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HomeMy WebLinkAbout1370 John Fitch Blvd - UST - Fire Marsha UNDERGROUND STORAGE I PG I of I , STATE OFCONNECTICUT 2. Department of Environmental Protection Q FACILITY NOTIFICATION UNDERGROUND STORAGE FACILITIES PROGRAM Bureau of Waste Management 79 ELM STREET,Hartford,CT 06106-5127 FIRST NOTIFICATION TEL.(860)424-3374 OR SITE I.0." to `>_, PLEASE TYPE OR PRINT.ALL THREE COPIES MUST BE LEGIBLE b SUBSEQUENT (if checked, " NOTIFICATION enter no.) Refer to INSTRUCTIONS FOR FILING NOTIFICATION before completing form. SI FE NAME NQ S'CREET Eq! )t TER0 t3>T tEET LO a u 4.1 BUSINESS NAME AND NAME NO.AND STREET ' 6. MAILING ADDRESS �,: ®,/�© 'A >i3 ' _ [0 ' A,"D STREET �,. ..:Z 7 PA(,"#LITY QtillNEl� "`; ,e� e O E- �- W B.TYPE OF OWNER 5 y PRIVATE ❑ STATE ❑ MUNICIPAL ❑ FEDERAL(G.S.A.NO. U OPERATOR/CONTACT NAME /4Ver41 /j ®j/d NO.A ,T�STREE 9. PERSON 11a. 11b. 12a. 12b.STATUS 13 TYPE OF 14.CONTENTS 15.CONSTRUCTION �G CONTENTS MATERIALS WANK I;t3 DATE OF z_ TOTAL w w I EST.QUANTITY o DATE c~i CHEMICAL NAME OF PRINCIPAL w E INSTALLATION A N CAPACITY w z LEFT STORED w TANK ¢o a o SUBSTANCE _j a 0 0 0 iO U) O I > �O V— w J¢F (Mo./Yr.) a o (Gals.) a a. (If any) 0 LAST w s D (not trade name) w c7 O in =z- w ,� ? a Z I (Gals.) w USED S =o (Enter C.A.S.No.,if known) v~i w z a o o _ a— I ¢ (Mo./Yr.) J U LL¢ rn Example 5/75 30 5000 X X Heating fuel#2 X Example 7/60 — 8000 X 8/78 X 1,1,1,-Tricloroethane X CAS#79016 ova i,i X �► U � Z O H W U) k M - 20.HAVE YOU ATTACHED SKETCH OF TANKS AND LOCATION??, YES 0 21.COMMENTS: ,.• / /'9 `•�r �:s.� / /�f��'vJr�c• " iP<-i ��1. t 'kj/��.✓�.» .r C,!:.y, r� Ti�W.I' lei ✓tr"� f^c 'd'1► �► Cn SOP i G. SEND TO LCAL FI�tE MARSHAL f _ _ C y ry ���f vi,S _ (�oiiv9 oao% 1 `� L JDe# -ao//- o �.� / Environmental Services, Inc. P.O.# DATE D? /t/- D // ,� Mitchell Associates Inc. CONT&M ❑ HAZMA r El DAY M T W Y::� F S SU ► CONTRACT ❑ � . SURCHARGE ❑ CONTACT PERSON 2 /Yt r/r. /c/ 1.800-486•SPIL (24 Hour Service) DEPART FROM SHOP PHONE#_P6 0 aS 9 7_Ze 90 Brookfield Street ARRIVE BACK AT SHOP CLIENT Ne N ,,�./ L� South Windsor,CT 06074 PR: TOTAL TRAVEL TIME BILLING ADDRESS /� �J 2 Ti/..i�/:[ ESI:(860)5269500 ';ro ' z d MAI:18601289 1000 JOB LOCATION So✓7 Gri,�,lr;f r 0 .4 V Si�T+irp ATTN LABOR: EQUIPMENT: '} NAME TITLE ST OT OT EO ID OTY TYP FLEET p X OF S A PICK-UP TRUCK SUPERVISOR EM RESPONSE VAN VACUUM ST.TRUCK FOREMAN SUPERVAC I MASTER VAC a EDOPER I VACUUM TRAILER k DRIVER f"T ROLLOFF TRUCKITRAILERED "= DRIVERfl I RACK TRUCK ED OPER I BOX TRUCK DRIVER TRAILER DUMP TRACTOR ENV.FIELD 6 WHEEL DUMP TRUCK ENV.FIELD TRI-AXLE DUMP TRUCK EXCAVATOR 0 ENV.FI LO BACKHOEIATTCHI I -TECHNICIAN BOBCATIATTCH I I SWEEPER PRESSURE WASHER t" CONFINED SPACE TRAILER s POWER WORK BOAT TAG-TRAILER DI POSAL• COMPRESSOR GENERATOR T MANIFEST# LIGHT PLANT j SOLID(DRUMS) UOUID(DRUMS) . LIDUID(BULK) -'�•,� ESTIMATED SOUDS IN L•� 1I/ I! _ MATERIAL f; 5' SCUD(BULK) SPEEDIDRI OVERPACK STEEL 17-H DRUM OVERPACK PLASTIC `qq" } SORBENTPAa BALE HAYBALES E ROII.OFF CANS INVENTORY:(Check"A"Onsite Onl ) 5'SORBENT BOOM BALE GALLON POLY DRUM CAN NUMBER CAN NUMBER CAN NUMBER CAN NUMBER CAN NUMBER 8'SORBENT BOOM BALE EPA LEVEL p,p,E ROLLOFF UNER POLY ROLL SIZE: SIMPLE GREEN DEGREASER DRUM LINERS CAMERA FILL pt SUPER CHOSE {: ANALYSIS: DUCT TAPE 17-E DRUM DTY TYPE LAB PDa SUBCONTRACTORS VENDORS: NAME OF COMPANY DESCRIPTION OF WORK PO p s JOB DESCRIPTION: v t r` /� JOB COMPLETED ❑ YES ❑ NO IQ'JOB DONE EXCEPT Customer: OR DISPOSAL / ky By: - E SIGNATURE: f IEWIRONKNXSERVICES INC MITCHELL ASSOCIATES,INC.REPRESENTATIVE) Pnm Nara PA of Date: _ TaN NONHAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Wasta Tracking Number WASTE MANIFEST (' ^ Fd 1sY`3 v a J 11 ,CY1,;S 77CC J} W,ty, '1 ? O 9 3 1 - f 5.Generator's Name and Mailing Address Generators Site Address(il different Than mailing address) 137G JOHN'FIT CH BOULEVARD SOUTH iM&1VMOR CT (; Q74 Generators Phone: 860 ':'4-?77 6.Transporter 1 Company Name U.S.EPA ID Number EiIVIPONMENTAL!�ER1'is;Eu.INC, i 'r 0 0 1 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facilitryy Name and Site Address U.S.EPA ID Number UNiTry 01;_RECCIVE-~Y.INC, 138 ORAte Ey AVENUE Facili s Phone: 'M3 2g.3-B;`^' ;"' (y 2 1 [i -! kj 8 tl $ - 9.Waste Shipping Name and Description10.Containers n 11.Total 12.Unit No. Type Quantity WtNol. QA SOUNE, Rnil. lZ 4 w 2. F 3. :Y.4. c _. 13.Special Handling Instructions and Additional Infomnafion ;� , 4- f31I)ERG KC " g9�2f- :%'i7 �l'r w�E !CAfi i1 lvE �IALC1-1E SJZ4 At M Pf ,"MUCT ES;G"_•C 14.GENERATOR'StOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately.descdbed above by the proper shipping name,and are classed,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. Generatoes/08eror's Printed/Typed Nana.° jI Signature Month Day Year "T 1v I J 15.International Shipments ❑Import to U.S. El Export from U.S. Port of entry/ex8: Transporter- Signature for exports only): - Dafe leavin U.S.: r¢ 16.Transporter Acknowledgment of Receipt of Materials Transported Pdntedfryped Name Signature Month Day Year 0 z Transporter 2 Printedlryped Name Signature Month Day Year 17.Discrepancy 17a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 171b.Alternate Reference Number:ate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: F17c.Signature of Alternate Facility(or Generator) Month Day Year 2 o w' '*` k lWIMP "1h� ri , 18.Designated Facility Owner or Operator.Certification of receipt of materials covered by the manifest except as noted in Item 17a Pdnted/ryped Name Signature Month Day Year i 69-BLC-0 6 10498(Rev.9/09) GENERATOR'S/SHIPPER'S INITIAL COPY CHAIN OF CUSTODY RECORD Temp Pg of OENTV Delivery: 587 East Middle Turnpike.P.O.Box 370.Manchester,CT 06040 Na❑ Fax q: �;, Email:info@phoenixlabs.com Fax(860)645-0823 Client Services (860) 645-8726 El Email: Environmental Laboratories, Inc. it/D.Sar.�a r Customer: &Z Aw, -e!5 7!ev,J��y/fjFJ Project: �/ 1 j�G�1aJ .121 J1 /j10 11✓ oject P.O: Address: �����,yir <j Report to: X11 .�J Ir Phone#: JGO — !,/1/,'9 --- f D r aL Invoice to: Fax#: Client Sample-Information-Identification Sampler' + � Analysis Signature ��/—e. Date: �� �� •y0 c�0 00 Request Matrix Code: rac DW=Drinking Water GW=Ground Water SW=Sudace Water WW=Waste Water SE=Sediment SL=Sludge S=Soil/Solid W=Wipe O=Other PHOENIX USE ONLY Customer Sample Sample Date Time �0P o�u o�c \JO da yy\ �50 �Oo aOS a O b SAMPLE 8 Identification Matrix Sampled Sampled AIV ,,RellnquishWbV A ccerted to Dat : Time: RI CT MA Data Format ❑Direct Exposure ❑RCP Cert ❑MCP Certification ❑Excel (Residential) ❑GW Protection ❑GW-1 ❑ ❑ PDF GW ❑SW Protection ❑GW-2 ❑GIS/Key Other ❑ GW-3 ❑EQuIS ❑ ❑GA Mobility Comments,Special Requirements or Regulations: ❑ S� ❑Other Turnaround: ❑GB Mobility Data Packaae CGS CJ ij 1�/3f�'� �3' ❑ t Day' ❑ S-z r' Residential DEC ❑Tier II Checklist ❑ 2 Days- ❑I/C DEC ❑ S-3 ❑Full Data Package' �'� � ❑ 3 Days' ❑Other ❑MWRA eSMART ❑ Phoenix Std Report ❑Standard I JE Other ❑ Other ❑ Other State where samples were collected: 'SURCHARGE APPLIES 'SURCHARGE APPLIES PHOE WX °�M° " c °ArycF U � U� a Environmental Laboratories, Inc. a a ,NY#11301 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: Attn:Mr.Wes Vancour All Phase Environmental July 19, 2011 186 Lake Street Manchester,CT 06040 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 07/14/11 13:30 Location Code: ALLPHASE I A Received by: LDF 07/15/11 10:41 Rush Request: Analyzed by: see"By"below P.O.#: SDG ID: GBA53379 Laboratory Data Phoenix ID: BA53379 Project ID: NEW ENGLAND SILICA 1370 JOHN FITCH BLVD Client ID: 1A Parameter Result RL Units Date Time By Reference Percent Solid 89 % 07/15/11 JL E160.3 Extraction of CT ETPH Completed 07/15/11 BN/F 3545 TPH by GC (Extractable Products) Ext.Petroleum HC ND 11 mg/Kg 07/18/11 JRB CT ETPH/8015 Identification ND mg/Kg 07/18/11 JRB CT ETPH/8015 QA/QC Surrogates %n-Pentacosane 83 % 07/18/11 JRB 50-150% Comments: If there are any questions regarding this data,please call Phoenix Client Services at extension 200. ND=Not detected BDL=Below Detection Level RL=Reporting Level This report must not be reproduced except in full as defined by the attached chain of custody. .COL Phyllis hiller,Laboratory Director Judy 19,2011 Page 1 of 1 Ver 1