Ill. Admin. Code tit. 35, § 742.APPENDIX D
1. The recitals set forth above are incorporated by reference as if fully set forth herein.
| 2. | [Use this paragraph if IEMA has issued an incident number] The Illinois | ||
| Emergency Management Agency has assigned incident number(s) | to the | ||
| Release(s). |
| 3. | Attached as Exhibit A is a scaled map(s) prepared by | [the Owner/Operator | |||
| or Property Owner] | that shows the Site and surrounding area and | ||||
| delineates the current and estimated future extent of soil and groundwater contamination above the applicable Tier 1 residential remediation objectives as a result of the Release(s). [Use the following sentence if either soil or groundwater is not contaminated above applicable Tier 1 residential remediation objectives: [Soil] [Groundwater] is not contaminated above the applicable Tier 1 residential remediation objectives.] | |||||
| 4. | Attached as Exhibit B is a table(s) prepared by | [the Owner/Operator | |||
| or Property Owner] | that lists each contaminant of concern | ||||
| that exceeds its Tier 1 residential remediation objective, its Tier 1 residential remediation objective and its concentrations within the zone where Tier 1 residential remediation objectives are exceeded. The locations of the concentrations listed in Exhibit B are identified on the map(s) in Exhibit A. | |||||
| 5. | Attached as Exhibit C is a scaled map prepared by | [the Owner/Operator | |||
| or Property Owner] | showing the area of the Highway Authority's | ||||
| right-of-way that is governed by this agreement ("Right-of-Way"). Because Exhibit C is not a surveyed plat, the Right-of-Way boundary may be an approximation of the actual Right-of-Way lines. | |||||
9. The Highway Authority further agrees to limit access by itself and others to soil within the Right-of-Way exceeding Tier 1 residential remediation objectives. Access shall be allowed only if human health (including worker safety) and the environment are protected during and after any access. The Highway Authority may construct, reconstruct, improve, repair, maintain and operate a highway upon the Right-of-Way, or allow others to do the same by permit. In addition, the Highway Authority and others using or working in the Right-of-Way under permit have the right to remove soil or groundwater from the Right-of-Way and dispose of the same in accordance with applicable environmental laws and regulations. The Highway Authority agrees to issue all permits for work in the Right-of-Way, and make all existing permits for work in the Right-of-Way, subject to the following or a substantially similar condition:
As a condition of this permit, the permittee shall request the office issuing this permit to identify sites in the Right-of-Way where a Highway Authority Agreement governs access to soil that exceeds the Tier 1 residential remediation objectives of 35 Ill. Adm. Code 742. The permittee shall take all measures necessary to protect human health (including worker safety) and the environment during and after any access to such soil.
16. Any notices or other correspondence regarding this agreement shall be sent to the Parties at following addresses:
| Manager, Division of Remediation Management | Property Owner or Owner/Operator | ||||
| Bureau of Land | [Address] | ||||
| Illinois Environmental Protection Agency | |||||
| P.O. Box 19276 | |||||
| Springfield, IL 62974-9276 | |||||
| [Contact at Highway Authority] | |||||
| [Address] | |||||
IN WITNESS WHEREOF, the Parties have caused this agreement to be signed by their duly authorized representatives.
| [NAME OF LOCAL GOVERNMENT] | ||||
| Date: | By: | |||
| Its: | ||||
| Property Owner or Owner/Operator | ||||
| Date: | By: | |||
| Title |
Highway Authority Agreement
| This Agreement is entered into this | day of | , 200 | pursuant | |||||
| to 35 Ill. Adm. Code 742.1020 by and between the (1) | ("Property Owner") | |||||||
| [or, in the case of a petroleum leaking underground storage tank, the owner/operator of the tank | ||||||||
| ("Owner/Operator")] and (2) | Name of Entity in Control of the Right-of-Way | |||||||
| ("Highway Authority"), collectively known as the "Parties." | ||||||||
| [Use this paragraph for sites with petroleum leaking underground storage tank(s)] | |||||
| WHEREAS, | is the owner or operator of one or more leaking | ||||
| underground storage tanks presently or formerly located at | common address or | ||||
| description of Site location | ("the Site"); | ||||
| [Use this paragraph for sites that do not have petroleum leaking underground storage | ||||
| tanks] WHEREAS, | is the owner of the property | |||
| located at | common address or description of Site location | ("the Site"); | ||
WHEREAS, as a result of one or more releases of contaminants [insert either "from the above referenced underground storage tanks" or "at the above referenced Site"] ("the Release(s)"), soil and/or groundwater contamination at the Site exceeds the Tier 1 residential remediation objectives of 35 Ill. Adm. Code 742;
WHEREAS, the soil and/or groundwater contamination exceeding Tier 1 residential remediation objectives extends or may extend into the Highway Authority's right-of-way;
WHEREAS, the Owner/Operator or Property Owner is conducting corrective action in response to the Release(s);
WHEREAS, the Parties desire to prevent groundwater beneath the Highway Authority's right-of-way that exceeds Tier 1 remediation objectives from use as a supply of potable or domestic water and to limit access to soil within the right-of-way that exceeds Tier 1 residential remediation objectives so that human health and the environment are protected during and after any access;
NOW, THEREFORE, the Parties agree as follows:
(Source: Added at 31 Ill. Reg. 4063, effective February 23, 2007)