Fillable Massachusetts Department of Environmental Protection - BWSC125 Notification of a Non-eDEP Electronic Submittal

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Massachusetts Department of Environmental Protection - BWSC125 Notification of a Non-eDEP Electronic Submittal

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The Massachusetts Department of Environmental Protection - BWSC125 Notification of a Non-eDEP Electronic Submittal form is 2 pages long and contains:

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BWSC125
Release Tracking Number
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
NOTIFICATION OF A NON-EDEP ELECTRONIC SUBMITTAL
Page 1of 2
Pursuant to 310 CMR 40.0015 (7) and 310 CMR 40.0009
1. Fill out Transmittal Form specified in Section C in eDEP, error check, and print completed form on paper.
D. NON-EDEP ELECTRONIC SUBMITTAL CHECKLIST:
2. Have Person Making Submittal sign the Transmittal Form specified in Section C in ink; LSP sign in ink.
3. Scan completed signed form, and put on CD with all required supporting documentation. Submittal does not meet the
requirements of 310 CMR 40.0015(7) unless the complete package is on the CD.
4. Submit this completed BWSC125 Notification of Non-eDEP Electronic Submittal Form, the original signed Transmittal Form
and a CD containing a scanned copy of the transmittal form and all required supporting documentation. The CD and attached
documents must be submitted to the regional office either by hand, or by regular or certified mail, before applicable deadline.
4. ZIP Code:
3. City/Town:
2. Street Address:
1. Site Name:
A. SITE LOCATION:
B. THIS FORM IS BEING USED TO:
b. Due to an eDEP problem, I was unable to make an eDEP submittal for this transaction. ( Attach email from
BWSC.eDEP@state.ma.us)
1. Make a BWSC non-eDEP Electronic Submittal (check one and fill out Sections C, D, F, and G):
a. The Person Making the Submittal does not have internet access, and/or will not authorize anyone that has internet access to
sign electronically on their behalf. (Section F must be signed by the Person Making the Submittal)
Describe Problem:
2. Submit supporting Documentation on CD (check one and fill out Sections C, E, and G):
b. I was unable to upload the supporting documentation. The supporting documentation is less than 30 mb. ( Attach email
from BWSC.eDEP @state.ma.us.)
a. I did not upload the supporting documentation for the submittal made in eDEP. The supporting documentation is greater
than 30 mb.
Describe Problem:
C. BWSC TRANSMITTAL FORM SUBMITTED:
(check one)
3. BWSC104 Permanent or Temporary Solution Statement
4. BWSC105 Immediate Response Action Transmittal Form
5. BWSC106 Release Abatement Measure Transmittal Form
6. BWSC107 Tier Classification Transmittal Form
7. BWSC108 CRA Transmittal Form & Phase I CS
1. BWSC50 Application for Special Project Designation
2. BWSC103 Release Notification and Retraction Form
11. BWSC115 Downgradient Property Status Form
Transmittal Form
8. BWSC111 Audit Plan & Post Audit Completion
Statement
10. BWSC113 Activity and Use Limitation(AUL) Form
12. BWSC119 URAM Transmittal Form
13. BWSC120 Homeowner Certification Transmittal Form
14. BWSC121 Notif. of Delay in Response Deadlines
Revised: 6/18/2014
9. BWSC112 Bill of Lading
BWSC125
Release Tracking Number
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
NOTIFICATION OF A NON-EDEP ELECTRONIC SUBMITTAL
Page 2of 2
Pursuant to 310 CMR 40.0015 (7) and 310 CMR 40.0009
Revised: 6/18/2014
-
3. Title:
2. Last Name:
1. First Name:
G. SIGNATURE OF LSP OR AUTHORIZED AGENT OF LSP:
5. Signature:
F. SIGNATURE OF PERSON MAKING SUBMITTAL :
(required if B1 is checked)
4. Date:
(mm/dd/yyyy)
1. First Name:
2. Last Name:
3. Title:
4. Date:
5. Signature:
2. Submit CD to applicable regional office with this completed BWSC125 Notification of Non-eDEP Electronic Submittal Form
along with a printed receipt of the eDEP Transaction. The CD and attached documents must be postmarked or delivered by
hand the next business day.
E. SUPPORTING DOCUMENTATION ON CD CHECKLIST:
3. Specify eDEP Transaction ID:
Date Stamp (DEP USE ONLY:)
1. Complete and Submit in eDEP, Transmittal Form specified in Section C.
(mm/dd/yyyy)
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Massachusetts Department of Environmental Protection - BWSC125 Notification of a Non-eDEP Electronic Submittal

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Completed 20 May 2020

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