Section 622.APPENDIX A   Landowner Acknowledgement Form

At a minimum, the following language shall be included in the landowner acknowledgement form required in Section 622.30(c)(1)(B)(ix).  Failure to include this language and to have the landowner sign and date shall invalidate the acknowledgement.

The Illinois Environmental Protection Agency, as well as the U.S. Environmental Protection Agency, requires the water treatment residuals you are receiving to be monitored for trace metals, organic and inorganic chemicals, and pathogens.  In addition, the Illinois Emergency Management Agency and Office of Homeland Security (IEMA-OHS) requires the monitoring of radium under 32 Ill. Adm. Code 622 (Part 622).  Radium is naturally present in soil and groundwater.  When removed from water and land-applied, these water treatment residuals could elevate the radium content in the soil above natural levels.

IEMA-OHS, as the regulatory agency for ionizing radiation, requires that land-applied water treatment residuals be monitored for radium, including the cumulative amount of radium, deposited on agricultural fields.  Fields that approach the regulatory limit of 3.1 pCi/g are required to utilize alternative sources of fertilizer (i.e., water treatment residuals without elevated radium from water).  The additional monitoring and land application provisions of Part 622 ensure that the public is protected from significant health, environmental, and agricultural impacts.

This form serves as an acknowledgement of awareness by the landowner, or authorized agent of the landowner, that biosolids applied to fields for beneficial nutrient purposes contain radium.  For further information, you may contact IEMA-OHS at EMA.RadiumResiduals@illinois.gov.

I hereby acknowledge my awareness of the above conditions resulting from application of treatment residuals to my property.

SIGNATURE OF LANDOWNER OR LANDOWNER'S DESIGNEE

PRINTED NAME

DATE