Illinois Administrative Code › Title 35 - ENVIRONMENTAL PROTECTION › Part 620 - GROUNDWATER QUALITY › Subpart F - HEALTH ADVISORIES › Appendix D - Confirmation of an Adequate Corrective Action Pursuant to 35 Ill. Adm. Code 620.250(a)(2)

Current through Register Vol. 48, No. 28, July 12, 2024
Pursuant to 35 Ill. Adm. Code
				  620.250(a)
				  if an owner or operator provides a written confirmation to the Agency that an
				  adequate corrective action, equivalent to a corrective action process approved
				  by the Agency, is being undertaken in a timely and appropriate manner, then a
				  groundwater management zone may be established as a three-dimensional region
				  containing groundwater being managed to mitigate impairment caused by the
				  release of contaminants from a site. This document provides the form in which
				  the written confirmation is to be submitted to the Agency.
Note 1.
Parts I and II are to be submitted to IEPA at the
							 time that the facility claims the alternative groundwater standards. Part III
							 is to be submitted at the completion of the site investigation. At the
							 completion of the corrective process, a final report is to be filed which
							 includes the confirmation statement included in Part IV.
Note 2.
The issuance of a permit by IEPA's Division of Air
							 Pollution Control or Water Pollution Control for a treatment system does not
							 imply that the Agency has approved the corrective action process.
Note 3.
If the facility is conducting a cleanup of a unit
							 which is subject to the requirements of the Resource Conservation and Recovery
							 Act (RCRA) or the 35 Ill. Adm. Code 731 regulations for Underground Storage
							 Tanks, this confirmation process is not applicable and cannot be used.
Note 4.
If the answers to any of these questions require
							 explanation or clarification, provide such in an attachment to this
							 document.
Part I. Facility Information
Facility Name
				  _____________________________________________________
Facility Address
				  ___________________________________________________
County
				  __________________________________________________________
Standard Industrial Code (SIC)
				  ________________________________________
1. Provide a general description of the type of
				  industry, products manufactured, raw materials used, location and size of the
				  facility.
2. What specific units (operating or closed) are
				  present at the facility which are or were used to manage waste, hazardous
				  waste, hazardous substances or petroleum?
YES
NO
Landfill
_________
_________
Surface Impoundment
_________
_________
Land Treatment
_________
_________
Spray Irrigation
_________
_________
Waste Pile
_________
_________
Incinerator
_________
_________
Storage Tank (above ground)
_________
_________
Storage Tank (underground)
_________
_________
Container Storage Area
_________
_________
Injection Well
_________
_________
Water Treatment Units
_________
_________
Septic Tanks
_________
_________
French Drains
_________
_________
Transfer Station
_________
_________
Other Units (please describe)
_________
_________
__________________________
_________
_________
__________________________
_________
_________
__________________________
_________
_________
3. Provide an extract from a USGS topographic or
				  county map showing the location of the site and a more detailed scaled map of
				  the facility with each waste management unit identified in Question 2 or
				  known/suspected source clearly identified. Map scale must be specified and the
				  location of the facility must be provided with respect to Township, Range and
				  Section.
4. Has the facility ever conducted operations
				  which involved the generation, manufacture, processing, transportation,
				  treatment, storage or handling of "hazardous substances" as defined by the
				  Illinois Environmental Protection Act? Yes ___No ___ If the answer to this
				  question is "yes" generally describe these operations.
5. Has the facility generated, stored or treated
				  hazardous waste as defined by the Resource Conservation and Recovery Act? Yes
				  ___ No ___If the answer to this question is "yes" generally describe these
				  operations.
6. Has the facility conducted operations which
				  involved the processing, storage or handling of petroleum? Yes ___No ____If the
				  answer to this question is "yes" generally describe these operations.
7. Has the facility ever held any of the following
				  permits?
a. Permits for any waste storage, waste treatment
				  or waste disposal operation. Yes ___ No ___ If the answer to this question is
				  "yes", identify the IEPA permit numbers.
b. Interim Status under the Resources Conservation
				  and Recovery Act (filing of a RCRA Part A application). Yes ___ No ___ If the
				  answer to this question is "yes", attach a copy of the last approved Part A
				  application.
c. RCRA Part B Permits. Yes ___ No ___ If the
				  answer to this question is "yes", identify the permit log number.
8. Has the facility ever conducted the closure of
				  a RCRA hazardous waste management unit? Yes ___ No ___
9. Have any of the following State or federal
				  government actions taken place for a release at the facility?
a. Written notification regarding known, suspected
				  or alleged contamination on or emanating from the property (e.g., a Notice
				  pursuant to Section 4(q) of the Environment Protection Act)? Yes ___ No ___ If
				  the to this question is "yes", identify the caption and date of
				  issuance.
b. Consent Decree or Order under RCRA, CERCLA,
				  EPAct Section 22.2 (State Superfund), or EPAct Section 21(f) (State RCRA). Yes
				  ___ No ___
c. If either of Items a or b were answered by
				  checking "yes", is the notice, order or decree still in effect? Yes ___ No
				  ___
10. What groundwater classification will the
				  facility be subject to at the completion of the remediation?
Class I ____ Class II ___ Class III ____ Class IV
				  ____
If more than one Class applies, please
				  explain.
11. Describe the circumstances which the release
				  to groundwater was identified.
Based on my inquiry of those persons directly responsible for
				  gathering the information, I certify that the information submitted is, to the
				  best of my knowledge and belief, true and accurate.
______________________
______________________
Facility Name
Signature of Owner/Operator
______________________
______________________
Location of Facility
Name of Owner/Operator
______________________
______________________
EPA Identification Number
Date
PART II: Release Information
1. Identify the chemical constituents release to
				  the groundwater. Attach additional documents as necessary.
Chemical
							 Description
Chemical Abstract
							 No.
_____________________________
______________________________
_____________________________
______________________________
_____________________________
______________________________
2. Describe how the site will be investigated to
				  determine the source or sources of the release.
3. Describe how groundwater will be monitored to
				  determine the rate and extent of the release.
4. Has the release been contained on-site at the
				  facility?
5. Describe the groundwater monitoring network and
				  groundwater and soil sampling protocols in place at the facility.
6. Provide the schedule for investigation and
				  monitoring.
7. Describe the laboratory quality assurance
				  program utilized for the investigation.
8. Provide a summary of the results of available
				  soil testing and groundwater monitoring associated with the release at the
				  facility. The summary or results should provide the following information:
				  dates of sampling; types of samples taken (soil or water); locations and depths
				  of samples; sampling and analytical methods; analytical laboratories used;
				  chemical constituents for which analyses were performed; analytical detection
				  limits; and concentrations of chemical constituents in ppm (levels below
				  detection should be identified as "ND").
Based on my inquiry of those persons directly responsible for
				  gathering the information, I certify that the information submitted is, to the
				  best of knowledge and belief, true and accurate and confirm that the actions
				  identified herein will be undertaken in accordance with the schedule set forth
				  herein.
______________________
______________________
Facility Name
Signature of Owner/Operator
______________________
______________________
Location of Facility
Name of Owner/Operator
______________________
______________________
EPA Identification Number
Date
Part III: Remedy Selection Information
1. Describe the selected remedy.
2. Describe other remedies which were considered
				  and why they were rejected.
3. Will waste, contaminated soil or contaminated
				  groundwater be removed from the site in the course of this remediation? Yes ___
				  No ___ If the answer to this question is "yes", where will the contaminated
				  material be taken?
4. Describe how the selected remedy will
				  accomplish the maximum practical restoration of beneficial use of
				  groundwater.
5. Describe how the selected remedy will minimize
				  any threat to public health or the environment.
6. Describe how the selected remedy will result in
				  compliance with the applicable groundwater standards.
7. Provide a schedule for design, construction and
				  operation of the remedy, including dates for the start and completion.
8. Describe how the remedy will be operated and
				  maintained.
9. Have any of the following permits been issued
				  for the remediation?
a. Construction or Operating permit from the
				  Division of Water Pollution Control. Yes ___ No ___
b. Land treatment permit from the Division of
				  Water Pollution Control. Yes ___ No ___ If the answer to this question is
				  "yes", identify the permit number.
c. Construction or Operating permit from the
				  Division of Air Pollution Control. Yes ___ No ___ If the answer to this
				  question is "yes", identify the permit number.
10. How will groundwater at the facility be
				  monitored following completion of the remedy to ensure that the groundwater
				  standards have been attained?
Based on my inquiry of those persons directly
				  responsible for gathering the information, I certify that the information
				  submitted is, to the best of my knowledge and belief, true and accurate and
				  confirm that the actions identified herein will be undertaken in accordance
				  with the schedule set forth herein.
______________________
______________________
Facility Name
Signature of Owner/Operator
______________________
Location of Facility
Name of Owner/Operator
______________________
EPA Identification Number
Date
PART IV: Completion Certification
This certification must accompany documentation which
				  includes soil and groundwater monitoring data demonstrating successful
				  completion of the corrective process described in Parts I-III.
Facility Name
				  ___________________________________________________________
Facility Address
				  _________________________________________________________
County
				  ________________________________________________________________
Standard Industrial Code (SIC)
				  ______________________________________________
Date
				  __________________________________________________________________
Based on my inquiry of those persons directly responsible for
				  gathering the information, I certify that an adequate corrective action,
				  equivalent to a corrective action process approved by the Agency, has been
				  undertaken and that the following restoration concentrations are being
				  met:
Chemical
							 Name
Chemical Abstract
							 No.
Concentration
							 (mg/L)
_______________
________________
________________
_______________
_______________
________________
_______________
________________
________________
______________________
______________________
Facility Name
Signature of Owner/Operator
______________________
Location of Facility
Name of Owner/Operator
______________________
EPA Identification Number
Date