Guide to the Remediation Report & Fee Submission Form



Similar documents
STATE OF TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION DIVISION OF UNDERGROUND STORAGE TANKS TECHNICAL GUIDANCE DOCUMENT - 008

2. determining that land is not contaminated land and is suitable for any use, and hence can be removed from the CLR or EMR, as relevant.

Risk-Based Decision Making for Site Cleanup

Frequently Asked Questions on the Alberta Tier 1 and Tier 2 Soil and Groundwater Remediation Guidelines. February 2008

Environmental Guideline. for. Contaminated Site Remediation

Alberta Tier 2 Soil and Groundwater Remediation Guidelines

Asbestos Storage Facility Plan Examples

Not Cleaning Up Someone Else s

WATER SUPPLY WELL RECEPTOR SURVEY GUIDANCE DOCUMENT

Presentation Outline. Introduction Ontario s Spill Legislation Spills Action Centre Ministry Field Response Roles and responsibilities

Innovative Solutions Using Risk Assessment Tools as a Map for Site Portfolio Management

PROTOCOL NO. 5: Petroleum Hydrocarbon Analytical Methods and Standards

ALBERTA TIER 2 SOIL AND GROUNDWATER REMEDIATION GUIDELINES

Alternate Concentration Limits/Groundwater Cleanup Levels. Title slide

Environmental Management Requirements (EMR) for Hazardous Materials and Contaminated Sites

A Federal Approach to Contaminated Sites

Site Cleanup in Connecticut

A METRO VANCOUVER POSITION PAPER ON BILL S 8: THE SAFE DRINKING WATER FOR FIRST NATIONS ACT

Street Address (number and street): City: County: ZIP Code: B. CURRENT SITE PRIORITY INFORMATION Was free product present this quarter?

San Mateo County Environmental Health Characterization and Reuse of Petroleum Hydrocarbon Impacted Soil

DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF WATER SUPPLY MANAGEMENT. Principles for Ground Water Pollution Prevention and Remediation

UNDERGROUND OIL STORAGE TANKS

TOUR DE TABLE CANADA

This guidance was prepared to parallel the Low Hazard Exemption process guidance prepared by the Waste and Materials Management Program.

Incident Reporting Requirements

Environmental guidelines for preparation of an Environment Management Plan

Appendix N Framework Spill Prevention, Containment, and Countermeasures Plan Prepared by: Idaho Power Company 1221 W Idaho Street Boise, ID 83702

V. ENVIRONMENTAL IMPACT ANALYSIS E. Hazardous Materials

Canada-wide Strategy for the Management of Municipal Wastewater Effluent

Presented by: Craig Puerta, PE, MBA December 12, 2012

APPLICATION FOR A BUSINESS OPERATOR'S CERTIFICATE

We are pleased to submit for your consideration the first annual report of the Remediation Monitoring Oversight Board (RMOB).

Getting Started - More Information:

Strategy and Procedures for Compliance and Enforcement

October Website Version. Audit of the Province s Management of Contaminated Sites and Landfills

Use of Alternate Concentration Limits (ACLs) to Determine Cleanup or Regulatory Levels Under RCRA and CERCLA

In-situ Bioremediation of oily sediments and soil

FIVE-YEAR REVIEW REPORT MASON COUNTY LANDFILL SUPERFUND SITE LUDINGTON, MICHIGAN FEBRUARY, 2001

BLUE ISLAND NORTHEAST MIXED-USE COMMERCIAL PARK 119TH STREET & VINCENNES AVENUE BLUE ISLAND, COOK COUNTY, ILLINOIS

Risk Assessment Based Environmental Management Systems for Petroleum Retail Stores

Wastewater Regulation and Designing Changes in South East Asia

SASKATCHEWAN POLICY STATEMENT APPLICATIONS TO THE SASKATCHEWAN FINANCIAL SERVICES COMMISSION

Central Area Community Improvement Plan

Will the Radon Mitigation Industry Grow and Why?

Proposal for a RECOMMENDATION OF THE EUROPEAN COMMISSION

All Oil and Gas Companies under the Jurisdiction of the National Energy Board (the Board or NEB) and All Interested Parties

June 2010 HEALTH, SAFETY, AND ENVIRONMENT MANAGEMENT SYSTEM (HSEMS)

RISK MANAGEMENT IN CONTRACTS

BP Texas City Refinery

Basement Flooding Protection. Subsidy Program. Information and Application. For more information:

UNDERGROUND STORAGE TANK SYSTEM CLOSURE REPORT FORM

DRAFT. GROUNDWATER REMEDY COMPLETION STRATEGY: Moving Forward with Completion in Mind

APPENDIX 4. Risk Tables

ONTARIO'S DRINKING WATER QUALITY MANAGEMENT STANDARD

COMPREHENSIVE DRINKING WATER SOURCE-TO-TAP ASSESSMENT GUIDELINE

Gravel Pit Rehabilitation Near Shallow Municipal Wells Threat or Opportunity?

APPENDIX 7-B. Hazardous Materials Management Plan

THE CORPORATION OF THE CITY OF COURTENAY BYLAW NO A bylaw to amend Storm Sewer Bylaw No. 1402, 1986

Professional Engineers Professional Engineers Providing Services in Environmental Site Assessment, Remediation and Management

Storage Tank Systems for Petroleum products and allied petroleum products regulations

Auditor General of Canada to the House of Commons

Environmental Guidelines for Preparation of an Environmental Management Plan

8.0 ENVIRONMENTAL PROTECTION MONITORING AND FOLLOW-UP

NRDA PROCEDURES AND TERMS

STATEMENT OF BASIS HYPERGOL SUPPORT BUILDING SWMU 65 NATIONAL AERONAUTICS AND SPACE ADMINISTRATION KENNEDY SPACE CENTER BREVARD COUNTY, FLORIDA

Environmental and Economical Oil and Groundwater Recovery and Treatment Options for hydrocarbon contaminated Sites

Cross Connection Control and Backflow Prevention Program Guidelines

NAPCS Product List for NAICS 54162: Environmental Consulting Services

October 25, Mr. Howard Peak, Chairman Board of Directors Brooks Development Authority 8030 Challenger Drive Brooks AFB, TX

Table of Contents. 1. Introduction Purpose Legislative Reference Responsibility Definitions...4

DECISION MEMORANDUM FOR ENVIRONMENTAL RESPONSE ACTIONS

TITLE 6. Health and Sanitation CHAPTER 1. Health and Sanitation

Defence College of Technical Training. Former RAF Lyneham Geo-Environmental Report Appendix D: Preliminary Qualitative Risk Assessment

Marine Protection Rules Marine Protection Rules Part 102 Certificates of Insurance Amendment 2014

PETROLEUM STORAGE TANK SYSTEM UNDERGROUND AND/OR ABOVEGROUND REMOVAL REPORT

Source Water Assessment Report

U. S. Army Corps of Engineers Ground Water Extraction System Subsurface Performance Checklist

HISTORICAL OIL CONTAMINATION TRAVEL DISTANCES IN GROUND WATER AT SENSITIVE GEOLOGICAL SITES IN MAINE

Municipal Affairs. Property Tax: Adding Amounts to the Tax Roll

How To Manage Waste In The Northwest Tokson

Appendix H. Hazardous Materials. Regulatory Agencies Involved in Hazardous Materials Pollution Prevention and Solid Waste in Alameda County

MBJ Environmental Programmes

ENVIRONMENTAL PROTECTION AGENCY

Environmental Site Assessments

Federal Remediation Technologies Roundtable Arlington, VA November 14, 2013 Jim Woolford, Director Office of Superfund Remediation and Technology

Remedial Investigation

BEAHR. Training Programs Guide. Environmental Training Opportunities for Aboriginal Communities

UPDATE ON MAINE'S UNDERGROUND TANK LAWS

Site Description and History

Before beginning any construction or demolition activities at your construction site,

New Cumberland Army Depot Formerly Used Defense Site (FUDS) Marsh Run Park Site Restoration Community Meeting

FINAL PLAN OF REMEDIAL ACTION

FLORIDA HAZARDOUS WASTE MANAGEMENT REGULATIONS THAT DIFFER FROM FEDERAL REQUIREMENTS

SANTA FE COUNTY'S OIL DEVELOPMENT ZONING ORDINANCE

Well Records and Maintenance Guidelines

How To Write A Listing Policy For A Species At Risk Act

CITY OF POMPANO BEACH Broward County, Florida

COMBINED GENERAL LIABILITY POLICY PROPOSAL FORM

CDPHE. The Colorado Department of Public Health and Environment, the State agency responsible for hazardous waste site compliance and oversight.

ONTARIO'S DRINKING WATER QUALITY MANAGEMENT STANDARD

Transcription:

Guide to the Remediation Report & Fee Submission Form May 1, 2012

TABLE OF CONTENTS 1 DEFINITIONS... 1 2 INTRODUCTION... 3 3 BACKGROUND... 3 3.1 EXISTING POLICY/GUIDELINES FRAMEWORK... 3 Domestic Fuel Oil Spill Policy... 3 Guidelines for the Management of Contaminated Sites... 4 Atlantic RBCA (Risk Based Corrective Action)... 4 Canadian Environmental Quality Guidelines (CCME)... 4 3.2 EXISTING FEE FRAMEWORK... 4 4 LEGISLATIVE AUTHORITY... 5 5 OVERVIEW... 6 6 SUBMISSION PROCEDURE... 7 7 FORM COMPLETION... 8 7.1 REMEDIATION REPORT SUBMISSION AND FEE DETERMINATION FORM... 8 1. Source Property Owner(s):... 8 2. Reason for Submission:... 8 3. Source Property Details:... 8 4. Site Conditions:... 9 5. Contaminant Information:... 9 6. Risk Screening... 10 7. Pathway Evaluation... 10 8. Adjacent Third-Party Impacted or Potentially Impacted Property Description(s):... 10 9. Fee Determination... 10 10. Summary Statement... 10 8 CHECKLIST COMPLETION... 11 8.1 CHECKLIST 1...12 8.2 CHECKLIST 2...12 8.3 CHECKLIST 3...12 V. 1.0 Final May 1, 2012 i

List of Attachments to this Guide: Remediation Report Submission and Fee Determination Form Checklist 1- Guidelines for the Management of Contaminated Sites Submission Checklist Checklist 2- Spill Remediation Submission Checklist Checklist 3- Domestic Fuel Oil Spill Policy Submission Checklist V. 1.0 Final May 1, 2012 ii

1 DEFINITIONS Remediation Reports Remediation reports are written submissions to Nova Scotia Environment that describe all of the remedial activities on and off a site, including reports that document risk assessment, site management or site remediation of residual contamination when the expected outcome is formal acceptance by the Department. Contaminants of Concern Contaminants of concern are grouped to make it easier to determine the appropriate administrative fee. Fees apply for single or multiple contaminant(s) of concern when the remediation report addresses site management/remediation in one of the following groups: A. inorganics B. volatile petroleum hydrocarbons and BTEX (ie. gasoline impacts) C. light extractable petroleum hydrocarbons (ie. fuel/diesel #2 impacts) D. heavy extractable petroleum hydrocarbons or PAHs (ie. lube oil impacts) E. phenolic substances F. chlorinated hydrocarbons G. halogenated methanes H. phthalate esters I. pesticides J. radioactive substances K. biological substances Third-Party Considerations Third-party considerations apply when the property of a person, (including persons, corporations, governments) other than the source property (where the contamination originated) has been affected by contaminants from the source site. Land Use Restrictions Land use restrictions occur when contaminated sites are managed by limiting activities or future development on the site or for more sensitive receptors. Land use restrictions can be synonymous with institutional controls. Examples include capped or encapsulated contaminants left in place, restrictions on gardening, or for toddler play areas. Water Use Restrictions Water use restrictions may apply in cases where risk based approaches are used on sites involving potable or non potable water that involve groundwater plume delineation and modelling to predict limited contaminant impact zones but involve exclusion of areas for water well withdrawal. For example, a site may have an upgradient well from the zone of contamination and direction of groundwater flow. However, the placement of wells in the centre of the plume to be used for potable water withdrawal may not be an acceptable option. Note: Water use restrictions may not be applied to potable off-site properties without a third party agreement in accordance with the standards, policies and guidelines of Nova Scotia Environment. V. 1.0 Final May 1, 2012 1/14

Engineering Controls Engineering controls include, but are not limited to, vapour extraction systems, water pumping systems, engineered caps and containment systems. Engineering controls attempt to control exposure pathways and may require maintenance or upkeep in order to validate their use. Ecological Considerations Ecological considerations involve sites that fail the ecological screening criteria in Atlantic RBCA, or where ecological impacts may, or have occurred. V. 1.0 Final May 1, 2012 2/14

GUIDE TO THE REMEDIATION REPORT AND FEE SUBMISSION FORM AND CHECKLISTS 2 INTRODUCTION The Department has revised the Remediation Report Submission and Fee Determination Form to support regulatory processing of remediation report submissions. This Guide has been developed to provide instruction on completing the form and applicable checklist based on the type of report being submitted. The Fee form and checklists are contained as appendices to this guide. The revised Remediation Report and Fee Submission Form is an administrative tool designed to present site details and conditions in a more streamlined format. Included with the form are checklists that identify the minimum reporting requirements outlined in existing Departmental guidelines and policies. The Fee form and checklists do not impose any additional requirements than those already in place. The overall goal of the form and checklists are to standardize the report submissions in such a manner that the Department can provide more timely response to stakeholders. 3 BACKGROUND 3.1 Existing Policy/Guidelines Framework Domestic Fuel Oil Spill Policy Since 2002, Nova Scotia Environment (NSE) has been using the Domestic Fuel Oil Spill Policy (DFOSP) as a regulatory framework to address domestic fuel oil spills. The objective of the policy is to provide clarification on the minimum requirements for the assessment, remediation and reporting of domestic fuel oil spills in Nova Scotia. This policy also establishes minimum eligibility requirements for both Certified Cleanup Contractors and Site Professionals. The remedial criteria specified in the policy were derived using risk based corrective action (RBCA) to assess potential effects on human health caused by petroleum hydrocarbon spills and leaks. The use of the Tier I Look Up tables and Tier II risk assessments for domestic fuel oil spills will not be accepted unless full environmental site assessments are performed on the properties. Site assessments must be performed by a Site Professional. Minimum criteria for environmental site assessments are provided in the Atlantic RBCA User Guidance for Petroleum Impacted Sites in Atlantic Canada, Version 2.0. (DFOSP 2005, Section 6). Successful implementation of the policy results in a Record of Site Condition (ROSC) for the property with recognition from NSE. The ROSC only applies to the location of the spill and does not address the condition of the entire property. V. 1.0 Final May 1, 2012 3/14

Guidelines for the Management of Contaminated Sites The Guidelines describe the process to be followed by owners and government in Nova Scotia to manage (i.e. to identify, assess, remediate or otherwise act at) contaminated sites. In general, the Guidelines identify the objectives of the process at each step, the required actions and available alternatives. The Guidelines also outline the responsibilities of the site owner/operator, the regulator and the site professional. The overall purpose of the Guidelines is to allow site owners to assume responsibility to the maximum extent possible, for appropriate and cost-effective management of contaminated sites, while ensuring that a consistent approach is used for all sites and that the public interest is protected. A component of this process is to complete one or more phases of Environmental Site Assessment according to published Canadian Standard Association (CSA) standards. The end result will provide the property owner with a Certificate of Compliance (COC), completed and signed by the Site Professional, with recognition from NSE. Atlantic RBCA (Risk Based Corrective Action) On October 26, 2000 the Department of Environment and Labour endorsed the use of Atlantic Risk Based Corrective Action (RBCA) for the management of petroleum hydrocarbon contaminated sites in Nova Scotia. Since that time, owners and professionals have utilized the RBCA toolkit to assess and manage sites. Work in this area continues and the toolkit has evolved. In late 2003, version 2.1 of RBCA was released for use in the Atlantic Provinces. RBCA establishes generic Tier I risk-based clean-up criteria for petroleum hydrocarbon impacted residential or commercial properties. It also allows the Site Professional to establish site specific criteria based on a Tier II Risk Assessment when site conditions differ from the default parameters. In some cases a Tier III approach may be warranted. The use of a Tier II or III approach for third party affected properties will be subject to approval of the third party property owner. Canadian Environmental Quality Guidelines These guidelines, developed by the Canadian Council of Ministers of the Environment (CCME), are nationally approved, science-based indicators of environmental quality for water, soil, sediment and tissue. They are recommended numerical or narrative limits for a variety of substances and environmental quality parameters, which, if exceeded, may impair the health of Canadian ecosystems. The Department supports the use of the policies and guidelines described above. Any parameters without Canadian generic criteria (i.e. CCME criteria) must be researched and results presented to the Department for review. 3.2 Existing Fee Framework Nova Scotia Environment recovers part of the cost associated with the administration of contaminated site Remediation Reports submitted to the Department. Fees are dependent on the type of Remediation Report submitted. Descriptions of the type of Remediation Reports and V. 1.0 Final May 1, 2012 4/14

submission fees can be found in the Environment Act and Regulations Fees Regulations or the revised Remediation Report Submission & Fee Determination Form. Remediation Reports are written submissions to the Department that describe remedial activities on and off a site, including reports that document risk assessment, site management or site remediation. The fees apply to Remediation Reports submitted to the Department pursuant to the following programs when the expected outcome is formal acknowledgment by the Department: The Guidelines for the Management of Contaminated Sites; The Domestic Fuel Oil Spill Policy; Remediation Reports completed using Atlantic RBCA, Canada Wide Standards, CCME Environmental Quality Guidelines; Remediation Reports submitted as required under Ministerial Orders; and, Environmental emergency remediation clean-ups. Fees do not apply to the following; Remediation Forms or Records of Site Condition submitted by Certified Clean-up Contractors for domestic oil spills; Environmental site assessment reports provided to the Department; Remedial action plans provided to the Department; Pollution incident reports of spills or release of substances; and Soil and water analytical results provided to the Department. The Fee Determination section of the revised Remediation Report Submission and Fee Determination Form itemizes the fees associated with each type of report being submitted. For instructions on how to complete Section 8 of the form please refer to Section 7 of this document. Reports shall be submitted to the applicable Regional or District office of the Department with the applicable fee payment enclosed, made payable to the Minister of Finance. Reports will not be accepted without full payment of the applicable fee. Incomplete or draft remediation reports will be rejected and full submission fees will apply upon re-submission. 4 LEGISLATIVE AUTHORITY The Environment Act, S. 8(2)(b), states that: The Minister, for the purposes of the administration and enforcement of the Act, and after engaging in such public review as the Minister considers appropriate, shall establish and administer policies, programs, standards, guidelines, objectives, codes of practice, directives and approval processes pertaining to the protection and stewardship of the environment. V. 1.0 Final May 1, 2012 5/14

Furthermore, the Environment Act, S. 71(a- c), states that: Any person responsible for the release of a substance under this Part shall, at that person s own cost, and as soon as that person knows or ought to have known of the release of a substance into the environment that has caused, is causing or may cause an adverse effect, shall: (a) (b) (c) take all reasonable measures to prevent, reduce and remedy the adverse effect of the substance, and remove or otherwise dispose of the substance in such a manner as to minimize adverse effects take any other measures required by an inspector or an administrator, and, rehabilitate the environment to a standard prescribed or adopted by the Department and furthermore, the Environment Act, S. 73(b-c) also states that: The Minister may prescribe the concentration, amount, level and rate, including the maximum concentration, amount, level and rate of a substance that may be released into the environment, and determine the manner in which a report of a release of a substance is to be made, and the contents of the report. 5 OVERVIEW Nova Scotia Environment has revised the Remediation Report and Fee Determination Form to include a summary of site conditions and the remediation work that was undertaken in an effort to expedite the administration of these reports. Additionally, three checklists have been prepared to accompany the form listing the minimum reporting requirements for each type of remediation report being submitted. The three checklists are as follows: Checklist 1: Guidelines for the Management of Contaminated Sites Submission Checklist Checklist 2: Spill Remediation Submission Checklist Checklist 3: Domestic Fuel Oil Spill Policy Submission Checklist With the exception of Checklist 2, the reporting requirements are simply a reiteration of those described in the existing policies and guidelines. Checklist 2 identifies the Departments minimum reporting requirements for spill remediation where a Certificate of Compliance is not being sought and the Domestic Fuel Oil Spill Policy does not apply. V. 1.0 Final May 1, 2012 6/14

6 SUBMISSION PROCEDURE The following procedure is to be used for the submission of remediation reports by site professionals and persons responsible. STEP 1: Complete the Remediation Report Submission and Fee Determination Form where closure documentation is being submitted. STEP 2: Complete the appropriate checklist presented below where closure documentation is being submitted: Checklist 1: Guidelines for the Management of Contaminated Sites Submission Checklist Checklist 2: Spill Remediation Submission Checklist Checklist 3: Domestic Fuel Oil Spill Policy Submission Checklist STEP 3: Sign and date both the form(s) and the appropriate checklist. Original copies are to be provided to the Department. In all instances where a Site Professional has overseen the work, both the Remediation Report Submission and Fee Determination Form and applicable checklist must be signed by the Site Professional. Only in cases where a Site Professional was not involved in the work (i.e. small spill response Checklist 2) will the signature of an Authorized Site Representative be acceptable on the Remediation Report Submission and Fee Determination Form. STEP 4: Attach these documents to the front of your reports or include them with a covering letter. STEP 5: Submit the information to the applicable Regional or District office of the Department with the applicable Fee payment enclosed, made payable to the Minister of Finance. The form(s) and appropriate checklist must be completed in full and be included with your report submission. As of May 1 2012, remediation reports submitted without these documents will be considered incomplete and will be rejected. Similarly, if sections of the form and/or checklist are not completed, the submission will be considered incomplete and will be rejected. V. 1.0 Final May 1, 2012 7/14

7 FORM COMPLETION 7.1 Remediation Report Submission and Fee Determination Form The report submission must include a copy of the completed Remediation Report Submission and Fee Determination Form (Refer to Appendix 1). The following provides a description of the information to be included in each section of the form. 1. Source Property Owner(s): Name/Company: Include the full first and last name of the owner(s) of the source property as depicted on the Service Nova Scotia Property Online website 1. If the property owner is a business, please include the full business name. Contact: Include the name of the most appropriate contact for the property or business (i.e. the property owner(s) or the Recognized Agent identified on the Access Nova Scotia Registry of Joint Stocks website 2 ). Phone: Include the most appropriate contact telephone number for the contact whether it is a home number, work number or mobile phone. Mailing Address: Use the mailing address shown on the Property Online website. For businesses, use the mailing address shown for the Recognized Agent as per the Registry of Joint Stocks website. 2. Reason for Submission: Select whether the submission is for closure using the Guidelines for the Management of Contaminated Sites, for a single Spill Remediation project, or for closure using the Domestic Fuel Oil Spill Policy. Also, select whether the Certificate of Compliance or the Record of Site Condition has been included with the submission. Please note, for the Department to acknowledge the work conducted by the Site Professional, the COC or ROSC must be included. Select the type of incident that occurred resulting in the submission. Check all that apply. 3. Source Property Details: Identify the Property Identification Number (PID) and civic address for the source property as depicted on the Property Online website. 1 http://www.gov.ns.ca/snsmr/property/default.asp?mn=282.46.1064 2 http://www.gov.ns.ca/snsmr/access/business/registry-joint-stock-companies/default.asp V. 1.0 Final May 1, 2012 8/14

Include the GPS coordinates for the property, if available. Select the appropriate land use(s) for the source property. 4. Site Conditions: This section of the form is designed to provide basic information about site conditions related to drinking water, where the contamination was present on site, and the sensitivity of the site overall. Please note: "A source water protection area is the area of a surface water watershed that contributes all the water used in a drinking water supply. Source water protection areas are also delineated for groundwater drinking water supplies. In Nova Scotia, all municipal drinking water supplies are required to have plans to protect these areas that contribute to drinking water protection - source water protection plans. Source water protection plans may involve provincial regulations ( http://novascotia.ca/nse/water/protectedwaterarea.asp ), municipal by-laws or other management options to reduce risks to the source water. A list of municipal drinking water supplies is found at: http://novascotia.ca/nse/water/publicwater.municipal.supply.asp If you are planning any activities in these areas, contact the appropriate municipal water utility." 5. Contaminant information: This section is intended to identify the chemicals of concern (CoC s) at the site. Note that VOC excludes BTEX compounds which are normally reported as part of a modified total petroleum hydrocarbon analysis. 6. Risk Screening: This section is designed to identify sites that typically require an evaluation of risk and/or ongoing site management. 7. Pathway Evaluation: Four pathways are listed, below each of which are specific concerns that must be evaluated. Check off all operable pathways that apply and check that the concerns identified below each applicable pathway have been evaluated. V. 1.0 Final May 1, 2012 9/14

8. Adjacent Third-Party Impacted or Potentially Impacted Property Description(s): Identify whether the impacts extended beyond the property boundaries onto adjacent properties (third party impacts). If not, select NO and continue to Section 9. If there is more than one impacted third-party, submit an additional Part 8 of the form for each affected property. If there are third party impacts, indicate whether impacts have been remediated to Tier I RBSLs or not. If impacts remain on third party properties above Tier I RBSLs, indicate whether or not written agreement(s) have been signed by the third parties and provided to the Department. Indicate whether the property is considered potable or non-potable and its current land use. Identify the type of water supply and the distance between the source of the spill and the water supply. Indicate whether there are buildings on the property and, if so, the type(s) of foundations that exist. Check all that apply. If there are no buildings on the property select the Not Applicable N/A option. 9. Fee Determination Applicable Fees for remediation reports are outlined in Section 9 of the Remediation Report Submission and Fee Determination Form. Please note: Fees are current as of May 1, 2012. Check the Environment Act and Regulations Fees Regulations for any fee changes. 10. Summary Statement Indicate the dates during which the assessment and remedial activities took place. Select the remedial criteria that were applied by selecting option A, B or C. To be more specific, within each option check/specify the type of criteria used. If different remedial criteria were applied to one or more third party properties, submit an additional Part 9 of the form for each affected property. If there are on-going management requirements, select option C, indicate the type of type of criteria applied and list the on-going management requirements. The options A through C are listed below: V. 1.0 Final May 1, 2012 10/14

A) Applicable generic remediation criteria (Check: DFSOP, Tier I RBSL, CCME, other (specify: ) have been met and no further action is required. B) Applicable risk based remediation criteria (Check: Tier II PSSL, Tier II SSTL, Soil Vapour Assessment, Tier III, other (specify: ) have been met and no further action is required. C) Select the applicable criteria (generic remediation or risk based) and describe the type of on-going management that is required (i.e. engineering controls, ongoing monitoring, or administrative controls on land use). Signature Once the form has been completed in full, the Site Professional or Authorized Site Representative who completed or supervised the work must print their name as well as sign and date the form where indicated. The Site Professional/Authorized Site Representative certifies that to the best of their knowledge and belief, the information provided in the form and supporting documentation is true and accurate and complies with the relevant provisions of the Environment Act, Guidelines for the Management of Contaminated Sites and/or Domestic Fuel Oil Spill Policy. In all instances where a Site Professional has overseen the work, both the Remediation Report Submission and Fee Determination Form, and applicable checklist must be signed by the Site Professional. Only in cases where a Site Professional was not involved in the work (i.e. small spill response Checklist 2) will the signature of an Authorized Site Representative be acceptable on the Remediation Report Submission and Fee Determination Form. 8 CHECKLIST COMPLETION As previously mentioned, there are three checklists to accompany the submission form. The checklists represent the minimum reporting requirements for each type of remediation report being submitted. The three checklists are as follows: Checklist 1: Guidelines for the Management of Contaminated Sites Submission Checklist Checklist 2: Spill Remediation Submission Checklist Checklist 3: Domestic Fuel Oil Spill Policy Submission Checklist With the exception of Checklist 2, the reporting requirements are a reiteration of those described in the existing policies and guidelines. Checklist 2 identifies the Departments minimum reporting requirements for spill remediation where a Certificate of Compliance is not being sought and the Domestic Fuel Oil Spill Policy does not apply however; the person responsible is seeking closure on the incident. V. 1.0 Final May 1, 2012 11/14

The Site Professional is expected to confirm that they have addressed each item on the list in their report. The Site Professional indicates this by checking YES or NO in the appropriate box and listing the report and page number where supporting documentation can be found. The three checklists are attached as appendices to this document. It is imperative that a YES or NO box is checked and a reference document and page number provided for each item on the applicable checklist. An incomplete checklist will be rejected by the Department. 8.1 Checklist 1 Checklist 1 summarizes the reporting requirements for all sites that were remediated using the Guidelines for the Management of Contaminated Sites (March 27, 1996) and a Certificate of Compliance or Record of Site Condition is being submitted to the Department for acknowledgment. This list includes items that are required as per the Atlantic Risk Based Corrective Action User Guidance document, updated March 2007. Please use Checklist 3 for all sites where the Domestic Fuel Oil Spill Policy generic criteria were applied. 8.2 Checklist 2 Checklist 2 summarizes the reporting requirements for spill remediation where a Certificate of Compliance is not being sought and the Domestic Fuel Oil Spill Policy does not apply however; the person responsible is seeking closure on the incident. Section 3.3.9 of the Atlantic Risk Based Corrective Action User Guidance document, updated March 2007 refers to this type of remediation as Limited Remedial Action. In order to obtain acknowledgment from the Department the items listed on Checklist 2 must be included within the report. The reporting requirements in the checklist are separated into two categories based on the likelihood of adverse effects. If the spill is determined to have no likelihood of adverse effect, the extent of site assessment will be lower than those that are considered to have a higher environmental risk. If adverse effect have or could have occurred, the site assessment and reporting requirements become more comprehensive. Examples of spills that are considered to have possible adverse effects include spills on sites with potable water, spills with ecological receptors within 150m, spills where free product is present, or spills where there are known or possible impacts to buildings or infrastructure. Sites with a potential for adverse effects are considered to have increased environmental risk and/or risk to public health therefore; additional assessment and reporting requirements are necessary. 8.3 Checklist 3 Checklist 3 summarizes the reporting requirements for sites following the Domestic Fuel Oil Spill Policy (December 1, 2005) generic criteria and a Record of Site Condition is being V. 1.0 Final May 1, 2012 12/14

submitted to the Department for acknowledgement. For sites where the Tier I Look Up tables and Tier II risk assessments for domestic fuel oil spills are used, complete Checklist 1 (Guidelines for the Management of Contaminated Sites Submission Checklist). the use of the Tier I Look Up tables and Tier II risk assessments for domestic fuel oil spills will not be accepted unless full environmental site assessments are performed on the properties. Site assessments must be performed by a Site Professional. Minimum criteria for environmental site assessments are provided in the Atlantic RBCA User Guidance For Petroleum Impacted Sites in Atlantic Canada, Version 2.0. (DFOSP 2005, Section 6). It is important to note that the Domestic Fuel Oil Policy states that monitoring wells are required on all sites involving potable groundwater. In rare cases deviation from this requirement may be considered however; justification for not completing a hydrogeological assessment should be thorough and must include an assessment of the preferential pathways and contaminant concentrations. The checklist should be selected based on the remedial criteria applied to the source property. Should the spill extend off-site onto third parties and the remedial criteria be different than that applied to the source property, please complete a second checklist for the third party. If the criterion is the same for both the source property and third party impacts, only one checklist is required. For spills where a Certified Clean-up Contractor is retained to complete the spill clean-up, the Certified Clean-up Contractor should continue to use the Remediation Form for Domestic Fuel Oil Spill located in Appendix C of the Domestic Fuel Oil Spill Policy, 2005. Clean-up Contractors are not required to complete the Submission Form or any of the Checklists however; as per the policy, they are limited to spills that meet the following criteria: The contamination has not migrated under the building. The spill does not extend beyond the boundaries of the property The groundwater is non-potable. There is no obvious indication of the presence of free product on the groundwater. Signature Once the checklist has been completed in full, the Site Professional who completed or supervised the work must print their name as well as sign and date the checklist where indicated. The signature is the Site Professionals certification that the information in the form is accurate, true, represents factual information, and complies with the requirements of the Department. V. 1.0 Final May 1, 2012 13/14

Attachments