surface water, soil, or ground water) that is affected

by the release from this source. If your source releases hazardous substances to more than one medium (e.g., a wastepile releasing

to air and ground water), treat the release to EACH medium as a separate source and complete Section II, Parts A, B, and C, of this

format for EACH medium affected.

 AIR If the medium affected is air, please also specify whether the source is a stack or a ground-based area source.

 Stack Indicate stack height in feet or meters

 SURFACE WATER

If the release affects any surface water body, give the name of the water body.

If the release affects a stream, give the stream order or average flow rate, in cubic feet per second.

Stream Order OR Average Flow Rate (cubic feet/second)

Surface

Water Body

Stream

Lake

If the release affects a lake, give the surface area of the lake in acres and the average depth in meters.

Surface area of lake (in acres) Average depth of lake (in meters)

 SOIL OR GROUND WATER

 If the release is on or under ground, the location of public water supply wells within two miles.

Optional Information The following information is not required to comply with the regulation; however, such information will assist EPA in evaluating the risks

associated with the continuous release. If this information is not provided, EPA will make conservative assumptions about the appropriate

values. Please note that the units specified below are suggested units. You may use other units; however, be certain that the units are clearly

identified.

Inside diameter (feet or meters) Gas Exit Velocity (ft or meters/sec) Gas Temp (degrees Fahrenheit, Kelvin, or Celsius)

For a stack release to air, provide the following information, if available:

For a release to surface water, provide the following information, if available:

Average velocity of surface water (feet/second)

Continuous Release Reporting Form Form Approved OMB No. 2050-0086

Expiration Date: XX-XX-XXXX

EPA Form 6100-10, Continuous Release Reporting Form Page of
INSTRUCTIONS

SECTION II: SOURCE INFORMATION

(Part B)

CR-ERNS Number:

 If you are reporting a release of a CERCLA hazardous substance(s), you will be assigned a CR-ERNS number when you make this

initial telephone call to the NRC (1-800-424-8802). This CR-ERNS number will become the identifier for your facility. Your CRERNS number will never change; it is the number that identifies you in the CR-ERNS database.

Part B - Specific Information on the Source:

You must identify the environmental medium (i.e., air, surface water, soil, or ground water) affected by the hazardous substance

release from each source identified in Section II, Part A. In addition, you must provide specific information on the source and its

affected environment. It is important to remember that if you have a release from a single source that affects two different media

(e.g., gypsum stack releasing radon to air and radionuclides to ground water), you should treat the release to each medium as a

separate source for purposes of reporting. Another important point to remember when completing all sections of the written report

is to include the appropriate units, such as kilograms, meters, or curies.

Estimated Average Stream Flow Rates

Stream

Order

1

2

3

4

5

6

7

8

9

10

Mean Flow

(CFS)

 0.65

 3.10

 15.00

 71.00

 340.00

 1,600.00

 7,600.00

 56,000.00

171,000.00

810,000.00

Mean

Velocity

(feet/sec)

1.0

1.3

1.5

1.8

2.3

2.7

3.3

3.9

5.6

5.9

Sources of Information for Estimating Average Lake Depth

If the lake is large enough to be navigable, your local Coast

Guard office will have a navigation chart that will provide the

average depth of the lake. For smaller lakes, you may estimate

the average depth of the lake by relying on your knowledge of

the use of the lake and the surrounding area, and your best

professional judgment.

Environmental medium - Identify the environmental medium (i.e., air, surface water, soil, or ground water) that is affected by the

release from the identified source.

 1. Air - If the medium affected is air, provide the following information:

a. Indicate whether the source is a stack or ground-based area source.

b. If the source is a stack, provide the stack height in feet or meters. The stack height is the distance from the ground

to the top of the stack.

c. If the source is an area source (e.g., a waste pile, surface impoundment, landfill, valve, pump seal, or storage tank

vent), provide an estimate of the surface area or area of the release source including the appropriate unit such as

square feet, square meters, or acres.

2. Surface Water - If the medium affected is surface water, provide the following information:

a. If the release affects any surface water body, give the name of the water body.

b. If the release affects a stream, give the “stream order” or the average flow rate (in cubic feet per second). This

information can be obtained from your state water resource division of USGS. If you cannot locate this

information, use the chart below to estimate the flow rate according to the velocity of the stream. If the velocity of

the stream fluctuates during the year, use the average velocity when calculating average flow rate.

c. If the release affects a lake, or other large surface water body (e.g., a bay) give the surface area of the lake (in

acres) and the average depth (in feet or meters). Below are sources of information for estimating the average lake

depth.

3. Soil or Ground Water - If the medium affected is soil or ground water, provide the following information:

a. If the release is on or under ground, indicate the distance to the closest public water supply well within a two-mile

radius of the site. Information regarding the location of public water supply wells may be available through the

county office that issues permits for wells.

Optional information - The following information is not required to comply with the regulation; however, such information will assist EPA in evaluating the risks

associated with a continuous release. If the information below is not provided, conservative values will be used to evaluate the risks associated with the continuous

release.

1. If the source is a stack release to air, provide the: (a) inside diameter of the stack; (b) gas exit velocity; and (c) gas temperature.

2. If the release affects surface water, provide the average velocity of the surface water.