SCANNE

BWSC-101

Massachusetts Department of Environmental Protection

Bureau of Waste Site Cleanup

SU

Release Tracking Number

RELEASE LOG FORM

27309

A. LOG INFORMATION:
Log Date:
12/07/2007
Log Time:
11:25

TYPE OF CALL (check one):

Release or TOR

El

DISPOSITION OF CALL (check the 2n most applicable disposition below):

If selecting one of the two following options, assign a Release
Tracking Number (RTN) in the spac provided above:
Reportable Release or Threat IRelease

Q-Inquiry

Complaint

CALLER (check one):

reAM
m PMPRP

Check one:

AM PM

Boston

SAmene

Telephone

(508)

Organization:

Other Government Agency

Citizen
Anonymous

LSP or PRP Agent

Oer erson

If selecting any option below, do not assign an RTN:

(with WSC-103 only)

Release Notifcation Retract

Not a 21E Release

Oh

Reporting Person: Lt.

eporting Threshold

Select one of the two following opt ons only if n

RTN was previously assigned:

Public Safety Official

Use of Form:
(check one)
SInitial Office

O1

Release or Threat of Release ess Than

Release or Threat of Release Exempt from Reporting Requirements

(not referred)

Boothby

Report Referred to Other Agency or Division

881-2323

Ext.:

Referred To:

Ashland Fire Department

No Action Taken

Site Visit

Compliance Site Visit

B. RELEASE OR THREAT OF RELEASE LOCATION:

Street:

Pond Street

City/Town:

Location Aid:

Ashland

Adequately Regulated Status:

Type of Location (check all that apply):

SFederal

El

Pole #23

El

Commercial

[]

Right of Way

Roadway

Industrial

Water Body

Fee Status:

Residential

El

Open Space

School

IT

Municipall

State

Other:

Release Tracking Number of Associated Transition or Tier Classified Site, if any:

C. RELEASE OR THREAT OF RELEASE (TOR) INFORMATION:

Notification Date, if different from log date:
"One Year" Status Date, if not one year after notification date;

Date and time reporting person obtained knowledge of the Release or TOR.
IF KNOWN, record date and time Release orTOR occurred. Date:

12/07/2007

12/07/2007

Time

11:00

AM

EPM

Time

10:30

RAM

IPM

Check all conditions that apply to the Release or Threat of Release:

2 HOUR REPORTING CONDITIONS

U Sudden Release

72 HOUR REPORTING CONDITIONS

Subsurface NAPL = or > 1/2 Inch

120 DAY REPORTING CONDITIONS

Lj

Threat of Sudden Release

SOil Sheen on Surface Water

Poses Imminent Hazard

SCould Pose Imminent Hazard

SRelease Detected in Private Well
]

Release to Storm Drain

Sanitar
Srm Ras
Sanitary Sewer Release
(Imminent Ha iard Only)

Source of Release or TOR (check all that apply):

Threat of UST Release

Release of Oil to Groundwater > RC(s)

Release to Groundwater near Water

Supply

Subsurface NAPL

Release to Groundwater near School

or Residence

Check here if Substantial Release Migration exists

in connection with 120 Day Reporting Conditions

UST

El Vehicle
Unknown
El Unknown
Federal LUST Eligible? f] Yes jI No
[

Tanker Truck

SSECTION
Revised 7/17/2001

Cubic Yards

L ST Release

Release of HM(s) to Soil or Groundwater > RC(s)

Release of Oil to Soil > RC(s) and Affecting > 2

Pipe/Hose/Line

Other

AST

= or >

Drums

S Inch and <12

Transformer

Boat

Specify: Capacitor Bank

DFS UST/AST Facility ID#

C IS CONTINUED ON THE NEXT PAGE.

Do Not Alter This Form

n/a

DFS UST/AST Tank ID#

n/a
Page 1 of 2

BWSC-101

Massachusetts Department of Environmental Protection

Bureau of Waste Site Cleanup

Release Tracking Number

2no

RELEASE LOG FORM(continued)

] Rupture

C. RELEASE OR THREAT OF RELEASE (TOR) INFORMATION:

Type of Release or TOR (check all that apply):

El

Fire

] Test Failure

Vehicle Accident

Spill

Leak

] Wetlands

Storm Drain

El

Other

F]

Unknown

Groundwater]

Dumping
]

Other

Specify:

Surface Water

Sediments

El

Public Water Supply

Private Well

Overfill

Tank Removal

Zone 2

Soil
]

Residence

Specify:

(check one)

MODF Non PCB

[] Air

Paved Surface

] Unknown
School
O or HM Released

Threat Only

Identify Media and Receptors Affected: (check all that apply)

CAS # (if known)

MD0 F1 HM
________ElOfHM

Amount or Conc.

Units

Gallons

RCs Exceeded?

____

Description of Release or Threat of Release:

Lt. Boothby reported a car collided with Pole #23 along Pond Street in Ashland. He
Cuc the sotl
inudcacea LlaL uhe accidenu caused Vie capacJlor bank cu Teak Jon-tCb vOu
shoulder of the referenced site. He stated that very little MODF had leaked to the
PRP Lamontagne
soil. He indicated that less than four gallons was on the ground.
1
*1,
p t),rln
rArprt
c.o-A
-h4
P~ .c A r'lc
Unrl,
nrc 'a
r
rr,,
t-lc

that utilities and the roadway were not impacted.

Lt Boothby stated
1

the capacitor bank.

D. PRP INFORMATION:

SPRP Unknown
SPRP

Unwilling or Unable to Perform Response Actions. Who is?

Name of PRP Organization:

Name of PRP Contact:

Street:

Eric

Other Person

Who:

Title:

Lamontagne

NE250

Check here ifthis PRP received a field NOR.

State:

Westwood

Telephone: (339)

DEP

Check here if additional involved parties are listed on an RLFA.

and Gas

NSTAR Electric

One Nstar Way,

City/Town:

PRP Performing Response Actions

Ext.:

987-7018

ZIP Code:

MA

02090

FAX:

E. CONTRACTOR:
Contractor Name:
Name of Contact:

F. LSP:
LSP Name:
Telephone

Clean Harbors

Telephone

Inc

645-82Ext.:

Check here if this is a State Contractor.

Paul Hogan

Dan Watton
Dan Watton
(339)

(800)

LSP Number:
Ext.:

987-7024

G. MCP RESPONSE ACTIONS:

61
6016

FAX:

(check any that apply)

El

IRA Assessment Only

IRA Oral Plan Approved*

El

Oral RAM Plan Approved*

Oral RAM Plan Denied

Date of Action, if different from Log Date:

] IRA Oral Plan Denied

E]

IRAPre-notification

Notice of Intent to Conduct a URAM

* Provide details of approved plans on an RLFA.

SCheck here if soil was removed from the site or

. notification.

Check here if the soil was removed as part of an UST closure.

Quantity of soil previously removed and destination:

H. DEP ASSIGNMENT:
RNF Submittal Requested:

El

Provisions of 21E Explained: B

Prepared By:

s
Yes

Kenneth Sanderson

No

From Who:

No

Why Not:

Less Than Reportable Quantit

Regional Use:
Number of RLFA Pages Attached:

Staff Lead Assigned

n/a
(if different from Preparer):
Revised 7/17/2001

El
Do Not Alter This Form

Check here if Release orTOR is unassigned.

Page 2 of 2

SCANNED

BWSC-101
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
RELEA E LOGFORMRelease Tracking Number
RELEASE LOG FORM
2n
A. LOG INFORMATION:
Log Date:
12/07/2007
Log Time:
11:25

TYPE OF CALL (check one):

Release or TOR

Check one:

CALLER (check one):

AM

__

5
]
O

Use of Form:
(checkone)
Initial Office
SBoston

Release or Threat of Release ess Than R porting Threshold

Public Safety Official

Select
onepreviously
of the twoassigned:
following o
RTN was

Other Government Agency

(508)

ions only if a

Release Notification Retraction (with BWSC-103 only)

Citizen

Not a 21 E Release

Anonymous
LSP or PRP Agent

If selecting any option below, do noj assign an RTN:

Release or Threat ofRelease Exemptfrom ReportingRequirements
referred)

Sn(not

Reporting Person: Lt.

Organization:
Organi

12

Other Person:

SAmended

Telephone

Inquiry

Complaint

PM

DISPOSITION OF CALL (check the g= most applicable disposition below):

Ifselecting oneofthetwofollowingo ions-essig a Release
Tracking Number (RTN) in the space rovided ab ve:
Reportable Release or Threat Release

Boothby
881-2323

Report Referred to Other Agency or Division

Ext.:

Ashland Fire Department

i
on:
___

Referred To:

No Action Taken

___

eion

Site Visit

un

mev

Compliance Site Visit

0ComplianceSiteVisit

B. RELEASE OR THREAT OF RELEASE LOCATION:

Street:

Pond Street

City/Town:

Location Aid: . Pole #23

Ashland

Adequately Regulated Status:

TypeofLocation(checkallthatapply):

Federal

Right of Way

[]

Commercial

Roadway

E]
]

Fee Status:

Industrial

Residential

Water Body

Open Space

School

MunicipalO State

Other.

Release Tracking Number of Associated Transition or Tier Classified Site, if any:

C. RELEASE OR THREAT OF RELEASE (TOR) INFORMATION:

Notification Date, if different from log date:
"One Year" Status Date, if not one year after notification date:

Date and time reporting person obtained knowledge of the Release or TOR.

12/07/2007

12/07/2007

IF KNOWN, record date and time Release or TOR occurred. Date:

Time

11:00

9AM

Time

10:30

[AM

PM
5PM

Check all conditions that apply to the Release or Threat of Release:

2 HOUR REPORTING CONDITIONS

1]

Sudden Release

F1

Threat of Sudden Release

F
5

Oil Sheen on Surface Water

Poses Imminent Hazard

72 HOUR REPORTING CONDITIONS

Source of Release or TOR (check all that apply):

Federal LUST Eligible? []

Vehicle
Yes

cf

]
No

UST

Unknown

Unknown

Specify:

Check here if Substantial Release Migration exists

in connection with 120 Day Reporting Conditions

AST

Drums

Transformer

Boat

Capacitor Bank

DFS UST/AST Facility ID#

SECTION C IS CONTINUED ON THE NEXT PAGE.

Revised 7/1712001

Release of Oil to Groundwater > RC(s)

IubnsurfaceNAPL=or>/8nchand<2

Pipe/Hose/Line

Other

Oil to Soil > RC(s) and Affecting > 2

Subsurface NAPL = or > 1/8 Inch and < 1/2

Release to Groundwater near School

or Residence

Sewer
Release
Sanitary
(Imminent Hazard Only)

Release of HM(s) to Soil or Groundwater > RC(s)

Cubic vards

Release to Groundwater near Water

Supply

Release Detected in Private Well

Release
Release

Threat of UST Release

Could Pose lmminent Hazard

Tanker Truck

Subsurface NAPL = or > 1/2 Inch

UST Release

Release to Storm Drain

O]Sanitary
Sewer Release

120 DAY REPORTING CONDITIONS

Do Not After This Form

n/a

DFS UST/AST Tank ID#

n/a
Page 1 of 2

BWSC-101

Massachusetts Department of Environmental Protection

Bureau of Waste Site Cleanup

Release Tracking Number

2730

RELEASE LOG FORM

C. RELEASE OR THREAT OF RELEASE (TOR) INFORMATION:
Type of Release or TOR (check all that apply):

SVehicle

Accident

E]

Leak

El

Test Failure

Spill

Fire

Storm Drain

Air []

Tank Removal

Dumping

Unknown

Groundwater [

Other

Overfill

Soil

Specify:

Surface Water

Sediments

Public Water Supply

Zone2

Residence

Specify:

(check one)

MODF Non PCB

Rupture

E] Private Well

Paved Surface
Other

Unknown
School
O or HM Released

E]

Threat Only

Identify Media and Receptors Affected: (check all that apply)

] Wetlands

(continued)

CAS # (if known)

HM

Amount or Conc.

Units

RCs Exceeded?

Gallons

HM

Description of Release or Threat of Release:

Lt. Boothby reported a car collided with Pole #23 along Pond Street in Ashland. He
.indcateI
Lida
cue accipuent caused che capacitor dauk17 LO
eak
Con-tu n IMouT
Lo Le
so.i.l
shoulder of the referenced site. He stated that very little MODF had leaked to the
soil. He indicated that less than four gallons was on the ground. PRP Lamontagne
the capacitor bank.

Lt Boothby stated that utilities and the roadway were not impacted.

D. PRP INFORMATION:
PRP Unknown

SPRP

Name of PRP Organization:

Name of PRP Contact:
Street:

Eric Lamontagne

987-7018

E. CONTRACTOR:
CONTRACT:
Contractor Name:

Clean Harbors Inc

Who:

Title:

Ext.:

Check here if this PRP received a field NOR.

ZIPCode:

02090

FAX:
(800) 645-8265
Telephone

Paul Hogan

Dan Watton
LSP Number:
(339)

Ext.:

987-7024

G. MCP RESPONSE ACTIONS:

Ext.:

Check here if this is a State Contractor.

LSP Name:
Telephone

Other Person

State: MA

Telephone: (339)

F. LSP:

Check here if additional involved parties are listed on an RLFA.

DEP

El

NE250

Westwood

Name of Contact:

E]

and Gas

NSTAR Electric

One Nstar Way,

CityfTown:

El

PRP Performing Response Actions

Unwilling or Unable to Perform Response Actions. Who is?

6016

FAX:

(check any that apply)

SIRA Assessment Only

Oral RAM Plan Approved*

IRA Oral Plan Approved*

IRA Oral Plan Denied

Oral RAM Plan Denied

Notice of Intent to Conduct a URAM

Date of Action, if different from Log Date:

IRA Pre-notification

Provide details of approved plans on an RLFA.

SCheck here if soil was removed from the site

odor to

notification.

Check here if the soil was removed as part of an UST closure.

Quantity of soil previously removed and destination:

H. DEP ASSIGNMENT:
RNF Submittal Requested:

Provisions of 21E Explained:

0,Yes

Prepared By:

Yes

[2 No
[]

Kenneth Sanderson

No

From Who:

Less Than Reportable Quantity

Why Not:
Regional Use:
Number of RLFA Pages Attached:

Staff Lead Assigned

n/a
(if different from Preparer):
Revised 7/17/2001

E
Do Not Alter This Form

Check here if Release or TOR is unassigned.

Page 2 of 2