Bwcs126, Miscellaneous Document Transmittal Form Page 2
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4Massachusetts Department of Environmental Protection
BWSC126
Bureau of Waste Site Cleanup
Release Tracking Number
Miscellaneous Document Transmittal Form
B. THIS FORM IS BEING USED TO (cont.): (check all that apply)
5. Submit Public Involvement Petition documents. (check all that apply). (Section C is not required).
a.
Submit a Public Involvement Petition
b.
Submit a Public Involvement Petition Retraction
c.
Submit a Positive Public Involvement Petition Designation Letter
d.
Submit a Negative Public Involvement Designation Letter
e.
Submit a Draft Public Involvement Petition Plan
f.
Submit a Revised Public Involvement Petition Plan
g.
Submit a Final Public Involvement Petition Plan
h.
Submit a Notice of Public Comment Period
Date of Close of Comment Period :
(mm/dd/yyyy)
i.
Submit a copy of a Public Involvement Petition legal notice
j.
Submit a Notice of Public Meeting
Meeting Date:_________________________
(mm/dd/yyyy)
k.
Submit other Public Involvement Petition related documents not specified above:
Describe:
6.
Submit a RCRA Contained-In-Determination to document that soil and/or groundwater is no longer considered a
hazardous waste pursuant to state (310 CMR 30.00) and federal (Title 40, Chapter I, Part 261 of the Code of
Federal Regulations) hazardous waste regulations.
7.
Submit notification and documentation of Reclamation Soil Reuse pursuant to 310 CMR 40.0031(2).
C. LSP SIGNATURE:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form,
including any and all documents accompanying this submittal. I am aware that significant penalties may result, including, but
not limited to, possible fines and imprisonment, if I submit information which I know to be false, inaccurate or materially
incomplete.
1. LSP #:
3. Last Name:
2. First Name:
3. Last Name:
4. Telephone:
5. Ext.
6. Email:
7. Signature:
8. Date:
(mm/dd/yyyy)
Page 2 of 4
Revised: 09/17/2013
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