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					                              OKLAHOMA CORPORATION COMMISSION
                               PETROLEUM STORAGE TANK DIVISION

                             Remediation Corrective Action Plan Proposal
PSTD Reviewer ___________________________ Approve [ ] Deny [ ] Date ________________

1.     CASE NUMBER                Submitted to (PSTD P.E.A.):
       FACILITY NUMBER                   To Fulfill Purchase Order:

2.              remediation method has been agreed to for this site and is being detailed in this report.

       The data requested in the following sections will be used to evaluate the proposed soil and/or ground water
       remediation technique(s). This proposal is to be submitted after the Remediation Selection Proposal has been
       approved and after site clean-up levels have been approved.

3.     Facility Name:
       Contact Person:          , Phone #:
       Street Address:
       City:                    , County:

4.     Owner/Operator:
       Contact Person:          , Phone #:
       Street Address:
       City:                    , State:        Zip Code:

5.     Remediation Consultant’s Signature     ___________________________ Date ____________
       PSTD License Number:           Expiration Date:
       Remediation Consultant and Firm
       Phone Numbers: Voice:         Fax:        Pager/Cell:
       E-Mail Address:

       Consulting Firm Principal Signature________________________________

6.     Have there been any changes since the ORBCA Report was completed? If yes please describe.

7.     Is the risk assessment data based on a Tier 1a or a modified Tier II? List the approved Risk-Based clean up
       levels in the table below.

ON SITE           Soil   / Groundwater             OFF SITE                    Soil     / Groundwater

Benzene:                 /       ppm               Benzene:                             /     ppm
Ethylbenzene:            /       ppm               Ethylbenzene:                        /     ppm
Toluene:                 /       ppm               Toluene:                             /     ppm
Xylenes:                 /       ppm               Xylenes:                             /     ppm
Naphthalene:             /       ppm               Naphthalene:                         /     ppm

8.     Have all the receptors been identified? Yes      No         If no please list.

9.     List all potential upgradient sources.


Remediation Plan Proposal
Revised September 2006
10.    Will the implementation of the corrective action plan effect any of the receptors in any way, if yes please explain.

11.    Describe requirements and schedule for the remediation system operation and maintenance, system sampling
and ground water sampling. Provide a list of proposed “Key Monitoring Wells,” “Key Free Product Monitoring Wells” and
compliance monitoring wells.

12.    Fill out the information on the Remediation Technology Fact Sheet. Please enter all applicable data for the
       proposed scope of work in order for the price estimate to be as precise as possible.

13.    Attach a copy of the OCC ORBCA clean-up level approval letter.

14.    Attachments

         A. Provide a scaled base map with all site structures, surface conditions, all utilities, all wells and all soil boring

         B. Provide contoured benzene and TPH data for both soil and groundwater plumes and free product thickness, if
            present, on separate scaled facility maps with the most recent data. Provide contoured concentration maps
            for all chemicals of concern. If there are different clean-up levels for on- and off-site be sure to differentiate
            those areas on this map.

         C. If not already submitted, provide 3-dimensional smear-zone analysis interpretation.

         D. Provide a facility map showing the proposed remediation equipment location, system layout. This map is to
            include, but is not limited to all connection piping; all system well bore locations, excavations and monitoring
            wells. Place the groundwater benzene cleanup (i.e. SSTL) contour(s) and areas with free product on this

         E. Provide a stratigraphic cross-section(s) showing representative monitoring well, injection (sparge),
            extraction (SVE), recovery well bores, etc.; construction for the proposed remediation system, any former or
            proposed excavations, the most recent potentiometric surface data, free product thickness and the known
            smear zone interval.

         F. Provide a detailed cost summary of the remediation system design, installation, operation and maintenance
            of approved technology (ies), and remediation system decommissioning.


Remediation Plan Proposal
Revised September 2006

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