Voluntary Cleanup Program (VCP) Application

VOLUNTARY CLEANUP PROGRAM APPLICATION

Submitted to: [STATE ENVIRONMENTAL AGENCY / VOLUNTARY CLEANUP PROGRAM UNIT]

Application Date: [__/__/____]

Program Track Requested: ☐ Voluntary Cleanup ☐ Brownfields ☐ Innocent Landowner ☐ Prospective Purchaser ☐ Dry Cleaner Program ☐ Other: [________________________________]

1. APPLICANT INFORMATION

Relationship to Site (check all that apply):

☐ Current fee owner
☐ Prospective purchaser under executed contract (attach purchase and sale agreement or LOI)
☐ Operator / lessee
☐ Lender or secured party
☐ Municipality / redevelopment authority
☐ Trustee / receiver / fiduciary
☐ Other: [________________________________]

Liability Status:

☐ Applicant is NOT a potentially responsible party (PRP) under CERCLA § 107 or state analog with respect to the site
☐ Applicant acknowledges status as a PRP and seeks participation under the program's PRP-eligible track
☐ Applicant claims bona fide prospective purchaser ("BFPP") status under 42 U.S.C. § 9601(40)
☐ Applicant claims contiguous property owner or innocent landowner defense

2. CONTROLLING STATE STATUTE AND PROGRAM

3. SITE DESCRIPTION

3.1 Site Identification

3.2 Site Characteristics

Current Use: [________________________________]

Historical Use (earliest known to present): [________________________________]

Proposed Post-Cleanup Use:

☐ Residential (unrestricted)
☐ Residential (restricted, e.g., multi-family / no gardening)
☐ Commercial
☐ Industrial
☐ Recreational / open space
☐ Mixed use: [________________________________]

Adjacent Land Uses (N / S / E / W): [________________________________]

Sensitive Receptors within 1/2 mile:

☐ Drinking water wells (public or private)
☐ Surface water bodies / wetlands
☐ Schools, daycares, or residences
☐ Hospitals or eldercare
☐ Environmental justice community (per state screening tool)
☐ None identified

3.3 Eligibility Screen

The site is NOT (check each that is true to confirm eligibility — any "No" may disqualify):

☐ Listed on the National Priorities List (NPL) or proposed for listing
☐ Subject to an unresolved federal or state enforcement order for the release at issue
☐ Subject to a RCRA corrective action order under 42 U.S.C. § 6928(h)
☐ A permitted TSD facility with ongoing corrective action obligations
☐ Subject to a UIC Class I or pending UST state-lead removal

4. ENVIRONMENTAL CONDITIONS

4.1 Known and Suspected Contaminants

Release History / Known Events: [________________________________]

4.2 Prior Investigations (attach as exhibits)

☐ Phase I ESA (ASTM E1527-21) dated [__/__/____], by [________________________________]
☐ Phase II ESA dated [__/__/____], by [________________________________]
☐ Supplemental / delineation investigation dated [__/__/____]
☐ Risk assessment (human health / ecological) dated [__/__/____]
☐ Prior agency correspondence or notices of violation
☐ Prior removal / interim measures report(s)

4.3 Data Gaps

[________________________________]

5. REMEDIATION PLAN

5.1 Cleanup Standards Proposed

☐ Unrestricted / residential use standards
☐ Restricted / non-residential standards with institutional controls
☐ Risk-based / site-specific cleanup objectives (attach basis)
☐ Tiered risk-based corrective action (e.g., ASTM E2081)
☐ Background concentrations (attach demonstration)

Governing state cleanup rule / technical guidance: [________________________________]

5.2 Conceptual Remedial Approach

Describe the proposed remedy by medium. Include selected technology, performance objectives, estimated duration, and monitoring.

Soil: [________________________________]

Groundwater: [________________________________]

Soil Vapor / Vapor Intrusion Mitigation: [________________________________]

Surface Water / Sediment: [________________________________]

Waste Disposition / Off-Site Transport: [________________________________]

5.3 Institutional and Engineering Controls

☐ Deed restriction / environmental covenant (e.g., UECA-based instrument)
☐ Activity and Use Limitations (AULs)
☐ Cap / cover system
☐ Vapor barrier or sub-slab depressurization system
☐ Groundwater use restriction / municipal water connection
☐ Fencing / access controls
☐ Long-term stewardship and monitoring plan

5.4 Schedule and Milestones

5.5 Financial Assurance

☐ Not required under program
☐ Performance bond — $[________________________________]
☐ Letter of credit — $[________________________________]
☐ Trust fund — $[________________________________]
☐ Self-guarantee (if financial test met)
☐ Insurance (pollution legal liability) — carrier: [________________________________]

5.6 Community Involvement / Public Notice

☐ Applicant will comply with state public notice requirements (newspaper, site posting, mailing list)
☐ Environmental justice outreach plan attached (if site in EJ-screened community)
☐ Tribal consultation (if applicable) — contact: [________________________________]

6. COVENANT NOT TO SUE / LIABILITY RELIEF REQUEST

The Applicant respectfully requests that, upon satisfactory completion of the remedial work approved by the Agency and issuance of a No Further Action determination, the Agency (and the State on its behalf) enter into a Covenant Not to Sue in favor of the Applicant, its successors, assigns, lenders, and future owners and operators of the Site.

6.1 Scope of Requested Covenant

The requested covenant shall provide that the State will not bring any civil action against the covered parties for:

☐ Recovery of response costs
☐ Injunctive relief compelling further response action
☐ Natural resource damages (to the extent authorized under the governing statute)
☐ Contribution claims based on the pre-existing release(s) addressed by the approved remedy

Covered Parties (proposed):

• The Applicant;
• Successors in interest to the Site, including any future owner, tenant, or lender;
• Officers, directors, employees, agents, and affiliates of the foregoing acting in such capacity;
• Any development or financing entity providing capital to the project.

6.2 Customary Reservations (acknowledged by Applicant)

The Applicant acknowledges that the Covenant Not to Sue typically reserves the State's rights for:

• New releases or new contamination first occurring after the certificate date;
• Contamination not known or reasonably discoverable at the time of the No Further Action determination;
• Fraud, misrepresentation, or failure to disclose material information during the VCP process;
• Failure to comply with institutional or engineering controls;
• Imminent and substantial endangerment;
• Federal claims by EPA or other federal trustees not within the State's authority to release.

6.3 Contribution Protection

The Applicant additionally requests that the Agency's No Further Action determination be accompanied by the contribution protection afforded by 42 U.S.C. § 9622(f)(2) and the analogous provision of the governing state statute, barring contribution claims by third parties for matters addressed by the approved remedy.

6.4 Transferability

The Applicant requests that the Covenant Not to Sue expressly run with the land and inure to the benefit of the Applicant's successors and assigns, consistent with 42 U.S.C. § 9628 and the governing state program.

7. REQUIRED ATTACHMENTS

☐ Legal description and recorded deed(s) for the Site
☐ Current title report or commitment (within 90 days)
☐ Site map / survey showing boundaries, buildings, utilities, and known release areas
☐ USGS topographic map (1:24,000) with Site located
☐ Phase I ESA (ASTM E1527-21 compliant) and any Phase II / supplemental reports
☐ Historical aerial photographs / Sanborn maps (if available)
☐ Proof of applicant's right to enter and conduct work at the Site (deed, lease, access agreement)
☐ Corporate good standing certificate and authority resolution
☐ Application fee payment (check, wire, or agency payment portal confirmation)
☐ Public participation / community notification plan
☐ Environmental Professional qualifications (CV / PE / PG license)
☐ Signed Voluntary Cleanup Agreement (if pre-negotiated) or request to enter negotiation

8. CERTIFICATIONS

8.1 Applicant Certification

I certify under penalty of perjury under the laws of the State of [____] that:

1. I am authorized to submit this application on behalf of the Applicant;
2. The information in this application and its attachments is true, accurate, and complete to the best of my knowledge and belief after reasonable inquiry;
3. The Applicant has disclosed all material information regarding releases of hazardous substances, petroleum, or other regulated constituents at the Site of which the Applicant has actual or constructive knowledge;
4. The Applicant is not currently subject to any outstanding federal or state enforcement order addressing the same release(s);
5. The Applicant will comply with all applicable program requirements, including payment of agency oversight costs.

Applicant Signature: [________________________________]

Printed Name: [________________________________]

Title: [________________________________]

Date: [__/__/____]

8.2 Environmental Professional Certification

I certify that I am a qualified Environmental Professional as defined in 40 C.F.R. § 312.10 and meet the qualification requirements of the governing state program, and that the technical information submitted with this application was prepared by me or under my direct supervision.

EP Signature: [________________________________]

Printed Name / License No.: [________________________________]

Firm: [________________________________]

Date: [__/__/____]

9. AGENCY USE ONLY

SOURCES AND REFERENCES

• CERCLA § 128, State Response Programs, 42 U.S.C. § 9628 — https://www.govinfo.gov/app/details/USCODE-2024-title42/USCODE-2024-title42-chap103-subchapI-sec9628
• CERCLA § 122, Settlements (covenants not to sue), 42 U.S.C. § 9622 — https://www.govinfo.gov/app/details/USCODE-2024-title42/USCODE-2024-title42-chap103-subchapI-sec9622
• EPA, Brownfields and Land Revitalization — https://www.epa.gov/brownfields
• EPA, State and Tribal Response Programs (CERCLA § 128(a)) — https://www.epa.gov/brownfields/state-and-tribal-response-programs
• 40 C.F.R. Part 312 (All Appropriate Inquiries rule; Environmental Professional definition) — https://www.ecfr.gov/current/title-40/chapter-I/subchapter-J/part-312
• ASTM E1527-21, Standard Practice for Phase I Environmental Site Assessments
• Uniform Environmental Covenants Act (UECA) — https://www.uniformlaws.org/committees/community-home?CommunityKey=6bab58e4-0f30-4e54-9c6c-4f6d1050eac2
• State agency program pages (confirm current URL for the governing jurisdiction):
• California DTSC Voluntary Cleanup Program
• Texas TCEQ Voluntary Cleanup Program
• Florida DEP Brownfields and VCP
• New York DEC Brownfield Cleanup Program
• Connecticut DEEP Brownfield Liability Relief Programs
• Illinois EPA Site Remediation Program
• Ohio EPA Voluntary Action Program

DISCLAIMER: This template is a general framework for a state Voluntary Cleanup Program application and does not substitute for the controlling state agency form, fee schedule, or technical guidance. Specific eligibility criteria, cleanup standards, covenant scope, and reservation language vary materially by state and by program track. Engage qualified environmental counsel and a licensed Environmental Professional in the governing jurisdiction before submitting.