OSWER #9355.7-03B-P Five-Year Review Site Inspection Checklist · r OSWER No. 9355.7-03B-P...

rOSWER No. 9355.7-03B-P

Five-Year Review Site Inspection Checklist

Purpose of the Checklist

The site inspection checklist provides a useful method for collecting important informationduring the site inspection portion of the five-year review. The checklist serves as a reminder ofwhat information should to be gathered and provides the means of checking off informationobtained and reviewed, or information not available or applicable. The checklist is divided intosections as follows:

I. Site InformationII. InterviewsIII. On-site Documents & Records VerifiedIV. O&M CostsV. Access and Institutional ControlsVI. General Site ConditionsVII. Landfill CoversVIII. Vertical Barrier WallsIX. Groundwater/Surface Water RemediesX. Other RemediesXI. Overall Observations

Some data and information identified in the checklist may or may not be available at thesite depending on how the site is managed. Sampling results, costs, and maintenance reports maybe kept on site or may be kept in the offices of the contractor or at State offices. In cases where theinformation is not kept at the site, the item should not be checked as "not applicable," but rather itshould be obtained from the office or agency where it is maintained. If this is known in advance, itmay be possible to obtain the information before the site inspection.

This checklist was developed by EPA and the U.S. Army Corps of Engineers (USAGE). Itfocuses on the two most common types of remedies that are subject to five-year reviews: landfillcovers, and groundwater pump and treat remedies. Sections of the checklist are also provided forsome other remedies. The sections on general site conditions would be applicable to a widervariety of remedies. The checklist should be modified to suit your needs when inspecting othertypes of remedies, as appropriate.

The checklist may be completed and attached to the Five-Year Review report to documentsite status. Please note that the checklist is not meant to be completely definitive or restrictive;additional information may be supplemented if the reviewer deems necessary. Also note thatactual site conditions should be documented with photographs whenever possible.

•ISuperfund

OSWER No. 9355.7-03B-P

Using the Checklist for Types of Remedies

The checklist has sections designed to capture information concerning the main types ofremedies which are found at sites requiring five-year reviews. These remedies are landfill covers(Section VII of the checklist) and groundwater and surface water remedies (Section IX of thechecklist). The primary elements and appurtenances for these remedies are listed in sections whichcan be checked off as the facility is inspected. The opportunity is also provided to note site •conditions, write comments on the facilities, and attach any additional pertinent information. If asite includes remedies beyond these, such as soil vapor extraction or soil landfarming, theinformation should be gathered in a similar manner and attached to the checklist.

Considering Operation and Maintenance Costs

Unexpectedly widely varying or unexpectedly high O&M costs may be early indicators ofremedy problems: For this reason, it is important to obtain a record of the original O&M costestimate and of annual O&M costs during the years for which costs incurred are available.Section IV of the checklist provides a place for documenting annual costs and for commenting onunanticipated or unusually high O&M costs. A more detailed categorization of costs may beattached to the checklist if available. Examples of categories of O&M costs are listed below.

Operating Labor - This includes all wages, salaries, training, overhead, and fringe benefitsassociated with the labor needed for operation of the facilities and equipment associated with theremedial actions.

Maintenance Equipment and Materials - This includes the costs for equipment, parts, and othermaterials required to perform routine maintenance of facilities and equipment associated with aremedial action.

Maintenance Labor - This includes the costs for labor required to perform routine maintenance offacilities and for equipment associated with a remedial action.

Auxiliary Materials and Energy - This includes items such as chemicals and utilities which caninclude electricity, telephone, natural gas, water, and fuel. Auxiliary materials include otherexpendable materials such as chemicals used during plant operations.

Purchased Services - This includes items such as sampling costs, laboratory fees, and otherprofessional services for which the need can be predicted.

Administrative Costs - This includes all costs associated with administration of O&M not includedunder other categories, such as labor overhead.

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Insurance. Taxes and Licenses - This includes items such as liability and sudden and accidentalinsurance, real estate taxes on purchased land or right-of-way, licensing fees for certaintechnologies, and permit renewal and reporting costs.

Other Costs - This includes all other items which do not fit into any of the above categories.

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Please note that "O&M" is referred to throughout this checklist. At sites where Long-TermResponse Actions are in progress, O&M activities may be referred to as "system operations" sincethese sites are not considered to be in the O&M phase while being remediated under the Superfundprogram.

Five-Year Review Site Inspection Checklist (Template)

(Working document for site inspection. Information may be completed by hand and attached to theFive-Year Review report as supporting documentation of site status. "N/A" refers to "not applicable.")

I. SITE INFORMATION

Site name: Date of inspection: / | —

Location and Region: EPA ID:

Agency, office, or company leading the five-yearreview:

Weather/temperature:

^ 1 S~° fRemedy Includes: (Check all that apply)

G Landfill cover/containment . G Monitored natural attenuationG Access controls G Groundwater containmentG Institutional controls G Vertical barrier walls

^5X3roundwater pump and treatmentG Surface water collection and treatmentG Other

Attachments: G Inspection team roster attached G Site map attached

II. INTERVIEWS (Check all that apply)

1. O&M site manager~ Name Title Date

Interviewed y/at site G at office G by phone Phone no.Problems, suggestions; G Report attached ',

2. O&M staff.Name Title Date

Interviewed G at site G at office G by phone Phone no.Problems, suggestions; G Report attached

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3. Local regulatory authorities and response agencies (i.e., State and Tribal officesresponse office, police department, office of public health or environmental health,recorder of deeds, or other city and county offices, etc.) Fill in all that apply.

AgencyContact

Name Title DateProblems; suggestions; G Report attached

AgencvContact


AgencvContact


AgencvContact

Name . Title DateProblems: suggestions; G Report attached

, emergencyzoning office,

Phone no.

Phone no.

Phone no.

Phone no.

'

4. Other interviews (optional) G Report attached.

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1.

2.

3. .

4.

III. ON-SITE DOCUMENTS &

O&M Documents

J O&M manualAs-built drawings

^Maintenance logsRemarks

Site-Specific Health and Safety Plan^^Contingency plan/emergency response

Remarks

O&M and OSHA Training RecordsRemarks

Permits and Service AgreementsG Air discharge permit

.^Effluent dischargeG Waste disposal, POTWG Other permitsRemarks T

t~^ S^tf&jJl^ ,o(X

RECORDS VERIFIED (Check all that apply)

§eadily availableeadily availableeadily available

^G^leadily availableplan ^xReadily available

^G^eadily available

G Readily availableG Readily availableG Readily availableG Readily available

5(5**-

<£XJp to datejig. Up to date(EjUp to date

<^£Xjp to date^G)Up to date

£^pUp to date

G Up to dateG Up to dateG Up to dateG Up to date

G N/AG N/AG N/A

G N/AG N/A

G N/A

G N/AG N/AG N/AG N/A

V^ Gas Generation Records G Readily available G Up to date G N/ARemarks

>c

7.

*"

9.

10.

Settlement Monument RecordsRemarks

Groundwater Monitoring RecordsRemarks

Leachate Extraction RecordsRemarks

Discharge Compliance RecordsG AirG Water (effluent)Remarks

Daily Access/Security LogsRemarks

G Readily available

/G^leadily available

G Readily available

G Readily availableG Readily available

G Readily available

G Up to date

•

£PP to date

G Up to date

G Up to dateG Up to date

G Up to date

G N/A

G N/A

G N/A

G N/AG N/A

C*/A

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IV. O&M COSTS

1.

2.

3.

O&M OrganizationG State in-houseG PRP in-house

^T^ederal Facility in-house

-~i

G Contractor for StateG Contractor for PRP

©Contractor for Federal Facilityy_}

O&M Cost Records(^pReadily available ^X)p to dateG Funding mechanism/agreement in placeOriginal O&M cost estimate G Breakdown attached

Total annual

From ToDate Date

From ToDate Date

From ToDate Date

From ToDate Date

From ToDate Date

cost by year for review period if available

G BreakdownTotal cost





attached

attached .

attached

attached

attached

Unanticipated or Unusually High O&M Costs During Review PeriodDescribe costs and reasons:

'

V. ACCESS AND INSTITUTIONAL CONTROLS G Applicable G N/A

A.

1.

B.

1.

Fencing

Fencing damaged G Location shown on site map G Gates secured ^O^/ARemarks

Other Access Restrictions

Signs and other security measures G Location shown on site mapRemarks

G N/A

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c.].

<?

2.

D.

1.

2.

3.

Institutional Controls (ICs)

Implementation and enforcementSite conditions imply ICs not properly implemented G Yes G NoSite conditions imply ICs not being fully enforced G Yes G No

Type of monitoring (e.g., self-reporting, drive by)FrequencyResponsible party/agencvContact

Name Title Date

Reporting is up-to-date G Yes G NoReports are verified by the lead agency G Yes G No

Specific requirements in deed or decision documents have been met G Yes G NoViolations have been reported G Yes G NoOther problems or suggestions: G Report attached

Adequacy G ICs are adequate G ICs are inadequateRemarks

General

Vandalism/trespassing G Location shown on site map /^G"^lo vandalism evidentRemarks

Land use changes on site G N/ARemarks r~V^&'

Land use changes off siteG^N/AxRemarks

G N/AG N/A

Phone no.

G N/AG N/A

G N/AG N/A

G N/A

VI. GENERAL SITE CONDITIONS

A.

1.

Roads G Applicable G N/A

Roads damaged G Location shown on site map g^Roads adequateRemarks SCK_C c<_oi/h/v»i>^-.y S<-v<rf-K-«-i

\

G N/A

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B.

A.

1.

2.

3.

4.

5.

6.

7.

Other Site Conditions

Rcmartc

VII.

Landfill Surface

Settlement (Low spots)Areal extentRemarks

CracksLengthsRemarks

ErosionAreal extentRemarks

HolesAreal extentRemarks

Vegetative CoverG Trees/Shrubs (indicateRemarks

LANDFILL COVERS G Applicabl£_GyN/A

G Location shown on site map GDepth

G Location shown on site map GWidths Depths



G Grass G Cover properly establishedsize and locations on a diagram)

Settlement not evident

Cracking not evident

Erosion not evident

Holes not evident

G No signs of stress

Alternative Cover (armored rock, concrete, etc.) G N/ARemarks

BulgesAreal extentRemarks

G Location shown on sitemap. GHeight

'

Bulges not evident

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8. Wet Areas/Water DamageG Wet areasG PondingG SeepsG Soft subgradeRemarks

G Wet areas/water damage not evidentG Location shown on site map Areal extent_G Location shown on site map Areal extent_G Location shown on site map Areal extent,G Location shown on site map Areal extent_

9. Slope Instability G Slides G Location shown on site map G No evidence of slope instabilityAreal extentRemarks

B. Benches G Applicable G N/A(Horizontally constructed mounds of earth placed across a steep landfill side slope to interrupt the slopein order to slow down the velocity of surface runoff and intercept and convey the runoff to a linedchannel.)

1. Flows Bypass BenchRemarks

G Location shown on site map • G N/A or okay

2. Bench BreachedRemarks

G Location shown on site map G N/A or okay

3. Bench OvertoppedRemarks

G Location shown on site map G N/A or okay

C. Letdown Channels G Applicable G N/A(Channel lined with erosion control mats, riprap, grout bags, or gabions that descend down the steepside slope of the cover and will allow the runoff water collected by the benches to move off of thelandfill cover without creating erosion gullies.)

1. SettlementAreal extent_Remarks

G Location shown on site map G No evidence of settlementDepth '

2.' Material Degradation G Location shown on site map G No evidence of degradationMaterial type Areal extentRemarks '

3. ErosionAreal extent_Remarks

G Location shown on site map G No evidence of erosionDepth

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4.

5.

6.

D.

1.

2.

3.

4.

5.

Undercutting G Location shown on site map G No evidenceAreal extent DepthRemarks

Obstructions TypeG Location shown on site mapSizeRemarks

Excessive Vegetative GrowthG No evidence of excessive growthG Vegetation in channels does not obstructG Location shown on site mapRemarks

Cover Penetrations G Applicable G N/A

Gas Vents G ActiveG Properly secured/lockedG FunctioningG Evidence of leakage at penetrationG N/ARemarks

Gas Monitoring ProbesG Properly secured/lockedG FunctioningG Evidence of leakage at penetrationRemarks

of undercutting

G No obstructionsAreal extent

Tvpe

flowAreal extent

G PassiveG Routinely sampled G Good condition

G Needs Maintenance

G Routinely sampled G Good conditionG Needs Maintenance G N/A

Monitoring Wells (within surface area of landfill)G Properly secured/lockedG Functioning G Routinely sampled G Good conditionG Evidence of leakage at penetration G Needs Maintenance G N/ARemarks

Leachate Extraction WellsG Properly secured/lockedG FunctioningG Evidence of leakage at penetrationRemarks

G Routinely sampled G Good conditionG Needs Maintenance G N/A

Settlement Monuments G Located G Routinely surveyedRemarks

G N/A

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E. Gas Collection and Treatment G Applicable G N/A

Gas Treatment FacilitiesG Flaring G Thermal destruction G Collection for reuseG Good condition G Needs MaintenanceRemarks

2. Gas Collection Wells, Manifolds and PipingG Good condition G Needs MaintenanceRemarks •

3. Gas Monitoring Facilities (e.g., gas monitoring of adjacent homes or buildings)G Good condition G Needs Maintenance G N/ARemarks :

F. Cover Drainage Layer G Applicable G N/A

1. Outlet Pipes InspectedRemarks

G Functioning G N/A

2. Outlet Rock InspectedRemarks

G Functioning G N/A

G. Detention/Sedimentation Ponds G Applicable G N/A

1. SiltationAreal extentG Siltation not evidentRemarks

Depth. G N/A

Erosion . Areal extent.G Erosion not evidentRemarks

Depth.

3. Outlet WorksRemarks

G Functioning G N/A

4. DamRemarks.

G Functioning G N/A

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H

1.

2.

I.

1.

2.

3.

4.

. Retaining Walls G Applicable G N/A

Deformations G Location showii on site map G Deformation not evidentHorizontal displacement Vertical displacementRotational displacementRemarks

Degradation ' G Location shown on site map G Degradation notRemarks

Perimeter Ditches/Off-Site Discharge G Applicable G N/A

Siltation ' G Location shown on site map G Siltation not evidentAreal extent DepthRemarks

Vegetative Growth G Location shown on site map G N/AG Vegetation does not impede flowAreal extent TvpeRemarks

evident

Erosion G Location shown on site map G Erosion not evidentAreal extent DepthRemarks

Discharge Structure G Functioning G N/ARemarks

VIII. VERTICAL BARRIER WALLS G Applicable G N/A

1.

2.

Settlement G Location shown on site map G Settlement not evidentAreal extent DepthRemarks

Performance MonitoringType of monitoringG Performance not monitoredFrequency G Evidence of breachingHead differentialRemarks

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A.

1.

2.

3.

B.

1.

2.

3.

IX. GROUNDWATER/SURFACE WATER REMEDIES (Îpplicable

Ground water Extraction Wells, Pumps, and Pipelines £GJLpplicab

G N/A

lie G N/A

Pumps, Wellhead Plumbing, and Electrical^GXjood condition /^^^ required wells properly operating G Needs Maintenance G N/A

Remarks

Extraction System Pipelines, Valves, Valve Boxes, and Other Appurtenances/G^Good condition G Needs Maintenance

tTemarks

Spare Parts and Equipment^G^fceadily available G Good condition G Requires upgrade G Needs to

Tlemarks

Surface Water Collection Structures, Pumps, and Pipelines CîÂpplicable G

Collection Structures, Pumps, and Electrical^)Good condition G Needs Maintenance

Remarks

be provided

N/A

Surface Water Collection System Pipelines, Valves, Valve Boxes, and Other Appurtenances/£?Good condition G Needs Maintenance

Remarks

V

Spare Parts and Equipment££?Readily available G Good condition G Requires upgrade G Needs to

Remarksbe provided

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C. Treatment System Applicable G N/A

1. Treatment Train (Check components that apply)^GlMetals removal G Oil/water separationG Air stripping (^S^Carbon adsorbers .

£5)Filters ^ft£? 6'cfeg^> ^ <W=»9^» T%.\fs /^Ltoo^

G Bioremediation

G Additive (e.g., chelation agent, flocculentG OthersG Good condition G Needs Maintenance

^OSampling ports properly marked and functionalCampling/maintenance log displayed and up to date)Equipment properly identified

G Quantity of groundwater treated annuallyG Quantity of surface water treated annuallyRemarks

Electrical Enclosures and Panels (properly rated and functional)G N/A <^>Good condition G Needs MaintenanceRemarks_

Tanks, Vaults, Storage VesselsG N/A Xtf^jSood conditionRemarks

G Proper secondary containment G Needs Maintenance

Discharge Structure and AppurtenancesG N/A (IpGood condition G Needs MaintenanceRemarks

5. Treatment Building(s)G N/A ^pGood condition (esp. roof and doorways)G Chemicals and equipment properly storedRemarks

G Needs repair

Monitoring Wells (pump and treatment remedy)G Properly secured/lockedG Functioning G Routinely sampledG All required wells located G Needs MaintenanceRemarks

G Good conditionG N/A

D. Monitoring Data

I. Monitoring Datas routinely submitted on time of acceptable quality

2. Monitoring data suggests:/'cT^jroundwater plume is effectively contained ^G)Contaminant concentrations are declining

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D.

1.

Monitored Natural Attenuation

Monitoring Wells (natural attenuation remedy)® Properly secured/locked^Qfunctioning {cjRoutinely sampled ^Good condition

G All required wells located G NeedsMaintenance G N/ARemarks

X. OTHER REMEDIES

If there are remedies applied at the site which are not covered above, attach an inspection sheet describingthe physical nature and condition of any facility associated with the remedy. An example would be soilvapor extraction.

XI. OVERALL OBSERVATIONS

A. Implementation of the Remedy

Describe issues and observations relating to whether the remedy is effective and functioning asdesigned. Begin with a brief statement of what the remedy is to accomplish (i.e., to contain contaminantplume, minimize infiltration and gas emission, etc.).

B. Adequacy of O&M

Describe issues and observations related to the implementation and scope of O&M procedures,particular, discuss their relationship to the current and long-term protectiveness of the remedy.

In

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C. . Early Indicators of Potential Remedy Problems

Describe issues and observations such as unexpected changes in the cost or scope of O&M or a highfrequency of unscheduled repairs, that suggest that the protectiveness of the remedy may becompromised in the future.

D. Opportunities for Optimization

Describe possible opportunities for optimization in monitoring tasks or the operation of the remedy.

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Five-Year Review Interviews

Information gathered from interviews during the site inspection may be key tounderstanding site status. Interviews should be conducted with various individuals or groups,including the operation and maintenance (O&M) site manager, O&M staff, local regulatoryauthorities and response agencies, community action groups or associations, site neighbors, andother stakeholders.

When conducting an interview, the interviewer should note the date of the interview, andthe name, title, and affiliation of the person interviewed. The'interviewer should also indicatewhether the interview was conducted at the site, the office, or by phone. Written documentation ofthe interview should briefly summarize the discussion, address any problems or successes with theimplementation of the remedy, and provide suggestions for future reference. Forms to use duringinterviews are provided at the end of this appendix.

The following tables provide lists of potential individuals to interview and the type ofinformation which may be obtained during the interviews. The potential individuals to beinterviewed are categorized by their ability to provide the following types of information:

Background information;• State and local considerations;• Construction considerations; and• Performance, Operation and maintenance problems.

All of these individuals may be contacted during the five-year review. In most casesinterviewing only a few key individuals will provide sufficient information for the review.

Background Information

The individuals listed below may provide information concerning previous and currentconcerns about the site, influences that affected the remedy decision, and further clarification ondecisions made during remedy selection.

Interview Information Sought

Previous EPA Staff/Management

Nearest Neighbors

staff members may offer insight and clarification on decisionsmade during remedy selection and implementation

neighbors may provide insight into the enforcement of institutionalcontrols, changes in land use, trespassing, and unusual orunexpected activity at the site

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Community Representatives* - members of the community may provide a broader view of siteactivities and issues than can be obtained during the siteinspection

* Several types of individuals may be interviewed: residents/businesses adjacent to or on the site;residents/businesses within the path of migration; local civic leaders, local officials, Community Advisory Group(CAG), Technical Assistance Grant (TAG) group, and local environmental groups; and other audiences listed in thecommunity profile in the Community Involvement Plan.

Some example interview questions are given below.

1. What is your overall impression of the project? (general sentiment)

2. What effects have site operations had on the surrounding community?

3. Are you aware of any community concerns regarding the site or its operation andadministration? If so, please give details.

4. Are you aware of any events, incidents, or activities at the site such as vandalism, trespassing,or emergency responses from local authorities? If so, please give details.

5. Do you feel well informed about the site's activities and progress?

6. Do you have any comments, suggestions, or recommendations regarding the site's managementor operation?

State and Local Considerations

State and local authorities may provide you with information about changes in State lawsand regulations and present and prospective land uses and restrictions.


State Contacts (including those responsiblefor State water quality, hazardous waste,and environmental health issues)

Local Authorities (such as police,emergency response or fire departments,and local environmental or planning offices)

changes in State laws and regulations that may impactprotectivenesswhether the site has been in compliance with permitting orreporting requirementsinformation on site activities, status, and issues

status of institutional controls, site access controls, newordinances in place, changes in actual or projected land use,complaints being filed, and unusual activities at the site

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2. Have there been routine communications or activities (site visits, inspections, reportingactivities, etc.) conducted by your office regarding the site? If so, please give purpose andresults.

3. Have there been any complaints, violations, or other incidents related to the site requiring aresponse by your office? If so, please give details of the events and results of the responses.

4. Do you feel well informed about the site's activities and progress?

5. Do you have any comments, suggestions, or recommendations regarding the site'smanagement or operation?

Construction Considerations

It is important for you to determine the status of construction at the site and to ensure thathealth and safety concerns are addressed.


Construction Contractor

Construction Manager

Local Emergency Response Officials

progress of project and changes in design due to field conditionsrevisions to the O&M Manual, implementation of the Health andSafety Plan/Contingency Planinsight into potential O&M problems

overview of all contractor construction activities at the site, healthand safety issues, site protectiveness during construction, and thequality of the construction

adequacy of contractor's Health and Safety Plan and thecontractor's implementation of the Planadequacy of contractor's emergency response duties as outlinedin the Contingency Plan or Emergency Response Plan of theHealth and Safety Plan

Some example interview questions for remedial actions still under construction are givenbelow.


2. What is the current status of construction (e.g., budget and schedule)?

3. Have any problems been encountered which required, or will require, changes to thisremedial design or this ROD?

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4. Have any problems or difficulties been encountered which have impacted constructionprogress or implementability?

5. Do you have any comments, suggestions, or recommendations regarding the project (i.e.,design, construction documents, constructability, management, regulatory agencies, etc.)?

Performance, Operation And Maintenance Problems

The following individuals may provide information to you regarding the performance of theremedy and status of O&M at the site so that the team can assess the progress of theimplementation and effectiveness of the remedy, and any O&M problems.


O&M Manager/Operating Contractor

O&M Staff

Remedial Design/Remedial ActionConsultant

O&M status of the remedy, compliance with permit and reportingrequirements, and complaints filedeffectiveness of the O&M Planinformation about any potential causes for concern about theremedyprogress and performance of the remedy

effectiveness of the O&M Manualinformation about any potential causes for concern about theremedyRecommendations for adjusting the mode of operation oroptimizing the operations protocol

original concepts behind the O&M of the remedyquestions about remedial design parameters, expectedperformance and cost, and changes that have occurred duringimplementation



-2. Is the remedy functioning as expected? How well is the remedy performing?

3. What does the monitoring data show? Are there any trends that show contaminant levelsare decreasing?

4. Is there a continuous on-site O&M presence? If so, please describe staff and activities. Ifthere is not a continuous on-site presence, describe staff and frequency of site inspectionsand activities.

5. Have there been any significant changes in the O&M requirements, maintenance schedules,or sampling routines since start-up or in the last five years? If so, do they affect theprotectiveness or effectiveness of the remedy? Please describe changes and impacts.

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6. Have there been unexpected O&M difficulties or costs at the site since start-up or in the lastfive years? If so, please give details.

7. Have there been opportunities to optimize O&M, or sampling efforts? Please describechanges and resultant or desired cost savings or improved efficiency.

8. Do you have any comments, suggestions, or recommendations regarding the project?

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INTERVIEW DOCUMENTATION FORM

The following is a list of individual interviewed for this five-year review. See the attachedcontact record(s) for a detailed summary of the interviews. .

Name Title/Position

(-*&zL(\M A|6r^< \̂Nataie *~~* Title/Position

<--^ft< £. D><*k«&-Name Title/Position

Name Title/Position

Name Title/Position

Name Title/Position

Organisation Date

).( — ̂ ^/—o~f-~Organization Date

Organization Date

Organization Date

Organization Date

Organization Date

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INTERVIEW RECORD

Site Name:

Subject:

Type: ^TelephoneLocation of Visit:

a Visit D Other

^

EPA ID No.:

Time: Date:

D Incoming D Outgoing

MContact Made By:

Name: Title: Organization:

Individual Contacted:

Name: Title:

Telephone No:Fax No:E-Mail Address:

£. &

o

Organization:

Street Address:City, State, Zip:

Summary Of Conversation

(?*-


INTERVIEW RECORD

Site Name: EPA ID No.:

Subject: Time: U Date:

Type: o Telephone TS^VisitLocation of Visit:

n Other D Incoming D Outgoing

Contact Made By:



Name: Title; Organization:




ST.

4

Page 1 of.

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INTERVIEW RECORD


Subject: Time: Date:

Type: D TelephoneLocation of Visit:

p&fisi D Other O Incoming D Outgoing

Contact Made By:




Telephone No:fax No:E-Mail Address:



J

3

0 '

f .<

of 7j3e

<tA~_V

\J

Page 1 of.

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INTERVIEW RECORD


Subject: Time: Q<j Date:

Type: Q TelephoneLocation of Visit:

a Visit D Other D Incoming D Outgoing

Contact Made By:







3,

1 ^

ON>C*.(t\— I

S r

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OSWER #9355.7-03B-P Five-Year Review Site Inspection Checklist · r OSWER No. 9355.7-03B-P...

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