Memorandum TO: Carrie L. Kruchell, P.G., Environmental Manager, Brownfields & CERCLA Administration, Through: <Name>, <Title> <Section>, <District (as applicable)> FROM: <Name>, <Title> <Section>, <District (as applicable)> SUBJECT: CERCLA Site Screening Request <Site Name> <Site Address> <Site City>, <Site County> <Parcel ID #> COMET Site ID#: <COM_> <Other Site ID #s:> <OGC #> DATE: <Date> <Include a brief description of the site and attach figures depicting the contamination, release, or suspected release at the site, if available>. The site is being referred to CERCLA Site Screening (CSS) for the following reason(s). <Check applicable boxes> Reasons: Site Conditions: No viable potential responsible party Monitoring well(s) contaminated ☐ ☐ (PRP) ☐ Soil contamination exists School/Day Care nearby ☐ PRP not responsive ☐ ☐ Citizen complaint ☐ Surface water nearby Municipal well(s) contaminated ☐ ☐ Release/suspected release Drums or tanks or other containers exist ☐ ☐ List contaminants of concern if known: Existing file data too old for enforcement ☐ PRP Information (if known): PRP Name:
Memorandum TO: Carrie L. Kruchell, P.G., Environmental Manager, Brownfields & CERCLA Administration, Through: <Name>, <Title> <Section>, <District (as applicable)> FROM: <Name>, <Title> <Section>, <District (as applicable)> SUBJECT: CERCLA Site Screening Request <Site Name> <Site Address> <Site City>, <Site County> <Parcel ID #> COMET Site ID#: <COM_> <Other Site ID #s:> <OGC #> DATE: <Date> <Include a brief description of the site and attach figures depicting the contamination, release, or suspected release at the site, if available>. The site is being referred to CERCLA Site Screening (CSS) for the following reason(s). <Check applicable boxes> Reasons: Site Conditions: ☐ No viable potential responsible party (PRP) ☐ Monitoring well(s) contaminated ☐ Soil contamination exists ☐ PRP not responsive ☐ School/Day Care nearby ☐ Citizen complaint ☐ Surface water nearby ☐ Municipal well(s) contaminated ☐ Release/suspected release ☐ Drums or tanks or other containers exist ☐ List contaminants of concern if known: ☐ Existing file data too old for enforcement PRP Information (if known): PRP Name:
CERCLA_Site_Screening_Request_Memo_04Oct18.docx