Notification to MassDEP of a release or threat of release of Oil and/or Hazardous Material is required under the regulations established by the Massachusetts Contingency Plan (MCP) at 310 CMR 40.0300.
The Release Notification & Notification Retraction Form for 120 Day reporting is for use by a person who wants to:
- Provide DEP with written notification of a release or threat of release of Oil, Hazardous Material for a 120 day release when an RTN has NOT been previously assigned.
When you first click on a BWSC form a "Pre Form" will appear on your screen:
- Enter the Regional Number of the location of the release: 1=Western Regional Office, 2=Central Regional Office, 3=Northeast Regional Office, and 4=Southeast Regional Office
- If necessary, find Your Regional Office
- Press Search to proceed to the next step.
- From the drop down list, select the Town of the Release which requires notification within 120 Days
- Press Next to proceed with filling out the form.
Instructions for Filling out BWSC103, the Release Notification and Retraction Form, for 120 Day Reporting Instructions:
Section A: Release or Threat of Release Location
A.1. Release Name/Location Aid
Enter a descriptive name of the release location. For many release locations the name of the company or organization located at the site is appropriate, e.g. Smith Oil Company, or the Smithville DPW yard. For Residential locations, the last name of the owner is appropriate, e.g., Smith Residence or Smith Property. Roadside spills and other release locations not specified above can use geographical descriptions as Release Names, e.g., the corner of Smith and Main St., or Vacant Lot at 2 Main St.
A.2. Street Address
Enter the Street Address that of the property where the release is location.
The City/Town will auto fill from the Pre Form, you can't edit the city/town without starting a new form.
A.4 .Zip Code
Enter a Zip Code.
A5. Coordinates: Latitude/Longitude Coordinates are required to be submitted with a Release Notification as per 310 CMR 40.0371. See Using GIS Location Finder for information how to use the "Identify Location of Release" button, or alternatively to enter them by hand.
Section B: Use of Form Section for BWSC103120Day (for 120 Day Reporting only)
Note that in most cases when a box on the Use of Form section is checked the system will require a supporting document or attachment See Managing WSC Attachments
for additional information about WSC supporting documents.
B.1 When submitting a BWSC103120Day, This box will auto check and can't be edited. (Note that currently there is no supporting documentation required if this box is checked. If you would like to attach optional descriptive information, then check the box in C8.)
B.2.This box is blocked from entry. Use a BWSC103 if submitting a Revised Release Notification.
B.3. This box is blocked from entry. Use a BWSC103 if submitting a Retraction of a Previously Reported Notification.
Section C: Release or Threat of Release Description:
C.1. The Oral Notification Date and Time section is blocked from entry since they are not applicable to the BWSC103120Day.
C.2. Enter the "Knowledge of the Release" Date and Time
- Indicate the date and time when the person or organization reporting the release or threat of release obtained knowledge of the event, which may differ from the date when the release or threat of release occurred.
C.3. Enter the Date and Time of the Release, if known.
Check at least one notification thresholds listed under C.6.that describe the release or threat of release. At least one such option must be selected.
C.4. The Two Hour Notification section is blocked from entry and not applicable for BWSC120Day.
C.5. The 72 Hour Notification section is blocked from entry and not applicable for BWSC120Day.
C.6. 120 Day Notification: See the MCP at 310 CMR 40.0315 for an explanation of each option.
C.7. Provide the following information about each type of Oil and/or Hazardous Material released or posing a threat of release:
- Record the three most plentiful types of oil or hazardous material released or posing a threat of release, listing the largest quantity or concentration first.
- Record the Chemical Abstracts Service (CAS) number for each Hazardous Material listed, if known. Most Oils do not have CAS numbers.
- Indicate whether each substance is an Oil (O) or a Hazardous Material (HM), as defined by the MCP.
- Record the quantity or concentration reported and the applicable units (e. g., 100 gallons, 50 ppm). Be sure to use the proper type of units. For example, use gallons or pounds for reportable quantities for sudden releases, "ppmv" for headspace screening measurements, "mg/kg" for soil measurements and "mg/l" for groundwater data.
- If the report concerns a Reportable Concentration (RC), specify which Reportable Concentration applies (i.e., RCS-1, RCS-2, RCGW-1, RCGW-2). If an RC is not applicable, select N/A. NOTE: This information is required when reporting any 120 Day reporting condition.
C.8. Check this box if you need to report additional types of Oil and Hazardous Materials released or posing a threat of release. Provide the same information as listed above. In addition, check this box if you would like to attach optional descriptive information relating to this Release Notification.
- Supporting Documentation Required if this box is checked.
Section D: Person Required to Notify
In this section provide information about the Person required to Notify, who must be a person described by the MCP at 310 CMR 40.0331, "Who Shall Notify":
Note that when submitting a BWSC120Day, D.1.a., D.1.b., D.1.c. are all blocked and unchecked.
D.2. Name of Organization: If an organization is reporting the release or threat of release or retracting a notification, record its name. (e. g., company, municipal department, public authority) Leave blank if not applicable (e. g., owner or occupant of residential property).
D.3., D.4. and D.6. Contact First Name, Last Name and Title
Individuals: If a person who is not associated with an organization is reporting a release or threat of release or retracting a notification, record his or her first and last name in this field. (e. g., owner or occupant of residential property)
Organizations: If an organization is reporting a release or threat of release or retracting a notification, provide the first and last name and title of a representative who has knowledge of the situation and whom DEP may contact for further information. The person listed must be the highest ranking individual having day-to-day responsibility for reporting a release or threat of release.
D.5. Street: Provide the street address of the individual named in D.3. and D.4. This location might differ from that of the release or threat of release (i.e., the site location).
D.7., D.8. and D.9. City/Town, State and Zip Code Provide the remainder of the mailing address for the individual named at D.3. and D4.
D.10., D.11. and D.12. Telephone, Ext. and Fax Number: State a telephone number, including area code and any extension, where DEP may reach the individual named at D.3. and D.4. If that person has access to a FAX machine, you may provide a FAX number. Note that the organization's telephone number, not the contact's number, will autofill here.
D.13. Check this box if you need to record additional names and addresses of owners affected by the release or threat of release, other than an owner who is submitting this Release Notification Form. Try to provide a complete mailing address and phone number, including area code, with each address.
- Supporting Documentation Required
Section E: Relationship of Person to Release or Threat of Release
Select the single response in Section E that best describes the relationship of the Person required to Notify, (who is named in Section D) to the release or threat of release. Do not provide information about an LSP or other individual who is preparing the form on behalf of or as an agent for the Person required to Notify. See the MCP at 310 CMR 40.0006 and 40.0331 and M. G. L. c. 21E for further definitions of terms used in this section of the form.
Section F: Certification of Person Required to Notify
F.1, F.2., and F.5.:
These fields are blocked from entry. Once the form is submitted the name of the person who electronically signs the certification (at the signature step of the process) will auto fill F.1. and F.2. and the date of signature will auto fill F.5. A Licensed Site Professional (LSP) should not sign his/her name as agent for Person required to Notify except if written authorization is obtained as per 310 CMR 40.0009.
F.3. Enter the Title of the Person required to Notify or the person signing on behalf of the Person required to Notify.
F.4. This field is auto filled from Section D.
F.6. (F.7. through F.13.) Check this box if the address of the person signing is different from the address in section D. Fill out the rest of the fields in this section as applicable.