Massachusetts Department of Environmental Protection
Environmental Results Program
Facility Name
Return to Compliance Plan
Facility ID#
Town
Important:
Instructions
When filling out
forms on the
Complete a separate Return to Compliance Plan for EACH compliance question answer that requires one.
computer, use
only the tab key
to move your
Only submit a Return to Compliance Plan for violations that you were unable to correct BEFORE certifying.
cursor - do not
use the return
Completing this form does not relieve the facility of its affirmative responsibility to operate in compliance
key.
with applicable regulations. Failure to operate in full compliance with the applicable regulations may result in
enforcement actions that may include fines or penalties.
Return to Compliance Plan
1. What is the Compliance Question number for which you are reporting noncompliance?
DEP USE ONLY
Date Received
Question number
2. What is the specific violation? Reference the requirement number or workbook section number (which
describes the requirements) from the ERP Workbook.
Requirement number
Provide a brief description of the requirement:
Brief Description
3. What corrective action will you take to return to compliance?
Describe Corrective Action
4. Return to compliance date - date you will be back in compliance after completing your corrective action:
MM/DD/YYYY
Signature
erprtc • rev. 06/07
Return to Compliance Form • Page 1 of 1
Massachusetts Department of Environmental Protection
Environmental Results Program
Facility Name
Return to Compliance Plan
Facility ID#
Town
Important:
Instructions
When filling out
forms on the
Complete a separate Return to Compliance Plan for EACH compliance question answer that requires one.
computer, use
only the tab key
to move your
Only submit a Return to Compliance Plan for violations that you were unable to correct BEFORE certifying.
cursor - do not
use the return
Completing this form does not relieve the facility of its affirmative responsibility to operate in compliance
key.
with applicable regulations. Failure to operate in full compliance with the applicable regulations may result in
enforcement actions that may include fines or penalties.
Return to Compliance Plan
1. What is the Compliance Question number for which you are reporting noncompliance?
DEP USE ONLY
Date Received
Question number
2. What is the specific violation? Reference the requirement number or workbook section number (which
describes the requirements) from the ERP Workbook.
Requirement number
Provide a brief description of the requirement:
Brief Description
3. What corrective action will you take to return to compliance?
Describe Corrective Action
4. Return to compliance date - date you will be back in compliance after completing your corrective action:
MM/DD/YYYY
Signature
erprtc • rev. 06/07
Return to Compliance Form • Page 1 of 1