SITE REHABILITATION COMPLETION ORDER (SRCO), FDEP PROJECT # 195591, OGC CASE # 98-1477, MONITOR WELL ABANDONMENT, NOTIFICATION OF SITE SCHDULE ACTIVITY
Florida Department of
Environmental Protection
Chari i e (rist
Governor
leff I<ottbmp
Lt. Govemor
Southwest District Office
13051 North Telecom Parkway
Temple Terrace. Florida 33637-0926
Michael W. Sole
Secretal]
April 22, 2008
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
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Ms. Karma Killian
City of Clearwater
P. O. Box 4748
Clearwater, FL 34618-4748
Subject: Site Rehabilitation Completion Order (SRCO)
Former Montgomery Ward Site (a/k/a CGI/IMR Site)
10 South Missouri Avenue
Clearwater, Pinellas County
FDEP Project # 195591
OGC Case No. 98-1477
Dear Ms. Killian:
The Southwest District has reviewed the No Further Action Proposal contained
in the Quarterly Groundwater Monitoring Report, dated November 2005 that was
prepared by URS Corporation for the former Montgomery Ward Site (a/k/a CGI/IMR
Site) located at 10 South Missouri Avenue, Clearwater, Florida. Maps showing the
location of the former Montgomery Ward Site (a/kl a CGI/IMR Site) and the former
location of the "contaminated site" (i.e. contaminant plume) for which this Order is
being issued are attached as Exhibits 1 and 2 and are incorporated by reference herein.
The contamination, which resulted from a discharge that was discovered in
March 1994, consisted of l,2-dichloroethane. The discharge may have been associated
with the aboveground and underground storage tanks at the site; 1,2-dichloroethane
has been associated with leaded gasoline. A Consent Order, OGC# 98-1477,
(hereinafter "the Agreement") was executed by the Department on July 28,1998 to
address the 1,2-dichloroethane contamination. The No Further Action Proposal is
supported by earlier submittals, prepared pursuant to the Agreement and the
.,/\'!()/"C !'i't}[CCt;tJ17, Less Process '"
!\'iI'I\'. del" stale /7. us
Karma Killian
Former Montgomery Ward Site (a/k/ a CGI/IMR Site)
Page two
requirements of Chapter 62-780, Florida Administrative Code ("F.A.C"), including, but
not limited to:
Contamination Assessment Report Preferred Auto Lease Property, dated
December 1994 (received January 6, 1995)
Contamination Assessment Report (CAR) Former Montgomery Ward, dated
December 1994 (received May 16, 1995)
CAR Addendum, dated November 1995 (received November 27, 1995)
Limited Phase II Environmental Assessment Report City of Clearwater 14-Acre
Parcel Project, dated April 10, 1998 (received April 20, 1998)
Quarterly Groundwater Monitoring Report, dated August 2005 (received
September 1,2005)
Based on the documentation submitted with the No Further Action Proposal and
the above-referenced documents, the Department has reasonable assurance that the
City of Clearwater has met the criteria in Chapter 62-780, F.A.C and has met the terms
of the Agreement. The submittals indicate that soil and groundwater contaminant
concentrations are below the applicable Soil Cleanup Target Levels and Maximum
Concentration Limits or Groundwater Cleanup Target Levels as adopted in Chapter 62-
777, F.A.C (Effective date April 17, 2005.) Therefore, you have satisfied the site
rehabilitation requirements for the above-referenced contaminated site and are released
from any further obligation to conduct site rehabilitation at the contaminated site,
except as set forth below. See attached tables (Exhibit 3), incorporated by reference
herein, which includes information regarding the contaminants, affected media, and
applicable cleanup target levels for the contaminated site that is the subject of this
Order. Therefore, you have satisfied the site rehabilitation requirements for the above-
referenced contaminated site and are released from any further obligation to conduct
site rehabilitation at the contaminated site, except as set forth below.
Failure to meet the following requirement will result in the revocation of this
Order:
(a) You are required to properly abandon all monitoring wells within 60 days of
receipt of this Order. The monitoring wells must be plugged and abandoned
in accordance with the requirements of Rule 62-532.50tl(4), F.A.C
Further, in accordance with Chapter 376.30701(4), Florida Statutes (F.S.), upon
completion of site rehabilitation, additional site rehabilitation is not required unless it is
demonstrated that:
(a) Fraud was committed in demonstrating site conditions or completion of site
rehabilitation;
Karma Killian
Former Montgomery Ward Site (a/k/a CGI/IMR Site)
Page three
(b) New information confirms the existence of an area of previously unknown
contamination which exceeds the site-specific rehabilitation levels
established in accordance with Section 376.30701(2), F.5., or
which otherwise poses the threat of real and substantial harm to public
health, safety, or the environment;
(c) The level of risk is increased beyond the acceptable risk established under
Section 376.30701(2), F.S., due to substantial changes in exposure conditions,
such as a change in land use from nonresidential to residential use~ Any
person who changes the land use of the site, thereby causing the level of
risk to increase beyond the acceptable risk level, may be required by the
department to undertake additional remediation measures to ensure that
human health, public safety, and the environment are protected consistent
with Section 376.30701, F.5.; or
.(d) A new discharge of pollutants or hazardous substances occurs at the site
subsequent to the issuance of this Order.
Legal Issues
The Department's Order shall become final unless a timely petition for an
administrative hearing is filed under sections 120.569 and 120.57, F.S., within 21 days of
receipt of this Order. The procedures for petitioning for a hearing are set forth below.
Persons affected by this Order have the following options:
A. If you choose to accept the Department's decision regarding this SRCO, you do
not have to do anything. This Order is final and effective as of the date on the top of the
first page of this Order.
B. If you choose to challenge the decision, you may do the following:
1. File a request for an extension of time to file a petition for hearing with the
Department's Agency Clerk in the Office of General Counsel within 21 days of receipt
of this Order. Such a request should be made if you wish to meet with the Department
in an attempt to informally resolve any disputes without first filing a petition for
hearing; or
2. File a petition for administrative hearing with the Department's Agency
Clerk in the Office of General Counsel within 21 days of receipt of this Order.
Karma Killian
Former Montgomery Ward Site (a/k/a CGI/IMR Site)
Page four
Please be advised that mediation of this decision pursuant to section 120.573,
F.S., is not available.
How to. Request an Extension of Time to File a Petition for Hearing
For good cause shown, pursuant to Rule 62-110.106(4), F.A.C., the Department
may grant a request for an extension of time to file a petition for hearing. Such a
request must be filed (received) by the Agency Clerk in the Office of General Counsel of
the Department at 3900 Commonwealth Boulevard, Mail Station 35, Tallahassee,
Florida, 32399-3000, within 21 days of receipt of this Order. Petitioner, if different from
the Person Responsible for Site Rehabilitation (PRSR), shall mail a copy of the request to
the PRSR at the time of filing. Timely filing a request for an extension of time tolls the
time period within which a petition for administrative hearing must be made.
How to File a Petition for Administrative Hearing
A person whose substantial interests are affected by this Order may petition for
an administrative hearing under sections 120.569 and 120.57, F.S. The petition must
contain the information set forth below and must be filed (received) by the Agency
Clerk in the Office of General Counsel of the Department at 3900 Commonwealth
Boulevard, MS 35, Tallahassee, Florida, 32399-3000, within 21 days of receipt of this
Order. Petitioner, if different from the PRSR, shall mail a copy of the petition to the
PRSR at the time of filing. Failure to file a petition within this time period shall waive
the right of anyone who may request an administrative hearing under sections 120.569
and 120.57, F.S.
Pursuant to subsection 120.569(2), F.S., and Rule 28-106.201, F.A.C., a petition for
administrative hearing shall contain the following information:
a) The name, address, and telephone number of each petitioner; the name,
address, and telephone number of the petitioner's representative, if any; the
site owner's name and address, if different from the petitioner; the DEP
facility number; and the name and address of the facility;
b) A statement of when and how each petitioner received notice of the
Department's action or proposed action;
c) An explanation of how each petitioner's substantial interests are or will be
affected by the Department's action or proposed action;
d) A statement of the disputed issues of material fact, or a statement that there
are no disputed facts;
Karma Killian
Former Montgomery Ward Site (a/k/a CGI/IMR Site)
Page five
e) A statement of the ultimate facts alleged, including a statement of the specific
facts the petitioner contends warrant reversal or modification of the
Department's action or proposed action;
f) A statement of the specific rules or statutes the petitioner contends require
reversal or modification of the Department's action or proposed action; and
g) A statement of the relief sought by the petitioner, stating precisely the action
petitioner wishes the Department to take with respect to the Department's
action or proposed action.
This Order is final and effective as of the date on the top of the first page of this
Order. Timely filing a petition for administrative hearing postpones the date this Order
takes effect until the Department issues either a final order pursuant to an
administrative hearing or an Order Responding to Supplemental Information provided
to the Department pursuant to meetings with the Department.
Judicial Review
Any party to this Order has the right to seek judicial review of it under section
120.68, F.S., by filing a notice of appeal under rule 9.110 of the Florida Rules of
Appellate Procedure with the Agency Clerk of the Department in the Office of General
Counsel, Mail Station 35, 3900 Commonwealth Boulevard, Tallahassee, Florida 32399-
3000, and by filing a copy of the notice of appeal accompanied by the applicable filing
fees with the appropriate district court of appeal. The notice of appeal must be filed
within thirty days after this order is filed with the clerk of the Department (see below).
Questions
Any questions regarding the Department's review of your No Further Action
Proposal should be directed to Teri Nehls at 13051 North Telecom Parkway, Temple
Terrace, FL 33637, (813)632-7600 ext. 403, teresa.nehls@dep.state.fl.us. Questions
regarding legal issues should be referred to the Department's Office of General Counsel
at (850)245-2242. Contact with any of the above does not constitute a petition for
administrative hearing or request for an extension of time to file a petition for
administrative hearing.
Karma Killian
Former Montgomery Ward Site (a/k/ a CGI/IMR Site)
Page six
Sincerely,
FILING AND ACKNOWLEDGMENT
FILED, on this date, pursuant to 9120.52
Florida Statutes, with the designated
Department Clerk, receipt of which is
hereby acknowledged.
~~~
Clerk
fJ 1/AA/~8
Date
Enclosures (Exhibits 1, 2, and 3)
cc: Thomas J. Carberry, Senior Project Manager, URS Corporation
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Exhibit 1
WiEt!Il
e EXISTING MONITOR Y11::L1.. LOCATIONS
BElOW DETECTION UMIT
BENZENE CONCENTRATlON IN MICROGRAMS PER llITR (ug/L)
ElHYLBENZENE CONCENTRATlON IN ug/L
TOTAL XYLENES CONCENTRATlON IN ug/L
1. 2 - DICHlOROEIHANE CONCENTRATlON IN ug/l
TRlCHlOROETHENE CONCENTRATlON IN ug/l
t.fTBE CONCEN1RAllON IN ug/l
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URS
July 9,2008
Ms. Karma Killian
City of Clearwater
100 South Myrtle Street, Suite 220
Clearwater, Florida 33758-4748
Re: Monitor Well Abandonment
CGI/IMR Global Corporation
Former Montgomery Ward
Clearwater, Florida
FDEP Facility No. 529401089
Dear Ms. Killian:
In accordance with the provisions of the Site Rehabilitation Completion Order (SRCO)
dated April 22, 2008, URS Corporation (URS) supervised the proper abandonment of
nine monitor wells located at the above-referenced property. The following nine monitor
wells were abandoned by a licensed well driller (Preferred Drilling Solutions, Inc.) on
June 12, 2008:
MW-14R
MW-16
MW -17R
MW-18
MW-22
MW -24
DMW-3
DMW-5
DMW-6
Copies of the well completion reports are attached to this conespondence. As noted in
the SRCO, following proper abandonment of these wells the City of Clearwater has
satisfied site rehabilitation requirements and is released from further obligation to
conduct site rehabilitation at the above-referenced site.
URS appreciates the opportunity to assist the City of Clearwater. Please contact us if you
have any questions or comments.
Sincerely,
;,.; I ~.,. c
URS Corporation Southern::.?
~~~
Thomas J. Cat'belTY
Senior Project Manager
f!&
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Edwin W. Siersema, Jr.,lf:,EL: . . .
Associate, Manager "
Waste Management Group - Tampa
Attachment - Well Completion Forms
URS Corporation
7650 West Courtney
Campbell Causeway
Tampa, FL 33607-1462
Tel: 813.286.1711
Fax: 813.287.8591
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Parcel # (Pin): .<, 2lt?
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WELL COMPLETION REPORr(Pleasecomplele in black ink or type)
PERMIT #:77r"t8lJ,:r: CUPlWlJ ~ DIO#:____. ____
Indicate the number otwells drift .. thi$mporl: ---.--L__~_
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DRill METHOD:
L I Rotary [ ) Cable Too!
I IJet I ] Auger
I I Domfttic ~r
(J~
Llother __it' ~I'~
MeaSlJl'tld Static Water Level; _.____ Meesuted Pu~Water lewl:_.
After _Hours at__GPM. Measuring Pt (Oo$aibe): ___
Which is ___,.J!. ( J above ! J below land =
Casing: r I Blacl< Steel [J GalYanited . PVC I J other.
I ) Open Hole Depth DRIU. ct1l11NGS lOG
[ ri'Sueen (feet) Examine el4Ilnp.iWery 20 ft..or at
I ~ t:hange$. Note cavities,
Casing Diameter From To depIh to produdngzooes.
and Depth (ft_) C{l/vr I Gtlltn sm, I T)'pf 111 ~
DIameIer. ~
From: L/
To: _ /7.
Diameter: -----
From: ------
To: -.----.
Liner ! lor
Casing I ]
Diameter:
From: __~~____J
To
~
L___
Driller's Name (print or type): ~~_J::!~~;__
J
WELL COMPLETION REPORT (Please complete in black ink Of type.)
PERMIT #:Tlf"~ ~f(.$' CUPIWUP#: ._~. DIO#......._....... .............
Indicate the oumlW of wells drill .tiI$ report .--...._.1-..
=~ I1UIllberpt wells perm' dtilledIabandoned that are being
WATER WELl CONTRACTOR'S '. U ..~
SIGNATURE ___..___ Ucense# ___/- _
I certffylhetlthe illfotmation provided in this18pOft 18 accurate and true.
Grout No. of s f:rom ft. To ft.
~Cement: I ...", e::> 1.7_
!:leot<mite:
LQ.lt\gj'J
WEll LOCATION: County _ ...e- 1t4.s ". ..' -=-
___ 114 of _~ 1/4 ofSec1ioo , TOWll$b/p~, Range~~_
Latitude: ___, longitude: _._.______.._______
DATE STAMP
SIceIch ct'. ~ O!) property
"~l/et.-t' S-.
0I!icIaI Use Only
...
~
~
(
x
CHEMICAl ANALYSIS WHEN RE.QUIRED
Iron: _pprn Sulfate: ___.ppm
Chlorides: ___ pprn 10$ fl'\W!
Conductivity umhoslCl] G' dislarv:es from septic lank and houw or
[ I lab Tesl f I Field Tes! Kit ! other referenre poin.:._._.______
Pump Type
f ] Centrifugal I I Jet [1 Submersible f ] Turbine
Horsepower: ____ __ Capacity: GPM:
Pump Dep1h:_____.....___ft. Intake Depth: _ ____It
Form LEG.R.OO5.00(10105)
OWNER'S NAME6~t!"H"'" l
COMPlETeTION DATE:
ParoeI # (Pin): ..Is Z.., ~ <l>
WELL USE:
I J Public Supply r J 11Tigatlon
{ JlnjeCtion { ] Other
DRill METHOD:
r I Rotary I J Cable TOOl
r ] Jet r lAuger
r I Domestic ~onitOf
l lCo~
[ 1 Other "/n:_.-f!' /!.,e~
Measured Static Walei' Level: _ Mea$ured ~ Water Level: ___
Atlef __Hoiml at __GPM. Mea$uring PI. \Deoat!el: _______
Whidlls _Ill 1 above ! I below.~ JOther: _______
Casing: I J Black SlBel I J Galvanized I
[ ] Open Hole Depth DRIlL CUTTINGS LOG
[~ (feet) Examine cu\tQlg$ every 20 It. Of al
I fotmation ~. Note cavities.
Caslng DIameter From To depth t(lprodudngzones.
and DepIh(lll ~ I Glail Size I T)'p9 Q( MaIeriaI
DIameter: .~
From: .0
To: --..J--Z-.
Ol8meler. ___ __
From: -
To: -.>~-
Liner [ lor -
Casing [ J
DIameter ------ ---I
I
From: --- .-{
To: - ----..-----. f-. !
--."--,.-._.,,"" ~---"--'-""'-""""------'~-"'^'".""-,, __~J
DrtIIer's Name (prim or type) ~~t"_c?rK"":____
WELL COMPLETION REPORT (P!ease
PERMIT #:7ZS:l/!$. 6cup!W
Indicate the number otWellt drft
=~ ~wd$permi
WATER WElL C T '8,
SIGNATURt
, c:erlJfy that the
Grout
Neat Cement:
&ntonite:
!Qb!rl
well LOCATION: County ;..~ /A...c
__ 1/4 of ~ 1/4 of Section ~T~it-"$. Range~dF
Latitude: _~ , longitude:
in black ink Of type.)
010#;
.oed this report:~=J-=-~-
notdrilledlabandoned that am being
DATE STAMP
0fliciaI Use 0hIy
~
~
1
x
CHEMICAl ANALYSIS WHEN REQVIRED
Iron: -----PPffiSu/fate: ~-..Jpm
Chlorides: _.__ ppm
Conch.Icfivitv umho!ll~
I JLab Test I 1 Field Test Kif
PumpType
[ J Centrifugal [J Jel [j Submersible []Turbine
Horsepower: ___' Capacity: GPM:
Pump Depth: __.._....fl. Intake Deplt1:.........ft
Fonn lEG-ROO5.00(10105}
Gi distances from septic lank and hotlse. Of
other raference points
OWNER.S..NAM.... .... E.~~~. ~.4f',.'. .../ . 'P'. '-b."i-~.,r 1?""'<;L.... '...._.
COMPlETETlON DArE: . Florida ~ 1.0..
P~#(Ptn):~! S~7911e:>b~~/' ',c::> -_.~~.
WELL USE:
I J Public Supply f llnigation [1 DornestIe ll'f'Monitor
r 1 Injection [ I Other
DRILL METHOD:
r ] RotaI}'
I IJef
Measured SIalic Water Level: "'^-~ MeaSU19d Pu~Water Level: ___
AlIllr _Hours lit _.GPM Measuring Pt 1\loeaibe1: ___
'Mli<:h 18 _It ( ] above ! 1 below land :(l:,ce
CasIIlg: [ ) Black Steel r 1 Galvanized [. pvc I 101her; ___
[ 1 Open tf(ge Depth DRILL cttlTlNGS LOG
l~ (feet) EXlIII'IM cuIllngs every 20 ft. or at
I foITIllllIon dlangee; Note cavities,
CaIIng IJlameter From To dE!plh to produdng ZI:lnes.
and Depth (ft.) Coiof IGml Size I Type of Ma/eriaI
Oiameler. -2:::...'":.
From: ;i...
To: 1 ~.-
Dlameter: _'_
From:
To: -----
Liner ( ] or _.
Casing( J ~- j
Diameter: --- -
Fro'll: ---'-""--~"-"'-' -
To~ ~."._-"" r_______._____
1
-~-^---_._---._'~.------!
I
ij",,",~~~-~, ~
-'."--.-. I
! I Cable T ooJ
[ 1 Auger
Oflller's Name (print or typel:~l'l~C..~ ~.L.-:.
Il~
r JOIhef jy_..~ ~;ot!
,
WELL COMPLETION REPORT(Please black ink or type.)
PERMIT #:7.71:14$.'2. CUPIWUP#: '_"__ D1D#
Indicate the number of wells drilledI~ ftJr ll1is
:~ nu~~f~~!$ permlledbut IIQtdlil
WAT.ERWEllCO~N. CT~. 'S .. . ,?
S.lGNATtJRE . . .. . ... ... IJcense # ~/ ~
I certify that the in ... .. ~ . . .... . . this raport is accurlJie;~ true.-
emut No, Of From To ft.
Neat cement 1$ 0 -;:z./
BentonIte: ..
tQb!r.l
WEll LOCATION: Goonty € A
_ 1/4 of .~_.__ 1/4 Oi~ TownShiP 2!!~, R8ilQEI/~F
Latitude: ____________._.longitude: _~.___.______
DATE STAMP Sketch otwell I~ 09 prqperty.
-.., I~tr.,._r~-.
OfIlCial Use Only
\I.
~
l
x
CHEMiCAL ANAL YSI$ WHEN REQ\JlRSO
Iron: .._--ppm Sulfate: __.j)pm
Chlolides: ~___ ppm IDS
Conductivlty umhoslcn:!
f J Lab Test 1 Field Test Kit
Pump Type
r 1 Coottifugal ]Jet f J Submersible [JTuroif1l,.
Horsepower Capacity: ________._. GPM:
Pump Deplh:._......__..Jt Intake Depth: __ow Jt
FOII'l1lEG-ROO5.00(10105,
G. distances from septic tank and house. or
other reference OOifl{s
OWNER'S NAME:t::e:>"'lI'!t'W...;
GOMPlETETION DATE:
Paroel # (Pin): .L<' Z"'fK ~.
WEll USE:
0r~~~""r:~,-'7__
~.. Florida Unique 1.0.: __
o~a~ ~
[ ) Public Supply [} Irrigation
[ } Injection [ } Other
DRill METHOD:
[ J Rotary [ ] Cabler 001
f ] Jet [ I Auger
[ ] Domestic ~itor
rJ~
r ] Other "....."".,,~ ~I"~
Meeauted Slallc Water Level: _. . MMIiOO Pumping Water LeveI:_
After _Hoors at ___GPM. Meawring PI. ~):
Whldlis _ft.l I abOve [J below laIlcI ~
Casing: I J Black Steel [J Galvanized {PVC [ ] Other:~~_
I 10pe0 Hole Depth DRILL CUntHGS lOG
{~ (filet) l:xaminecutlll'lg$ eYeIy 20: It or at
C8$lng Dlameter T fonnatiQn changes. ~cavl!lea,
From To <lept!lo pmduclng zones.
and 0epIh (ft) Cobr I GrlliI'ISile I Type dt.t$tial
Dfarneter. ~~.
From: __._______._____
To: --21___
DIamele~ -
From: h -----
To:
Liner I jor ,---.
Casing [ j
Diamete~ --- .......... -
From: --,
To: f-
..._'"'- ----1
f
___"...._____L.__... __~...._ --.,--, ~,,~ . . . ---------------l
~-----~.. J
,""',...,.-~......__.,__. '_'_rv__ h
Driller's Name {print or 1y:;;.'}. ~/":JDr. Cfi" i.r k::
WELL COMPLETION REPORT (P!eaS6 complete in black ink 0' type.)
PERMIT #:71r._!i!IIll3 CUPNVUPI: --------,______ OID#:......._.__._. ..
Indicate the numbett)fwe!1s drilledl~~th~.__L__
:u;e numbetJ~ permitted butnotdfilllil\7l!!!!!!!!gJhat are being
WATERwru.~
SIGNATURE!. . ... . . .... llcense# ~t:>
lcetlifylhfd them' . 'In JtIis roport is accuriJte and t~~-
Gf:OutNo.. of FrQm ft. To~
Neat cement: J Z-O 2.. ~
~: -.
!QJbtr)
WEll LOCATION: COunty .~ &
_11401 _1/4ofS8ction
lalHudEt:
T()WO$h1p - $, Rar;g~=t~~
.longilude.__. .,......-.---
~pfwelllo<.;j1oo ~ ~rty
. . 1#,.,h.:4 -I' S""'"
DAtE STAMP
0fIIclal Use Only
~
~
j
~
x
CHEMICAL ANALYSiS WHEN REQUIRED
Iron:--pprTl Sulfate: -..J)prTl
Chlorides: _._ . ppm TO
~ \Y1J~
r J Lat> Test ! J Field Test Kit
Pump Type
r J Centrifugel r 1 Jet ! J Submersible f ] Turbine
Horsepower.._._ Capacity: ___._._. GPM:
Pump Depth:.....____Jt Intake Depth:__.__..ft
Form lEG-R.OO5.00(10105)
G dlstances from septic lank and h,')u~. or
other reference pohts
OWNER'S NAME:C"~"!!~"'''''1
COMPlfiTEnON DATE:
PatceI#(Pirl):.I~ .z~.~ ~
WELL USE:
r ] Public Supply r J Irrigation
{ J Injection I 1 Other
DRill METHOD:
r lRotary [ ] CableTOOI
I ] Jet I JAug$(
[ I Domestic rf1'1ionitor
rl~n
r JOIher ~__d ";:,.e
.
Meesured Static Water Level: ___... ~~W8lerLevel:_
NI8r _Hours al___ GPM. Metsurlng Pl ~):__~~____..._
Which la_ft. [ J above I ] beIowleM=
~;( 1 Black Steel r J Galvanized ..PVc I J Other:._____
[ l Open Hole Depth ORIU.CQ1TINGS lOG
[~ (feet) ExamIne Cllttlngs ~ 20 fl. Of at
I fmmatlon 1.lbanges. Nole cavities,
CasIng. Di8rneter From To _ to prtldudng zones.
aod Depth (ft.) Cokv'I GnIkI SIza I Twe of Material
Diarneler~
From'
'. ~_.
To: ;;.... '_'_
Diameter. _'__
From:____
To: -_. -
liner ! lor
Casing [ J
Diameter: -. ---
-- '.' -
From: --- > "'---'-""".
To: ~___H" "_,___~"' -,----- --'--
_.- -.-----.--... --,- .. '" ----.--1
------ _.__~-==:J
Driller's Name (print or type) ';;.&~r C.r!!Lk~____
WELL COMPLETION REPORT (Please complete in black ink Of type.)
PERMIT#:77)"~4t.lcu DID#:
lndicatelhe n. of_ 0 r this re~:__=::_r""--:~
=~ num~wtIls notdrilledJabandoned that are being
WATER WELl CON OR
SIGNATURE
I CfNtify th<<..1hft in
Orocd
Ne.at Cemem:
Bentonite:
!QlI.wl
~ L~:~: r,of.I'r t TOwnshfp ~"$t Rafl9t! I~:;r
latHude: ___ . Longitude: _____
DATE STAMP
0fliciaI Use Only
"
~
l
x
CHEMICAL ANAL YSISWHEfII REQUIRED
Iron: -----PPfll Sulfate: ----.PPITl
Chlorides: _____ ppm TO
C~ ymb9s1cm
{ 1 Lab Tesl I ] FieldTesl Kit
Pump Type
[ J Centrifugal [J Jet r I Submersible ! 1 Turbine
Horsepower: Capadty:.______ GPM:
Pump Depth: ____tl Intake Depth: __ .. ft.
Form LEG-ROOS_OO<101OO}
G distaoces trom septic tank and house, or
ather referen<:e points
OWNER'S NAME:C'.:p~......O,{"",
COMPLErenONOATE:
Pareel # (PItI): z.", $8
WElt tJSE;
[ lPubllc Supply (J lITIgation { J Domestic ~nitor
[ llnjeetion [ J Other
DRill METHOD:
{ lRotary r J Cable Tool f J ~ ,
( lJet [ ] Auger [ I Other~_c,. ;"..e
Measured Sfalic Water Level: - Measunld Pumping Water level: __
AAer _Hours at _GPM. Measuring Pt.. (DIeaibej; _________ ._
Wlic" is ~fll J aboye [I below lan4~ce
Caslrlg: I I Black Steel [I Galvani2:ed (. PVC [ I~___- -._"--
{ 1 Open !tie DEpth om CU1TtNGSlOG
I~ (feet) Examlnellllltlngll every 20 It or at
1 Iormatlonctlanges. Nol&cavities.
Calling. DiaITleter From To depth to produdngzones_
and Depth (ft.) Cc/or I GmI ~ I Twe at Ma/eri81
~...A.::
From:~_7
To: ~ -e>
Diameter. _~_
From: --------
To' -----
Uner[ Jor
Casing r J
Diameler: -.----- --
From: ___'_"'_n.,__ !
To: ---~--,~.....,. ~ --1
~'.'-'-~-"-----""'- .--.__~J
i
-___J
[Inlier's Name (print or type): s;.1,,_~..I~.... C!r ~ ..
URS
June 6, 2008
Mr. John Sego, P.G.
Brownfield Coordinator, Southwest Division
Florida Department of Environmental Protection
13051 N. Telecom Parkway
Temple Terrace, Florida 33637-0926
Re: Notification of Site Schedule Activity
Monitor Well Abandonment
CGI/IMR Global Corporation
Former Montgomery Ward
Clearwater, Florida
FDEP Facility No. 529401089
Dear Mr. Sego:
This letter will serve as notification of the schedule for field actIvItIes at the
above-referenced site. URS Corporation plans to properly abandon monitor wells on
Friday, June 13, 2008. It is anticipated that abandonment of the wells will be completed
in one day.
Please contact us at your earliest convenience if this schedule is not acceptable. Your
continued cooperation is appreciated.
Sincerely,
URS CORPORATION
~/~<=-
Thomas J. Carberry
Senior Project Manager
cc: Ms. Karma Killian - City of Clearwater
URS Corporation
7650 W. Courtney Campbell Causeway
Tampa, FL 33607-1462
Phone: 813-286-1711
Fax: 813-636-2499
www.urscorp.com
R: Iwaslel2 0071proj eels leoe- imrgwmoni to r- 12002228 leo ITCSp Ii mr fdepnot 06060 8. doe
Page 1 of 1
Killian, Karma
From: Tom_Carberry@URSCorp.com
Sent: Friday, June 06, 2008 11: 10 AM
To: Sego, John R.
Cc: Killian, Karma
Subject: City of Clearwater - IMR Site
John:
We are planning to abandon the wells at IMR next Friday (June 13, 2008). Attached is a notification letter. Contact me if
you have any questions/comments.
Thanks.
(See attached file: IMRFDEPNOT06060B.pdf)
Tom Carberry
Senior Project Manager
URS Corporation
7650 W. Courtney Campbell Causeway
Tampa, Florida 33607
Direct: (813) 675-6807
Fax: (813) 636-2499
Cell: (813) 335-1728
This e-mail and any attachments are confidential. If you receive this message in error or are not the intended recipient, you should not
retain, distribute, disclose or Lise any of this information and you should destroy the e-mail and any attachments or copies.
6/18/2008
WMIS - Well Construction Permit Detail Info
Page 1 of 1
S( 'III 1l\\'h I FIlIP 11 ,\ \\ \] fl< i\t'lNA\ J1 \1f N] Dh nun
:ATERMANAGEMENT '.INFORMATION SYSTEM
WCP Detail - 775388
General Info Well Info Completions Financial
II Owner Informa::~--"--------"-^---'^--"
! Name: REDEVELOPMENT AGENCY
I
I Address: BOX 4748
I 1"'-""""'"'''''''''''''''''"''' w...,,,,,,,,,,,.,
1 City/State: tS:~~~~IJI{.t\T~~",_,~_W'
I ZIP Code: 1~~?$$~~7~$
I
i Phone:
Do~~ment~,,,9-L.!Lck Map
I Application Information
Issuing Location:
Application Status:
Application Type:
Application Date:
Issue Date:
Suspense Date:
Construction Date:
:JSSUED
,....... .......'....MMM..~U..M ,
rANBANi)6~NM'E'N'Tv''''''''NNN'''''"'~'~~'N
,~, 'W""""'~"_"'~."~_~_'N'~~~~~~=.we.wN^"'."
:6/9/2008']
[~Z~Z~~~~~[:,:~[]
:~ZtZ?QQ~'.[:~]
3/2008
i
I
II Contractor Information
I
I' License #: 3
Name:
I Address:
I City/State:
I ".,.....
. ZIP Code: 133773 :
I Phone:"~6~~7~77
i
I
I
I
i
I
I Stipulations
Description
PLUGGING - FULL GROUT
L"""""","",",".,__"_,,,,.___,,
Ptii'ilP
http://www8.swfwmd.state.fl.usIWM I S/wcp/wcpdetail. aspx?permit= 77 5388
7/14/2008
SYSEM
WCP File of Record Report
South\vest Florida
Water Management District
....,.,'*o;:::O:;if:#."'-':.'.'''A._. - :":>''''''o+,;t.9:t''o;:_;''''',,,,
Permit #:
Reference #:
Well Use:
775388
Status:
Type:
Const. Date:
Issued
Abandonment
06/I3/2008
Application Received:
Issue Date:
Suspense Date:
06/09/2008
06/09/2008
09107/2008
PLUGGED
Owner Information: 775388
Name
Address
City/State/Zip
CLEARWATER, FL 337584748
COMMUNITY REDEVELOPMENT
AGENCY
PO BOX 4748
Contractor Information: 775388
Name
License #
Address
City/State/Zip'
GREGORY W CAMPBELL
2613
11747 87TH STREET NORTH
Well Information: 775388
Diameter
Drill Method
Depth
Primary
Casing
Material
Casing
Depth
Casing
Diameter
Contamination
2
PLUGGED BY APPROVED METHOD
20
Cement
Well Location: 775388
Site ID Address
715840 P.O. Box 33758
715843 P.O. Box 33758
715844 P.O. Box 33758
715845 P.O. Box 33758
715846 P.O. Box 33758
715847 P.O. Box 33758
715848 P.O. Box 33758
715849 P.O. Box 33758
City/State
Clearwater
Lat Long Section Township Range
27057" 55.10' 82047" 17.97' 15 29 15
27057" 55.10' 82047" 17.97' 15 29 15
27057" 55.10' 82047" 17.97' 15 29 15
27057" 55.10' 82047" 17.97' 15 29 15
27057" 55.10' 82047" 17.97' 15 29 15
270 57" 55.10' 82047" 17.97' 15 29 15
27057" 55.10' 82047" 17.97' 15 29 15
27057" 55.10' 82047" 17.97' 15 29 15
Clearwater
Clearwater
Clearwater
Clearwater
Clearwater
Clearwater
Clearwater
Data Currency: July 13, 2008
Page 1 of!
Report Generation Date: July 14,2008
WCP File of Record Report
Southwest J"lorida
lf11ter Management District
"'-"H.,:,j9jglf:#!$::~"""":-, :_".^~,,,,,::,",aVW"o"'"
Report Cover Page
Selection Criteria:
. Permit Number: 775388
. Report Name: WCP File of Record Report
The information provided is based on the information available at the time of request. The information is believed to be accurate and
complete, but is subject to the accuracy and completeness of information submitted to the District by permittees and other sources and is
subject to the specific request made. The District does not warrant that the information is suitable for any particular use.
Data Currency: July 13,2008
Report Generation Date: July 14, 2008