13th Phase V Report Transmittal 9-09-
BWSC108
Release Tracking Number
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
COMPREHENSIVE RESPONSE ACTION TRANSMITTAL
FORM & PHASE I COMPLETION STATEMENT
B. THIS FORM IS BEING USED (check all that apply)
Page 1 of 5Revised: 4/1/2009
6. If applicable, provide the Permit Number:
d. Tier IIc. Tier ICb. Tier IBa. Tier IA
5. Check here if a Tier Classification Submittal has been provided to DEP for this disposal site.
4. ZIP Code:3. City/Town:
2. Street Address:
1. Site Name:
A. SITE LOCATION:
Pursuant to 310 CMR 40.0484 (Subpart D) and 40.0800 (Subpart H)
5. Submit a final Phase II Report and Completion Statement, pursuant to 310 CMR 40.0836.
1. Submit a Phase I Completion Statement, pursuant to 310 CMR 40.0484.
3. Submit a Phase II Scope of Work, pursuant to 310 CMR 40.0834.
4. Submit an interim Phase II Report. This report does not satisfy the response action deadline requirements in
310 CMR 40.0500.
7. Submit a Phase III Remedial Action Plan and Completion Statement, pursuant to 310 CMR 40.0862.
9. Submit a Phase IV Remedy Implementation Plan, pursuant to 310 CMR 40.0874.
11. Submit an As-Built Construction Report, pursuant to 310 CMR 40.0875.
2. Submit a Revised Phase I Completion Statement, pursuant to 310 CMR 40.0484.
8. Submit a Revised Phase III Remedial Action Plan and Completion Statement, pursuant to 310 CMR 40.0862.
6. Submit a Revised Phase II Report and Completion Statement, pursuant to 310 CMR 40.0836.
10. Submit a Modified Phase IV Remedy Implementation Plan, pursuant to 310 CMR 40.0874.
Specify the outcome of Phase IV activities: (check one)
c. The requirements of a Class C Response Action Outcome have been met. No additional Operation, Maintenance or
Monitoring is necessary to ensure the integrity of the Response Action Outcome. A completed Response Action Outcome
Statement and Report (BWSC104) has been or will be submitted to DEP.
b. The requirements of a Class A Response Action Outcome have been met. No additional Operation, Maintenance or
Monitoring is necessary to ensure the integrity of the Response Action Outcome. A completed Response Action Outcome
Statement and Report (BWSC104) will be submitted to DEP.
a. Phase V Operation, Maintenance or Monitoring of the Comprehensive Remedial Action is necessary to achieve a
Response Action Outcome.
d. The requirements of a Class C Response Action Outcome have been met. Further Operation, Maintenance or
Monitoring of the remedial action is necessary to ensure that conditions are maintained and that further progress is made
toward a Permanent Solution. A completed Response Action Outcome Statement and Report (BWSC104) has been or
will be submitted to DEP.
13. Submit a Phase IV Completion Statement, pursuant to 310 CMR 40.0878 and 40.0879.
12. Submit a Phase IV Status Report, pursuant to 310 CMR 40.0877.
705
459 PLEASANT ST
PLEASANT JOURNEY USED CARS
NORTHAMPTON
1
4
010600000
4
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BWSC108
Release Tracking Number
Page 2 of 5Revised: 4/1/2009
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
COMPREHENSIVE RESPONSE ACTION TRANSMITTAL
FORM & PHASE I COMPLETION STATEMENT
Pursuant to 310 CMR 40.0484 (Subpart D) and 40.0800 (Subpart H)
15. Submit a Phase V Status Report, pursuant to 310 CMR 40.0892.
(check all that apply)B. THIS FORM IS BEING USED TO (cont.):
17. Submit a Remedy Operation Status, pursuant to 310 CMR 40.0893.
20. Submit a Termination of a Remedy Operation Status, pursuant to 310 CMR 40.0893(6).(check one)
21. Submit a Phase V Completion Statement, pursuant to 310 CMR 40.0894.
a. The requirements of a Class A Response Action Outcome have been met. No additional Operation, Maintenance or
Monitoring is necessary to ensure the integrity of the Response Action Outcome. A completed Response Action Outcome
Statement (BWSC104) will be submitted to DEP.
Specify the outcome of Phase V activities: (check one)
b. The requirements of a Class C Response Action Outcome have been met. No additional Operation, Maintenance or
Monitoring is necessary to ensure the integrity of the Response Action Outcome. A completed Response Action Outcome
Statement and Report (BWSC104) will be submitted to DEP.
c. The requirements of a Class C Response Action Outcome have been met. Further Operation, Maintenance or
Monitoring of the remedial action is necessary to ensure that conditions are maintained and/or that further progress is
made toward a Permanent Solution. A completed Response Action Outcome Statement and Report (BWSC104) will be
submitted to DEP.
23. Submit a Post-Class C Response Action Outcome Status Report, pursuant to 310 CMR 40.0898.
22. Submit a Revised Phase V Completion Statement, pursuant to 310 CMR 40.0894.
14. Submit a Revised Phase IV Completion Statement, pursuant to 310 CMR 40.0878 and 40.0879.
18. Submit a Status Report to maintain a Remedy Operation Status, pursuant to 310 CMR 40.0893(2).
16. Submit a Remedial Monitoring Report. (This report can only be submitted through eDEP.)
i. Initial Report
ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration.
iii. A Remedial Monitoring Report(s) submitted concurrent with a Status Report.
iii. Final Reportii. Interim Report
d. Number of Remedial Systems and/or Monitoring Programs:
A separate BWSC108A, CRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring
Program addressed by this transmittal form.
a. Type of Report: (check one)
b. Frequency of Submittal: (check all that apply)
19. Submit a Transfer and/or a Modification of Persons Maintaining a Remedy Operation Status (ROS) , pursuant to 310
CMR 40.0893(5) (check one, or both, if applicable).
i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard.
iv. Class C RAOiii. Remedy Operation Statusii. Phase Vc. Status of Site: (check one)i. Phase IV
a. Submit a Transfer of Persons Maintaining an ROS (the transferee should be the person listed in Section D, "Person
Undertaking Response Actions").
b. Submit a Modification of Persons Maintaining an ROS (the primary representative should be the person listed in Section
D, "Person Undertaking Response Actions").
c. Number of Persons Maintaining an ROS not including the primary representative:
a. Submit a notice indicating ROS performance standards have not been met. A plan and timetable pursuant to 310 CMR
40.0893(6)(b) for resuming the ROS are attached.
b. Submit a notice of Termination of ROS.
705
4
4
2
1
4
4
4
-
BWSC108
Release Tracking Number
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
COMPREHENSIVE RESPONSE ACTION TRANSMITTAL
FORM & PHASE I COMPLETION STATEMENT
Page 3 of 5
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including
any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the
standard of care in 309 CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR 4.03(2), and (iii) the
provisions of 309 CMR 4.03(3), to the best of my knowledge, information and belief,
C. LSP SIGNATURE AND STAMP:
5. Ext.:
1. LSP #:
8. Date:
7. Signature:
6. FAX: 4. Telephone:
2. First Name:
I am aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit information
which I know to be false, inaccurate or materially incomplete.
3. Last Name:
9. LSP Stamp:
Revised: 4/1/2009
> if Section B indicates that a Phase I, Phase II, Phase III, Phase IV or Phase V Completion Statement and/or a Termination of a
Remedy Operation Status is being submitted, the response action(s) that is (are) the subject of this submittal (i) has (have) been
developed and implemented in accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are)
appropriate and reasonable to accomplish the purposes of such response action(s) as set forth in the applicable provisions of M.G.L.
c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with the identified provisions of all orders, permits, and approvals identified in this
submittal;
> if Section B indicates that an As-Built Construction Report, a Remedy Operation Status, a Phase IV, Phase V or Post-Class
C RAO Status Report, a Status Report to Maintain a Remedy Operation Status, a Transfer or Modification of Persons
Maintaining a Remedy Operation Status and/or a Remedial Monitoring Report is being submitted, the response action(s) that is
(are) the subject of this submittal (i) is (are) being implemented in accordance with the applicable provisions of M.G.L. c. 21E and 310
CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the purposes of such response action(s) as set forth in the
applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with the identified provisions of all orders, permits,
and approvals identified in this submittal.
> if Section B indicates that a Phase II Scope of Work or a Phase IV Remedy Implementation Plan is being submitted, the
response action(s) that is (are) the subject of this submittal (i) has (have) been developed in accordance with the applicable provisions
of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the purposes of such response
action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with the identified
provisions of all orders, permits, and approvals identified in this submittal;
Pursuant to 310 CMR 40.0484 (Subpart D) and 40.0800 (Subpart H)
(mm/dd/yyyy)
705
Ralph P Penney
RALPH P
5082611288
09/23/2009
7755
1
PENNEY
-
BWSC108
Release Tracking Number
Page 4 of 5
E. RELATIONSHIP TO SITE OF PERSON UNDERTAKING RESPONSE ACTIONS:
9. ZIP Code:7. City/Town:
5. Street:6. Title:
3. Contact First Name:
2. Name of Organization:
D. PERSON UNDERTAKING RESPONSE ACTIONS:
4. Last Name:
8. State:
Specify Relationship:4. Any Other Person Undertaking Response Actions
3. Agency or Public Utility on a Right of Way (as defined by M.G.L. c. 21E, s. 5(j))
2. Fiduciary, Secured Lender or Municipality with Exempt Status (as defined by M.G.L. c. 21E, s. 2)
Specify:
d. Transporterc. Generatorb. Operatora. Owner1. RP or PRP
e. Other RP or PRP
c. change in the person
undertaking response actionsb. change of address
12. FAX: 11. Ext.:10. Telephone:
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of any
Phase Reports to DEP.
1. Check here if the Response Action(s) on which this opinion is based, if any, are (were) subject to any order(s), permit(s)
and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
F. REQUIRED ATTACHMENT AND SUBMITTALS:
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
Revised: 4/1/2009
1. Check all that apply:a. change in contact name
8. Check here if any non-updatable information provided on this form is incorrect, e.g. Site Name.
Send corrections to: BWSC.eDEP@state.ma.us.
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
COMPREHENSIVE RESPONSE ACTION TRANSMITTAL
FORM & PHASE I COMPLETION STATEMENT
Pursuant to 310 CMR 40.0484 (Subpart D) and 40.0800 (Subpart H)
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the availability of a
Phase III Remedial Action Plan.
5. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of any field work
involving the implementation of a Phase IV Remedial Action.
4. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the availability of a
Phase IV Remedy Implementation Plan.
6. If submitting a Transfer of a Remedy Operation Status (as per 310 CMR 40.0893(5)), check here to certify that a statement
detailing the compliance history for the person making this submittal (transferee) is attached.
7. If submitting a Modification of a Remedy Operation Status (as per 310 CMR 40.0893(5)), check here to certify that a
statement detailing the compliance history for each new person making this submittal is attached.
Check here to change relationship
705
013010000
PLEASANT JOURNEY USED CARS INC
MA
4
4
ROBERT
4
GREENFIELD
1
4
KALISH
PRP GENERIC OR NON-SPECIFIED
4
504 LAMPBACK RD
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BWSC108
Release Tracking Number
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
COMPREHENSIVE RESPONSE ACTION TRANSMITTAL
FORM & PHASE I COMPLETION STATEMENT
Page 5 of 5
Date Stamp (DEP USE ONLY:)
1. I, , attest under the pains and penalties of perjury (i) that I have
personally examined and am familiar with the information contained in this submittal, including any and all documents
accompanying this transmittal form, (ii) that, based on my inquiry of those individuals immediately responsible for obtaining the
information, the material information contained in this submittal is, to the best of my knowledge and belief, true, accurate and
complete, and (iii) that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. I/the
person or entity on whose behalf this submittal is made am/is aware that there are significant penalties, including, but not limited to,
possible fines and imprisonment, for willfully submitting false, inaccurate, or incomplete information.
3. Title:2. By:
G. CERTIFICATION OF PERSON UNDERTAKING RESPONSE ACTIONS:
13. FAX:12. Ext.:11. Telephone:
10. ZIP Code:9. State:8. City/Town:
7. Street:
4. For:
(Name of person or entity recorded in Section D)
Signature
Revised: 4/1/2009
6. Check here if the address of the person providing certification is different from address recorded in Section D.
Pursuant to 310 CMR 40.0484 (Subpart D) and 40.0800 (Subpart H)
5. Date:
(mm/dd/yyyy)
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
>if Section B indicates that this is a Modification of a Remedy Operation Status (ROS), I attest under the pains and penalties of
perjury that I am fully authorized to act on behalf of all persons performing response actions under the ROS as stated in 310 CMR
40.0893(5)(d) to receive oral and written correspondence from MassDEP with respect to performance of response actions under the
ROS, and to receive a statement of fee amount as per 4.03(3).
I understand that any material received by the Primary Representative from MassDEP shall be deemed received by all the persons
perform ing response actions under the ROS, and I am aware that there are significant penalties, including, but not limited to, possible
fines and imprisonment, for willfully submitting false, inaccurate or incomplete information.
705
9/24/2009 9:51:26 AM
PLEASANT JOURNEY USED CARS INC 09/24/2009
Robert P. Kalish
Robert P. Kalish
1