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BWSC-101
SU
27309
A. LOG INFORMATION:
Log Date:
12/07/2007
Log Time:
11:25
El
Q-Inquiry
Complaint
Check one:
AM PM
Boston
SAmene
Telephone
(508)
Organization:
Oh
eporting Threshold
Use of Form:
(check one)
SInitial Office
O1
Boothby
881-2323
Ext.:
Referred To:
No Action Taken
Site Visit
Pond Street
City/Town:
Location Aid:
Ashland
SFederal
El
Pole #23
El
Commercial
[]
Right of Way
Roadway
Industrial
Water Body
Fee Status:
Residential
El
Open Space
School
IT
Municipall
State
Other:
Date and time reporting person obtained knowledge of the Release or TOR.
IF KNOWN, record date and time Release orTOR occurred. Date:
12/07/2007
12/07/2007
Time
11:00
AM
EPM
Time
10:30
RAM
IPM
U Sudden Release
Subsurface NAPL
UST
El Vehicle
Unknown
El Unknown
Federal LUST Eligible? f] Yes jI No
[
Tanker Truck
SSECTION
Revised 7/17/2001
Cubic Yards
L ST Release
Pipe/Hose/Line
Other
AST
= or >
Drums
Transformer
Boat
n/a
n/a
Page 1 of 2
BWSC-101
2no
El
Fire
] Test Failure
Vehicle Accident
Spill
Leak
] Wetlands
Storm Drain
El
Other
F]
Unknown
Groundwater]
Dumping
]
Other
Specify:
Surface Water
Sediments
El
Private Well
Overfill
Tank Removal
Zone 2
Soil
]
Residence
Specify:
(check one)
[] Air
Paved Surface
] Unknown
School
O or HM Released
Threat Only
MD0 F1 HM
________ElOfHM
Amount or Conc.
Units
Gallons
RCs Exceeded?
____
Lt. Boothby reported a car collided with Pole #23 along Pond Street in Ashland. He
Cuc the sotl
inudcacea LlaL uhe accidenu caused Vie capacJlor bank cu Teak Jon-tCb vOu
shoulder of the referenced site. He stated that very little MODF had leaked to the
PRP Lamontagne
soil. He indicated that less than four gallons was on the ground.
1
*1,
p t),rln
rArprt
c.o-A
-h4
P~ .c A r'lc
Unrl,
nrc 'a
r
rr,,
t-lc
SPRP Unknown
SPRP
Street:
Eric
Other Person
Who:
Title:
Lamontagne
NE250
Westwood
Telephone: (339)
DEP
and Gas
NSTAR Electric
City/Town:
Ext.:
987-7018
ZIP Code:
MA
02090
FAX:
E. CONTRACTOR:
Contractor Name:
Name of Contact:
F. LSP:
LSP Name:
Telephone
Clean Harbors
Telephone
Inc
645-82Ext.:
Paul Hogan
Dan Watton
Dan Watton
(339)
(800)
LSP Number:
Ext.:
987-7024
61
6016
FAX:
El
El
E]
IRAPre-notification
. notification.
H. DEP ASSIGNMENT:
RNF Submittal Requested:
El
s
Yes
Kenneth Sanderson
No
From Who:
No
Why Not:
Regional Use:
Number of RLFA Pages Attached:
El
Do Not Alter This Form
SCANNED
BWSC-101
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
RELEA E LOGFORMRelease Tracking Number
RELEASE LOG FORM
2n
A. LOG INFORMATION:
Log Date:
12/07/2007
Log Time:
11:25
Check one:
AM
__
5
]
O
Use of Form:
(checkone)
Initial Office
SBoston
Select
onepreviously
of the twoassigned:
following o
RTN was
(508)
ions only if a
Citizen
Not a 21 E Release
Anonymous
LSP or PRP Agent
Sn(not
Organization:
Organi
12
Other Person:
SAmended
Telephone
Inquiry
Complaint
PM
Boothby
881-2323
Ext.:
Referred To:
No Action Taken
___
eion
Site Visit
un
mev
0ComplianceSiteVisit
Pond Street
City/Town:
Ashland
TypeofLocation(checkallthatapply):
Federal
Right of Way
[]
Commercial
Roadway
E]
]
Fee Status:
Industrial
Residential
Water Body
Open Space
School
MunicipalO State
Other.
Date and time reporting person obtained knowledge of the Release or TOR.
12/07/2007
12/07/2007
Time
11:00
9AM
Time
10:30
[AM
PM
5PM
1]
Sudden Release
F1
F
5
Vehicle
Yes
cf
]
No
UST
Unknown
Unknown
Specify:
AST
Drums
Transformer
Boat
Capacitor Bank
IubnsurfaceNAPL=or>/8nchand<2
Pipe/Hose/Line
Other
Sewer
Release
Sanitary
(Imminent Hazard Only)
Release
Release
Tanker Truck
n/a
n/a
Page 1 of 2
BWSC-101
2730
SVehicle
Accident
E]
Leak
El
Test Failure
Spill
Fire
Storm Drain
Air []
Tank Removal
Dumping
Unknown
Groundwater [
Other
Overfill
Soil
Specify:
Surface Water
Sediments
Zone2
Residence
Specify:
(check one)
Rupture
E] Private Well
Paved Surface
Other
Unknown
School
O or HM Released
E]
Threat Only
(continued)
HM
Amount or Conc.
Units
RCs Exceeded?
Gallons
HM
Lt. Boothby reported a car collided with Pole #23 along Pond Street in Ashland. He
.indcateI
Lida
cue accipuent caused che capacitor dauk17 LO
eak
Con-tu n IMouT
Lo Le
so.i.l
shoulder of the referenced site. He stated that very little MODF had leaked to the
soil. He indicated that less than four gallons was on the ground. PRP Lamontagne
the capacitor bank.
Lt Boothby stated that utilities and the roadway were not impacted.
D. PRP INFORMATION:
PRP Unknown
SPRP
Eric Lamontagne
987-7018
E. CONTRACTOR:
CONTRACT:
Contractor Name:
Who:
Title:
Ext.:
02090
FAX:
(800) 645-8265
Telephone
Paul Hogan
Dan Watton
LSP Number:
(339)
Ext.:
987-7024
Ext.:
LSP Name:
Telephone
Other Person
State: MA
Telephone: (339)
F. LSP:
DEP
El
NE250
Westwood
Name of Contact:
E]
and Gas
NSTAR Electric
CityfTown:
El
6016
FAX:
IRA Pre-notification
odor to
notification.
H. DEP ASSIGNMENT:
RNF Submittal Requested:
0,Yes
Prepared By:
Yes
[2 No
[]
Kenneth Sanderson
No
From Who:
Why Not:
Regional Use:
Number of RLFA Pages Attached:
E
Do Not Alter This Form