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Forms CEA Forms Biennial Certification Form Guidance & Instructions

Instructions for Preparation of a Biennial Certification Monitoring Report for a Classification Exception Area (CEA)

I. Site Background Information

 

Note: Please review this sample document thoroughly in order to assist you in completing the biennial certification monitoring report correctly. Guidance and examples are identified in bold and italics.

 
       
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Guidance  
 
  A. 

Facility Name and Location:

 
   

Site Name at the time the CEA was issued: ABC Company

Current Site/Property Name (if different than above):

Site/Property Street Address: 126 Copper Street

Municipality (-ies): List City (ies) County (ies): List County (ies)

 
   

Blocks (Impacted On-Site):

1B

Lots (Impacted On-Site): .11 and 12

   

Blocks (Impacted Off-Site):

 

1B

 

Lots (Impacted Off-Site): 13 and 14

 
   

For Multiple Blocks/Lots: Block 20, Lot 1,2,3 and Block 21, Lot 1,4,6 should read as Blocks: 20;21, Lots: 1,2,3; 1,4,6

Year of Tax map from which this information is obtained: 1999

 
  B. 

Person responsible for maintaining the CEA and submitting the associated Biennial Certification:

 
    Person Responsible (Name of Individual or Legal Entity): John Doe
Name of Business responsible for submitting this report: EFG Company (if different than original site name listed above, complete as appropriate).
Relationship to the Site (check as appropriate): Owner __ ___ Operator_____
Lessee ______ Person Conducting the Cleanup __X___
Other (describe)______
Street Address: 127 Mercury Street
City: List City State: Provide State Initials (PA) Zip code: 00000-0000
Telephone Number: (555) 000-0000
FAX Number: (555) 000-1111
E-mail Address: Provide E-mail Address
 
  C. 

All Current Owner, Lessee(s) and Operator(s) (complete all that apply)

 
   

Owner
Contact Person Name: Jane Ownit
Contact Person Affiliation: President of ABC Company
Business Name: ABC Company
Street Address: 126 Copper Street
City: List City State: Provide State Initials (NJ) Zip code: 00000-0000
Telephone Number: (555) 000-0000
FAX Number: (555) 000-1111
E-mail Address: Provide E-mail Address

Lessee(s)
Contact Person Name: Joe Rentit
Contact Person Affiliation: President of XYZ Lease Corporation
Business Name: XYZ Lease Corporation
Street Address: 72 Metal Way
City: List City State: Provide State Initials (NJ) Zip code: 00000-0000
Telephone Number: (555) 000-0000
FAX Number: (555) 000-1111
E-mail Address: Provide E-mail Address

Operator(s)
Contact Person Name: John Operator
Contact Person Affiliation: Owner of Truck Hauling
Business Name: Truck Hauling, Inc.
Street Address: 72 DriveWay
City: List City State: Provide State Initials (NJ) Zip code: 00000-0000
Telephone Number: (555) 000-0000
FAX Number: (555) 000-1111
E-mail Address: Provide E-mail Address

 
  D.   Case Specific Information (Complete all that apply)
 
   
  • Program Interest Name: ABC Company
  • Program Interest Number:126555 (PI Number)
  • Known Contaminant Site List (KCSL) Number (if available): NJL555555555 (12 characters)
  • Incident Report Number 99-10-10-1000-10 (10 or 12 Digit Case Number)
  • Industrial Site Recovery Act Number: E95555 or E95555555 (6 or 9 digits)
  • UST Registration Number: 0055555 (7 digits)
  • Date Department approved CEA: 12/03/09
  • Name and Bureau of assigned Case Manager at the time the CEA was issued: Mr. Ian Reviewer, Bureau of Operations , Maintenance and Monitoring
 
  E.  Existing Site Conditions
   
  • Describe the physical characteristics of the site: The site is 2 acres in size and is capped with asphalt with the exception of one manufacturing/office building with a concrete floor.

  • Describe the current site operations: ABC Company is operating at the site. Lighting fixtures are manufactured.

  • Describe each remedial action that included the CEA. Please check and describe, as required, the appropriate selection below.

    __ __ Natural Attenuation

    __X__ Other (please describe below

    Pump and treatment system that includes a receptor trench along southern edge of the property boundary and a treatment system with a re-injection trench along the northern property boundary. _________________________________

 

Next: II. CEA Protectiveness Evaluation