776 - Sandri Sunoco Gasoline Release Notice 2-22-21Charles D. Baker
Governor
Karyn E. Polito
Lieutenant Governor
Matthew A. Beaton
Secretary
Martin Suuberg
Commissioner
This information is available in alternate format. Contact Michelle Waters-Ekanem, Director of Diversity/Civil Rights at 617-292-5751.
TTY# MassRelay Service 1-800-439-2370
MassDEP Website: www.mass.gov/dep
Printed on Recycled Paper
Notification to MassDEP of a release or threat of release of Oil and/or Hazardous Material is required
under the regulations established by the Massachusetts Contingency Plan (MCP) at 310 CMR 40.0300.
The Release Notification & Notification Retraction Form is for use by a person who wants to:
Provide DEP with written notification of a release or threat of release of Oil, Hazardous Material or
both for 2 and 72 hour releases or for a 120 day release when an RTN has been previously
assigned, or
Revise a previously submitted oral or written notification of a release or threat of release, or
Retract a previously submitted oral or written notification of a release or threat of release.
When you first click on a BWSC form a "Pre Form" will appear on your screen:
Entering the Release Tracking Number (RTN)
Enter the Regional Number: 1=Western Regional Office, 2=Central Regional Office,
3=Northeast Regional Office, and 4=Southeast Regional Office
Enter the Tracking Number: Do not enter left hand zeros. For example, enter the tracking
number for 3-0099999 as 99999.
Press Search to proceed to the next step.
Selecting the Person Making the Submittal
Click on the blue arrow to see the complete list of persons.
Select the appropriate Person Making the Submittal from the dropdown list.
If the appropriate Person Making the Submittal is not on the list, check "add a new person".
Click Next to proceed with filling out the form.
Note that to have a person added to the dropdown list on future submittals, you need to send an
email to BWSC.eDEP@state.ma.us. Specify the RTN, the person's information (name, company,
address, and telephone) and the relationship to the RTN (e.g., current owner) in your email.
Note that the RTN will auto fill the upper right hand corner of the form on every page. The RTN is not
editable. If the wrong RTN is entered the form must deleted and recreated with the correct RTN.
Section A: Release or Threat of Release Location
Each of the following fields auto fills from the WSC Program Database, and cannot be updated
through the form. Send requests for corrections to BWSC.eDEP@state.ma.us. Note that once
the corrections are made the form will need to be recreated since it is not possible for BWSC
staff to change data directly on a form.
A.1. Release Name/Location Aid
A.2. Street Address
A.3. City/Town
A.4 .Zip Code
A5. Coordinates: Latitude/Longitude Coordinates are required to be submitted with a Release
Notification as per 310 CMR 40.0371. See Using GIS Location Finder for information how to use
the "Identify Location of Release" button, or alternatively to enter them by hand. .
Section B: Use of Form Section for BWSC103
Note that in most cases when a box on the Use of Form section is checked the system will
require a supporting document or attachment See Managing WSC Attachments for further
information about WSC supporting documents.
B.1. Check this box if submitting a Release Notification for a 2 or 72 Hour Notification. Also,
check this box if submitting a Release Notification for a 120 Day Notification that has been
previously assigned an RTN. (Note that currently there is no supporting documentation required if
this box is checked. If you would like to attach optional descriptive information, then check the
box in C8.)
B.2. Check this box if revising a Release Notification.
Supporting Documentation required if this box is checked
B.3. Check this box if submitting a Retraction of a Release Notification.
Supporting Documentation required if this box is checked
Section C: Release or Threat of Release Description:
C.1. Enter the Oral Notification Date and Time, if applicable
C.2. Enter the "Knowledge of the Release" Date and Time
Indicate the date and time when the person or organization reporting the release or threat
of release obtained knowledge of the event, which may differ from the date when the
release or threat of release occurred.
C.3. Enter the Date and Time of the Release, if known.
Check at least one notification thresholds listed under C.4., C.5. and/or C.6.that describe the
release or threat of release. At least one such option must be selected. The most stringent
reporting condition selected will categorize the release or threat of release.
C.4. Two Hour Notification: See the MCP at 310 CMR 40.0311 and 40.0312 for an explanation of
each option.
C.5. 72 Hour Notification: See the MCP at 310 CMR 40.0313 and 40.0314 for an explanation of
each option.
C.6. 120 Day Notification: See the MCP at 310 CMR 40.0315 for an explanation of each
option. Do not check a 120 Day reporting condition when Reportable Concentrations are related
to or consistent with the basis for a Two Hour or 72 Hour reporting condition.
C.7. Provide the following information about each type of Oil and/or Hazardous Material released
or posing a threat of release:
Record the three most plentiful types of oil or hazardous material released or posing a
threat of release, listing the largest quantity or concentration first.
Record the Chemical Abstracts Service (CAS) number for each Hazardous Material listed,
if known. Most Oils do not have CAS numbers.
Indicate whether each substance is an Oil (O) or a Hazardous Material (HM), as defined by
the MCP.
Record the quantity or concentration reported and the applicable units (e. g., 100 gallons,
50 ppm). Be sure to use the proper type of units. For example, use gallons or pounds for
reportable quantities for sudden releases, "ppmv" for headspace screening measurements,
"mg/kg" for soil measurements and "mg/l" for groundwater data.
If the report concerns a Reportable Concentration (RC), specify which Reportable
Concentration applies (i.e., RCS-1, RCS-2, RCGW-1, RCGW-2). If an RC is not
applicable, select N/A. NOTE: This information is required when reporting any 120 Day
reporting condition.
C.8. Check this box if you need to report additional types of Oil and Hazardous Materials released
or posing a threat of release. Provide the same information as listed above. In addition, check
this box if you would like to attach optional descriptive information relating to this Release
Notification.
Supporting Documentation Required if this box is checked.
Section D: Person Required to Notify
If you selected a person from the Pre Form list that person's information will auto fill this section. Yow will
not be able to edit the Organization. Other fields are editable under the following circumstances:
D.1.a. Check this box if you would like to change the Contact Name. When you check this box
the First Name, Last Name and Telephone Number will be editable.
D.1.b Check this box if you would like to change the Address of the Person Required to
Notify. When you check this box Street, City/Town, and Zip Code will be editable.
D.1.c Note this box will be auto checked if you selected "add a new person", you will not be able
to uncheck this box.
If you selected "add a new person", provide information about the Person required to Notify, who
must be a person described by the MCP at 310 CMR 40.0331, "Who Shall Notify":
D.2. Name of Organization: If an organization is reporting the release or threat of release or
retracting a notification, record its name. (e. g., company, municipal department, public
authority). Leave blank if not applicable (e. g., owner or occupant of residential property).
D.3., D.4. and D.6. Contact First Name, Last Name and Title
Individuals: If a person who is not associated with an organization is reporting a release or threat
of release or retracting a notification, record his or her first and last name in this field. (e. g.,
owner or occupant of residential property)
Organizations: If an organization is reporting a release or threat of release or retracting a
notification, provide the first and last name and title of a representative who has knowledge of the
situation and whom DEP may contact for further information. The person listed must be the
highest ranking individual having day-to-day responsibility for reporting a release or threat of
release.
D.5. Street: Provide the street address of the individual named in D.3. and D.4. This location
might differ from that of the release or threat of release (i.e., the site location).
D.7., D.8. and D.9. City/Town, State and Zip Code Provide the remainder of the mailing address
for the individual named at D.3. and D4.
D.10., D.11. and D.12. Telephone, Ext. and Fax Number: State a telephone number, including
area code and any extension, where DEP may reach the individual named at D.3. and D.4. If that
person has access to a FAX machine, you may provide a FAX number. Note that the
organization's telephone number, not the contact's number, will autofill here.
Note that the WSC Database does not automatically update with any new data or corrections you
may have made to the fields above. Send requests for corrections to BWSC.eDEP@state.ma.us,
include the RTN and the new or updated information . Do not reference form fields since BWSC
staff can't edit or see forms that you are working on. Once the corrections are made, they will
appear on any new forms created for that RTN.
D.13. Check this box if you need to record additional names and addresses of owners affected
by the release or threat of release, other than an owner who is submitting this Release
Notification Form. Try to provide a complete mailing address and phone number, including area
code, with each address.
Supporting Documentation Required
Section E: Relationship of Person to Release or Threat of Release
Note that if you selected a person from the Pre Form Pick List you will not be able to edit this
section. Send requests for corrections to BWSC.eDEP@state.ma.us. Note that once the corrections are
made the form will need to be recreated since it is not possible for BWSC staff to change data on a form.
For "new persons" select the single response in Section E that best describes the relationship of the
Person required to Notify, (who is named in Section D) to the release or threat of release. Do not provide
information about an LSP or other individual who is preparing the form on behalf of or as an agent for the
Person required to Notify. See the MCP at 310 CMR 40.0006 and 40.0331 and M. G. L. c. 21E for further
definitions of terms used in this section of the form.
Section F: Certification of Person Required to Notify
F.1, F.2., and F.5.:
These fields are blocked from entry. Once the form is submitted the name of the person who
electronically signs the certification (at the signature step of the process) will auto fill F.1. and F.2.
and the date of signature will auto fill F.5. A Licensed Site Professional (LSP) should not sign
his/her name as agent for Person required to Notify except if written authorization is obtained as
per 310 CMR 40.0009.
F.3. Enter the Title of the Person required to Notify or the person signing on behalf of the Person
required to Notify.
F.4. This field is auto filled from Section D.
F.6. (F.7. through F.13.) Check this box if the address of the person signing is different from the
address in section D. Fill out the rest of the fields in this section as applicable.
Charles D. Baker
Governor
Karyn E. Polito
Lieutenant Governor
Kathleen A. Theoharides
Secretary
Martin Suuberg
Commissioner
This information is available in alternate format. Contact Michelle Waters-Ekanem, Director of Diversity/Civil Rights at 617-292-5751.
TTY# MassRelay Service 1-800-439-2370
MassDEP Website: www.mass.gov/dep
Printed on Recycled Paper
February 22, 2021
URGENT LEGAL MATTER: PROMPT ACTION NECESSARY
Ms. Rebecca Zukowski
Sandri Energy, LLC
400 Chapman Street
Greenfield, MA 01301 Re: Northampton
Sandri Energy Sunoco Gas Station
776 North King Street
Release Tracking # 1-21273
RELEASE NOTIFICATION and
NOTICE OF RESPONSIBILITY;
M.G.L. c. 21E and
310 CMR 40.0000
Dear Ms. Zukowski:
On February 19, 2021, at 4:12 AM, personnel from the Northampton Fire Department provided
notification to the Department of Environmental Protection (the Department) of a release of gasoline at
the subject location (the site). As reported, a customer overfilled a vehicle fuel tank, resulting in a release
of an unknown amount of gasoline to the paved fueling pad at the site. This condition constitutes a
reportable release as listed in the Massachusetts Contingency Plan, 310 CMR 40.0000 (the "MCP"). In
addition to oral notification, 310 CMR 40.0333 further requires that a completed Release Notification
Form (RNF) be submitted to the Department within 60 calendar days of the date of oral notification.
The Department has reason to believe that the release that was reported is or may be a disposal site as
defined in the MCP. The Department also has reason to believe that you (as used in this letter “you”
refers to Sandri Energy, LLC) are a potentially responsible party (PRP) with liability under Section 5(a)
of M.G.L. c. 21E. This liability is "strict", meaning that it is not based on fault, but solely on your status
as owner, operator, generator, transporter, disposer or other person specified in said Section 5(a). This
liability is also "joint and several", meaning that you are liable for all response action costs incurred at a
disposal site even if there are other liable parties.
The Department encourages PRPs to take prompt and appropriate actions in response to releases and
threats of release of oil and/or hazardous materials. By taking the necessary response actions, you may
significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the
Department in taking such actions. You may also avoid or reduce certain permit or annual compliance
Ms. Rebecca Zukowski
Sandri Energy, LLC
Notice of Responsibility
RTN 1-21273
Page 2
fees payable under 310 CMR 4.00. Please refer to M.G.L. c. 21E for a complete description of potential
liability. For your convenience, a summary of liability under M.G.L. c. 21E is attached.
You should be aware that you may have claims against third parties for damages, including claims for
contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are
governed by laws which establish the time allowed for bringing litigation. The Department encourages
you to take any actions necessary to protect any such claims you may have against third parties.
At the time of notification, the Department approved the following response actions as Immediate
Response Actions (IRA): deployment of absorbents; and, completion of assessment activities.
Specific approval is required from the Department for the implementation of an IRA with the exception of
assessment activities, the construction of a fence and/or posting of signs. Additional submittals are
necessary with regard to this notification including, but not limited to, the filing of an IRA Plan within 60
days of the date of notification, unless an IRA Completion Statement and/or a Permanent or Temporary
Solution Statement has been filed prior to that date. IRA Status Reports are required to be submitted
within 120 days of the date of notification and every six months thereafter, unless an IRA Completion
Statement and/or a Permanent or Temporary Solution Statement has been filed prior to the IRA submittal
due dates. The MCP requires that a fee of $1470.00 be submitted to the Department when a Permanent or
Temporary Solution Statement is filed greater than 120 days from the date of initial notification.
It is important to note that you must dispose of any Remediation Waste generated at the subject location
in accordance with 310 CMR 40.0030 including, without limitation, contaminated soil and/or debris.
Any Bill of Lading accompanying such waste must bear the seal and signature of a Licensed Site
Professional (LSP). You may contact the LSP Board of Registration at 617/556-1091 or access the
following internet link: https://eeaonline.eea.state.ma.us/portal#!/search/lsp to obtain the current LSP list.
Unless otherwise provided by the Department, responsible parties have one year from the initial date
notice of a release or threat of release is provided to the Department pursuant to 310 CMR 40.0300 or
from the date the Department issues a Notice of Responsibility, whichever occurs earlier, to file with the
Department one of the following submittals: (1) a completed Tier Classification Submittal; or (2) a
Permanent Solution or Temporary Solution Statement; or (3) a Downgradient Property Status Submittal.
The deadline for these submittals for this disposal site is February 19, 2022.
Please note that all submittals requiring a LSP Opinion for this release must be submitted through e-DEP,
MassDEP’s electronic document and form submittal repository. For more information on electronic
submittal of forms and reports, please visit MassDEP’s website,
www.mass.gov/dep/service/compliance/edeponlf.htm .
Ms. Rebecca Zukowski
Sandri Energy, LLC
Notice of Responsibility
RTN 1-21273
Page 3
If you have any questions relative to this notice, you should contact Anthony Kurpaska at the above
letterhead address or by telephone at 413-755-2236. All future communications regarding this release
must reference the Release Tracking Number (RTN) contained in the subject block of this letter.
Sincerely,
David A. Slowick
Section Chief
Emergency Response
DAS:AFK:afk
P:1-21273-Northampton-NOR
ecc: Northampton
Fire Department
Mayor’s Office
Health Department
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
RELEASE NOTIFICATION & NOTIFICATION
RETRACTION FORM
BWSC103
Release Tracking Number
-
Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C)
A. RELEASE OR THREAT OF RELEASE LOCATION:
1. Release Name/Location Aid:
2. Street Address:
3. City/Town: 4. ZIP Code:
5. Coordinates: a. Latitude: N b. Longitude: W
B. THIS FORM IS BEING USED TO: (check one)
1. Submit a Release Notification
2. Submit a Revised Release Notification
3. Submit a Retraction of a Previously Reported Notification of a release or threat of release including supporting
documentation required pursuant to 310 CMR 40.0335 (Section C is not required)
(All sections of this transmittal form must be filled out unless otherwise noted above)
C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE (TOR):
2. Date and time you obtained knowledge of the Release or TOR:
3. Date and time release or TOR occurred, if known:
mm/dd/yyyy
Time:
Time:
Time:
hh:mm
hh:mm
hh:mm
AM
AM
PM
PM
Check all Notification Thresholds that apply to the Release or Threat of Release:
(for more information see 310 CMR 40.0310 - 40.0315)
4. 2 HOUR REPORTING CONDITIONS
a. Sudden Release
b. Threat of Sudden Release
c. Oil Sheen on Surface Water
d. Poses Imminent Hazard
e. Could Pose Imminent
Hazard
f. Release Detected in
Private Well
g. Release to Storm Drain
h. Sanitary Sewer Release
(Imminent Hazard Only)
Revised: 07/18/2013
5. 72 HOUR REPORTING CONDITIONS
a. Subsurface Non-Aqueous
Phase Liquid (NAPL) Equal to
or Greater than 1/2 Inch (.04
feet)
b. Underground Storage Tank
(UST) Release
c. Threat of UST Release
d. Release to Groundwater
near Water Supply
e. Substantial Release Migration
6. 120 DAY REPORTING CONDITIONS
a. Release of Hazardous
Material(s) to Soil or
Groundwater Exceeding
Reportable Concentration(s)
b. Release of Oil to Soil
Exceeding Reportable
Concentration(s) and Affecting
More than 2 Cubic Yards
c. Release of Oil to Groundwater
Exceeding Reportable
Concentration(s)
d. Subsurface Non-Aqueous
Phase Liquid (NAPL) Equal to or
Greater than 1/8 Inch (.01 feet)
and Less than 1/2 Inch (.04 feet)
1. Date and time of Oral Notification, if applicable:
mm/dd/yyyy
mm/dd/yyyy
AM PM
Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
RELEASE NOTIFICATION & NOTIFICATION
RETRACTION FORM
BWSC103
Release Tracking Number
-
Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C)
C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE (TOR): (cont.)
7. List below the Oils (O) or Hazardous Materials (HM) that exceed their Reportable Concentration (RC) or Reportable Quantity
(RQ) by the greatest amount.
O or HM Released CAS Number,
if known
O or HM Amount or
Concentration
Units RCs Exceeded, if
Applicable (RCS-1, RCS-2,
RCGW-1, RCGW-2)
D. PERSON REQUIRED TO NOTIFY:
1. Check all that apply: a. change in contact name b. change of address
2. Name of Organization:
c. change in the person
notifying
3. Contact First Name:
5. Street:
7. City/Town:
10. Telephone: 11. Ext.:
4. Last Name:
6. Title:
8. State: 9. ZIP Code:
12. Email:
13. Check here if attaching names and addresses of owners of properties affected by the Release or Threat of Release,
other than an owner who is submitting this Release Notification (required).
E. RELATIONSHIP OF PERSON TO RELEASE OR THREAT OF RELEASE:
1. RP or PRP a. Owner
e. Other RP or PRP
b. Operator c. Generator d. Transporter
Specify:
2. Fiduciary, Secured Lender or Municipality with Exempt Status (as defined by M.G.L. c. 21E, s. 2)
3. Agency or Public Utility on a Right of Way (as defined by M.G.L. c. 21E, s. 5(j))
4. Any Other Person Otherwise Required to Notify Specify Relationship:
Revised: 07/18/2013 Page 2 of 3
Check here to change relationship
Check here if an amount or concentration is unknown or less than detectable.
Check here if a list of additional Oil and Hazardous Materials subject to reporting, or any other documentation relating to this
notification is attached.
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
RELEASE NOTIFICATION & NOTIFICATION
RETRACTION FORM
BWSC103
Release Tracking Number
-
Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C)
F. CERTIFICATION OF PERSON REQUIRED TO NOTIFY:
1. I, , attest under the pains and penalties of perjury (i) that I have personally
examined and am familiar with the information contained in this submittal, including any and all documents accompanying this
transmittal form, (ii) that, based on my inquiry of those individuals immediately responsible for obtaining the information, the
material information contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii)
that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. I/the person or
entity on whose behalf this submittal is made am/is aware that there are significant penalties, including, but not limited to,
possible fines and imprisonment, for willfully submitting false, inaccurate, or incomplete information.
2. By:
Signature
3. Title:
4. For:
(Name of person or entity recorded in Section D)
5. Date:
mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section D.
7. Street:
8. City/Town:
11. Telephone: 12. Ext.:
9. State: 10. ZIP Code:
13. Email:
YOU ARE SUBJECT TO ANNUAL COMPLIANCE ASSURANCE FEES FOR EACH BILLABLE YEAR FOR TIER
CLASSIFIED DISPOSAL SITES. YOU MUST LEGIBLY COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR
DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM, YOU MAY BE
PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Revised: 07/18/2013 Page 3 of 3