NCD980602163_19830527_Warren County PCB Landfill_SERB C_Application for Cooperative Agreement Between US-EPA and the State of NC-OCR

STAT~ OP NORTH CAROLINA
OFFICE OF THE GOVERNOR
RALEIGH 27611
.JAMES 8. HUNT, .JR.
GOVERNOR
May 27, 1983
Dear Mr. Jeter:
Attached is North Carolina's application for a cooperative agreement requesting
Comprehensive Environmental Response Compensation and Liability Act/Resource
Conservation and Recovery Act 3012 assistance to do preliminary assessments and
site inspections of EPA's Emergency and Remedial Response Inventory System List
of North Carolina sites.
This application has been prepared by the North Carolina Department of Human
Resources. I have designated the Department of Human Resources as the lead
agency for this project and Mr. 0. W. Strickland, Head of the Solid and Hazardous
Waste Management Program as the project officer.
North Carolina is ready to provide the assurances necessary to comply with
CERCLA and RCRA 3012 requirements. We are very much interested in the survey
-and evaluation of the old site identified by the ERRIS Program. The study
would determine what hazardous wastes exist and what follow-up remedial action is
needed.
We appreciate the excellent cooperation your staff has provided in the past
and look forward to a continuing close working relationship as the project
develops.
My warmest personal regards.
Mr. Char les Jeter
Reg i on al Administrator
Environ mental Protection Agency
345 Courtland Street, N.W.
Atlanta, Georgia 30308
Attachment
APPLICATION FOR
Cooperative Agreement Between
The U.S. Environmental Protection Agency
And The State Of North Carolina
· For
· A Grant To Do Preliminary Assessments &
Site Inspections of EPA's ERRIS (Emergency
and Remedial Response Inventory System)
List of Sites In North Carolina
Using CERCLA Funds to Implement
Section 3012 of RCRA
APPLICATION FOR
Cooperative Agreement Between
The U. S. Environmental Protection Agency
And the State Of North Carolina
For
A Grant To Do Preliminary Assessments &
Site Inspections of EPA's ERRIS (Emergency
and Remedial Response Inventory System)
List of Sites In North Carolina
Using CERCLA Funds to Implement
Section 3012 of RCRA
JUNE, 1983
N. C. DEPARTMENT OF HUMAN RESOURCES
Dr. Sarah T. Morrow
DIVISION OF HEALTH SERVICES
Dr. Ron Levine
ENVIRONMENTAL HEALTH SECTION
James B. Stamey
SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH
O. W. Strickland, Head
Part I.
Part II.
Part III.
Table of Contents
GENERAL ADMINISTRATIVE I NFORMATION
A. Purpose of Project
B. Lead Agency
C. Summary of Budget Information
D. State Assurances
E. Contract Services
F. Reporting
G. EPA Forms & Project Approval
Information
STATEMENT OF WORK PROGRAM
A. Background Information
B. Work Plan
-PA -Preliminary Assessment Needed
-SI -Preliminary Assessment Completed
Site Inspection Needed
C. Work Program Schedule
D. Program Rationale
E. Project Safety Plan
F. Quality Assurance (QA) Project Plan
G. Lab Work
APPENDIX
Preliminary Assessment Form 2070-12
Site Inspection Form 2070-13
Indirect Cost Memo
PAGE
2
3
4
5
9
12
13
30
32
38
44
46
48
50
52
53
54
PART I
GENERAL ADMINISTRATIVE INFORMATION
1
A. Purpose of Project
The state of North Carolina proposes to do preliminary assessments and
site inspections for North Carolina sites listed in the EPA's ERRIS List. The
results of this study will be used to determine the need for EPA FIT team
follow-up inspections, and required cleanup or remedial action. Outputs will
be submitted to EPA for inclusion into EPA's ERRIS system.
Coordination of 3012 activities with RCRA interim status inspections will
be insured as the same state agency is responsible for both activities.
2
B. Lead Agency
North Carolina has requested that the lead project role should be taken by
the State.
By the transmittal letter Governor James B. Hunt has designated the N. C.
Department of Human Resources as lead agency for this project and has granted
the agency authority to sign a Cooperative Agreement with EPA.
The project officer for N. C. is:
vO.t/1:tJ;~
0. W. Strickland,' Head
Solid & Hazardous Waste Management Branch
N. C. Department of Human Resources
In accordance with PL 96-510 and by Executive order No. 12316, dated
August 16, 1981, the project officer for the U. S. Environmental Agency is:
3
c. Summary of Budget Information
The costs for the project is estimated to be:
ADMIN. COSTS PREL. ASSESSMENTS SITE I NSPECTIONS TOTAL
Personnel $ 143,307 $ 47,769 $ 191,076
Fringe Benefits 28,299 9,432 37,731
Travel 18,750 6,250 25,000
Equipment 13,575 4,525 18,100
Supplies 12,000 4,000 16,000
Contractual 37,777 12,592 50,369
Other (data process-
ing, phone, postage,
admin. costs) 17,749 3,251 21,000
Total Direct Charges $ 271,457 $ 87,819 359,276
Indirect (25.5%) 36,543 12,181 48,724
TOTALS $ 308,000 $ 100,000 $ 408,000
Percentage of Total . 75% 25 % 100%
4
D. State Assurance
In the transmittal letter Governor James B. Hunt, Jr. has expressed his
interest to enter into a cooperative agreement with EPA for a grant to do
preliminary assessments and site inspections of EPA's ERRIS List of sites in
North Carolina. The state agrees to comply with all of the assurances listed
in this section of the application.
5
Form ,:..nproved
0!.18 No. 758-AO! iO
PART V
A£SURANCES
The Aoplicant hereby agrees and certifies that he will comply with the regt.:lations. policies, guidelines. and rec;uirements
including 0MB Circular No. A-95 .. .;-102 and FMC 74-4 . as they relate to the application. acceptance and use of Federal
tunas for this Federally assisted project. Also the Applicant agrees and certifies with respect to the grant that:
1. It possesses legal authority to apply for the grant: that
a resolution. motion or similar action has been duly
adopted or passed as an ottici2: act of the applicant"s
governing body, authorizing tht: filing of the applica-
tion. including all understandings and assu,ances
contained therein. and directing and authorizing the
person id&ntified as the otticial representative of the
applicant to act in connection with the 2;::p !ication and
to provide such additional information as may be
required.
2. It will comply with Title VI of the Civil Rights Act of 1964
/P L. 88-352) and in accordance with Title VI of that
Act. no person in the United States shall. on the ground
of race. color. _or nation origin. be excluded from
participation in. be denied t:-ie beneiits of. or be
otherwise subjected to discrimination under any pro-
gram or activity for which the applicant receives
Federal financial assistance and will immediately take
any measures necessary to ettectuate this agreement.
3. It WIii comply with Title VI of the Civil Rights Act of 1964
/42 USC 2000d) prohibiting employment ciscrimina-
tion where ( 1) the primary source of a g,ant is to
provide employment or (2) discriminatory employment
practices will result in unequal treatment of persons
who are or should be benefiting from the grant-aided
activity.
4. It will comply with requirements of the provisions of the
Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (P.L. 91-646) which provides
for fair and equitable treatment of persons displaced
as a result of Federal and federally assisted programs.
5. It will comply with the provisions of the Hatch Act which
limit the political activity of employees.
6. It will comply with the minimum wage and maximum
hours provisions of the Federal Fair Labor Standards
Act. as they aoply to employees of institutions of higher
ecucation. hospitals. other non-profit organizations.
ar;C to en1ployees of State and local governments who
are not employed in integral operations in areas of
tradi:1onal governmental functions.
7 It wil! es:ablish safeguards to proh1b1t employees irom
using their positions for a purpose that is or gives the
appearance of being motivated by a desire for private
gain for themselves or others. particularly those with
whom they have family . business. or other ties.
EPA Form 5700-33 (Rev. 10-79)
6 - 7
8. It will give the grantor agency and the Comptroller
General through any authorized representative the
access to and the right to examine all records. books.
papers. or documents related to the grant.
9. It will comply with all requirements imposed by the
Federal grantor agency concerning special require-
ments of !aw. program requirements. and other 2.d-
ministrative requirements.
10. It will insure that the facilities under its ownership.
lease or supervision which shall be utilized in the
accomplishment of the proiect are not listed on the
Environmental Protection Agency"s (EPA) list of Violat-
ing Facilities and that it wi ll r,otify the Federal granter
agency of the receipt of any communication from the
Director of the EPA Office of Federal Activities indicat-
ing that a facility to be used in the project is under
consideration tor listing by the EPA.
11 . It will comply with the ilood insurance purchase
requirements of Section 102(a) of the Fiood Disaster
Protectior. Act of 1973. Puolic Law 93-234. 87 Stat.
975. approved December 31. 1976. Section 102(a)
requires. on and after March 2, 1975. the purchase of
flood insurance in communities where such insurance
is available as a condition for the receipt of any Federal
financial assistance for construction or acquisition
purposes for use in any area that has been identified
by the Secretary of the Department of Housing and
Urban Development as an area having special flood
hazards.
. 12. It will comply with all applicable requirements of
Section 13 of the Clean 'Nater Act Amendments of
1972 (P.L. 92-500), if the grant is awarded under any
grant authority of that Act. which provides that no
person in the United States shall. on the ground of sex
be excluded from participation in. be denied the
benefits ot. or be otherwise subject to discrimination
under any program or activity under the said Clean
Water Act Amendments for which the applicant re-
ceives financial assistance and wil! take all necessary
measures to effectuate this agreement.
"u.s. =~•won 1'!11,m,,c omct 197' -620-22e/4054
PAGE1:20F12
The State will comply with 40 CFR Part 33, Procurement under Assistance
Agreements.
The State will comply with the Federal Grant and Cooperative Agreement Act
and its implementing regulation, EPA General Grant Regulations and Procedures,
40 CFR Part 30.
The State agrees to the following conditions for the letter of credit
method of financing:
(a) cash drawdown will occur only when needed for its disbursements,
(b) provide timely reporting of cash disbursements and balances as
required by the EPA letter of credit users manual, and
(c) impose the same standards of timing and reporting on secondary
recipients, if any.
The cost principles of the Office of Management and Budget circular A-87.
The maximum daily rate for consultant services shall not exceed the daily rate
for a GS-18, which is currently $245.36.
The State will assist EPA in making its records and employees available if
EPA litigates against responsible parties associated with sites where work is
done under this cooperative agreement.
8
E. Contract Services
The state has signed the Procurement System Certification Form which
follows.
North Carolina will contract some of the work to North Carolina and EPA
contractors. We will also employ an environmental engineer II, an
environmental chemist, a geologist II, and a secretary.
9
SECTION I• INSTRUCTIONS
This form must ac::ompany each application for EPA As:sinzmce. If the applicant has certified its prOOJrement synem to EPA within the
cast 'tWO vears and the svsi:em has not been subs'"..antially revised, complete Part A in Section 11, then sign and date the form. If the syrum
has not ~n certified within the pan rwo years, complete Part B, then sign and date the form.
SECTION II• CERTIFICATION
A. I affirm t!\l't tne applic.ant has within me put two ymrs certified its proc:..,nrmem rynem Tt) EPA as complying with 40
CFR Part 3.'.l and tl'\at the rym~m has not b~ sub=ntially revis.ed. Tht cu, of the applic.ant's la-ten certification is:
I MONTH/YEAR
B. ~ i.;:on my .,..!union of the applican_t'1_~ rvn-m. I, IIS allthoriud ~tltiw o1 ~ht applic.ant: (Ched: om, of th• fol/c,wing:J
[2Q 1. Ci;STI FY tlvt the applicant's 1)1"0CUl"ffl'lent rynam will men all of the reQui~nu ot 40 CFR f'art 33 including the .ached
at..00&/"U befo~ undertak.ing any proeurement action with EPA auisuncs.
P1aaa.e fumiih c:iations to applic:aola Sate or local ort1inancas and 1"19Ul11tions..
0 2. 00 NOT CERTIFY, The applicam will follow tht requiremfflts of 40 CFR Part 33 and allow EPA pruward revi~ of
pn:,posed proc:vrement actions tl'lllt will ust EPA ~imn~.---:·.·_:--. ---· . --..
TIPEC NAME 6' TITl.E OF CHIEF EXECUTIVE OFFICER SIGNATURE CATE
Sarap T. Morrow, M.D., M.P.H.· /
~=~~~;!:;'.t nf Hnm~n Re s n urces (~ ~~✓ ~ • 7"/ZZ-/83
SECTION Ill -SUMMARY OF REQUffiEMENTS
Below is a· list of S1Jbparu and sections of 40 CFR Part 33 which contain some but not all · of the requirements for procurements under
E?A auis---..ance. The purpose of this list is to assist in the evaluation of the applicant's procurement system to determine if it is certifiable
and meetS the basic procurement principles as artiCJ!ated in Part 33. As such, this list highlights certain aspects of the regulations which
the rec;pient shall use in its evaluation process and is not intended to replace a detailed reading of Part 33. ·
PART:?:3
REFERENCE
33.210
33.220
33.230
. .. ...
SECTION TITLE ANO SUMMARY
SUBAGREEMENT ADMINISTRATION· System must ensure that contractors perform in accordance with all
applicable contract requirements.
LIMITATION ON RECJPIENT AWARD· System must consider listed factors in determining contractor responsi•
bility.
COMPET!TION • System must have procurement transaction procedures that provide maximum open and free
competition.
EPA Form 5700-48 (Rft. 9-82) ( CONTINUED O.N REVEf:tSE) 10
33.235 EBQE !IS· System procedures must allow only fair and reasonable profitS to contrac:tors.
:!l3.240 SMA!.,L MINORITY. WQMEN'S, AND !.AflQB SURPl.US AREA 6US!~ESSES · Synem must provide for u~ of'these
businesses as specified in this section.
33.250 DOCUMENTATION • Syrum must require that procurement records and files for purchases over $10,000 includ·e items
specified in this section.
33.255 SPECjFlCATIONS • Synem procedures for establishing specifications for produ~..s or ~rvices to be procured must meet
requirements of this section.
33.265 BONDING AND INSURANCE• System procedures and requirements related to bonding and insurance must met!t
requirements of this ~c:tion.
.
33.270 CODE OF CONDUCT• S~..em must have a written code or standards of conduct meeting the requirements of this
section.
33.275 FEDERAL COST PRINCIPLES• System procsdures for determining allowable costs must comply with the cost
principles specified in this section.
33.285 PROHIBITED TYPES OF CONTRACTS· System may not allow use of cost-plus-percentage-of cost (multiplier) or
percentage-of-construction~st types of contracts.
--. 33.290 COST ANO PR ICE CONSIDERATIONS• System procedures must allow for consideration of cost and price as required
in this section.
33.295 SU3..!-.G R::MENTS AV/ARDED SY A CONTRACTOR · System must provide that the contractor's subagreemer.ts
·c::mply witn provisions specified in this sact1on.
·-
33.305-310 S~AAL,~ ?URCHASi • System smal! ~urchase procedures must meet requir ements of t~ese sac,:ior.s: . !
33.405-435 FORMAL ADVERTISING• System procedures related to formal advertising, including those for bidding documenu
and contract awards, must meet the requirements of these sections.·
33.505-535 COMPETITIVE NEGOTIATION• System procedures for compe~itive negotiation must meet the requirements o.!_!~.:.5e
sections.
:n.605 NONCOMPETITIVE NEGOTIATION• System procedures for noncompetitive negotiation must meei: the requirements
of this section.
SUBPARTS SYSTEM MUSTCOMPL Y W1TH REQUIREMENTS IN THESE SUBPARTS: C-G .
C CLEAN WATER. ACT REQUIREMENTS• Subpart applies to procurement under auimnce agreements for construction
of treatment work.s under the Clean Water Act.
D REQUIREMENTS FOR INSTfTUTIONS OF HIGHER EDUCATION AND OTHER NONPROFIT ORGANIZATIONS·
Subpart describes the proa.irement requirements for nonprofit organizatiolll. .
REQUIREMENTS FOR RECIPIENTS OF REMEDIAL ACTION COOPERATIVE AGREEMENTS UNDER THE
E COMPREH!:NSIVE ENVIRONMENT Ab, RESPONSE, COMPENSATION AND LIABl!.ITY ACT OF 1980 • Subpart
describes the additional procurement requirements for recipients of these cooperative agreemenu.
... ...
F SUBAGREEMENT PROVISIONS• Subagreements for procurement under EPA Assistance must contain the approptiate
clauses, or their equivalent. specified in this subpart.
G PBQ!Efil:S. Subpart applies to all applicants for EPA assistance except for nonprofit organizations.
EPA f,om, 5700-48 (Rw. 9-&2.) ~ 1,1
F. Reporting
Monthly Reports to be submitted to EPA:
Preliminary assessments will be reported on EPA Preliminary Assessment
Form (2070-12)
Site inspection will be reported on EPA Site Inspection Form (2070-13)
The above forms are found in the appendix.
Quarterly Reports to be submitted to EPA:
Summary progress reports that will identify the:
Number of Sites
Name of Sites
Funds Expended
Contract Status
Problems or Delays
END · OF YEAR REPORT
PRELIMINARY
ASSESSMENTS
COMPLETED
Summary of above information.
12
SITE
INSPECTIONS
COMPLETED
G. EPA Forms & Project Approval Information
The North Carolina State Clearinghouse is located in the Department of
Administration. Project reviews are conducted by the Clearinghouse in
accordance with 0MB Circular A-95. The Clearinghouse review follows:
13
BD-7
RESPONSE TO APPLICANT
North Carolina A-95 Clearinghouse
Office of State Budget and Management
116 West Jones Strce~ Raleigh, NC 27611
[phone]
Notification of your intent to apply for assistance has been received. A copy of this notification has been forwarded to the appropriate
state agencies and Regional Clearinghouse(s) for their review. ..
State Clearinghouse Number: Project Title/County: Grant to do assessments/ins pe{~ ti on s of ~ticipated Co~lete Date:
-~·,
83-C-0000-1028 old hazardous waste sites(ERRIS sites )/Statewide :05/27/83
Funds Request-=d 1estimate): Funding Agftncy:
t-z 6 :J a.. a.. ~
s; 11.n,q nnn
Emil Breckling
N.C. Dept. of Human Resources
Solid & Haz. Waste Mgmt. Brancy
P.O. Box 2091
Ralei
14
·I •
~-... ,_
.f.
~-,; ..
~ J ":-r ...
. .
(if checked)
Please forward the attached questionnaire
to the Department of Cultural Resources.
Failure to do so will cause undue delay in
processing your request.
:! ~
~ i
I
g
N
~ ~ ... ~
I
~
§
i
~
8 g
FEDERAL ASSISTANCE 2. APPLI• •· NUM8ER 3. STAT[ a. NU)'BER
Al"PLICA-CANT'S TION 1, TYPE 0 PREAPPLICATION APPL!, b. DAT£ IDENTI• b. DATE Yoor mo7\th dai, OF
19
1~3 mo-nth <U\W ACTION IBl APPLICATION CATION 03 18 FIER ASSIGNED 19 81 04 16
(Mark a;,-0 l'lOTIFICATION OF INTENT (Opt.) L04U bo01>NU 02) 0 REPORT Of FEDDW. ACTION Bla"Jc
4. LEGAL APPLICANT /RECIPIENT 5. FEDERAL EMPLOYER IDENTIFICATION NO.
1. Ai,pll .. nl N.ITII :N . C. De pt . o f Huma n Re sour ce s
b. Or11nl1.1tlot1 Unit :D iv i sion of Hea l t h Se r v i c e s 6. N/A I I I °' I I I I c. St..-..t/P.O, llCll :So l i d & Ha z . Wa s te Mgt . Br anch PRO, a. HUM3ER
d. City : P. 0 . Box 2091 •· C.-inty :Wake GRAM b. TITLE RCRA 3012 -
:Rale igh, NC I , ZIP Cod1:2 7 60 2 ( Frcn,, ST ATE INVENTORY OF UNCON I. Stall F~ TROLLED
h. Contact Ptnen (Na,,.. C..uu,,g) HAZAR DOUS WASTE SITES
~ t,wpl\,,,.. No.) : Em i 1 Breck ling 73 3-21 78
7. TITLE AND DESCRIPTION OF APPLICANT'S PROJECT 8, TYPE OF APPLICANT/RECl?IE1H
1,-Stalt H-Commun;ty Action ,J,a1ncy
Co operative B-lntentalt I-Hi&htr Educational Institution a greement to do asse s smen t s / C-Subatat, J-Indian Trio.
District 1\--0thtr (S:,.df',1): inspec t ions of o ld ha zardou s wa ste sites D-County E-City
(ERR IS s i t es ) F-~l District
G-S~l1I PurpoM E,.,..,. ap,,,-opr,4t, Z..ttn-[A] See Remarks, Sec tion IV D trlct
9. TYPE OF ASSISTANCE
!,-Buie Gnnt D-ln,i,ranet
B-Supplemental Grant E---Othtr £.,.t,rr appro-[E
C-lo.n priat, l•ttn·(,) E
10, AREA OF PROJECT IMPACT (Ncnnu of citi .. , co,,.ntiu, 11. ESTIMATED NUM-12. TYPE OF APPLICATION
Sta tu, .te.) BER OF PERSONS 1,-N"' C-R.-,isioo E-->.u1mentatlon BENEFITING B-R .,,,., a I C-Continu,tion
Ent•r o;p;,rop-riat• 1,ttn-~
13. PROPOSED FUNDING 14, CONGRESSIONAL DISTRICTS OF: 15, TYPE OF CHANGE (For JJc °" H•)
408,000 APPLICANT b. PROJECT A-lncre>M Doll1ra F-Othor (Sp•cif'II):
1 . FI DEi\Al s .00 .. E>-0.cr,.u Dolin,
1s t C-lncrast Duration N/A b. APPLICAl<T .00 Sta tewi de D-0Krus. Our1tio,o
16. PROJECT START 17. PROJECT E--Cancellotion c. STATE .00 DATE l'eor -i. d.a',1 DURATION E"tcr a;ppro-I I I I d. LOCAi .00 19 83 06 0 1 17 M o,,tl\, pri.it. lettn-(,) :
•· 0,HfR .00 18. ESTII.AATED DATE TO Year month CO)/ 19. EXISTING FEDERAL IDENTIFICATION NUMBER
408 ,000 BE SUBMITTED TO
f. TOTAi. $ .00 FEDERAL AGENCY ► 19 83 03 3 1
20. FEDERAL AGENCY TO RECEIVE REQUEST (Nam,, Cit11, SCAU, ZIP ct><L.) 21, REMARKS ADDED
Envi r onmental PrQtec ~i QD Aopn c.v RPo irrn TV Ar 1 ;an r ;::i r..A 1n1nA KJ Vea O No
22. ,: To tho b .. t of my knowleda• and belle!, b. II roquirod by 0MB Ci1"ular A-95 this 1pplit.al1on wu ,ubmll!td, pur,uanl to in, Nor,-Re1po,u•
deta In lhia prNppllt.alion/ap~llcatlon art alruct,ona thanin, to &ppropriatt clNrlnahouses 1nd 111 , ... l)C>nus ano a\tachf<I: apo,u• attac>.«I
THE trua and corr.ct, th• docum•nl hu """
APPLICANT duly authorlzoJ by th• ro-,,ln1 body of D D CERTIFIES th• •wliunt and tt.. appllunt will comply (l) N • C. Clear i nghouse ·-
THAT ► with lht atu<:hed -.irintM If tht Ullat-(2) D □ 1nce Is app,,,.,ed. (J) D D
23. a. TYPED NAME AND TITI.£ b. SIGNATURE c. DATE SIGNED
CE::!TIFYING Sarah T. Morrow , M.D., M.P.H. i---:;· Y""r ffl07ltA d.>11
REPRE• Sec retary ~...L,.A , ~ h ~-19 ?3 'l-2 S£NTATIV£ Deoartment of Human Resources --)&,-""--2-...
:Z... AGE.NCY NAME
26. ORGANIZATIONAL
29, ADDRESS
31, ACTION TAKEN
Q 1. AWARDED
D b. REJECTED
0 c. RITURHED FOR
A.'11 L '10 ME.NT
D d. DEFIARED
D •. WITHDRAWN
3&
1"£DtRAL AGENCY
A-98 ACTION
42+-101
l 25. APPLICA· Y.or mo"tl\ d.oy TION
RECEIVED 19
UNIT 27. ADMINISTRATIVE OFFICE 28, FECERAL APPLICATION
IDENTIFICATION
30. FEDERAL GRANT
IDENTIFICATION
32. FUNDING y..,.r monV. ,ky 3-4. y...,,. ... .,,.u. d.o1,1
a. FEDERAL $ .00 33. ACTION DATE ► 19 STARTING DATE 19
b. APPLICANT .00 35. CONTACT FDR ADDITIONAL INFORMA· 3 5, l'•ar ,nCH'\t~ do11 TION (Nam• and lel•pAo,,f nwmb..,.) ENDING c. STATE .00 DATE 19
d. LDCI.L .00 37. REMARKS ADDEO
1. OTHER .00 ,. TOTAL $ .00 O Yes QNo
•· In ukln1 abo,,o tctlon, 1ny commonb r.eol,-.d fn:,m clNrio,hou,ts war• co,,. b. FEDE RAL AGENCY 1,-95 OFFICIAL alcltrod. If a1w,cy , .. ponw la duo ur,dor provl1lo<11 of Part l, 0MB Ci1"ular },.95, lt ha bMn ot 11 l>oln1 mado.
15
(Nam• and t.1,pl\o,w 1\0,)
STANO .... RO fORa.l 42-4 PAOl 1 (10--73) Pr-nH<I -ir, GS.,;,,· F ~ 1,1"-il.,_-,.4 c;,,.,..:..,, 71,...,
... ·-·-· ·--·-· ----------
SECTION IV-REMARKS (Please reference the proper item number from Sections I,
II, or III if applicable)
Reference Section I, Description
Congress appropriated funds under the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980 (CERCLA) to implement
Section 3012 of the Resource Conservation and Recovery Act (RCRA). Objectives
for the North Carolina project are:
To do preliminary assessments, and site inspections for North Carolina
ERRIS sites, to document what problems exist, and what remedial or follow-up
action is required. The state study will attempt to do responsible party
searches and discovery work on any additional sites that should be added to
the ERRIS List. Those that are problem sites will be referred to EPA FIT
teams for follow-up inspections and actions.
16
PART II
Form Approved
0MB No. 158-R0110
PROJECT APPROVAL INFORMATION
Item 1.
Does th is assistance request State, local, regional, or other priority
rating?
_____ Yes __ X_No
Item 2.
Does this assistance request require State, or local advisory, educa-
tional or health clearances?
X _____ Yes ____ No
Item 3.
Does this assistance request require clearinghouse review in accord-
ance with 0MB Circular A-95?
_X __ Yes ____ No
Item 4.
Does this a·ssistance request require State, local, regional or other
planning approval?
____ Yes _ X __ No
Item 5.
Is the proposed project covered by an approved comprehensive
plan?
____ Yes X ____ No
Item 6.
Will the assistance requested serve a Federal installation?
____ Yes _ X __ No
Item 7.
Will the assistance requested be on Federal land or installation?
_____ Yes _ ..a.X=--_No
Item 8.
Will the assistance requested have an impact or effect on the
environment?
Item 9.
X _____ Yes ____ No
Has the project for which assistance is requested caused, since
January 1, 1971 , or will it cause, the displacement of any individual,
family, business, or farm?
____ Yes _ X __ No
ite,,, 10.
Is there other related assistance on this project previous, pending,
or anticipated?
_____ Yes ___ X~-No
Item 11.
Is project in a Designated Flood Hazard Area?
__x_ Yes ---NO
EPA Form 5700-33 (Rev. 10-79/
17
N/A Name of Governing Body _________________ _
Priority Rating _____________________ _
Name of Agency or
Board _______________________ _
(Attach Documentation) N/A
(Attach Comments)
Name of Approving Agency ___ .;.N;.,/ccA:..:... __________ _
Date _________________________ _
Check one: State 0
Local 0
Regional 0
Location of Plan ________ N_/_A __________ _
Name of Federal lnstallation ___ Nc.;/_A ___________ _
Federal Population benefiting from Project _________ _
Name of Federal Installation ___ N_,_/...:A;.c... __________ _
Location of Federal Land _________________ _
Percent of Project ____________________ _
See instructions for additional information toiJe provided.
Number of:
I ndivid uals _________ ..:.N.:.J...:..A,__ _________ _
Families _______________________ _
Businesses _______________________ _
Farms ________________________ _
See instructions for additional information to be provided.
N/A
PAGES OF 12
GRANT NUM.S~R _____________ _
PLEASE COHPLE'TE J>.ND R..-c--:,JR.~ T i:U.3 PAGE W!Tii YOUR APP..,!Cl\TIO'l
LIST KEY P!:RS02'."NEL WEO 'A.~ TO RECEIVE A. COPY OF THE GR.ANT AW ARD
1. AGE NCY DIR...,'PCTQR (Person ~ho normally sig ns applications; Co:::..~i ss i oner, Chairm3n,
Director of Health, ~~yor, Secreta:y, County ~~nager, etc).
Name and Title of Person Dr. Sarah T. Morrow, Secretary for NC Dept. of Human Resources
Name and 1>,.ddress of Grantee NC Department of Human Resources
325 North Salisbury Street
Albemarle Building
Raleigh, NC 27611
Telephone (Include Area Code)[phone]
2. f?QGRJ:~ ~@!Ch~ ?IR;;CTOR (~dministrative Assist.ant, Chief, Secretary-Treasurer,
Administrator, Manager, etc.).
Name and Title of Person: 0. W. Strickland, Head of Solid & Hazardous Waste Management
Branch
Name and Address of Grantee: NC Department of Human Resources
Division of Health Services
-Box 2091
Raleigh, NC 27602
Telephones (Include ~ea Code) [phone]
3 . IINANCE DIRECTOR (Penon Yho submit.a payment requests and the Financial Status
Report,.~d vho could answer questions on th~se reports).
Name and Title of Persons Johnny Poplin. Budget Officer
Na.me and 1'ddreas of Grantees :•oiv1s1on of Health Services
· PO -Box 2091
:Raleigh , NC 27602
Telephone 1 (Include Ar•a Code ) ( 919) 733-7 470
4. Any other •nY• people should be listed on the back of this form
_·_:_-_ ·-·. -~18 -------··•----·--· -
. ' / ,.
STATE OF NORTH CAROUNA
Division of State Bud,:zet and Mana,:zement
REQUEST TO APPLY FOR FEDERAL AND OTHER ~ON-STATE FliNDS
I. De;:artment
DEPARTMENT OF HUMAN RESOURCES
2. Division
DIVISION OF HEALTH SERVICES
7. Fund ing Agency I Code
I 0. Federal Program Title
Comprehensive Envi r. Response, Compensation,
~ Liability Act of 1980 (CERCLA)
1"4. Projea Description
CERCLA Grant to carry out requ irements of
Section 3012 of RCRA
IS. Project DirectorD. W. Strick 1 and, Head
Solid & Hazardous Waste Mgt . Branch
ni"ic::ir,n ,-.,f HP.:,lrh ~Prvir i=>c::
Title Phone
Branch Head (919 ) 733-2178
16. Fundini
Current Year I New Funds Requested --------1
Federal
Oeash }
State or
Din Kind
Local
Other
TOTAL
17. Grant Start Date
I ! 04-15-83
19. Project Sw-t Date
04-15-83 .
21. Fo< l"\Jlti-Year Projects
NONE
. !his is year 1 of 2 years
i YES
I $ 408,000
I
I
I
I
I
I
I
I
I
I
I
: $ 408,000
I 8. Grant End Date
09-31-84
20. Project End Date
09-31-84
22. WII I Future State Funds be
ReQUested O YES [i] NO
:23. Date of Future Suite Fundini/Corrments
NIA
·3.0ate-P~ed
'. :03-1·8~83
5. Request Number
~-~•tez,ti0!J :~il~i;' ,; .. , .,, :{ 6. Budiet Code/Subhead
.. 03-25-83 .--24021 /18303
I I. Federal Catalog Number
N/A
13. Type Grant/ funding
fxlProjecr nFormJla
2◄. &..td:et Line I~
Salaries
Frin:e Benefits
Servi~ ( T.rave 1) ·
(Sopp 1 i.es )
Equipment (.Va it ) .
(Furniture )
De.ta Proc:essln1 ' Phone · .. • ..
9_:,A-95 Ou.rinpcc~ ~ . .. .
12. Type Appl icati on
[x)New 0Rene.....al D 1-'odified
. .. •. ....
. .
,t,'.
" ... ..
·., ·•
PROJECT LIF.E:
·· 27 mos.•¥=·_·_.
$.191,076
37,731
25 ,000
16,000
18 , 100
C 21 ,000
Postage. .. .· .. •..... r ..... , ....... • ;·,·,<: ••
. . Tr~~~~~es . _; .... _ .... ;~ ; · .. ·~-:·<. ,,~•• ,.
!. . ~_.: ..
.. -
•,• ' .. >'.-:'~. : .. ::t:.:: :..:··.. ·. :
. Transfers-Local
Indirect Cost (25 ~ Yi'o )
AIIO:he:r (Contracts ) ·
·TOTAL
25. New Positions Required
Number I Classific:2tion
SEE ATTACHMENT
,.•. ·•.·.
· 48,724 ,.··::.-
., so, 369 · · " -----------·
I Sal...-.,
FOR DEPARTMENTAL USE: (obtain only necessary si"1atures. additional signature space on reverse..)
Division/Ai:ency Budget Officer
Division/A1ency Plannin& Office
Division/Ai:ency Director
FOR DIVISION OF STATE BUDGET USE:
0 Request Approved as Sut:mitted
0 Request Approved as Revised (see rernarits on reverse)
D Request Returned 'widlou~ Aalori (see remarks on reverse)
date
date
date
19
I
Plan/Grants Coordinator date
I
Approved, --,----t t1eaa date
I
Approved, Chief Fiscal Officer date
slinature
title date
27 MOS.
PAY FOURTH 1984 1985 PROJECT
POSITION GRADE STEP QUARTER 1st YR. 2nd YR TOTAL
Envir. Eng. II 75 5th $ 6,801 $ 27,204 $ 28,500 $ 62,505
Geologist II 71 5th 5,622 22,488 23,556 51,666
Envir. Chemical
Consultant 71 5th 5,622 22,488 23,566 51,666
Clerk-Typist III 56 4th 2,751 11,004 11,484 25,239
$ 20, 796 $ 83,184 $ 87,096 $ 191,076
Fringe Benefits (Ret. 9,92 + Social 3,519 14,075 14,737 32,331
Security 7.00) 16.92%
Insurance $600 600 2,400 2,400 5,400
$ 24,915 $ 99,659 $104,233 $ 228,807
20
N ---~IIUV r■ul AIIALY A""" CIIEHI 11111 I cc Lury fol< '.lnG.,N I Z/\ TI 'lN/\L f,11.,n T SOI.ID It llflZ/\R!JOllS \H\\ 1[ 11/\N/\S(ll[IIT B~/\Nf.11 RR/INCi! 11[/ID H/1111\GUIENT -O.\J. Strlcl<.lnnd ✓~l-0 ~\Tt!:S DJ\/ \{l. I r"'C:a n: S[(n[T/IRY IV ------r::: ·:::-------/ITTORN(Y I l :";hc]hy Strr,henson --I t~6(?.I< "l"fll61' .or I [ ATTORIIF.Y ] Glenn Ounn J [NFORUl1[Nf ---, Tom tlr..-ch~m I CURK TYrlST111 I ----------------I Sr.crHory Ill-~ 1.yncllr C.nhorn I ~E()I..OGl~ a: ,C~-C~Svt.r. ln.!:~R~~~~:•"-· l llr.11 Sr.lier• f.lndy Trlnk• H.CIINICl\l surr<11n I M/11.YSIS ~ rl.lltllllN:; ~ Hlltll\r.r_M(Nl __ , __ I llazHdous 1hsle I rrn11 ll s I Solid 1i;st~~ r r;IVIR. rt~ [NVIR. (NG. Ill HI\' IR . ( NG . JI f.mil n,-r.rhlirtJ: -------------~ Wll J ln'II Mr.yer Gor,.lnn 1,:,yl.on I ' I ' I ___ I CIIEH. CONSIJL T. [IIVIR. [NG.11 G£0lOGIST __ J ~=~~ ··-=---I ' ' \Jtlll"m hlge T.-,m Knrnosld t;3ry nahb Wflnf l'rocr:~~ln ' ~•r1t!1 Al~ton -----011r11 rnor.r.ssrnr. ' X" Ith Ln\l!llon l"'nt fl f.nt.ry ' .J~rry Rh<>de8 Rogr..-Co.-tP: orrn1110R COOll O IN /I IOR ' ' Ochhlc Horg~n nr~nd:t Mnnnr I I ~ r~mi: ,~-~/\~T rr. IP ~1 -r.oOROINl\lOR. . K~tt,rrlnr C. Nt~l' \__;__'---'---C -. _J r1uo Or[R/\T IONS I W(S T[RN /IR(/1 £/\Sl(llN 11~1 StJr[~VISOR Sllrl RV I <;QI .luli:,n Fo,;cuc Tr.rr.v 11nvc --I North J · l Cr.nlr,,I llrglonaf [a~l.r.rn R~qlonal ,--··--··------• Olflcl' Office I I I I ~I I I I DS OS DS 05 OS OS ttS OS OS OS Robert Rich•rd ,I. w. 5 t.cp!,~n Jt')!=:Cf'h Ray ni I l_v rrrrl L1rry nl r.h.,rd Arrle O<>hy '-1nore rhl hh~ llr::1kin~ Chord, ~orri5 Wnod f'rrr_v r.,y lll'Vl~r.n: ltllRCll I• l?OJ V t.JEvJ PliS Ill•"-''>
Synopsis:
1. Problems grant addresses -
Evaluation of old hazardous waste sites to determine and document
follow-up action needed.
2. What will grant accomplish -
Determine action required and establish next step needed to do remedial
action or eliminate site from ERRIS List.
This grant will serve the entire State population.
See front of this form for budget.
3. How will the project be implemented?
The State will employ one environmental engineer II, a chemist, a
geologist II, and a secretary. State and EPA contractors will also do
some of the work.
4. Accomplishments in previous year -
New Project.
5. State match -
None.
I
22
GRANT NUMBER ________ _
OBJECT COST CATEGORIES
Numbe r in
Specified Man
1. PERSONNEL: JOB TITLE Job Class Years Federal Total
Environmental Ern;dneer II 1 ? ? r; $ 62,505 Geologist II 1 2 .?5 51,666
Environmental Chemical Consultant 1 2.?c; 51,666
Clerk-Typist III 1 ? ? c; 25,239
i
i
I
'
THREE PERSONNEL TOTALS 9.00 $191,076 $191,076
2. FRINGE BENEFITS:(Rpt _q Q?~• ss 7.nn. Tn~ iAnnONE TOTAL $ 17 711 17 71 1
3. TRAVEL: ONE TOTAL $ 25 onn 25 ('\()('\
23
G::-a nt Number
OBJECT COST CATEGORIF.S
Fe de ral Total
4. EQUIPMENT:
A. List each item costing $2500 or more (Attach list if necessary )
l,; TnN Vt.N
SUB-TOTAL $ 9 ')()()
B. Lis t items costing less than $2500. You ma y list t he items by
groups, as appropriate . (Attach list if nece ssary)
F 11 rni t-11ro f ,..,,... .f r..l .,.-T"\ .OT.T ~ r. -l ~ 5,600 Other ' ' 3 ,000
SUB-TOTAL $ 8 finn
COMBINED EQUIPMENT TOTAL $ 18,100 p 18, 100
5. SUPPLIES: (List by groups, as appropriate. Attach list if
necessary)
Data Process im~ Suoolies 1,000 Printing 3,000
Other 12,000
SUPPLIES TOTA L $16,000 $16 ,000
24
Grant Number
OBJECT COST CATEGORIES
Federal Total
6. CONTRACTURAL: (List the contract and the cost for each)
(Ind i vidua 1 contracts wi 11 be submitted later )
COMBINED CONTRACTURAL TOTAL $ 50,369 $ 50,36'
7. ASSIGNEES:
ONE ASSIGNEE TOTAL $ -$ -
8. OTHER: (Explain by major categories items not in above)
Phone t 6,000 Postage 2,000
Svsterns Analvst 6,000 Office Renovation 3,000
MIS 4,000
-
ONE TOTAL FOR OTHER S 21 ,000 $ 21, ooc
9. TOTAL DIRECT CHARGES: t359, 276 $359,27
(25.5% salaries )
10. INDIRECT COSTS: (Please attach a copy of vour indirect cost rate) b 48,724 $ 48 7 2l;
11. GRAND TOTAL: t408,000 1$408,0G
25
"-> a-PART Ill-BUDGET INFORMATION SECTION A-BUDGET SUMMARY ESTIMATED UNOBLIGATED FUNDS GRANT PROGRAM, FEDERAL FUNCTION OR ACTIVITY CATALOG NO. FEDERAL NON-FEDERAL FEDERAL (a) (b) (cl (di (el 1. RCRA 3012 $ $ $ 408 000 2. 3. 4. 5. TOTALS $ $ $ 408,000 SECTION B-SCHEDULE A BUDGET CATEGORIES GRANT PROGRAM, FUNCTION OR ACTIVITY 6. Object Class Categories (11 Preliminary (2) Site (3) Ac:c:o c: c:mon t-c: Tnc:nor t-i ')TIC:: a. Personnel $ 143 307 $ 47 769 $ b. Fringe Benefits 28 299 9 432 c. Travel 18,750 6,250 d. Equipment 13 575 4 525 e. Supplies 1 ? nno 4 nno f. Contractual 37 777 12 59? g. Construction ----h. Other (phone, postage, & 1ata r1.r-.c.e,.. .... .;_~ ,...;.._ . ..:.,... ..... 17 749 1 ?51 i. Total Direct Charges ? 1 7 6. ', 7 P.7 P.lQ J i. Indirect Charges lf-i ',l,1 1 ? 1 81 k. TOTALS $308,000 $ 100,000 $ --7. Program Income $ $ $ EPA Form 5700-33 (Rev. 10-79) rorm Approved 0MB No. 158-ROT 10 NEW OR REVISED BUDGET NON-FEDERAL TOTAL (fl (g) $ $ 408.000 $ $ 408,000 TOTAL (4) (51 $ $ lQl n7Fi 37 731 25,000 1 P. 1 nn 1r.. nnn so 1r..o --?1 nnn ':IC O ')7?.. I, P. 7? /, $ $ 408,000 $ $ PAGE 7 OF 12
SECTION B -SCHEDULE B -BUDGET CATEGORIES
6. Program Elements FUNDING
(1) FEDERAL (2) NON-FEDERAL
a. $ $
PrPliminrtrv A~sPssments 308.000
b.
~it"P In~nections 100,000
c.
d.
e.
f.
g.
h.
i. Total Program Elements $ $ 408,000 ---
j. STATE TOTAL $ $
EPA Form 570~33 (Rev. 10-79) 27
(3)
$
$
$
Form Approved
0MB No 158-ROT 10
(4)
MAN-
TOTAL YEARS
308,000 6
100,000 3
408,000 9
PAGE e OF 12
N (X) .. SECTION C-NON-FEDERAL RESOURCES (al GRANT PROGRAM (b) APPLICANT (C) STATE (d) OTHER SOURCES 8. $ $ $ 9. 10. 11. 12. TOTALS $ $ $ SECTION D-FORECASTED CASH NEEDS TOTAL FOR 27 mos. 9Months 6 Months 6 Months 13. Federal $ 408,000 $ 136,002 $ 90,666 $ 90 666 14. Non-Federal 15. TOTALS $ 408.000 $ 136,002 $ 90,666 $ 90 666 SECTION E-BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (a) GRANT PROGRAM (b) FIRST (c) SECOND (d) THIRD 16. $ $ $ 17. 18. 19. 20. TOTALS $ $ $ SECTION F-OTHER BUDGET INFORMATION (Attach Additional Sheets If Necessarv) 21. Direct Charges: 22. Indirect Charges: 25.5% (See Neg. Memo in Appendix) 23. Remarks: EPA Form 5700.JJ (Rev. 10-79) PART IV-PROGRAM NARRATIVE (Attach per instruction) Form Approved 0MB No. 158-ROf 10 (e) TOTALS $ $ 6._Mon ths $ 90 666 $ 90 666 ·-(e) FOURTH $ $ PAGE 9 OF 12
PART II
STATEMENT OF WORK PROGRAM
29
A. Background Information
North Carolina has six hundred and twenty-eight (628) identified hazardous
materials uncontrolled/abandoned sites which may pose a threat to human health
and the environment. This inventory is currently contained in EPA's Emergency
and Remedial Response Inventory System [ERRIS]. ERRIS data was dr.awn from the
Hazardous Waste Data Management System, Site Tracking System, The CERCLA
Section 103(c) Site Notification Program, and other State and EPA inventories.
During 1981-1982, investigations were initiated to determine potential
human health and environmental risks that may be posed by these sites. One
hundred and sixty-two (162) notifications were studied using State and EPA
personnel with the following results:
126 Notifications
36 Notifications
36 Notifications
480 Notifications
-Preliminary Assessment Completed
No Additional Action Needed
-Preliminary Assessment Completed
Site Inspection Needed
-Site Inspection Completed
Site Inspection Follow-Up Needed
By EPA FIT Contractors
-Preliminary Assessment Needed
(14 Sites added to ERRIS List by State)
30
B. WORK PLAN
31
B. Work Plan
The work plan for this project proposes that two activities would be
undertaken for North Carolina ERRIS sites. For those sites that a preliminary
assessment has not been completed this would be done. For the remaining sites
that need site inspection, these would be completed within budget limitations ..
Training to be completed by staff -University of Arkansas Course, PA
Training, and Chain Of Custody Training.
The ERRIS List is divided into five categories. Each site will be
classified and put into one of five categories that identifies required
follow-up work.
1) PAC Preliminary assessments completed no additional action needed
by 3012
2) PA Preliminary assessment needed
3) SI Preliminary assessment completed site inspection needed
4) SIC Site inspection completed, no additional action needed
by 3012
5) SIF Site inspection completed, site inspection follow-up needed
by EPA FIT Team
Preliminary site assessment and site inspection work has been completed on
some sites. Some do not need additional follow-up work as no hazards were
found.,
The work activity would determine those sites that are hazards so that
resources can be used more effectively to do follow-up work.
Some responsible party searches would be completed as preliminary
assessments and site inspections are made. The following kinds of sources
.would be used for information on owners, operators, and generators:
Federal, State, and local government files, reports, and court cases;
Title records;
Owner/operator interviews;
Labels, logos on readily visible drums, or other containers;
Owner/operator records.
If new sites are discovered they would be added to the work program, the
following information should be developed:
Site name;
Street location;
City;
County;
Zip Code.
32
PRELIMINARY ASSESSMENT WORK
Preliminary assessment work to be completed for each site would consist of:
Determine if a site needs further action. If warranted, further action
could include a site inspection. Preliminary assessment would characterize in
a preliminary fashion the hazardous substances present, potential pollutant,
dispersal pathways, the population and resources which might be affected,
facility management practices, and the potential responsible parties.
A preliminary assessment is a quick, low cost review of readily accessible
data to determine if the site potentially poses a problem and, if so, what
type of follow-up work should be undertaken.
The assessments would provide the following information:
1. Name, location, and ownership of the site;
2. Identification of other responsible parties;
3. Brief site description, including size and operations;
4. Type(s) of hazardous substances present and type(s) of containers;
5. Characteristics of the relevant hydrogeological and meteorological
factors;
6.
7.
8.
9.
Population density of surrounding area;
Location of other environmentally sensitive receptors (e.g., water
supplies, wildlife habitat); and
Conclusions and recommendations.
ERRIS Input
corrections to currect data
alias names
date of assessment completion
33
The following types of tasks would be completed in doing preliminary
assessments.
Interviews with Federal, State, and local government personnel, and
fire departments;
Review of Federal, State, and local government files, reports, and court
cases;
-Limited title searches;
Review of U. S. Geological Survey, Soil Conservation Service, State
Water Resource Office, or other comparable institutions with
geological, hydrological, and topographical data;
Review of State and local private and public well logs;
Review of Federal and local meteorological data;
-Review of land use data from local planning agencies;
Review of available aerial imagery;
-Review of flood insurance rate maps available through the U. S.
Department of Housing and Urban Development;
Off-site reconnaissance of site (windshield survey).
Site Inspection Work
· The site inspection work to be completed for each site identified would
consist of:
Define the extent of the problem at a site and provide a data base
sufficient to determine the next action (i.e., additional investigations,
emergency response, enforcement, and/or remedial response). A site inspection
would provide data adequate to apply to the [EPA -Hazard Ranking System] (HRS).
34
Initial enforcement measures would be supported with this data. Site
specific data on the hazardous substances present, pollutant dispersal
pathways, types of receptors, and site management practices would be
gathered. The scope of the inspection would vary depending upon the nature of
ex isting information on the site. In general, an initial site inspection
would not include a detailed hydrological assessment of the site.
A site inspection report should include the following items:
1. Name, ownership, and location of the site;
2. Identification of other potential responsible parties;
3. Sketch of the site and photographs;
4. Description of the type and history of the site;
5. Description of storage, treatment, and disposal operations;
6. Characteristics of hazardous substances present;
7. Amount of hazardous substances present;
8. Assessment of geological and hydrological situation;
9. Identification of sensitive receptors;
10; Data compilation and analysis;
11. Initial priority system scoring;
12. Conclusions and recommendations; and
13. ERRIS Input
-alias names
-activity start date
-activity completion date
-latitude
-longitude
35
The following types of tasks would be completed for each site identified.
collect/analyze soil and off-site samples;
collect/analyze ground water samples from existing wells;
collect/analyze samples or take readings of volatile organics in air;
collect/analyze samples from open drums or lagoons;
survey and document site, structures, topography, lagoons, drainage,
drums, bulk tanks, monitoring wells, roads, access, boundaries, etc.;
document location of homes, public buildings, natural areas, etc.;
scan site for underground tanks, drums with metal detectors;
collect samples using organic vapor analyzer, portable gas
chromatographs/mass spectrographs;
review of operator records.
36
C. WORK PROGRAM SCHEDULE
37
C. Work Program Schedule
The work program scheduled was developed with the goal that North Carolina
ERRIS sites that need to go through the preliminary assessment process will be
completed by September 30, 1985 within budget limitations. Those sites which
require follow-up inspection work would be referred to EPA FIT teams for
follow-up.
North Carolina has already identified one hundred and twenty-six sites
that require no additional action by the 3012 program.
All North Carolina ERRIS sites will be evaluated and put into one of the
following five categories. The work program shows work activities on category
numbers two and three.
1) PAC -Preliminary assessments completed no additional action needed
2) PA Preliminary assessment needed
3) SI Preliminary assessment completed site inspection needed
4) SIC Site inspection completed, no additional action needed
5) SIF Site inspection completed, site inspection follow-up needed
by EPA FIT Team
38
I.,) "' ACTIVITY PRELIMINARY ASSESSMENTS SITE INSPECTIONS -.._; N. C. ERRIS SITES PREL. ASSESSMENTS/SITE INSPECTIONS WORK PROGRAM & SCIIEOU l,E FY 1983 FY 1984 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter .July -Sept. Oct. -Dec. Jan. -Mar. April -June 60 60 60 5 5 ' ' 5 ---65 65 65 ' TOTAL 4th Quarter July -Sept. 60 240 5 20 --65 260
.i:--0 ACTIVITY PRELIMINARY ASSESSMENTS SITE INSPECTIONS ' N. C. ERRIS SITES PREL. ASSESSMENTS/SITE INSPtCTIONS WORK PROGRAM & SCHEDULE FY 1985 1st Quarter 2nd Quarter 3rd Quarter . Oct. -Dec • , Jan. -Mar . .. 60 60 60 5 5 .5 ---65 65 65 TOTAL 4th Quarter .July -Sept. 60 240 5 20 --65 260
N. C. ERRIS SITES
CATEGORIES LIST
CATEGORIES NO.
CO~U:LETED
1) PAC-PREL ASSZSSY.:.EKT COMPLETED 126
NO .A.DD ITIOl·:J.AJ... ACTION NEEDED
2) PA-?REL ASS ESS~fEKT NEEDED
3) SI-?REL ASSESSMENT COMPLETED
SITE rnsPECTION NEEDED
4) SIC-SI'IE Il\SPECTION COYJ..PLETED 0
NO P.DDITIOKAL ACTION NEEDED
5) SIT-SITE INS?ECTION COHPLETED
SITE INSPECTION FOLLOW UP
K:E:EDED BY EPA FIT TE.AMS
126
41
OF SITES
TO REF TOTAL CGST NO. COST
TO EPA NEED TO ?ER SCF.DL
COMPLE TE SITE IN
WORK
FLA.,
480 $642 480 S308,000
$2,500 100,000
36 40
36
36 516 520 $408,000
"' r,..) WORK PROGRAM SCIIEDULE 6CLIYIU'. Quarter (1983) Output Pct~ .Q_u :i rte r PA -(Preliminary Assessments) SI -(Site Inspections) 1st Quarter (1984) PA SI 2 n~ua rte r PA SI 3rd Quarter PA SI 4t~uarter PA SI 1st Quarter (1985) PA SI 2nd Quarter PA SI 3rd Quarter PA SI 4th Quarter PA SI 60 +5 65 60 +5 65 60 +5 65 60 +5 65 60 +5 65 60 +5 65 60 +5 65 60 +5 -65 Tn r90 t Comrlollon __12~_1_0 __ 9-31-83 9-31-8) 12-31-83 12-31-83 3-31-84 3-31-84 6-3 l-8L1 6-31-84 9-31-84 9-31-84 12-31-84 12-31-84 3-31-85 3-31-85 6-31-85 6-31-85 9-31-85 9-31-85 [Ultnatnd __!&_ll_ $642 per site $2,500 per site rori.onnol }&dLll!!llLf: 30 per site 83 per site AClllnl Comp lot Ion __ l!_.'!_1._o __
D. PROGRAM RATIONALE
43
D. Program Rationale
The list of ERRIS sites that we proposed to do preliminary assessments and
site inspections is included in the work plan. Based on four hundred and
eighty (480) sites that need preliminary assessments and thirty-six sites that
require site inspection, we estimate that North Carolina will need the
$408,000, see table below.
ESTIMATED TOTAL COST
Number Of Sites Estimated Cost
Work Per Site Work
Plan Total Cost Plan
Preliminary Assess. 480 480 $ 642 $308,000
Site Inspections 40 40 2,500 100,000
520 520 $408,000
North Carolina will coordinate its ERRIS site inspection and evaluation
program with EPA FIT resources by providing EPA with a list of sites that will
require follow-up inspections. These would be added to the ERRIS data base
for follow-up.
44
E. PROJECT SAFETY PLAN
45
E. Project Safety Plan
Safety plans for this project will be consistent with the requirements of
CERCLA 104(f), U. S. EPA's Occupational Health and Safety Manual as well as
other applicable U. S. EPA safety guidance. All safety plans will be prepared
prior to undertaking on-site inspections.
In awarding contracts to any person engaged in response actions funded by
this agreement, the state shall require compliance with Federal Health and
Safety Standards established under Section 30l(f) of Public Law 96-510 by
contractors and subcontractors as a condition of such contracts.
Consistent with Section lll(c)(6) of CERCLA, uses of the fund are subject
to such amounts as are provided in appropriation acts, the costs of a program
to protect the health and safety of employees involved in response to
hazardous substance releases. The program shall include, but not be limited
to, measures for identifying and assessing hazards to which persons engaged in
removal, remedy, or other responses to hazardous substances may be exposed,
methods to protect workers from such hazards, and necessary regulatory and
enforcement measures to assure adequate protection of such employees.
The project safety plan, was previously mailed. The site safety manual
includes a description of the four basic safety levels A-D and criteria for
their use, procedures for modification of safety plans, and a written
structure. The Branch will use EPA contractors to do level A and B type
inspections. The manual covers organization of the field investigation area,
organization for work, entry to the hazardous site, site safety procedures,
exit from the hazardous site, decontamination procedures, and closing the
personnel decontamination station.
46
F. PROJECT ASSURANCE (QA) PROJECT PLAN
47
F. Project Assurance (QA) Project Plan
The Quality Assurance Project Plan shall follow the guidelines in the
North Carolina Solid & Hazardous Waste Management Branch's Standard Operating
Procedures and Quality Assurance Manual (SOP Manual). The SOP Manual was
previously mailed to EPA.
A quality assurance project plan will be required for investigations
conducted under contract. The State of North Carolina would be responsible
for the quality assurance overview of any samples submitted to EPA National
contract Laboratories. ESD would provide technical assistance to state in
procedures to be utilized in overviewing contract laboratory data.
48
G. LAB WORK
49
G. Lab Work
All lab work to be completed by EPA's National Analytical Contract Program
for 3012 activities which are provided to the states at no cost. We will
access the contractor as indicated in the "User Guide To Contract Laboratory
Sample Analysis Program".
The State of North Carolina will be responsible for Q/A overview of any
sample data received from the EPA Contract Laboratory Program. The ESD will
provide technical assistance to the state in providing procedures for
overviewing the data.
50
APPENDIX
51
PRELIMINARY ASSESSMENT
FORMS (2070-12)
52
.
REGION S,T E NU M SER (lo b• ··-CEPA POTENTIAL HAZARDOUS WASTE SITE • iQned by Hq)
IDENTIFICATION AND PRELIMINARY ASSESSMENT
MOTE: This form is completed for each potential hazardous waste site to help set priorities for site in spection. T h e info rmation
• ubm.itted on this form is based on available records and may be updated on subsequent forms as a result of additional inquiries
sod 00-eite in9pectiona.
CEMERAL IMSTRUCTIOMS: Completa Section• I sod Ill throuih X aa completely aa possible before Section II (Preliminary
A saesci:nenl). F ile thia form ln the Re~onal Hazardous Wute Loi File and submit a c opy to: u.s. E nvironmental P rotection
Ai eocy; Site Tra ctinit System; Hu:ai-doua 'l'aate Enforcement Task Force (EN -335); 401 M St., SW; Washington, DC 20460.
t' l. SITE IDEMTIFICA TIOM -A, SITE NAME B. ST REE T1(or o ther Ident ifi er)
C. CITY D. STATE I E. ZIP CODE F . COUN T Y NAME
G. OWNER/OP.ERATOR (If known)
1. NAME 1 •· T E L EPHONE NUMBER
H, TYPE OF OWNERSHI P
0 1. FEDERAL LJ2. ST A T E 0 3. CO UN T Y =:)4 MUNIC'P AL ,--. s PRIVATE ~6 UNKN0W"J --
I. SITE DESC RIPTION
J. HOW IDEN TIFIED (I.e., citizen'~ complaints , OSHA citations, etc.) K. DATE i CENTIFI E D
(mo., ds y, & yr,)
•.
L . PRINCIPAL STATE CONTAC T
t . N.AME 1 •· T EL EPHON E NUMBER
ll.i PRELIMINARY ASSESSMENT (complete this section last)
A. APPARENT SER IO USNESS OF PROBLEM
LJ 1. HIGH 0 2. MEDIUM □3. LOW -NONE [Js. UN KNOWN L.J4
e. RECOMMENDATION
□ 1. NO ACTION NEEDED (no hazard) CJ 2. IMMEDI AT E SITE I NSPECTION NEEDED
a. TENTA T 'VE LY SCHEDULED FOR:
CJ l. SITE INSF>ECTION N f;_EOED
a . TENTATtVl:.L'r SCHEDULED FOl'I: . b . WIL.L B E l='ERF'ORMEC ev :
b. WILL BE l"El'll"O"MED BY : LJ 4. SITE INSPECTION NEEDED (low priority)
c. PREPARER INFORMATION
1. NAME 1 •· T ELEPH ON E NUMBER I 3. D A r E (mo,, day, & y r,)
III. SITE INFORMATION
A. SITE STATUS
~ 1. \ACTIVE (Tho .. lnduerrl•l or 0 2. INACTIVE (Thooe Q 3. O THER rspecr/y):
munJci~I •He• which are beln, u••d •1t•• which no /on,er receJve o ee •itee that include ~uch incident• like "midnlQht dumplnQ" where
/or •••t• tr••tm..,t, ator•I•-. or di apo••l .,,,, .. , ... ) no reQular or continuinQ use of the s ite fo r wa.,,e dlspoe•I ha• occurred.:
on• contlnu/n• bael•, •••n It :/ntr•-
quently.)
B. IS GENERATOR ON SITE?
Ot. NO 0 2. YES (•p•clfy Qeneretor'• fou,-diQi t SIC Code):
c. AREA OF SITE (In acre•) D. IF APPARENT SERIOUSNESS OF SI TE IS HIGH. SPECI F Y COORDINATES
t. LATITUDE (deQ.-mln,-eec,) 1 •· LONGITUDE (deQ,-mln,-aec,)
E. ARE THERE BUILDINGS ON THE SITE?
D 1. NO D :Z. YES (•p•cJfy):
T2070-2 (10-79)
Continued Fcom Front
IV. CHARACTERIZATION OF SITE ACTIVITY
lndica:e :he S1ajor site ac tivity(ies ) and details re lating to e ac h a c:1\':ty by marking 'X' in the appropriate boxes •
A, 7 RANSPORTER B. STORER C. TREATER
• X. ,__. D. OISPOSER
J, P ILE ,. LANP F"ILL
:"· SUh~A CE IMPOUN D"-tE N T
jJ. VOL U ME R E DUC T ION
!4 . TA N K, A B OY E GROUND '4. ~E CY CL ING /RECO V ERY ~-SURF="ACE IMPOUNDMENT
1~-T ANK , E E LOW GROUND
.. Q 7:.. .. £:~ (Spl!Ctfy): ,-...., ~6-CTH E '1 f spec,ty): ' t e , s :OLO G!C A L TREAT~~N T ;6 IN C 'N ER A T l ON
l7 · ..,.ASTE O I L.. R E PROCESSING ~ • :..J .. ~CE R G c;_ 0 UNO IN .J E. C T : 0 N
Is. SO L V EN T RECOVER Y
OT HER (spe c,/y ):
E. SP E c :;y DE TAILS O F SI TE ACTIVIT I ES AS NEEDED
V. WASTE RELATED 11-!FORMATION
A. WAS"'!"E T YP E
=-= 1 UNKNOWN _____J 2. L IQUID
S. WAST E C H "-RA CTERIST ICS
t ! ~ UNKNOWN uS TOXIC
;_j 2. CORROSIVE
1_j7 REAC T IV E
D 1 O. 0 TH ER (speci fy):
C, WASTE CATEGORIES
;:::]3. SO LID
w 3-IGN I TABLE
De INERT
0 4. SL UDGE
.--.__J 4 RADIO ACTIVE
i 9 FLAMMABLE
I 5. G AS
~5 HIGHL Y VOLATIL E
1. Are r ec ords of wastes availabl e? Specify items such as manifests, inventories, etc. below.
2. Estima te the arnount(specify unit of measure)of waste by category; mark 'X' to indicate which wastes are present.
a . SLUDGE
A.MOU NT
UNI T O F MEA SU RE
X' I ( 1) PA INT ri P IGMENTS
I!£.) MET A LS ! S L UDGES
13 ) P O T W
!4 1 AL'.JMINUM
SL :.JDGE
I •. i ~ t 51 o 'T--i ER( s pecify):
b. OIL
AMOUNT
UNIT OF MEASURE
l2:J 1110ILY i WASTES
LJ <2 l O THER ( specify):
EPA Form T2070·2 (1 0•79)
c . SOLV ENTS
AMOUNT
U N IT OF' MEASURE
'X' 11 :t-eALOGENATED
-SOL V ENTS
t2JN ON-t-1ALOG NT O
SOL.V ENTS
_ (31 OTH ER(specziy).
d. CHEMICALS
AMOUN T
UNI T OF MEASURE
'X' (11 ACID S
121 P ICKL IN G
LICUO'1S
!3 1CA USilCS
14 1 PESTIC ID ES
!!I O Y ES/IN t<S
I _,!6 l C YAN 10E
1171 PHENOL5
181 MA L O G ENS
\91 PCB
l10)ME JA L S
_ '11 i O T H E R (epec1fy)
PAGE20F4
•· SOLIDS f. OTHER
AMOUN T AMOUNT
UNIT O F M EASU RE UNIT OF MEASURE
·x· . _11 1 L A BO~A TO~Y
PHARMACEUT.
1,1 ASBES TOS IL JHOSPI TAL.
lf3 )i..-i1LLl,-.,G/
. M IN E T A IL IN G S 13) Fe AOIOACTIVE
►ER ROUS
t ,4 I 5 M L T G. V! A 5 T E: 5 l 4J lt,.#l.,JN IC IPA.L
t6 1 OT HE=1.\0ec1/yJ: -
Continue On Page J
V. WASTE RELATED IN FORMATION (continued)
3. L IST SUBSTANCES OF GREATEST CONCERN WHICH MAY BE ON THE SITE (place 1n descendinQ order of hazard).
---4. ADDI T IONAL COMMENTS OR NARRATIVE DESCRIPTION OF SI TUATION KNOWN OR REPORTED TO EXIST AT THE SITE.
VI. HAZARD DESCRIPTION
e. c. PO TEN· D,DATEOF
A, TYPE OF HAZARD T I AL ALLEGED INCI DENT E , REMARKS
HAZARD INCIDENT (mo.,day,yr,)
(mark 'X') (mark 'X')
I I , NO H•ZARD
2 , HUM,._N HEALTH
3. NON•WORKER
INJURY/EXPOSURE .. WORKER IN.JURY I
5. CO NTAMINATION I O F ""ATER SUPPLY
e. CO N T AMINATIO N
I O F F O OD CHAIN
7 . CONTAMINAT ION I OF GROUND w•TER
B. CONTAMINATION
OF SURF•CE w•TER
P. O•M•CE TO
FLORAIF•UN,._
I
10. FISH KI LL I .
1 ,. CONTAMINATION 4
O F A IR
12. NOTICE .. BLE ODORS
tS. CONTAMINATION OF SOIL
14. PROPERTY 0,._M,.CE
1 5. FIRE OR EXPLOSION
I
le. 5PILL5/LE•KI NC CONT .. 1NER5/
RUNOFF/ST .. NDINC L IQUIDS
1 7 . SEWER, STOR"' OR.IN PROBLEMS
18. EROSION PROBLEMS
1 Q. IN,.OE<:11.JATE SECURITY
20. INCO"'P .. TI BLE W._STES
21. MION ICHT OUMPIN C
2 2-OTHER (specify):
EPA Form T2070•2 (10•79) PAGE30F4 Continue On Reverse
C.:nrfrwed From Front ;-,,.,
VII. PERMIT INFORMATION
A. INDICATE Ale. A F'PL.I C~BLE PERMITS HELD BY THE Sl ,E,
--, .. NPDE S PERMIT ' 2. SPC C PLAN ~ 3. STATE PERMIT(specily):
....-, 4 . AI R PERMI TS -s. LOCAL PERMIT " G. RCRA TRANSPORTER _J ~ '--' ,, 7 RCRA S,ORER r-, 8. RCRA TREATER =i 9 RCRA DISPOSER -~
-I ~0. OTHER (s-;,eciiy):
.B. IN COMPL I ANCE' -----; 1. Y ES 2. :.;o 3. UNKNOWN ---I
4. WITH RESPECT TO (lis r re~u/ation nsme & number):
VIII. PAST REGULATORY ACTIONS -' I :..._J A. NONE ,__J 8. YES (summari ze below)
IX. INSPECTION ACTIVITY (PBS( or on·i;/oi ni;/)
-.---, = A NON E Y ES (complete item:, 1 ,2,J, & 4 below) ~ --
2 DA.T E OF 3 PERFORMED
' TY l=)E O F ACT'V •TY PA.ST A.C T ION ev: 4 . OESCR IPTION
(mo., day, & y r,) (EPA /State)
-
I
X. REMEDIAL ACTIVITY (past or on-going)
! ' --A. NON E ' e. "':::'.S (comple:e items 1, 2, 3 1 & 4 below)
2.D.lTE OF 3. PERFORMED
1. TYPE OF ACT IVITY PAST .lCTION BY : •• DESCRIPT ION
(mo,, day, & yr,) (EPA/State)
--
NOTE: Based on the inforrnation 1n Sections III through X, fill out the Preliminary Assessment (Section ll)
information on the fi rst page of this form.
EPA Form T2070-2 (10-79) PAGE 4 OF 4
SITE INSPECTION FORM
( 2070-13)
53
POTENTIAL HAZARDOUS WASTE SITE
SITE IMSPECTIOr{ REPORT
REGION \SITE NUM&!i.R (to be aullln-
•d by Hq)
GENERAL INSTRUCTIO~S: Complete Sections I and III throu11:h XV of thia Corm aa ,comj:>letely u ?Osaible. Then use the informa•
tion on this form to develo? a Tentat've Disposition (Section ll). File this form in its entirety in the regional Haz:erdous Waete Loa:
File. Be sure to include all iippropriate Supplemental Reports in the file. Submit a copy of the forms to: U.S. Environmental Pro-
tection Agency; Site Traclci."lg System; Hazardous Waate Enforcement Tacit Force (EN·33S); 401 M St., SW; Wuhinzton, DC 20460.
I. SITE ID ENTI F !CA TIOM
A. SITE NAME
C. CITY
G. SITE OPERATOR INFORMATION
1. NAME
H. Ht.AL. I 'r v.-lNt.R INrvRMI'<, IUN (ii amerenr from operctor ot elle)
t. NAME --3, CITY
I. SITE DESCRIPTION
B, STREET (or other ldentl/ler)
D, STATE IE, ZIP CuuE r. COU•'1Y NA,.t.
2. TltL.EPl-<ONE NUM ■ltl'I
-a.STATE-1 z1Pc°oc£
2, TEL.EPMONE NUM9El'I
-1. ZIPCOCE
J, TYPE OF' OWNERSHIP
0 1. FEDERAL 0 2. STATE 0 3. COUNTY 0 4. MUNICIPAL 0 5, PRIVATE
11. TENTATIVE DISPOSITION (complete this section last)
A. ESTIMATE DATE OF' TENTATIVE
DISPOSITION (mo., day, 6, yr,)_
B, APPARENT SERIOUSNESS OF' PROBLEM
D 1. HIGH D z. MEDIUM ~ 3. LOW
C. PREPARER INFORMATION
1. NAME I 2, TEL.EPMONE NUM ■El'I
A. PRINCIPAL INSPECTOR INFORMATION
1, NAME
-- - -3. ORGANIZATION
B. INSPECTION PARTICIPANTS
t . NAME
III. INSPECTION INFORMATION
2, ORGANIZATION
C. SITE REPRESENTATIVES INTERVIEWED (corporate ottlciete, work•r•, r•eldent•)
2, TITLE• TEL.EPMONE NO.
EPA Form T2070•3 (10-79) PAGE 1 OF 10
0 4. NONE
I J, CATE (mo,, _dey, .s, yr,)_
3, TEL.EPMONE NO.
a. ACCFIE5S
Continue On Reverse
-
-
Continued From Front
!IT. INSPECTIOI\ INFORMA TIOt-; (continut1d)
D. GENERATOR IN FORMA. IIOh! f:io1:coa of wa•to)
1. NA~E i 2, 7EL.£PMONE NO, 3, ADDRESS 4 . WASTE iYPE GENER.A.TEO
I i
I i !
i I l
1 E. T R~NS?ORTER/~AULE~ I ~I ,C<::1-1,i,, TION
1. NAME 2. TEL.EPMOt,;E NO, 3 , ADDRESS ,.WASi"E "':"YPE TRANSPORTED
!
' I I i !
f'. If' WASTE IS PROCESSED ON S1,E A NO ALSO SHIPPED TO OTHER SITES, IDENTIF'Y Of'f'·SITE f'ACILITIES USED FOR DISPOSAL,
1. NAME I Z, TEL.E?HONE NO, 3. AOORESS I
I
I
I
G, DATE OF INSPECTION I H. TIME OF I NSPECTIO~ I, ACCESS GAINED BY: (credentl11le muot b• •hown in all c"BU) ~ (mo., d•y, cl, yr,) ' 0 1. PERMISSION 0 2. WARRANT i
J. WEATHER (deQcrtbo)
IV. SAMPLING INFORMATION
A. Marie 'X' for the ty?es· of ssrr.plea taken and indicate where they have been sent e.g., regional lab, other EPA lab, contractor,
etc. and estimate wher .. th.e re1;ults vlia be available.
!2. SJ..MPI...E -4, :-ATE
1, SAMPLE TYPE TAKEN S.SAMPLE SENT, TO: RESU L. TS -fm•rk 'X'> AVAILABLE
a, GROUNDWATER
b, SURF'ACE WATER
c. WA.STE
d, AIR
.. RUNOFF
f. SPIL.L.
i• SOIL
h. V E.CETATION
I, o THE R ( apeclty)
B. FIELD MEASU REM;::N1'S TI>. KEN (o,i." radioactlvtcy, exploelvity, PH, etc,).
1, TYPE 2 , LOCATION OF MEASUREMENTS 3. RESUL.TS
I
'
EPA Form T2070-3 10-79 PAGE 2 OF 10 C ti on n ue On Pa eJ
Continued From Paf2e 2
IV. SAMPLING INFORMATION (continued)
C. PHOTOS ,. TV PE OF" PMOT05 12, P,_.OTOI IN CUS T ODY OF:
CJ a. GROUND Db ... ERI .. L
D. SITE MAPPED1 .
,7 YES. SPECIFY LOCATION OF MAPS:
E. COOR DIN ATES
1 , LATITUDE (des,-min.-sec.) 12, LONGITUDE (deQ,·mln,-.. c,)
V. SITE INFORMATION
A. SITE STATUS
D 1, ACTIVE (Those inductrial or 0 2. INACTIVE (Those 0 3. OTHER(specily):
municipal sites which are beinQ used site• which no /onter receive (Those eites that include such incidents like "midniQht dumping"
for wsste treatment, store se, or dispo,;a/ waates,). where no regular or continuinQ uee of the site for waete dicpo,al
on B continuinB basis, even if in/re-ha• occurred,).
quently~)
8. IS GENERATOR ON SITE'
I --1 1. NO 0 2. Y ES(specify Qenerator's /our-diQit SIC Code): ---
C. AREA OF SITE (in acr••J D. ARE THERE BUILDINGS ON THE SITE1
□,. NO 0 2. YES(•P•clfy):
VI. CHARACTERIZATION OF SITE ACTIVITY
Indicate the major site activity(ies) and details relating to each activity by marking 'X' in the a pproprie te boxes.
·x x· x· X' -A. TRANSPORTER -B. STORER -C, TREATER -D, DISPOSER
1. RA IL 1. PILE 1,~ILTRATION 1. LANO~ILL
2. SHIP 2,SURFACE IMPOUNDMENT 2.INCINERATION 2 , LANOFARM
3, B._RGE 3. DRUMS 3. VOLUME REDUCTION 3 . OPEN DUMP
.t. TRUCK 4., TA.NK, A BOVE GROUND 4 , RECYCLING/RECOVERY 4,SURFACE IMPOUNCMENT
!L P IPELINE 5. TANK, BELOW GROUND ti, CHEM./PHYS,/TREATMENT 5. MIDNIGHT DUMPING
e . o T,_.ER (specify): e. OT ... ER(•p•clfy): e. BIOLOGICAL TRE .. TMENT 6 , INCINERATION ,-.. ,__
7. WASTE O IL REPROCE5SING 7. UN-DER GROUND INJECTIOt-,;
8. SOLVENT RECOVERY 8 . OT>-;ER (specify):
9. OT ... ER(Bpeci/y): -
E. SUPPLEMENTAL REPORTS: Uthe •ite fall■ within any o( th• catr-gorie■ Hated below, S~lemental Report■ mu ■t be completed. Indicate
which Supplemental Report■ you have filled out and attached to thia for ••
0 1. STORAGE 02. INCINERATION 0 3, LANDFILL 04, SURFACE 0 S. DEEP WELL IMPOUNDMENT
06. CHEM/BIO/ 0 7 . LANDFARM 0 8. OPEN DUMP 09, TRANSPORTER 0 10. RECYCLOR/RECLAIMER PHYS TREATMENT
VII. WASTE RELATED INFORMATION
A, WASTE TYPE
0 1. LIQUID 0 2. SOLID 0 3. SLUDGE 0 4. GAS
8. WASTE CHARACTERISTICS
0 I. CORROSIVE 0 2. IGNITABLE 0 3. RADIOACTIVE 0 4. HIGHLY VOLATILE
0 S. TOXIC 0 6. REACTIVE 0 7. IN ERT 0 e. FLAMMABLE
n 9. OTHER(•peclfyJ:
C. WASTE CATEGORIES
1. k e record ■ of wa ■tea available? Specify item■ ■uch a■ m■ni!e ■t ■, J.nventoriea, etc. below.
EPA Form T2070-3 10-79) PAGE 3 OF 10 Continue On Reverse
Continued From Front
VII. WASTE RELATED INFORMATION (continued)
2. Eatimate the amount (specify unit of measure) ol waste by catee;ory; mark 'X' to indicate which wastes are present.
a. SLUDGE b, OIL c, SOLVENTS d. CHEMIC.a.LS •· SOL IDS (. OTHER
AMOUNT AMOUNT AMOUNT AMOUNT AMOUNT A.MOUNT
UNIT OF MEASURE UNIT o,r ME.Asu,-;a UNIT OF ""4£AIURE UNIT OF MEASURE UNIT OF ~EA 5 U RE UNIT OF MEASU!lltE
• X
111 :td:~NTs X'
(l l~~~~ES
. x· X ' x· 'X
111 ~~=~::~~~;: ---(I) ;;::~;!~:TED -<I< A C10S -111 FLYASM -
i MET A 1-S 2 ) OTHER(ep•clfy): N0N4 HAL.0GNTO. P ICKLIN G
<2 > SLUDC.ES -<2> SOLVENTS 12) LIQUORS 121 ASBESTOS t2 1 '"iOSPIT AL-
13 )POTW I-3) OTHER(ep•cily): 13) C AUST<CS t "-"ILL.ING/MINE
l l TAILINGS (31 R.AOIOACTI VE
AI-UMINUM
i.J SLUDC.E <•> PESTICIDES (Al ~NEGR:~~~:;ELT (A)MUNICIPAL
-le) OTHER(epecl/y): lei DYES/INKS I I NON•FERROUS ~ SML TG, WASTES
-1~1 OTHER(•P•<ily):
le l CYANIDE -161 OTHER(specl/y):
(71 PHENOL..S
Ill HALOGENS
IP) PCB
1101 METALS
-t1 'I OTHER(•peci/yJ
D, LIST SUBST.a.NCES OF GRE,A.TEST CONCERN WHICH ARE ON TME SITE (pl•ce in deacendlnQ order of h•z•rd)
2. FORM 3. TOXICITY
(marlc 'X') (m•rk 'X')
1. SU BST .a.NCE •• 50· b. C, VA .. b • c. d. 4. c.a.s NUMBER S . .a.MOUNT 6 . UtllT
LIO LIQ, POR MIGM MEO, LOW NONE
VIII. HAZARD DESCRIPTION
~IELD EVALUATION HAZARD DESCRIPTION: Place an 'X' in the box to indicate that the listed hazard exiats. Describe the
hazard in the space provided.
0 A. HUM,A.N HE.a.L TH HAZARDS
EPA F °''" T2070-3 (1 0-79) PAGE 4 OF 10 Continue On PaQe 5
Continued From ?ag~ 4 ·
Vlll. HAZARD DESCRIPTION (continued)
0 8. NON•WORKER INJURY/EXPOSURE
D c. WORKER INJURY/EX-POSURE
D o. CONTAMINATION OF WATER SUPPLY
D E, CONT,4.MINATION OF FOOD CHAIN
0 F, CONTAMINATION OF GROUND WATER
D G. CONTAMINATION OF SURFACE WATER
EPA Form T2070•3 (10•79) P"GE 5 OF 10 Continue On Reverse
Continued From Fron
Vlll. HAZARD DESCRIPTION (continued)
0 H. DAMAGE TO FLORA/FAUNA
0 I. FISH KILL
0 J . CONTAMINATION OF AIR
0 K. NOTICEABLE ODORS
D L. CONTAMINATION OF SOIL
0 M. PROPERTY DAMAGE
EPA Form T2070-3 (10-79) PAGE 6 OF 10 C.onlinae On Page 7
Cantinued From Page 6
Vlll. HAZARD DESCRIPTION (continued)
□ N. FIRE OR EXPLOSION
0 0. SPILLS/LEAKING CONTAINERS/RUNOFF/STANDING LIOUIO
D P. SEWER, STORM DRAIN PROBLEMS
CJ o. EROSION PROBLEMS
L.J R. IN ADEQUATE SECURITY
D s. INCOMPATIBLE WASTES
EPA Form T2070•3 (1 0-79) PAGE 7 OF 10 Continue On Reverse
VIII. HAZARD DESCRIPTION (continued)
0 T. MIDNIGHT DUMPING
D U. OTHER (•p•clly/:
IX. POPULATION DIRECTLY AFFECTED BY SITE
C . APPROX, NO. OF PEOPL.E D, APPROX. NO, E. DISTANCE
A, L.OCATION OF POPUL.ATION B,-"PPROX. NO. AFFECTED WITHIN OF BUil.DiNGS TO SITE
OF PEOPL.E AFFECTED UNIT AREA AFFECTED (specify unit•)
1. IN RESICENTIAL AREAS
2• ~NR ~~~~;;~i':t A REAS
IN PUBLICLY 3• TRAVE\.LEC AREAS
• PUBLIC USE AREAS · (park•, •chool•, etc,)
X. WATER AHO HYDROLOGICAL DATA
A. DEPTH•. TO GROUNOWATER(epecl/y unit) e. DIRECTION OF Fl.OW c. GROUNDWATER USE IN VICINITY
D. POTENTIAL. YIELD OF AQUIFER E. DISTANCE TO DRINKING WATER SUPPLY F, DIRECTION TO DRINKING WATER SUPPL.Y -(•p•clly unit of m•••ur•J
G. TYPE OF DRINKING WATER SUPPLY
□ 1. NON•COMMUNITY □ 2. COMMUNITY (opecl/y town): < 15 CONNECTIONS° ) 15 CONNECTIONS --□ __, 3. S\!RFACE WATER •· WELL
EPA Form T2070-3 (10•79) PAGE 8 OF 10 Continue On Page 9
Continued F rom Pa~e 8
X. WATER ANO HYDROLOGICAL DATA (continued)
H. LIST ALL DRINKING WATER WELLS WITHIN A 1/4 MILE RADIUS OF SITE
1. WEL.L. 2. DEPTH ( sp•ci ly unit)
I. RECEIVING WATER
1. NAME
-------
3. L.OCATION /proxlrnlty to popul•tlon/ bulldlnf•)
~
DD 2_, SEWE-RS --
4. L.AKESI RESERVOIRS
.. NON•COM•
MUNI TV
(rn•rl< 'X')
6 . SPECIFY U SE ANO CLASSIF ICATION OF RECEIVING WATERS
XI. SOIL ANO VEGITATION DATA
L.OCATION OF SITE IS IN:
D A. KNOWN FAULT ZONE D B. K"RST ZONE 0 C. 100 YEAR FLOOD PLAIN DD, WETL ... ND
DE. A REGULATED FLOODW"Y D F. CRITICAL H.ABITAT 0 G, RECHARGE ZONE OR SOLE SOURCE AQUIFER
XII. TYPE OF GEOLOGICAL MATERIAL OBSERVED
Mark 'X' to indicate the type(s) of iteological material observed and specify where necessary, the component parts.
'X
.....-A. C.VERBURDEN
1. SANO
2. CL.AV
3. GRAVEL
0 A. UNKNOWN
'X -X'
B, BEDROCK (•P•clfy below) -C. OTHER (•p•clly below)
XIIl. SOIL PERMEABILITY
0 C. HIGH (1000 to 10 cm/uc,)
& • COMMUN• I TV
(mark 'X')
-·
'.::JD, MODERATE (10 to .1 cm/aec,J
0 B. VERY HIGH (100,000 to 1000 cm/oec.J
0 E. LOW (.1 to .001 cm/He,) 0 F. VERY LOW (.001 to .00001 cm/ oec,J
G. RECHARGE AREA
D 1. YES 0 2. NO 3. COMMENTS:
H. DISCHARGE AREA
LJ 1. YES 0 2. NO 3. COMMENTS:
I. SLOPE
1. ESTIMATE,-. OF !LOPE I 2, SPECIFY DIRECTION OF SL.OPE. CONOITION OF SL.OPE. ETC.
J. OTHER GEOLOGICAL D"T"
'.: PA Form 12070-3 (1 0-79) PAGE 9 OF 10 Con tinue On Reveree
Continued From Front
XIV. PERMIT INFORMATION
L iat all applicable permit• held by the site and provide the related information.
"· IN COM,-LI A~CE
0, CATE E, EX,-IRA TION (mark 'X')
A, PERMIT TYPE 8, ISSUING C, PEPIMIT ISSUEO CATE I , 2, J, U N• (e,Q,.RCRA,St•te,NPDES,etc,) AGENCY NUMBER (mo.,d•y,&yr,) (mo.• day,la yr,) Y El NO KNOWN
r-
\
XV. PAST REGULATORY OR ENFORCEMENT ACTIONS
D NONE 0 YES (eummarl•• In th/e •P•c•)
NOTE: Based on the information in Sections III through XV, fill out the Tentative Disposition (Section I/) information
on the first page of this form. ~
EPA Form T2070-3 (10•79) PAGE 10 OF 10
INDIRECT COST MEMO
54
STATE AND LOCAL DEPARTMENT/AGENCY
INDIRECT COST NEGOTIATION AGREEMENT
0MB CtRCULAR A-87 NEGOTIATION
DATE: September 3, 1982 INSTITUTION: DIVISION OF HEALTH SERVICES
Department of Hu1:1an Resources
State of North Carolina
325 North Salisbury Street
Raleigh, North Carolina 27611
FILING REF.: This Replaces
Negotiation Agreement Dated:
July 1, 1982
The Indirect Cost Rate(s) contained herein is for use on grants and contracts
with the Federal Government to which 0MB Circular A-87 applies subject to the
limitations contained in the Circular and in Section II-A. The rate(s) was
negotiated by the Department of Health and . Human Services in accordance with
the authority contained in Attachment A., Section J.3 of the Circular.
SECTION I: RATE(S)
--------
EFFECTIVE PERIOD
TYPE mm -m RATE* LOCATIONS APPLICABLE TO --
FIXED 7-1 -81 6-30-82 28.6% Al1 All Programs
FIXED 7-1-82 6-30-83 @ All All Programs
*BASE: Direct salaries and wages including vacation, holiday and sick pay,
but excluding other fringe benefits.
TREATMENT OF FRINGE BENEFITS: Fringe benefits applicable to direct salaries
and wages are treated as direct costs.
TO: CMT and Branch Beaus
FROM, Johnny C:. P~plin1
DATE: September 21, 1982
FOR YOUR INFORMAT TON
...
INSTITUTIOIJ: DIVISION OF HEALTH Sl:.f<VlLt~, NL. UU'AKIMt.NI ur-nuM/-\r1 l'\c..:>vu11~i:...:>
SECTION II: GENERAL
A. LIMITATIONS: Use of the rate{s) contained n this agreement is subject to
any statutory or administrative limitations and is applicable to a given
grant or contract only to the extent that funds are avail ab1 e. Acceptance
of the rate{s) agreed to herein is predicated on the conditions: {l) that
no costs other than those incurred by the grantee/contractor or allocated
to the grantee/contractor via an approved state-wide/local-wide cost
allocation plan were included in its indirect cost pool as finally
accepted and that such incurred costs are legal obligations of the grantee/
contractor and allowable under the governing cost principles, (2) that the
sa1i1e costs that have been treated as indirect costs have not been claimed
as direct costs, (3) that similar types of costs have been accorded consis-
tent accounting treatment, and (4) that the information provided by the
grantee/contractor which was used as a basis for acceptance of the rate{s)
agreed to herein is not subsequently found to be materially inaccurate,
{5) in accordance with the agreement allocating costs of central services
provided by others.
B. AUDIT: Adjustments to amounts resulting from audit of the cost allocation
plan upon which the negotiation of this agreement was based will be
compensated for in a subsequent negotiation.
C. CHANGES: If a fixed or predetermined rate(s) is contained in this agree-
ment, it is based on the organizational structure and the accounti:.g
system in effect at the time the proposal was submitted. Changes in the
organizational structure or changes in the method of accounting for costs
which ~ffect the amount of reimbursement resulting from use of rates in
this agreement require the prior approval of the authorized representative
of the responsible negotiation agency. Failure to obtain such approval
may result in subsequent audit disallowances . .
D. THE FIXED RATE{S) contained in this agree1aent is based on an estimate of
the costs which will be incurred during the period for which the rate
applies. When the actua 1 cos ts for such period have been detenni ned, an
adjustment wll be made in a subsequent negotiation to compensate for the
difference between that cost used to es tab 1 i sh the fixed rate and that
which would have been used were the actual costs known before the time.
E. NOTIFICATION TO FEDERAL AGENCIES: Copies of this document may be provided
to other federal offices as a means of notifying ther.i of the agreement
contained herein.
F. SPECIAL REMARKS: Feder a 1 programs currently rei mburs i rig direct costs to
this Department/Agency by means other than the rate(s) cited in this
agreement should be credited for such costs and the applicable rate cited
herein be applied to the appropriate base to identify the proper ar.iount of
indirect costs allocable to the program.~
BY THE STATE DEPARTMENT/AGENCY
DIVISION OF HEALTH SERVICES
TJ~~Vii'ff liTSOlJRCTI
M~ 1s1 { Name ·
St;itc> IIC'al th D1 rC'rtor TTflTel _______ --. ---
septcrnhcr 13, l 982 T!YateT---------. -
BY THE RESPONSIBLE AGENCY FOR THE
FEDERAL GOVERNMENT
AAT~ENT OF HEALTH AND HUMAN SERVICES
';JL/1!/IJ j Date: September 3, 1982
W. -W,~:-, Director
Division of Cost Allocation
NEGOTIATED BY: Fred Edgecor.ib, Jr.
TELEPHOf4E: (404)--Z:.11 ·.:14~----
{FTS) 242-2t.55
ATTACHMENT 10 NEGOTlATJON AGREEMENT TRANSMITTAL LETTER
STATE AND LOCAL GOVERNMENT AGENCIES
Requirements for aoJustments to indirect costs claimed unoer federal grants
and contracts resulting from this negotiation are dependent upon the type of
rate(s) contained in the Negotiation Agr(:ement.
1. If indirect costs were previously claimea based on the use of a
"provisional" rate and a "final" rate is contained in the Agreement,
adjustments to the clainis to reflect the establishment of the final rate
are required. For Department of Health and Human Services grants these
adjustments must be in accordance with the procedures described in
Chapter 6-150 of the Department's Grants Administration Manual.
Adjustments under Department of Health and Human Services contracts must
be made in accordance with the provisions of the contracts. Adjustments
under grants and contracts awarded by other f edera 1 agencies must be
made in accordance with the policies of those agencies.
2. If a "fixed" rate has been established, all adjustments for the period
covered by the fixed rate will be made in a subsequent rate negotiation
in accordance with the provisions of the Negotiation Agreement.
3. If a "predeterminea" rate has been established, no aujustments for the
period covered by the predetermined rate will be necessary.
An indirect cost proposal encompassing all activities of your agency,
together with the required supporting information, must be submitted to this
office for each fiscal year in which your agency claims indirect costs under
grants and contracts awarded by the Federal Government. The proposal is due
within four months after your state/local-wiae cost allocation plan has been
approve~lf your state/locality has not submitted a state/l~cal-wide cost
allocation plan, your agency's indirect cost proposal is due ahnua1ly,
within six months after the close of your agency's fiscal year. Your
indirectcost proposal, based upon actual costs for your current year,
together with the required supporting information will be used to establish
an indirect cost rate(s) for the fiscal year subsequent to the last approved
period. Failure to submit a timely proposal will be interpreted as a
forfeiture of reimbursement for indirect costs. Consequently, awards made
by the Department of Health and Human Services subsequent to the prescribed
date will be for direct costs only and will --not provide for the recovery of
indirect costs. In addition, indirect costs claimed aainst awards already
made may be subject to disallowance. Detailed information concerning the
preparation of a proposal can be found in the brochure entitled, "A Guide
for State/Local Governments Agencies," OASC-10,..
.In order to effect a timely negotiation, it is requested that the following
information be submitted with your next proposal:
l. A certification by a responsible official that the proposal has been
prepared in accordance with 0MB Circular A-87. An example of this
certification is shown in the brochure noted above.
2. A listing by federal agency of grants and contracts, the amount of
expenditures incurred on each for the period involved, and the overhead
limitations (if any) applicable to each. When more than one rate is
being proposed, a listing should be presented for each rate.
3. A copy of your audited financial statements for the period under negotia-
tion, cross-referenced to the proposal. If audited statements are not
available, the proposal should be accompanied by other financial
documents prepared by your agency or other off ice that can be used to
substantiate amounts shown in your proposal.
4. A chart s~owing the organizational structure of your agency during the
period covered by the proposal, along with a functional statement(s)
noting the duties and/or responsibilities of all units .that comprise
your agency (if one has been submitted previously, only the revisions to
it need be submitted with your proposal.)
5. A detailed explanation of the type of service provided to other state
agencies by your agency, the basis for establishing the costs of
services provided and the method used to bi 11 these costs to other
agencies.
Your proposal and relevant correspondence should be adaressed to:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Regional Administrative Support Center
Division of Cost Allocation
101 Marietta Street, N.W., Suite 1504
Atlanta, Georgia 30323
...