| Form
(linked back to the SRRA Forms page) |
Version & Date |
Changes Since the Previous Version |
|
7.5 Percent Cost of Remediation Summary and Certification |
1.0 - 5/7/12 |
|
|
Alternative Remedy Application Form |
1.3 - 9/13/12 |
- Bolded note at top of form and added "by the person responsible
for conducting the remediation"
- Section B: Added note to stop if you answer "no" to question
1. Do not submit form.
|
| 1.2 - 5/31/12 |
- Added "and Remedial Action Workplan Approval" to name of form
- Added new Section B "Remedial Action Workplan Required"
- Renamed Section C from "General" to "Alternative Remedy"
|
| 1.1 - 5/7/12 |
|
| Alternative
Soil Remediation Standard Application |
2.1 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages
|
| 2.0 - 1/10/12 |
- Form entirely redesigned.
|
| 1.4 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.3 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked.
|
| 1.2 - 1/12/11 |
- Section C: Developer Certification removed.
|
Annual
Remediation Fee Reporting form The changes
to this form include: General Instructions: Contamination area
language inserted; applicability language changed to include opt
in; check made out to Treasurer - State of NJ; Grammar & punctuation;
Section A: Citation change, removed state plane coordinates, removed
block & lots; Section B: Fee Billing Contact added; Section
C: Note edit describing regulated UST, Subtotal Fee line added;
Section D: Subtotal Fee line added; Total Fee line automatically
totals Subtotals from Section C and Section D; Section F: Developer
Certification removed. |
1.6 - 6/4/2012 |
- Removed version 1.6 "Annual Remediation Reporting Fee" form on 2/6/2013
- Added new Section E "Prorated Fees" and updated instructions
|
| 1.5 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.4 - 1/12/11 |
- New version number for splitting the instructions from the
form.
|
| Annual
Remediation Fee Reporting form (Online) |
1.1 - 12/11/12 |
- Added option for permanent LSRP to paragraph 1 of MyWorkspace
Setup.
|
| Case
Inventory Documents Worksheet |
1.0 - 11/4/09 |
|
| Case
Inventory Documents Example Sheet |
1.1 - 1/12/11 |
|
| Guidance
for the Preparation of the Case Inventory Documents |
1.1 - 1/12/11 |
|
| CEA/Well
Restriction Area (WRA) Fact Sheet form |
1.3 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
- Form Name: Deleted "Permit" & added "Form" to the title.
- General Instructions: Added references/links. Clarified general
submittal procedures.
- Section A: Changed to use Program Interest ID. Added five
check boxes & updated instructions accordingly.
- Section B: Now starts at CEA Component Information. All later
Section IDs changed. Added to instructions.
- Section B.1. (Contaminant(s)): Note (4) was updated.
- Section B. 2. (CEA Boundaries): Added check box to indicate
if Block & Lot changed.
- Exhibit C: Clarified form & instructions, added "Notes for
GIS maps:" (Geologic Formation/Unit): Changed form & added information
sources to instructions. Now allows for multiple ground water
flow directions & multiple water bearing zones. (Ground Water
Classification): Added information regarding Class III areas.
- Exhibit D: This is now the CEA spreadsheet. Send to new GIS
email & put it on the CD.
- Section C. Exhibit F( Well Search Results): Added guidance
to instructions.
- Section E: An exemption was added for form submittal, "Exhibit
G" was deleted; VI information was added.
- Addendum: Modified to match changes to Section B.
|
| 1.2 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.1 - 1/12/11 |
- Instructions included, Citation edits, Mailing address for
completed form changed,
- Section A: #1 - reference to CEA changed to Exhibit A,
- Section C: Direction of GW flow requested, Exhibit E checkbox
for Historic Fill and one for all other information,
- Section D: Exhibit G table for requested information,
- Section E: SE signature page changed
|
| CEA/Well
Restriction Area (WRA) Spreadsheet |
1.0 -1/12/11 |
|
| Confidentiality
Request Form |
1.1 - 5/7/12 |
- Section B: Changed individual ISRA and UST fees options to
a single fee.
|
| 1.0 - 9/7/11 |
|
| Confirmed
Discharge Notification form |
1.6 - 5/7/12 |
- Section B: Changed from "Person Responsible For Conducting
the Remediation" to "Discharge Being Reported With This Submission".
- Section D: removed "Substance Released" table.
|
| 1.5 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.4 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.3 - 1/12/11 |
- Section D: Clarification for Substance Release table,
- Section G: Developer Certification removed.
|
| De
Minimus Quantity Exemption Application form |
1.4 - 8/01/12 |
- Added definitions for "industrial establishment, owner, and
operator" to instructions
- Section E: Removed "Absence of Contamination Acknowledgement"
certification
|
| 1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
- For the instructions: Under General Instructions, No. 4, the
statement that states this form should be submitted along with
the Individual Document Submittal was deleted.
|
| 1.2 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
- Typo fixed on pg. 5 of 5 of form
|
| Developer
Certification (Appendix A for the ARRCS Rule) |
|
|
|
Discharge to Ground Water Permit by Rule Authorization Request |
1.0 - 9/17/12 |
|
|
Exemption from Spill Act Liability Certification |
1.1 - 4/2/2013 |
- Changed "municipality" to "governmental entity" throughout form.
- Sec B: New Section B added "Property Owner"
- Sec C: Added 2 questions asking if work has been or will be conducted.
|
| 1.0 - 10/4/12 |
|
| Full
Laboratory Data Deliverables form |
1.5 - 9/13/12 |
- Updated Tech Reg citations in the instructions under Applicability.
|
| 1.4 - 5/7/12 |
- Removed Non-LSRP certification page.
|
| 1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.2 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
- Section D: Sampling Dates added;
- Section G: Developer Certification removed.
|
| General
Information Notification |
1.8 - 9/13/12 |
- Section A: Removed Date
- Added federal case question and instructions
|
| 1.7 - 5/7/12 |
- Added instructions to top of form about submitting a revision/update.
- Section D: Renumbered questions.
|
| 1.6 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
- Check boxes were added to the title block to specify if this
was a new GIN or Revised/Updated GIN. If this was a revision/update,
then the ISRA Case Number and Program Interest Number is required
in Section A.
|
| 1.5 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.4 - 1/12/11 |
- Grammar & punctuation,
- Section J: Developer Certification removed.
|
Hazardous
Discharge Site Remediation Fund Application form
|
1.2 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.1 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
- New version number for splitting the instructions from the
form
|
| 1.0 - 5/21/10 |
|
| HDSRF
Application - Cost Estimate Format Spreadsheet |
1.0 - 5/21/10 |
|
| HDSRF Child Care Facility
Grant Application |
1.0 - 4/25/2013 |
|
| IEC
Response Action form |
1.5 - 5/7/12 |
- Removed Non-LSRP certification page.
|
| 1.4 - 1/19/12 |
- Section A: Removed "Mailing Address if different than street
address"
- Section C: Removed "Essential Utility Disruption", Added questions
2 and 3
- Section E: Renamed first section from "Immediate Notification"
to "Information Submittal". Removed 14-day notification check,
added first 2 questions to "Information Submittal" Removed "Date
of spreadsheet submittal date".
Reworded questions in "1 – year IEC source control report".
- Section F: Added a question about fed regulated USTs, changed
all questions from check boxes to yes/no questions.
- Section G: Changed "within 100’ of free product (any
type)" to "within 100’ of free product (excluding diesel)"
Incorporated "free product type" question into other questions
Changed "ground water –to-indoor air pathway" to "vapor
intrusion pathway".
- Updated instructions
|
| 1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.2 - 2/25/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
- Grammar & punctuation,
- Section B: Case Manager section added,
- Section D: Fee Billing section added,
- Section E: Timeframe changes,
- Section G: “Rapid Action” wording changes,
- Section H: Developer Certification removed,
- Sec I: Non-LSRP and SE signature pages added
|
| IEC
- Potable Water Spreadsheet |
1.1 - 8/2/10 |
|
| IEC
- Vapor Intrusion Spreadsheet |
1.1 - 8/2/10 |
|
| ISRA
Alternate Compliance Option Application |
1.5 - 5/7/12 |
- Removed Non-LSRP certification page.
- Removed Section B. ISRA Alternate Compliance Fees and Section
C. Expedited Review / Limited Site Review
|
| 1.4 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
- A new Section B was added with check boxes and list of fees
for ISRA Alternate Compliance Fee Types.
- Section E. Minimal Environmental Concern Waiver was
deleted.
|
| 1.3 - 1/11/11 |
|
| ISRA
Certificate of Limited Conveyance Application |
1.1 - 7/24/12 |
- Section A. Remove Date and Sic Code
- Section D. Added place for check number
- Section E. Removed question "have you enclosed check" at end
of RP certification.
|
| 1.0 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
- Formatted to be the same format as the LSRP forms. It was
previously posted on the ISRA Forms Web Page.
|
| LNAPL
Free Product Reporting Form |
1.6 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages
|
| 1.5 - 1/31/12 |
- General: Removed the words "product" and "free product" from
form. Removed format restrictions for zip codes
- Section A: Changed title from "Site Location" to "Site Name
and Location". Changed Date triggered compliance with" to "Date
Remediation Initiated Pursuant to N.J.A.C. 26C-2"
- Section C: Replaced the word "product" with "NAPL" through
out section. Added several questions to item 2.
- Section C: Replaced the word "product" with "NAPL" through
out section. Added several questions to item 2.
- Section D: Replaced the word "Deviation" with "Variance" through
out the section.
- Section F: Removed the facility and responsible party sections
from subsurface evaluator certification.
- Changed submission instructions to "Completed forms should
be sent to:"
|
| 1.4 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.3 - 2/25/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.2 - 1/12/11 |
- Grammar & punctuation,
- Section E: Developer Certification removed
|
| LSRP
Notification of Retention or Dismissal |
3.0 - 5/7/12 |
- Removed version 3.0 "LSRP Notification of Retention or Dismissal" form on 2/6/2013
- Removed Section F. "OPT IN" Request.
|
| 2.9 - 2/16/12 |
- Section E. Item 7. Added "regulated tank closure" as a reason
to hire an LSRP
|
| 2.8 - 1/10/12 |
- Section E. Deleted question 5, added to question 8 (now 7)
asking the total number of AOCs for the site.
|
| 2.7 - 11/23/11 |
- Section B. Deleted "I have been hired to address an area of
concern or a full site"
- Section D. Changed citations for N.J.S.A. 58:10C
- Deleted question asking to "indicate relationship to the site"
Inserted 7 new questions
- Deleted "current oversight mechanism" question
Deleted "Does the site involve or potentially impact a childcare
center,
school, or residence" question
- Instructions Updated instructions for Sections A, E and F.
|
| 2.6 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
- Section B was revised to clarify: Provide name of replaced/released
LSRP.
|
2.5 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 2.4 - 1/12/11 |
- General Instructions #1.b. and #4. Clarification of who is
to sign form,
- Section E: Child Care Center added as relationship to site,
- Section F: form must be submitted before LSRP can request
disbursement
|
| Model
Deed Notice (Appendix B for the ARRCS Rule) |
|
|
| Model
Termination of Deed Notice (Appendix C for the ARRCS Rule) |
|
|
| Monitoring
Well Certification Form A - As-Built Certification |
1.0 - 9/7/11 |
|
| Monitoring
Well Certification Form B - Location Certification |
1.3 - 2/26/13 |
- Section C:
Question 3, increased reporting accuracy of Lat/Long to 1/100 of a second
Question 4, increased reporting accuracy of State Plane Coord to nearest foot
Question 5, added Elev Top of Outer Casing, Elev of Ground, and Vertical Datum reference.
- Section D: Added Firm Name and Certificate of Authorization #
|
| 1.2 - 9/12/12 |
- Compressed form to 1 page
|
| 1.1 - 11/28/11 |
- General: Removed format restriction for zip codes
- Section C: Question 2 fixed entry box that didn’t work
|
| Name
and Address Change Reporting |
1.1 - 3/13/13 |
- Form completely reformatted.
|
| 1.0 - 9/7/11 |
|
Negative
Declaration (Only required for cases initiated before 11/4/2009) |
1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.2 - 1/12/11 |
- Section D: Developer Certification removed
|
Potable
Well/Indoor Air Sampling Notification form |
1.4 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
|
| 1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.2 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
- Grammar & punctuation,
- Section D: Developer Certification removed
|
Sampling
Notification Spreadsheet |
1.0 - 2/4/10 |
|
| Preliminary
Assessment/Site Investigation form |
1.7 - 3/25/13 |
- (old) Sec B NJDEP Case Manager: Removed this section
-
Section B Submittal Status:
Added question for method of EDD submittal.
Added Technical Impracticability Determination to list.
-
Section D Case type: Alphabetized list. Expanded choices for types of federal cases,
added "Spill Act Defense", removed "not applicable" and "Site is located within an
economic development priority Area".
-
Section F General: Updated instructions for order of magnitude evaluation;
Question 9 - added questions B and C: "Does the site contain any land use features..",
and "Have the necessary land use permits been issued.."
-
Section G Site Info: Section G5 inserted new question b.7) "Are any soil analytical
results greater than ... Criteria in an ESNR"
- Section H Lab Data Added new Section H. Laboratory Data
- Section I Alt STD: Added "ecological site specific goal"
|
| 1.6 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
- Section B: added radionuclide reports list.
- Section G: changed question 10 to specify if RI complete
for AOCs or entire site Added question 11 to ask if the AOCs
were addressed within the regulatory timeframe.
- Section H: Added question H4.e. about Unknown Source Investigation.
|
| 1.5 - 1/10/12 |
- General: Removed format restrictions for zip codes.
- Section C: Added updated list of submittals, Added column
for Document Withdrawal.
- Section G: Added question 9 about ESNRs.
- Section I: Changed word "deviation" to "variance".
- Instructions updated.
|
| 1.4 - 9/7/11 |
Form
- Section K: Updated address on the 3 Section K pages Removed
the Block and lot, Owners Name, and Assigned Case Manager sections
on Subsurface Evaluator Certification page.
Instructions
- Instructions: Updated address.
|
| 1.3 - 2/25/11 |
|
| 1.2 - 1/12/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 2/26/10 |
- Grammar & punctuation,
- Section J: Developer Certification removed, Edits for fill-in
codes in Adobe Acrobat
|
| Public
Notification and Outreach form |
1.6 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
|
1.5 - 11/30/11 |
- General: Removed formatting for zip codes
- Section A: Changed "Date trigger compliance with Section 30…"
to "Date Remediation Initiated Pursuant to N.J.A.C. 7:26C-2:"
- Section B: Added new question 1, question 4 was incorporated
into question 2, "local health agency" was added to question
6. Question 7 explanation expanded. Question order was changed.
- Section D: Removed facility information, block and lot, and
owner information sections in the subsurface certification.
- Instructions: all sections updated.
|
1.4 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.3 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.2 - 1/12/11 |
- Section C: Developer Certification removed
|
| PUST
Remediation, Upgrade and Closure Fund Application form - Regulated
Tanks(Closes 6/30/2010) |
1.1 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
- New version number for splitting the instructions from the
form
|
| 1.0 - 6/8/10 |
|
| PUST
Remediation, Upgrade and Closure Fund Application form - Unregulated
Tanks (Including Residential Heating Oil Tanks) |
1.1 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
- New version number for splitting the instructions from the
form
|
| 1.0 - 6/8/10 |
|
| Project
Summary Sheet Spreadsheet |
1.0 |
|
| Receptor
Evaluation form |
1.7 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
- Section A: Added paragraph explaining purpose of form.
- Section E: Removed "other existing conditions" from question
4 and made it a new question 2, Changed language in old question
4: added "petroleum free product" to 30 ft check box and "non-petroleum
free product to 100 ft check box.
- Question 7: changed "vapor intrusion sampling" to "soil gas
sampling".
- Changed "NJDEP's Vapor Intrusion Rapid Action Levels" to "NJDEP's
Rapid Action Levels" throughout section.
|
| 1.6 - 3/8/12 |
- Section A: Removed "No Change" check box and added checkboxes
to capture reason for submitting form
- Section C: Inserted new question 2. For Soil Migration Pathway
- Section D: Inserted new question 3. – "Has GW been delineated
to Applicable Remediation Standard?"
- Added new question 11. – "Has GW receptor investigation
been completed?"
- Section E: Inserted new question 2. – "Has GW contamination
been delineated to the vapor trigger?"
Divided last question into two parts.
- Section F: Expanded question 6. To indicate types of media
impacted.
- INSTRUCTIONS
Revised instructions for Updates in General Instructions, and
added instructions for new questions in sections C, D, and E.
|
| 1.5 - 10/20/11 |
- Fixed broken hyperlink in form to EPA DNAPL Overview
|
| 1.3 - 2/25/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.2 - 1/12/1 |
- General Instructions. Timeframes: As detailed in the
Compliance Advisory Update, the proposed Mandatory timeframe
for submission of the initial RE form is 2 years. If remediation
was initiated prior to November 4, 2009 the initial RE Mandatory
timeframe is March 1, 2012; As detailed in the Compliance Advisory
Update, the proposed regulatory date has been extended to March
1, 2011 or one year after the initiation of remediation;
- Section A: Added if there were no changes to the form the
LSRP shall skip to Section G; Checkboxes for Initial Submission,
Interim Submission, or No Change added to Sections B, C, D,
E, & F,
- Section B: Questions 2 and 3 have been revised to follow formats
of other forms;
- Section C: Clarification in the instructions for high concentration
source materials has been added;
- Section D: The direction for action on an IEC has been removed
from the form and guides the LSRP to the website instead;
- Section E: The LSRP is now required to identify any structures/
sensitive populations on a scaled map. An option has been added
to indicate that no structures exist within the specified distances.
The direction for action on an IEC has been removed from the
form and guides the LSRP to the website instead. Several questions
have been changed to include the proposed vapor intrusion rapid
action levels and the indoor air results that fall between the
indoor air screening levels and the vapor intrusion rapid action
levels and the actions that need to be taken;
- Section F: The LSRP is now required to answer Yes or No to
the site conditions;
- Section G: Developer Certification removed
|
|
Well Search Spreadsheet |
1.1 - 2/18/12 |
- Table format changed to match new dataminer query
- Additional fields added under case information tab
|
| 1.0 - 1/12/11 |
- Headers & footers and ‘DRAFT’ watermark removed
to prevent errors when extracting data
|
| Remedial
Action Report form |
1.9 - 5/8/13 |
-
Section G: Question 14 - corrected mistake changed "11 or 12" to "12 or 13"
|
| 1.8 - 3/25/13 |
-
Sec B Submittal Status:
- Added question for method of EDD submittal;
- Added technical Impracticability Determination to the list
- Section D Case Type: Added new Section D: Case Type;
-
Section G General:
- Made Question 2b into Question 3.
- Added Pesticides to question 7.
- Added N/A box to Question 8.
- Moved table from Question 11 to new item 14.
- Added new Question 13 "Are ground water contaminants from the site discharging to an ESNR".
-
Section H Site Cond:
- Added new Question 1: "Has dioxin been detected in any site media".
- Removed dioxin from table in Question 2.
- Changed "compound/element" to "contaminant" in Question 3.
- Added "screening level" to questions 3 and 4.
- Added ESNRs to GW and Soil columns in Question 5.
- Section I Alt STDs: Added "ecological site specific goal";
-
Section J Applicable STDs:
- Changed "compounds" to "contaminants" in Question 1;
- Added table of compliance averaging methods to Question 2;
- Section K Soil/Sed Reuse section renamed "Alternative and Clean Fill Use", section rewritten;
- Section L RAR Info: Made question 1 from Section M a new question 12
- Section M Misc: Removed section
|
| 1.7 - 8/23/12 |
- Section L: Miscellaneous, Question #2, Fixed Yes/No box
|
| 1.6 - 5/7/12 |
- General Instructions: Modified instructions for submission
of RE forms and Case Inventory Documents (CID) Removed Non-LSRP
and Subsurface Evaluator certification pages.
- Section B: added radionuclide reports list.
|
| 1.5 - 1/10/12 |
- Section A: Changed citation for "Date Remediation Initiated"
- Section B: Changed title to "Submittal Status", updated Alternate
Standard form name, replaced Annual Fee form with Public Notification
Form, and added withdrawal column
- Section E: Turned first 2 questions in General Section moved
to New Section "Scope of Remedial Action Workplan", and added
questions about total AOCs for the site and total AOCs addressed
in submittal. Removed question 7 about dioxin (dioxin now included
in section G.)
- Section G: (old section F) added Surface Water column, dioxin,
and EPH
- Section H: (old section G) changed the word "deviation" to
"variance" through out section
- Section I: (old section H) Check boxes reworded to yes/no
questions
- Section J: First two questions moved to "Applicable Remediation
Standards"
- Section K: (old section J) questions 3 and 4 added to Ecological
section.
|
| 1.4 - 9/7/11 |
Form
- Section A: Removed Mailing Address line
- Section B: Added Remedial Action Report
- Section E: Question 1 - added space for total number of
contaminated AOCs. Added table for question 12. Question 2 -
Numbered two sub-questions, added place to answer second sub-question
- Section G: Change yes/no statement to a question
- Section J: Made question 4 part of question 3, renumbered
5 and 6.
- Section M: removed first section of subsurface evaluator certification.
Instructions
- Changed all instances of "Department" to "NJDEP".
- Section A: Added examples of NJDEP site ID numbers. Removed
mailing address only instruction
- Section E: Removed instruction to attach Section H2 of the
PA/SI form. Added requirement to identify All AOCs individually.
- Section G: Spell out Vapor Intrusion and Johnson & Ettinger.
|
| 1.3 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.2 - 1/12/11 |
- Citation edits, Grammar & punctuation,
- Section B: RAO Report changed to RAO letter,
- Section E: Renumbered,
- Section L: Developer Certification removed
|
| Remedial
Action Workplan form |
1.6 - 3/25/13 |
-
Section B Submittal Status:
- Added question for excess alternative fill;
- Added question for method of EDD submittal;
- Added question to ask if a CEA proposal included.
- Added technical Impracticability Determination to the list
- Section D Case Type: Added new Section D: Case Type.
-
Section G General:
- Added Pesticides to question 7; Added new Question 11: "Are ground water contaminants
from the site discharging to an ESNR".
- Added N/A box to Question 8.
- Moved table in Question 10 to new item 12.
- Added new Question 11: are contaminants discharging to surface water?
-
Section H Site Cond:
Added new Question 1: "Has dioxin been detected in any site media"; Removed dioxin
from table in Question 2; Changed "compound/element" to "contaminant" in Question 3;
Added "screening level" to questions 3 and 4; Added ESNRs to GW and Soil columns in
Question 5, added ESNR to migration pathway and exposure in Question 6
- Section I Alt Stds: Added "ecological site specific goal".
-
Section J Applicable Stds: Changed "compounds" to "contaminants" in Question 1.
Added table of compliance averaging methods to question 2.
- Section K Soil/Sed Reuse section renamed "Alternative and Clean Fill Use", section rewritten.
-
Section L RAW Info:
- Added new Question 2 "Are land use permits required..."
- Made question 1 from Section M a new question 12.
- Section M Misc: Removed section.
|
| 1.5 - 5/7/12 |
- General Instructions: Modified instructions for submission
of RE forms and Case Inventory Documents (CID) Removed Non-LSRP
and Subsurface Evaluator certification pages.
- Section B: added radionuclide reports list.
|
| 1.4 - 1/10/12 |
- Section A: Changed citation for "Date Remediation Initiated"
- Section B: Changed title to "Submittal Status", updated Alternate
Standard form name, replaced Annual Fee form with Public Notification
Form, and added withdrawal column
- Section E: Turned first 2 questions in General Section moved
to New Section "Scope of Remedial Action Workplan", and added
questions about total AOCs for the site and total AOCs addressed
in submittal. Removed question 7 about dioxin (dioxin now included
in section G.)
- Section G: (old section F) added Surface Water column, dioxin,
and EPH
- Section H: (old section G) changed the word "deviation" to
"variance" through out section
- Section I: (old section H) Check boxes reworded to yes/no
questions
|
| 1.3 - 9/7/11 |
Form
- Section A: Removed Mailing Address line
- Section B: Added Remedial Action Report
- Section E: Question 1 – Added space for total number of
contaminated AOCs. Added table for question 11.
- Section G: Spell out vapor intrusion.
- Section M: Removed first section of subsurface evaluator certification.
Instructions
- Changed all instances of "Department" to "NJDEP".
- Section A: Added examples of NJDEP site ID numbers. Removed
mailing address only instruction
- Section E: Removed instruction to attach Section H2 of the
PA/SI form. Added requirement to identify All AOCs individually.
- Section G: Spell out Vapor Intrusion and Johnson & Ettinger.
|
| 1.2 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
- Grammar & punctuation, Citation edits, Grammar & punctuation,
- Section E: Renumbered,
- Section F: Removed SW column,
- Section L: Developer Certification removed,
- Section M: 3 signature pages added
|
| Remedial
Action Permit Application Form for Ground Water |
1.5 - 6/19/12 |
|
| 1.4 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
|
| 1.3 - 1/18/12 |
|
| 1.2 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
- Citation edits,
- Section L: Developer Certification removed,
- Section M: Removed some Block and Lots on SE signature pg
|
Ground
Water Monitoring Plan Spreadsheet 
|
0.0 - 2/24/10 |
|
| Remedial
Action Permit Application Form for Soils |
1.6 - 7/24/12 |
- Section B. Moved fee billing contact information from Section
B. to New Section C. and renumbered subsequent sections
- Section E. Updated question 1 and added question 2 (Was GIS
Compatible map sent..) and 9 (Is Deed Notice for historic fill)
- Section G. - Removed "Engineering Control" from title
of section - Added "loan or grant" to question 6
- Section H. - Made question 3 part of question 2
- Added extra space for question 4
- Section I. Added new Section I. Receptor Evaluation Summary
|
| 1.5 - 6/19/12 |
|
| 1.4 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages
|
| 1.3 - 1/18/12 |
|
| 1.2 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.1 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.0 - 1/12/11 |
- Grammar & punctuation, Mailing address for form changed,
- Section E: Deed Notice – more information requested,
- Section G: Engineering Control – whole section changed,
- Section I: Developer Certification removed
|
| Remedial
Action Permit Transfer/Change of Ownership Application |
1.3 - 6/19/12 |
|
| 1.2 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
|
| 1.1 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.0 - 3/4/11 |
- Form finalized
- Allows the Yes/ No Check boxes to be checked & unchecked
- Corrected Fee Amounts
|
| 0.0 - 1/12/11 Draft |
|
Remedial
Action Protectiveness/Biennial Certification Form - Ground Water
(Was "Remedial
Action Protectiveness Certification Form - Ground Water") |
1.5 - 10/5/12 |
- Fixed defect in Section E. Email address entry box.
|
| 1.4 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
|
| 1.3 - 3/8/12 |
- Form
Removed format restrictions for zip codes
- Section A: renumbered questions
- Section G: Question 2 - changed If "Yes" to If "No"
- Section N: Question 1 - changed "F,H,I,J,K" to "F,G,I,J,K"
Question 3 - changed "Check here if the answer to question 2
in
section G was answered "Yes" to
"Check here if the answer to question 2 in section G
was answered "No"
- Instructions
Changed all instances of "Department" to "NJDEP"
- Fixed incorrect section references within instructions
- General: Added address for Initial Notice
Added "GIS compatible maps shall be submitted as per instructions
found at
http://www.nj.gov/dep/srp/gis to srpgis_cea@dep.state.nj.us."
to Regulatory Requirements
- Section A: Added names of fields to bullet items
Renumbered questions
- Section J: Updated GIS links
- Section O: Added instruction explaining this section is not
to be signed by the LSRP or lawyer
|
| 1.2 - |
- Added Section B - Fees
- Added certification pages for Non-LSRP and Subsurface Evaluator
|
| 1.1 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 0.1 - 3/4/11 Draft |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 0.0 - 1/12/11 Draft |
|
Remedial
Action Protectiveness/Biennial Certification Form - Soil
(Was "Remedial
Action Protectiveness Certification Form - Soils") |
1.6 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
|
| 1.5 - 3/8/12 |
- Updated GIS links in Instructions, Sections A.4 and J.1
|
| 1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.1 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.0 - 1/12/11 |
- Grammar & punctuation, Regulatory requirements noted in
General Instructions #2 and Section I
- Section B: Checkbox if Current Owner has changed since last
submittal,
- Section K: LSRP Signature Page added
|
| Remedial
Investigation Report form |
1.7 - 3/25/13 |
-
Section B Submittal Status:
- Added question for method of EDD submittal.
- Added question to ask if a CEA proposal included.
- Added technical Impracticability Determination to the list.
- Section D Case Type: Added new Section D: Case Type.
-
Section G Site Conditions:
Added new Question 1: "Has dioxin been detected in any site media";
Removed dioxin from table in Question 2; Changed "compound/element"
to "contaminant" in Question 3; Added "screening level" to questions 3 and 4,
Added ESNRs to GW and Soil columns in Question 5;
-
Section H Applicable STDs:
- Changed "compounds" to "contaminants" in Question 1.
- Added table of compliance averaging methods to question 2.
- Section I Background Conditions: Updated citations.
- Section J Alt STD: Added "ecological site specific goal".
- Section K Historic Fill: Updated wording of questions 1 and 2, combined questions 3 and 4, and updated instructions.
- Section I GW Trigger: Updated citations.
- Section M GW RI Info: Question 3.b. changed reference from Tech Regs to Guidance Document.
- Section N Eco Receptors: Updated citation in question 4.
|
| 1.6 - 5/7/12 |
- General Instructions: Modified instructions for submission
of RE forms and Case Inventory Documents (CID) Removed Non-LSRP
and Subsurface Evaluator certification pages.
- Section B: added radionuclide reports list.
|
| 1.5 - 1/10/12 |
- General: Removed format restrictions for zip codes
- Section A: Changed citation for "Date Remediation Initiated"
- Section B: Changed title to "Submittal Status", updated Alternate
Standard form name, replaced Annual Fee form with Public Notification
Form, and added withdrawal column
- Section E: small wording changes, expanded question about
number of AOCs to identify total AOCs for the site and total
AOCs addressed in submittal
- Section G: Check boxes reworded to yes/no questions
- Section I: changed the word "deviation" to "variance" through
out section
- Section K: added Question 2 "Is contamination in soils fully
delineated?"
- Section L: added Question 4 "Is contamination in ground water
fully delineated?"
- Section M: added new section- Ecological Receptors
|
| 1.4 - 9/7/11 |
Form
- Section A: Removed Mailing Address line
- Section B: Added more space for Permit Application List.
- Section E: Removed instruction to attach Section H2 of the
PA/SI form. Added space RI complete date and space for number
of contaminated AOCs.
- Section F: Question 1 added "at the time of remedial
investigation" Question 4 - removed "Co-mingled
on-site ground water plumes" and "Co-mingled ground
water plumes from both on-site and off site sources". Added
"Background ground water contamination".
- Section G: Added "DAF Modification", "Immobile
Chemicals List", "Soil and Ground Water Analytical
"Data Evaluation".
- Section H: Removed question 1.
- Section L: Rewritten, expanded to 3 questions plus 4 sub questions.
- Section M: Removed question 6 about clean fill.
- Section N: Changed question 2. to 1a. Added new questions:
2. (were additional AOCs ID), 5. (Has clean fill has been brought
onto the site), and 7. (Have past deficiencies/notice of deficiencies
been addressed).
- Section P: Removed first section of sub surface evaluator
certification.
Instructions
- Changed all instances of "Department" to "NJDEP"
Changed mailing address
- Section A: Added examples of NJDEP site ID numbers. Removed
mailing address only instruction
- Section B: Added Remedial Action Report
- Section E: Removed instruction to attach Section H2 of the
PA/SI form. Added note that PA/SI is required for "entire
site" option. Added requirement to identify All AOCs individually.
- Section H: Removed question 1, renumbered questions 2a and
2b to 1 and 2.
- Section I: Spell out Vapor Intrusion and Johnson & Ettinger.
- Section L: Rewritten to match new questions.
- Section M: Removed question 6 about clean fill.
- Section N: Renumbered item 2 to item 1a. added new items 2,
5, and 7. Fixed link for list of regulated USTs
- Section P: Removed first 3 bullet items in Subsurface Cert.
|
| 1.3 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.2 - 1/12/11 |
- Grammar & punctuation
- Section O: Developer Certification removed
|
| Remediation
Cost Review/Estimate form |
1.1 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.0 - 3/25-11 |
- Form finalized
- Sec. F, item 5 removed
|
| 0.2 - 3/4/11 Draft |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 0.1 - 1/12/11 Draft |
- DEP Oversight checkbox added to top of form,
- Section C: additional checkbox
- Section D: more Mechanisms added
- Section I: new signature page for person establishing and
maintaining a remediation funding source added, 30 calendar
days after disbursement to submit, & shall not include ineligible
legal costs/legal fees on 3 signature pages
|
| Remediation
Certification form |
1.6 - 11/27/2012 |
- Removed Pubic Notary Requirements from Sections E, F, and
G.
- Updated instructions for Applicability.
- Added instruction to submit the Remediation Cost Review and
RFS/FA form in Section D.
|
| 1.5 - 5/7/12 |
- Removed Non-LSRP certification page.
|
| 1.4 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.3 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.2 - 1/12/11 |
- Grammar & punctuation
- Section D: surcharge added
|
Remediation
Cost Review and RFS-FA Form
Formerly called: "Remediation
Funding Source - Self Guarantee Form" or "Remediation
Funding Source Form" |
1.5 - 5/6/13 |
- Added subsurface and LSRP check boxes on front
- Section B:
- Added question about submitting GIN
- Added question asking if site is in Direct Oversight
- Added "For RFS Only (not FA)" notice for exemption question
- Added Note at bottom of section
- Section C:
- Added "check all that apply"
- Removed instructions to attach instrument for first two items
- Added "Biennial Cost Review" and "Using RFS as FA" to list
- Section D: Added question 3 about changing the amount of FA
- Section E: Added estimated cost for FA
- Section F: Renamed Section, added three questions about FA
- Section G: Expanded question 2 into 3 questions and added new question 3
- Section J: Added subsurface evaluator Cert
|
| 1.4 - 11/14/12 |
- Section B: Added a list of possible exemptions from the requirement
to post RFS.
- Section D: Added boxes to indicate if the mechanism is for
a RFS or RA for both initial and replacement mechanisms.
|
| 1.3 - 7/23/12 |
- Removed options for Non-LSRP and DEP Oversight certification
- Removed "No Changes Since Last Submittal" on all certifications
- Section B: Added instructions to attach additional sheets
if needed
- Section C: - Added box for "Change in Remediation Funding
Source or Financial Assurance Mechanism" - Removed contact
information for person who prepared cost estimate
- Section D: - Renamed "Current Mechanism" to "Initial
or Existing Mechanism" - Added spaces in Replacement Mechanism
to indicate provider (lender) for each choice - Removed
questions 2 through 5 - Added new question 2 for "Amount
of remediation funding source or financial assurance posted"
- Section E: - Provided link for cost estimate guidance
- Added "Estimated cost to complete remediation" and "Full legal
name of person who prepared the cost estimate"
- Section G: Removed "Estimated remaining costs to complete
the remediation"
|
| 1.2 - 9/7/11 |
- Changed name from: "Remediation Cost Review Estimate
Ver 1.1" to "Remediation Cost Review and RFS-FA Form
Ver 1.2"
|
| 1.1 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.0 - 3/25/11 |
- Form finalized
- Sec. B, item 3 added: Name of entity that entered into the
oversight document
|
| 0.1 - 3/4/11 Draft |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 0.0 - 1/12/11 Draft |
|
Remediation
TimeFrame Notification |
1.0 - 5/7/12 |
|
| Request
to Proceed Without Department Pre-Approvals (The Opt In form)
See the LSRP Notification of Retention
or Dismissal form. |
|
|
| Response
Action Outcome form |
2.0 - 3/25/13 |
- Section B Submittal Status: Added Technical Impracticability Determination to the list.
- Section D Case Type: Added new Section D: Case Type.
-
Section J Applicable STDs:
Changed "compounds" to "contaminants" in Question 1.
Added table of compliance averaging methods to Question 2.
- Section K Media Impacted: Question 4 - added "site specific".
- Section L Alt STDs: Added "ecological site specific goal".
|
| 1.9 - 8/23/12 |
- Fixed page numbering error
|
| 1.8 - 5/7/12 |
Form
- General Instructions: Modified instructions for submission
of RE forms and Case Inventory Documents (CID).
- Section B: added radionuclide reports list.
- Section F: changed child care fee from $225 to $450.
- Section E: added checkbox for "Lease Hold Portion Only –
Child Care Center Facility" to question 1.
- Added question 4 "Are there AOCs where an ROA has not been
filed".
Instructions
- General instructions: Added item 4 indicating supporting document
must be submitted with the RAO. Added "Completed forms should
be sent to..."
- Updated instructions for Sections A, B, E, J, L
|
| 1.7 - 1/10/12 |
Form
- General: Removed formatting for zip code.
- Section A: Changed citation for "Date Remediation Initiated."
- Section B: Changed title to "Submittal Status", updated Alternate
Standard form name, replaced Annual Fee form with Public Notification
Form, and added withdrawal column.
- Section C: Added "Government" to current and future uses,
and deleted "Agriculture" from future use.
- Section E: Added 2 questions identifying total number of AOCs
for the site and total AOCs addressed in this submittal.
- Section I: New section "Applicable remediation Standards"
created out question 1.
- Section J: Changed the word "deviation" to "variance" and
added "or alternate vapor intrusion screening level", and added
question: "A site-specific screening level was developed for
the evaluation of the VI pathway."
- Section K: (old section J) changed the word "deviation" to
"variance" through out section.
- Section L: (old section K) question 3. changed "ground water
contamination not yet remediated" to "ground water contamination
not yet investigated."
Instructions
- General instructions: Added item 4 indicating supporting document
must be submitted with the RAO. Added "Completed forms should
be sent to…"
- Updated instructions for Sections A, B, E, J, L
|
| 1.6 - 9/7/2011 |
- Intro: Deleted introduction paragraph and note.
- Section A: Removed "mailing adddress if different than
street address" Changed "Date trigger compliance with
Section 30 of Site Remediation Reform Act P.L." to "Date
Remediation Initiated Pursuant to N.J.A.C. 7:26C-2.2 or 2.3(b):"
- Section B: Expanded list of required submittals to match other
forms.
- Section F: Added Section F for child care fee
- Instructions: Updated version and date to match form
|
| 1.5 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
- 11 New check boxes added under Section J. 3. to reflect the
addition of the new “Groundwater Contamination due to
Regional Historic Fill” notice and “Child Care Center
Notices.” The “Child Care Center Notices”
check box consolidates/replaces three Child Care notices/check
boxes that have been deleted. Same notice changes made to the
RAO Shell Document.
|
| 1.4 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.3 - 2/9/11 |
- The Response Action Outcome (RAO) Form and Instructions have
been modified to solicit information regarding the existence
of a Remediation Funding Source (RFS) for the remediation for
which the RAO is being issued.
- Section K of the RAO Form will now identify in accordance
with N.J.A.C. 7:26C-5 whether a RFS has been posted and, if
posted, serve as notice (if applicable) to the Department that
all or part of the RFS needs to be returned. The RAO Form and
Instructions further provides a reminder that the "Remediation
Cost Review Form" must be included with the submission
if either a return or decrease in the RFS is being requested.
By completing this information, the Department will be able
to identify those cases where RFS needs to be returned or reduced
in a more efficient manner allowing for prompt return of the
RFS. The labeling of the sections of the RAO form following
the new Section K have also been adjusted.
|
| 1.2 - 1/12/11 |
- Grammar & punctuation,
- Section E: ISRA leasehold properties clarification;
- Section K: Developer Certification removed
|
| Model
Response Action Outcome (Appendix D for the ARRCS Rule) |
|
|
Technical
Assistance Grant form
|
1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.2 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
|
| Underground
Storage Tank System Closure Notification / Extension Request form |
1.3 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 1.2 - 3/4/11 |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 1.1 - 1/12/11 |
- Grammar & punctuation, LSRP signature page made consistent
with other forms
|
| Vapor
Concern (VC) Response Action Form |
1.2 - 5/7/12 |
- Removed Non-LSRP and Subsurface Evaluator certification pages.
|
| 1.1 - 1/19/12 |
- Section A: Removed "mailing Address if different than street
address"
- Section E: changed all questions from check boxes to yes/no
questions.
- Section F: Changed "within 100’ of free product (any
type)" to "within 100’ of free product (excluding diesel)"
Incorporated "free product type" question into other questions
Changed "ground water" to-indoor air pathway" to "vapor intrusion
pathway".
- Updated instructions for sections A, C, F and G
|
| 1.0 - 5/25/11 |
- Address change to reflect the new DEP mail codes.
|
| 0.2 - 2/25/11 Draft |
- Allows the Yes/ No Check boxes to be checked & unchecked
|
| 0.1 - 1/12/11 Draft |
- New version number for splitting the instructions from the
form
|
| Variance
Identification Form |
1.0 - 7/11/12 |
|
| |
|
|