Contaminated Media Transport and Treatment or Disposal Approval Form

The Alaska Department of Environmental Conservation (DEC) must approve the movement or disposal of contaminated soil and water from a site in accordance with 18 Alaska Administrative Code (AAC) 75.325(i), 18 AAC 75.370(b), and 18 AAC 78.274(b). The Contaminated Media Transport and Treatment or Disposal Approval Form should be used to document this approval. Soil treatment facilities regulated under 18 AAC 75.365 are required by their Operations Plans to only accept contaminated soil for which an approval form has been signed by a DEC project manager.

Site information can be found on the Contaminated Site Database or the Spills Database.

Instructions to Complete:

Hazard ID # or Spill ID #: For a contaminated site, the Hazard ID can be found on the Contaminated Sites Database. For a spill, the Spill ID can be found in the subject line of letters from DEC or the Spills Database. If the waste originates from multiple sites, all Hazard IDs or Spill IDs must be listed.
Name of Contaminated Site or Spill: For a contaminated site, the official site name can be found on the Contaminated Sites Database. For a spill, the official name of the spill is found in the subject line of letters from DEC or the Spills Database.
Contaminated Site or Spill Location – Address or Other Appropriate Description: This address or description captures the origin of the contaminated media or the location of the spill. For a contaminated site, the address or other appropriate description can be found on the Contaminated Sites Database. For a spill, this can be found on the Spill Report or the Spills Database.
Current Physical Location of the Media: Provide the physical location where the contaminated media (soil, water, etc.) is currently stored. This location may be the same as location provided in the “Contaminated Site or Spill Location”, or it could be a hazardous waste facility or other location/staging area agreed upon in the DEC-approved work plan.
Source of Contamination (Day Tank, Fire Training Pit, LUST, etc.): List all sources which contributed to the contamination in the media being transported. Sources can include previous releases that have comingled. If the source is unknown, state “Unknown”.
Contaminants of Concern (CoCs): List all contaminants detected above the most stringent Method 2 Tables B1 and B2 soil cleanup levels in 18 AAC 75.341(c) and (d), the Table C groundwater cleanup levels in 18 AAC 75.345, and other applicable action levels (e.g., TCLP results). Attach the laboratory data package for the contaminated media that is being disposed of and, if applicable, a data summary table or narrative to this form. Data gathered during site characterization activities may be sufficient to determine the CoCs. There are situations in which generator knowledge of the contaminant source may be accepted by a treatment or disposal facility in lieu of analytical sample results, such as, diesel-impacted media from a heating oil tank. If you are using generator knowledge in lieu of analytical sample results, include a statement which documents this knowledge in the Comments section.
Estimated Volume: Include the total volume of contaminated media to be transported; for instance, “Nine 55-gallon drums” or ‘”25 cubic yards of soil.”
Date(s) Generated: Provide the date the media was generated (e.g., excavated, pumped out of the ground, etc.). If the media was generated over multiple days, list the range of dates.
Post Treatment Analysis Required (such as GRO, DRO, RRO, VOCs, PAHs, metals, PFAS, chlorinated solvents, etc.): Provide the list of all contaminants that exceed the most stringent Method 2 cleanup levels. For DEC-approved soil treatment facilities in Alaska, specific post treatment analyses will be determined by the facility based upon the contaminants and requirements of their Operations Plan. If the media are being transported to a landfill or permitted liquid waste facility without off-site treatment, include “Not Applicable”.
Comments or Other Important Information: Provide any other information which needs to be conveyed.
If generator knowledge of the CoCs is being used in lieu of sample analytical results, an explanation needs to be provided in this field.
If the material is going to be placed in a landfill in Alaska, include a statement that the landfill has agreed to accept the material and provide the contact information for the landfill point of contact. If the material is going to be placed in a Class 2 or 3 landfill, attach the DEC Solid Waste Program’s approval letter to this form.
If the media is going to an intermediate location or facility prior to its final destination, describe the complete transportation route with intermediate locations in this field.
Treatment Facility, Landfill, and/or Final Destination of Media: Include the name of the facility, landfill, or the final destination of the media. A list of DEC-approved Alaskan soil treatment facilities is available at www.dec.alaska.gov/spar/csp/offsite-remediation. If multiple treatment facilities will be used, use separate forms to document what media will go to which facility. For material that will go to a waste transfer facility prior to disposal at another facility, the final destination should be listed.
Physical Address/Phone Number: Provide the physical location and telephone number of the facility, landfill, or the final destination of the media.
Responsible Party: Provide the name of the party responsible for the contaminated site or spill.
Address/Phone Number: Provide the mailing address and telephone number of the responsible party.
Waste Management Co./Organizer: Provide the name of company or person shipping and/or organizing the shipment of the media.
Address/Phone Number: Provide the mailing address and telephone number of the waste management company or organizer.

Submit this completed form along with all necessary attachments to the assigned DEC project manager for approval, or contact the Contaminated Sites Program at (907) 269-7558 or the Prevention, Preparedness and Response Program at (907) 269-7557.

Download the Form

Download the fillable PDF here: Contaminated Media Transport and Treatment or Disposal Approval Form