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APPENDIX B TO PART 307-CLAIM FOR CERCLA RESPONSE ACTION

United States Environmental Protection Agency

Washington, DC 20460

Claim for CERCLA Response Action

Form Approved. OMB No. 2050-0106
Expiration Date 12-31-94

General Instructions: Complete all items in ink or by typewriter. If an item is not applicable to your claim, write "N/A" in the appropriate space. Attach typewriten sheets for additional information. Specific instructions are presented on page 3 of this form.

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E.

Address how each of the PDD terms and conditions were met (in the order that they appear in the PDD).
Provide documentation of such adherence in an appendix.

F Provide the name and address the location where all cost documentation and any other records relating to the claim will be maintained.

EPA Form 2075-4 (Rev 1-92)

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With the exception of contractual services provide detailed summaries of the components of each of the above cost categories Address how the costs incurred were required under the POD and reasonable allowable and allocable according to Federal cost principles Specify which of the Federal cost principles were used and explain the basis for that selection

C Provide a cost breakdown of all contractual services performed for this claim submission Explain how the incurred costs were required under the PDD and reasonable allowable and allocable according to Federal cost principles Specify which of the Federal cost principles were used and explain the basis for that selection

Certification

I certify that di information herein is true to the best of my knowledge. Lagree to supply additional information, as requested in support of this application and access to the site for purpose of inspection

Signature of Claimant

CERCLA Penalty for Presenting Fraudulent Claim

Any person who knowing, gives or causes to be given faise information as a part of a claurn against the Hazardous Substance Superfund may, upon conviction be fired in accordance with the applicable provisions of Title 18 of the United States Code or imprisoned for not more than 3 years for not more than 5 years in the case of a second or subsequent conviction) or both 12 USC 9612 (bH 1}}

Civil Penalty for Presenting Fraudulent Claim

The claimant is able to the United States for a civil penalty of $2.000 and an amount equal to two tries the amount of damages sustained by the Government because of the acts of that person including costs of the civil action

Criminal Penalty for Presenting Fraudulent Claim or Making False Statements Thela mant will be charged a maximum line of riot more than $10 000 or be imprisoned for a maximum of 5 years or both (See 62 Stat 698 749 18 USC 287 1001)

INSTRUCTIONS FOR SUBMITTING A CLAIM

FOR A CERCLA RESPONSE ACTION

This form is for claims against the Hazardous Substances Superfund as authorized by sections 111 (a)(2) and 112 of the Comprehensive Environmental Response. Compensation and Liability Act of 1980 (CERCLA). Claims can only be awarded for reasonable response costs incurred pursuant to a preauthorization decision document (PDD) issued by EPA. The regulatory procedures for obtaining preauthorization from EPA and for the submission and award of claims are found at 40 CFR Part 307

The public reporting burden for the completion of this form is estimated to vary between 25 and 59 hours averaging 42 hours per claim. These estimates include the time needed to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information Any comments concerning the burden estimate (including suggestions for reducing the burden) and any other aspect of this form should be sent to the following addresses:

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The claimant bears the burden for demonstrating that his response costs should be reimbursed. Consequently all claim submissions should be factually thorough, well-documented and based on sound analysis. Due to the complexity of the issues involved, it is in the claimant's best interest to organize the submission so that it can be easily read by EPA officials.

In many cases, the spaces provided on this form will be insufficient for a full presentation of the information solicited. In such circumstances, the claimant shall attach typewritten sheets and provide clear cross-references between the items on this form and the attachments.

A number of items will also require that the claimants provide appendices. In these appendices, the claimant shall supply sufficient documentation to support the statements presented in the form. Since it would be impractical and undesirable to include all supporting data, the appendices should usually consist of detailed summaries of the primary data. However, the onginal documents should be identified, catalogued and available for presentation, if requested As with the attachments, the claimant shall provide clear cross-references between this form and the appendices Claimants should consult 40 CFR Section 307 22 (g) to assert any claims of business confidentiality

When completed, this form should be sent to

US Environmental Protection Agency

401 M Street S W

Washington, DC 20460

Attention Director, Office of Emergency and Remedial Response (OS-220)

The sections below provide instructions for particular items on the claim form.

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Provide the name, title and address of the person(s) submitting this claim If the claim is submitted by a group of persons who have created a legal entity to act as claimant, information should be provided concerning the identity and location of both the entity and the constituent parties Provide the site name as it appears on the PDD

Supply the number and date of the PDD for this claim A copy of the PDD shall also be provided in an appendix If the claimant has been granted preauthorization to modify the PDD, these amendments must be described and copies provided.

"Agent" refers to any duly authorized agent, executor administrator or other legal representative of the claimant If this claim is submitted by such an agent he/she must present evidence of authority to so represent the claimant

Self-explanatory

Pursuant to 40 CFR Section 307 33(e), if 1) the first claim was denied by the responsible party or not responded to within 60 days, and 2) EPA agrees that there is no reason to believe that subsequent claims would be honored by such responsible party, the denial of the first claim, or lack of response, shall be considered a denial of every subsequent claim. The claimant may seek EPA's agreement at any time a claim is presented The claimant will be advised of EPA's agreement when the claimant is notified in writing regarding the award or denial of the claim

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B

Self-explanatory

Self-explanatory

This item is concerned with the actual response costs incurred during the time period represented by this claim submission - not the percentage of those response costs for which the claimant is seeking reimbursement Federal cost principles are presented in the following documents. OMB Circular A-87 (State and local governments and Federally recognized Indian Tribes). OMB Circular A-122 (non-profit organizations), 48 CFR 31 1. 31 2 (profit-making organizations). If the claim represents more than one stage of response activity, indicate this on the form and provide similar cost breakdown in an appendix These instructions are applicable to Item VC below

C Contractual services will vary depending on the response action performed and the operatie unit represented by the claim submission Typical categories of response activity include

Security

Groundwater sampling

Construction

Administrative Expenses

Materials

Operation & Maintenance

APPENDIX C TO PART 307-NOTICE OF

LIMITATIONS ON THE PAYMENT OF
CLAIMS FOR RESPONSE ACTIONS,
WHICH IS TO BE PLACED IN THE FED-
ERAL REGISTER PREAMBLE WHEN-
EVER SITES ARE ADDED TO THE
FINAL NPL

Limitations on the Payment of Claims for Response Actions

Sections 111(a)(2) and 122(b)(1) of CERCLA authorize the Fund to reimburse certain parties for necessary costs of performing a response action. As is described in more detail at 58 FR 5460, Jan. 21, 1993, 40 CFR part 307, there are two major limitations placed on the payment of claims for response actions. First, only private parties, certain potentially responsible parties (including States and political subdivisions), and certain foreign entities are eligible to file such claims. Second, all response actions under sections 111(a)(2) and 122(b)(1) must receive prior approval, or "preauthorization," from EPA. APPENDIX D TO PART 307-NOTICE OF LIMITATIONS ON THE PAYMENT OF CLAIMS FOR RESPONSE ACTIONS WHICH IS TO BE PLACED IN PUBLIC DOCKETS

Statutory Limitations on the Payment of Claims for Response Actions Filed Pursuant to Sections 111(a)(2) and 122(b)(1) of CERCLA

The Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as amended by the Superfund Amendments and Reauthorization Act of 1986 (SARA) (42 U.S.C. 9601 et seq.) authorizes a number of mechanisms for responding to a release, or threat of release, of hazardous substances or pollutants or contaminants. One of these mechanisms is response claims. Section 111(a)(2) of CERCLA authorizes the Environmental Protection Agency (EPA or the Agency) to compensate claimants for necessary response costs if certain conditions are met. Section 122(b)(1) of CERCLA authorizes EPA to reimburse certain potentially responsible parties for a portion of the costs of response actions conducted pursuant to a settlement agreement. These conditions are outlined below.

First, only private parties, parties to section 122(b)(1) agreements (including States and political subdivisions thereof) and foreign entities are eligible for payment through the response claims mechanism. Federal, State, and local government units, and Indian Tribes can receive funding for response activities through other authorities of section 111(a) or section 123 of CERCLA.

Second, eligible claimants can only be reimbursed for costs that are incurred in carrying out the National Contingency Plan (NCP), 40 CFR part 300. In order to be in conformity with the NCP, all claims must receive prior approval, or "preauthorization,” from EPA. This means that before response work is initiated, the party must:

(1) Notify EPA of its intent to file a claim; (2) Demonstrate that the release merits priority consideration;

(3) Propose activities to remedy the release that can be carried out consistent with the NCP; and

(4) Demonstrate the capabilities necessary to carry out such activities in a safe and effective manner.

In order for potentially responsible parties to be eligible for reimbursement they must conduct the response actions as specified in a Consent Decree or administrative order. Only if EPA preauthorizes a response action can the party begin work, and later file a claim for reimbursement of costs.

The limitations placed on the payment of claims for response actions and the procedures for filing such claims are described in more detail at 58 FR 5460, Jan. 21, 1993, 40 CFR part 307. Additional information can be obtained by contacting William O. Ross, Office of Emergency and Remedial Response (5203 G), Environmental Protection Agency, 401 M Street, SW., Washington, DC 20460, (703) 603-8798, or the RCRA/CERCLA Hotline, (800) 424-9346 (or (703) 920-9810 in the Washington, DC metropolitan area).

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APPENDIX I TO PART 310-EPA REGIONS AND

NRC TELEPHONE LINES

APPENDIX II TO PART 310-APPLICATION FOR REIMBURSEMENT TO LOCAL GOVERNMENTS FOR EMERGENCY RESPONSE TO HAZARDOUS SUBSTANCE RELEASES UNDER CERCLA SECTION 123

AUTHORITY: 42 U.S.C. 9611(c)(11), 9623.

SOURCE: 58 FR 4827, Jan. 15, 1993, unless otherwise noted.

Subpart A-General

$310.05 Purpose, scope, and applicability.

(a) Purpose. Through this part, the Environmental Protection Agency (EPA) is establishing the procedures for reimbursing local governments for temporary emergency measures to prevent or mitigate injury to human health or the environment, as authorized under section 123 of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as amended by the Superfund Amendments and Reauthorization Act of 1986 (SARA). This program is intended to alleviate significant financial burden on local governments for response to releases or threatened releases of hazardous substances or pollutants or contaminants and will not supplant local funds normally provided for response. Reimbursement does not apply to expenditures incurred in the course of providing what are traditionally local services and responsibilities, such as routine firefighting.

(b) Scope. Applications for reimbursement for temporary emergency measures may be submitted only through the procedures established in this part. Any general purpose unit of local government for a political subdivision may request reimbursement. States are not eligible for this program. Under this part, local governments may apply for reimbursement for temporary emergency measures performed subsequent to October 21, 1987. Reimbursement may be made for temporary emergency measures conducted during either Federal-lead or non-Federal-lead responses.

(c) Applicability. Reimbursement to local governments for temporary emergency measures may not exceed $25,000

per single response, nor may reimbursement supplant local funds normally provided for response. Because CERCLA specifies that no more than 0.1% of the amount appropriated from the Hazardous Substance Superfund (Superfund or the Fund) may be allocated to the reimbursement program for the five fiscal years beginning October 1, 1986, some requests may not ever be reimbursed even though they meet all requirements of this part.

8310.10 Abbreviations.

CERCLA-The Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (Pub. L. 96510, 42 U.S.C. 9601-75), as amended by the Superfund Amendments and Reauthorization Act of 1986, also known as Superfund.

EPA or the Agency-Environmental Protection Agency

NCP-National Oil and Hazardous Substances Pollution Contingency Plan also known as the National Contingency Plan.

OMB Office of Management Budget.

and

SARA-The Superfund Amendments and Reauthorization Act of 1986 (Pub. L. 99-499, 42 U.S.C. 9601). USCG-U.S. Coast Guard.

§310.11 Definitions.

For purposes of this part except when otherwise specified:

(a) Date of completion means the date when all field work has been completed and all deliverables (e.g., lab results, technical expert reports) have been received by the local government;

(b) Emergency Planning and Community Right-To-Know Act of 1986 means Title III-Emergency Planning and Community Right-To-Know Act of the Superfund Amendments and Reauthorization Act of 1986 (EPCRA) (Pub. L. 99-499, 42 U.S.C. 960);

(c) General purpose unit of local government means the governing body of a county, parish, municipality, city, town, township, Federally-recognized Indian tribe or similar governing body; (d) Hazardous substance, as defined by section 101(14) of CERCLA, means:

(1) Any substance designated pursuant to section 311(b)(2)(A) of the Federal Water Pollution Control Act;

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