## 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 EACHmedium 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 Average Flow Rate (cubic feet/second) 

### OR 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 of Page

## 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 thisinitial 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.