Bwcs126, Miscellaneous Document Transmittal Form printable pdf download

Bwcs126, Miscellaneous Document Transmittal Form

Massachusetts Department of Environmental Protection

BWSC126

Bureau of Waste Site Cleanup

Release Tracking Number

Miscellaneous Document Transmittal Form

A. DISPOSAL SITE LOCATION:

1. Disposal Site Name:

2. Street Address:

3. City/Town:

4. Zip Code:

B. THIS FORM IS BEING USED TO: (check all that apply)

Correct typographical errors and/or make corrections that do not materially affect the nature or complexity of the

response actions. If changes are materially significant, then a revised or modified submittal must be made to the

Department. List the report/form that is being corrected that is associated with the above Release Tracking Number

(RTN). Attach an errata sheet containing a description of the errors and/or corrections.

Submittal Date

Transaction ID

Form/Report

(mm/dd/yyyy)

Submit other documents associated with this RTN that cannot be submitted to the Department using any other

BWSC transmittal form. Do not submit documents that are of a time-critical nature and/or that require a direct

response from the Department and/or that require an LSP Opinion pursuant to 310 CMR 40.0015. (Section C

is not required).

Description of Submittal_______________________________________________________________

Resign as LSP-of-Record for the above Release Tracking Number (RTN). Attach a copy of the LSP resignation

letter. (Section D, E, and F are not required).

Submit copies of Public Notices required pursuant to 310 CMR 40.1400: (check all that apply)

(Section C is not required )

Check here if submitting a copy of a legal notice

Tier I Classification

Tier II Classification

Check here if submitting a copy of a legal notice

Immediate Response Action (IRA)

Release Abatement Measure (RAM)

Downgradient Property Status (DPS)

Utility-related Abatement Measure (URAM)

Comprehensive Response Actions

Activities related to recording/registering an

Check here if submitting a copy of a legal notice

Activity and Use Limitation (AUL)

Permanent or Temporary Solution

(All sections of this transmittal form must be filled out unless otherwise noted)

Revised: 09/17/2013

Page 1 of 4

Bwcs126, Miscellaneous Document Transmittal Form

Related Articles

Related forms

Related Categories