ATSDR Requests for Certified PHAs/HCs

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Form Approved
0MB No. 0923-0057
Exp. Date XX/XX/XXXX
ATSDR estimates the average public reporting burden for this collection of information as 7 minutes per re sponse, including the time
for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and
comp leting and reviewing the co ll ection of information. An agency may not conduct or sponsor, and a person is not required to
respond t o a collection of information un less it displays a currently valid 0MB Control Number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR
Information Collection Review Office, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA (0923-0057).

ATSDR REQUEST (Lane Plating Works, Inc., TX site example) FOR CERTIFIED PHAs/HCs (ARMSS
SCREENSHOTS)
I
Edit Request
Req uest Name: 20210028

0 Request Details G
Request Date

2018-05-17
Request Rece ived Through

Request Type

Other
Other

Request 's Primary Focus

Public Hea lth Assessment/Health Consultation

Community Concern

Commun ity

Request Source G

Request Source Detai l (>

Public
Request Source Description (Opt ional)

Request Source POC (Opt io nal)

Coop Program G

Jurisdiction

Yes

Texas

No

Description
Fo rmer metal plating facility, on-s ite soil contaminants consists of metals including hexavalent chrom ium; PFAS and meta ls in were found in shallow groundwater.

Provisional Site Name G
Lane Plating Works, Inc.

City (Optional)

State

County (Opt ion al)

Dallas

Dallas

Texas

0 Preliminary Assessment (Tri age) @
Section

Team/ Region

Current POC

Central

ATSOR Purview
Yes

Kessinger,J essica

Evidence of Exposure
No

Date Ready for Scoping
2021-12-14

No

Request Accepted

Is Scoping Required?

Yes

Yes

No

No

1

0 Scoping o
Scoping - To help prioritize this request, please provide the perceived / potential level of exposure and public health impact.

Scoping Date
20 19-05-01

Public Hea lt h Impact Rating

Level of Exposure Rating

3 - Exposure at leve ls high levels

Prio rit izatio n Ra n k
B - Imm ediat e but not Urgent; Targ et Complet ion w it h in 6 mont hs

2 - Co uld lead to public health improvements

Primary Contaminant

Other Contamina nt (Op tio nal)
Lead, M ercury

Chromium

30-Day Milestone (Prioritization Complete )
2019-05-31

Number of People Potentially Exposed
51-100

Primary Exposure Pathway Media

Other Exposu re Pathway (Optio nal)

Soil

surface water, sediment

0 Planning/ Health Investigatio n o
Open Activities
N11me

Request ...

V

Une Plating...

V

V

20210028

Jurisdiction

Activityl...

Health Cons...

Texas

COOP

ActivityP ...
V

V

Kess11,ger. L.

SiteNilmes

V

Updilt... ,l,,

Upd•ted By

V

V

Truhe. John

mm/ II

Activity C...

V

mm/ II

St1tu1

V

V

amt

1/ 23/ 2023

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Edit Health Consultation

Status Checklist O
Select the next step when completed.

Start Date
2021-07-01

Complete Date

[!]

2023-01 -23

Pu blic Comme nt Required
Yes
No

Initiated
Data Analysis in Progress
Draft in Progress
Data Validation in Progress

Initial e-Clearance Informat ion

Final e-Clearance Informat ion

Initial Accession Numbe r

Fina l Accession Nu mber

NCEH-PSS-8/ 2/22-99d la

NCEH-PSS-8/ 2/ 22-99d1a

Final Pre-Clearance
Final e-Clearance

SIA
SIA QC Review
Cleared for Posting
Posted to ATSDR website

Initia l Docu ment Na me
Lane Plating Works, Inc. Superiund Site Health Con

Final Docu me nt Name
Lane Plating Works, Inc. Superfund Site Health Con

2

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REQUEST SCREENS (Colonial Pipeline Spill Jane 8, 2021 LHC site example) FOR NON-CERTIFIED
PHAs/HCs – SAME AS CERTIFIED EXCEPT THE “SCOPING” SCREEN IS NOT COMPLETED AND THE
FOLLOWING SCREEN IS COMPLETED.
Edit Non -Certified PHA/HC
Site Info @
Sites
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Documents @

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Colonial Piprtin~ Spill Jan 8, 2021 LHC

3/ 16/2023, 11 :02:36 AM

Actions

LauraFrazif!f

Non -Certifi ed PHA/HC Det ail s@
Actua l Start Oatit

2020-1 1·03

Activity Ty~

Compl•t• Oatit

[!]

202 1-01-00

•

Health Consultation

3