CERCLA Response Action Request and Documentation

CERCLA RESPONSE ACTION REQUEST AND DOCUMENTATION

PART I: SITE IDENTIFICATION AND PRELIMINARY INFORMATION

A. Site Information

Site Name: [________________________________]

Site Address:
Street: [________________________________]
City: [________________________________]
State: [____] ZIP Code: [__________]
County: [________________________________]

EPA Site ID (if assigned): [________________________________]

NPL Status:
☐ Listed on National Priorities List (NPL)
☐ Proposed for NPL Listing
☐ Not on NPL
☐ NPL Status Unknown

Site Coordinates:
Latitude: [________________________________]
Longitude: [________________________________]

B. Property Ownership Information

Current Property Owner:
Name: [________________________________]
Address: [________________________________]
City: [________________________________] State: [____] ZIP: [__________]
Phone: [________________________________]
Email: [________________________________]

Previous Owners (if known):
| Owner Name | Dates of Ownership | Contact Information |
|------------|-------------------|---------------------|
| [________________________________] | [__/__/____] to [__/__/____] | [________________________________] |
| [________________________________] | [__/__/____] to [__/__/____] | [________________________________] |
| [________________________________] | [__/__/____] to [__/__/____] | [________________________________] |

PART II: CONTAMINATION INFORMATION

A. Nature of Contamination

Known or Suspected Hazardous Substances:

PFAS Contamination (Per EPA April 2024 Designation):
☐ PFOA (Perfluorooctanoic Acid) Detected
☐ PFOS (Perfluorooctanesulfonic Acid) Detected
☐ Other PFAS Compounds: [________________________________]
☐ No PFAS Contamination Known

B. Release Information

Date of Discovery: [__/__/____]

Date of Release (if known): [__/__/____]

How Was Release Discovered:
☐ Routine Monitoring
☐ Citizen Complaint
☐ Regulatory Inspection
☐ Environmental Site Assessment
☐ Odor/Visual Observation
☐ Other: [________________________________]

Estimated Extent of Contamination:
Approximate Area Affected: [________________________________] acres/square feet
Depth of Contamination: [________________________________] feet
Groundwater Plume Length (if applicable): [________________________________] feet

C. Receptor Information

Potential Human Receptors:
☐ Residential Population within 1 mile: Estimated [________] persons
☐ Schools/Daycare Centers within 1 mile: [________] facilities
☐ Hospitals/Healthcare Facilities within 1 mile: [________] facilities
☐ Private Drinking Water Wells within 1 mile: [________] wells
☐ Public Water Supply Wells within 4 miles: [________] wells

Sensitive Environmental Receptors:
☐ Wetlands: [________________________________]
☐ Surface Water Bodies: [________________________________]
☐ Endangered/Threatened Species Habitat: [________________________________]
☐ Critical Habitat Designation: [________________________________]

PART III: RESPONSE ACTION TYPE

A. Type of Response Requested

☐ Removal Action (CERCLA § 104)
☐ Time-Critical Removal (response within 6 months)
☐ Non-Time-Critical Removal
☐ Emergency Response

☐ Remedial Action (CERCLA § 104)
☐ Remedial Investigation/Feasibility Study (RI/FS)
☐ Record of Decision (ROD) Development
☐ Remedial Design/Remedial Action (RD/RA)
☐ Operation and Maintenance (O&M)

B. Justification for Response Type

Imminent and Substantial Endangerment Factors:
☐ Actual or potential exposure to hazardous substances
☐ Migration of contamination to drinking water sources
☐ Threat to sensitive populations (children, elderly, immunocompromised)
☐ Documented health effects in community
☐ Fire or explosion hazard
☐ Direct contact hazard
☐ Other: [________________________________]

Narrative Justification:
[________________________________]
[________________________________]
[________________________________]
[________________________________]

PART IV: POTENTIALLY RESPONSIBLE PARTIES (PRPs)

A. PRP Identification

Category 1: Current Owners/Operators
| Name | Address | Basis for Liability |
|------|---------|-------------------|
| [________________________________] | [________________________________] | ☐ Current Owner ☐ Current Operator |
| [________________________________] | [________________________________] | ☐ Current Owner ☐ Current Operator |

Category 2: Past Owners/Operators at Time of Disposal
| Name | Address | Dates of Ownership/Operation |
|------|---------|----------------------------|
| [________________________________] | [________________________________] | [________________________________] |
| [________________________________] | [________________________________] | [________________________________] |

Category 3: Generators/Arrangers
| Name | Address | Substances Arranged for Disposal |
|------|---------|--------------------------------|
| [________________________________] | [________________________________] | [________________________________] |
| [________________________________] | [________________________________] | [________________________________] |

Category 4: Transporters
| Name | Address | Substances Transported |
|------|---------|----------------------|
| [________________________________] | [________________________________] | [________________________________] |
| [________________________________] | [________________________________] | [________________________________] |

B. CERCLA Defenses Claimed by PRPs

☐ Innocent Landowner Defense (§ 101(35))
☐ Bona Fide Prospective Purchaser Defense (§ 101(40))
☐ Contiguous Property Owner Defense (§ 107(q))
☐ Third-Party Defense (§ 107(b)(3))
☐ Act of God Defense (§ 107(b)(1))
☐ Act of War Defense (§ 107(b)(2))
☐ Federally Permitted Release (§ 107(j))

PART V: PREAUTHORIZATION REQUEST (For Non-Federal Parties)

A. Preauthorization Application (40 CFR Part 307)

Applicant Information:
Name: [________________________________]
Organization: [________________________________]
Address: [________________________________]
City: [________________________________] State: [____] ZIP: [__________]
Phone: [________________________________]
Email: [________________________________]

Type of Preauthorization Requested:
☐ Response Action at NPL Site
☐ Response Action at Non-NPL Site
☐ Natural Resource Damage Assessment

B. Proposed Response Action Description

Proposed Activities:
[________________________________]
[________________________________]
[________________________________]

Estimated Costs:
| Cost Category | Estimated Amount |
|--------------|-----------------|
| Site Characterization | $[________________] |
| Removal/Remediation | $[________________] |
| Monitoring | $[________________] |
| Administrative/Legal | $[________________] |
| Contingency (15-25%) | $[________________] |
| TOTAL | $[________________] |

Proposed Schedule:
Start Date: [__/__/____]
Completion Date: [__/__/____]

C. Compliance with National Contingency Plan (NCP)

Certification:
The undersigned certifies that the proposed response action will be conducted in compliance with the National Contingency Plan (40 CFR Part 300), including:

☐ Selection of cost-effective response consistent with NCP
☐ Compliance with Applicable or Relevant and Appropriate Requirements (ARARs)
☐ Public participation requirements (if applicable)
☐ Documentation and record-keeping requirements
☐ Quality assurance/quality control requirements

PART VI: ATTACHMENTS AND SUPPORTING DOCUMENTATION

Required Attachments Checklist

☐ Site Location Map (USGS topographic or equivalent)
☐ Site Layout/Facility Map
☐ Aerial Photographs (current and historical if available)
☐ Environmental Site Assessment Reports (Phase I and/or Phase II)
☐ Analytical Data and Laboratory Reports
☐ Groundwater Monitoring Data
☐ Risk Assessment (if completed)
☐ Previous Regulatory Correspondence
☐ Cost Estimates and Supporting Documentation
☐ Health and Safety Plan (HASP)
☐ Quality Assurance Project Plan (QAPP)
☐ Community Relations Plan (if applicable)
☐ Evidence of Financial Assurance/Insurance
☐ Documentation of PRP Search

PART VII: CERTIFICATIONS AND SIGNATURES

Certification Statement

I hereby certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

Signature: [________________________________]
Printed Name: [________________________________]
Title: [________________________________]
Organization: [________________________________]
Date: [__/__/____]

Attorney Certification (if applicable)

I certify that I have reviewed this submission and, to the best of my knowledge, information, and belief formed after reasonable inquiry, this submission is well-grounded in fact, warranted by existing law or a good faith argument for the extension, modification, or reversal of existing law, and is not submitted for any improper purpose.

Attorney Signature: [________________________________]
Printed Name: [________________________________]
Bar Number: [________________________________]
Firm Name: [________________________________]
Date: [__/__/____]

STATE-SPECIFIC NOTES

California

• California Health and Safety Code § 25300 et seq. (Hazardous Substance Account Act) provides state Superfund authority
• Cal/EPA Department of Toxic Substances Control (DTSC) administers state program
• Additional notification requirements under Proposition 65
• California Environmental Quality Act (CEQA) review may be required

Texas

• Texas Health and Safety Code Chapter 361 (Solid Waste Disposal Act) provides state authority
• Texas Commission on Environmental Quality (TCEQ) administers state Superfund program
• Texas Risk Reduction Program (TRRP) standards may apply
• Voluntary Cleanup Program available for eligible sites

Florida

• Florida Statutes Chapter 376 provides state Superfund authority
• Florida Department of Environmental Protection (FDEP) administers program
• Brownfield Redevelopment Act (Chapter 376, Part IV) provides incentives
• Site Rehabilitation Program provides alternative cleanup pathway

New York

• New York Environmental Conservation Law Article 27 provides state authority
• New York State Department of Environmental Conservation (NYSDEC) administers program
• State Superfund program and Brownfield Cleanup Program available
• Additional requirements under SEQRA (State Environmental Quality Review Act)

SOURCES AND REFERENCES

• EPA Superfund Program: https://www.epa.gov/superfund
• National Contingency Plan (40 CFR Part 300)
• CERCLA Statute (42 U.S.C. § 9601 et seq.)
• EPA Preauthorization Procedures (40 CFR Part 307)
• EPA PFAS Enforcement Policy (April 2024)

This template is provided for general informational purposes. Environmental response actions are highly regulated and site-specific. Always consult with qualified environmental counsel and technical professionals before initiating any CERCLA response action.