Mississippi Administrative Code › Title 11 - Mississippi Department of Environmental Quality › Part 3 - Hazardous Waste Management Regulations › Chapter 2 - Mississippi Commission on Environmental Quality Final Regulations Governing Brownfield Voluntary Cleanup and Redevelopment in Mississippi › Subchapter 3 - REVOLVING LOAN FUND › Appendix 11-3-2-3-D - ECOLOGICAL CHECKLIST

Current through June 25, 2024
MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY
					 BROWNFIELD VOLUNTARY CLEANUP PROGRAM ECOLOGICAL CHECKLIST
Section I- Facility
					 Information
1. Name of Facility:
					 _______________________________________________________
2. Location of Facility:
					 _______________________________________________________
County:
					 _______________________________________________________
3. Mailing Address:
					 _______________________________________________________
4. Type of Facility:
					 _______________________________________________________
5. Describe land use at and in the vicinity of the release
					 site _______________________
____________________________________________________________________________
6. Attach a USGS topographic map of the facility and aerial
					 and other photographs of the release site and surrounding areas.
Section 2-Surrounding Land Use
					 Information
1. Describe land use adjacent to the facility.
					 ___________________________________________________________________________
2. Provide the following information regarding the nearest
					 water body:
Name of surface water body:
					 ________________________________
Type of surface water body (pond, lake, river etc:
					 ________________________________
3. Do any potentially sensitive environmental areas exist
					 adjacent to or in proximity to the site, e.g., Federal and State parks,
					 National and State Monuments, wetlands, etc.
					 ____________________________________________________________________________
Section 3 - Release
					 Information
1. Nature of release.
					 ________________________________
2. Location of the release (within the facility)
					 ________________________________
3. Location of the release with respect to the facility
					 property boundaries:
___________________________________________________________________________
4. Chemicals of Concern (COC) known or suspected to have
					 been released: __________________________________
____________________________________________________________________________
5. Indicate which media are known or suspected to be
					 impacted and if sampling data are available:
____________________________________________________________________________
Soil 0-6 feet bgs yes no
____________________________________________________________________________
groundwater yes no
____________________________________________________________________________
surface water/sediment yes no
					 ____________________________________________________________________________
6. Has migration occurred outside the facility property
					 boundaries? yes no
If yes, describe the designated use of the land impacted:
					 ____________________________________________________________________________
Section 4 - Criteria for Further
					 Assessment
If the Area of Impact (AOI) meets all of the criteria
					 presented below, then typically no further ecological evaluation shall be
					 required. If the AOI does not meet all of the criteria, then a screening level
					 ecological risk shall be conducted. The Submitter should make the initial
					 decision regarding whether or not a screening level ecological risk assessment
					 is warranted based on compliance of the AOI with criteria listed below. After
					 review of the ecological checklist and other available site information, the
					 Mississippi Department of Environmental Quality will make a final determination
					 on the need for a screening level ecological risk assessment. If site
					 conditions at the AOI change such that one or more of the criteria are not met,
					 then a screening level ecological risk assessment shall be conducted.
The criteria for exclusion from further ecological
					 assessment include:
The area of impacted soil is approximately 1 acre or less
					 in size;
There is no current (or potential) release (via runoff or
					 groundwater discharge) of COCs from the AOI to a surface water body;
Recreational species, commercial species, threatened or
					 endangered species, and/or their habitats are not currently being exposed, or
					 expected to be exposed, to COCs present at or migrating from the AOI;
					 and
There are no obvious impacts to ecological receptors or
					 their habitats.
Section 5 - Site
					 Summary
The ecological checklist submittal shall include a site
					 summary which presents sufficient information to verify that the AOI meets or
					 does not meet the criteria for further assessment.
Section 6 - Submitter
					 Information
Date:
Name of person submitting this check list:
Affiliation:
Signature
Additional Preparers:
Miss. Code
					 Ann. §§
											49-35-1, et seq., 49-2-9(1)(b),
					 49-17-17, 17-17-1, et seq., 49-2-1, et seq. and 49-17-1, et
					 seq.