OKLAHOMA CORPORATION COMMISSION
PETROLEUM STORAGE TANK DIVISION
Remediation Corrective Action Plan Proposal
PSTD Reviewer ___________________________ Approve [ ] Deny [ ] Date ________________
1.
CASE NUMBER
FACILITY NUMBER
2.
Submitted to (PSTD P.E.A.):
To Fulfill Purchase Order:
remediation method has been agreed to for this site and is being detailed in this report.
The data requested in the following sections will be used to evaluate the proposed soil and/or ground water
remediation technique(s). This proposal is to be submitted after the Remediation Selection Proposal has been
approved and after site clean-up levels have been approved.
3.
4.
5.
Facility Name:
Contact Person:
Street Address:
City:
, Phone #:
, County:
Owner/Operator:
Contact Person:
Street Address:
City:
, Phone #:
, State:
Zip Code:
Remediation Consultant’s Signature
___________________________ Date ____________
PSTD License Number:
Expiration Date:
Remediation Consultant and Firm
Phone Numbers: Voice:
Fax:
Pager/Cell:
E-Mail Address:
Consulting Firm Principal Signature________________________________
6.
Have there been any changes since the ORBCA Report was completed? If yes please describe.
7.
Is the risk assessment data based on a Tier 1a or a modified Tier II? List the approved Risk-Based clean up
levels in the table below.
ON SITE
Benzene:
Ethylbenzene:
Toluene:
Xylenes:
Naphthalene:
Soil
/ Groundwater
OFF SITE
/
/
/
/
/
Benzene:
Ethylbenzene:
Toluene:
Xylenes:
Naphthalene:
ppm
ppm
ppm
ppm
ppm
8.
Have all the receptors been identified? Yes
9.
List all potential upgradient sources.
No
Soil
/ Groundwater
/
/
/
/
/
ppm
ppm
ppm
ppm
ppm
If no please list.
1
Remediation Plan Proposal
Revised September 2006
10.
Will the implementation of the corrective action plan effect any of the receptors in any way, if yes please explain.
11.
Describe requirements and schedule for the remediation system operation and maintenance, system sampling
and ground water sampling. Provide a list of proposed “Key Monitoring Wells,” “Key Free Product Monitoring Wells” and
compliance monitoring wells.
12.
Fill out the information on the Remediation Technology Fact Sheet. Please enter all applicable data for the
proposed scope of work in order for the price estimate to be as precise as possible.
13.
Attach a copy of the OCC ORBCA clean-up level approval letter.
14.
Attachments
A. Provide a scaled base map with all site structures, surface conditions, all utilities, all wells and all soil boring
locations.
B. Provide contoured benzene and TPH data for both soil and groundwater plumes and free product thickness, if
present, on separate scaled facility maps with the most recent data. Provide contoured concentration maps
for all chemicals of concern. If there are different clean-up levels for on- and off-site be sure to differentiate
those areas on this map.
C. If not already submitted, provide 3-dimensional smear-zone analysis interpretation.
D. Provide a facility map showing the proposed remediation equipment location, system layout. This map is to
include, but is not limited to all connection piping; all system well bore locations, excavations and monitoring
wells. Place the groundwater benzene cleanup (i.e. SSTL) contour(s) and areas with free product on this
map.
E. Provide a stratigraphic cross-section(s) showing representative monitoring well, injection (sparge),
extraction (SVE), recovery well bores, etc.; construction for the proposed remediation system, any former or
proposed excavations, the most recent potentiometric surface data, free product thickness and the known
smear zone interval.
F. Provide a detailed cost summary of the remediation system design, installation, operation and maintenance
of approved technology (ies), and remediation system decommissioning. Note: The Advisory Council has
approved design costs that are to be calculated by multiplying the sum of the remediation system
installation price plus its operation and maintenance price by 3.0%. The total design cost has a cap of
$20,000.00. Design cost is to be deducted from system installation cost.
2
Remediation Plan Proposal
Revised September 2006