Contaminated Water Supplies at Camp Lejeune

ASSESSING POTENTIAL HEALTH EFFECTS

Committee on Contaminated Drinking Water at Camp Lejeune

Board on Environmental Studies and Toxicology

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
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Committee on Contaminated Drinking Water at Camp Lejeune Board on Environmental Studies and Toxicology Division on Earth and Life Studies

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by Contract W81K04-07-C-0005 between the National Academy of Sciences and the U.S. Depart- ment of the Navy. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-13699-0 International Standard Book Number-10: 0-309-13699-7 Additional copies of this report are available from The National Academies Press 500 Fifth Street, NW Box 285 Washington, DC 20055 800-624-6242 202-334-3313 (in the Washington metropolitan area) http://www.nap.edu Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON CONTAMINATED DRINKING WATER AT CAMP LEJEUNE Members DAVID A. SAVITZ (Chair), Mount Sinai School of Medicine, New York, NY CAROLINE L. BAIER-ANDERSON, Environmental Defense Fund, Washington, DC JAMES V. BRUCKNER, University of Georgia, College of Pharmacy, Athens PRABHAKAR CLEMENT, Auburn University, Auburn, AL CAROLE A. KIMMEL, Consultant, Southern Shores, NC FRANCINE LADEN, Harvard School of Public Health, Boston, MA BRUCE P. LANPHEAR, Simon Frasier University, Vancouver, BC, Canada XIAOMEI MA., Yale University School of Medicine, New Haven, CT JOHN R. NUCKOLS, Colorado State University, Fort Collins ANDREW F. OLSHAN, University of North Carolina, Chapel Hill LIANNE SHEPPARD, University of Washington School of Public Health, Seattle ELAINE SYMANSKI, University of Texas School of Public Health, Houston JANICE W. YAGER, University of New Mexico School of Medicine, Albuquerque Staff SUSAN N. J. MARTEL, Project Director NORMAN GROSSBLATT, Senior Editor RUTH E. CROSSGROVE, Senior Editor MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center RADIAH ROSE, Editorial Project Manager TAMARA DAWSON, Program Associate PATRICK BAUR, Research Assistant Sponsor U.S. DEPARTMENT OF THE NAVY v

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BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY1 Members JONATHAN M. SAMET (Chair), University of Southern California, Los Angeles RAMON ALVAREZ, Environmental Defense Fund, Austin, TX JOHN M. BALBUS, Environmental Defense Fund, Washington, DC DALLAS BURTRAW, Resources for the Future, Washington, DC JAMES S. BUS, Dow Chemical Company, Midland, MI RUTH DEFRIES, Columbia University, New York, NY COSTEL D. DENSON, University of Delaware, Newark E. DONALD ELLIOTT, Willkie, Farr & Gallagher LLP, Washington, DC MARY R. ENGLISH, University of Tennessee, Knoxville J. PAUL GILMAN, Covanta Energy Corporation, Fairfield, NJ JUDITH A. GRAHAM (Retired), Pittsboro, NC WILLIAM M. LEWIS, JR., University of Colorado, Boulder JUDITH L. MEYER, University of Georgia, Athens DENNIS D. MURPHY, University of Nevada, Reno DANNY D. REIBLE, University of Texas, Austin JOSEPH V. RODRICKS, ENVIRON International Corporation, Arlington, VA ARMISTEAD G. RUSSELL, Georgia Institute of Technology, Atlanta ROBERT F. SAWYER, University of California, Berkeley KIMBERLY M. THOMPSON, Harvard School of Public Health, Boston, MA MARK J. UTELL, University of Rochester Medical Center, Rochester, NY Senior Staff JAMES J. REISA, Director DAVID J. POLICANSKY, Scholar RAYMOND A. WASSEL, Senior Program Officer for Environmental Studies EILEEN N. ABT, Senior Program Officer for Risk Analysis SUSAN N.J. MARTEL, Senior Program Officer for Toxicology KULBIR BAKSHI, Senior Program Officer ELLEN K. MANTUS, Senior Program Officer RUTH E. CROSSGROVE, Senior Editor 1 This study was planned, overseen, and supported by the Board on Environmental Studies and Toxicology. vi

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OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Review of the Federal Strategy for Nanotechnology-Related Environmental, Health, and Safety Research (2009) Science and Decisions: Advancing Risk Assessment (2009) Phthalates and Cumulative Risk Assessment: The Tasks Ahead (2008) Estimating Mortality Risk Reduction and Economic Benefits from Controlling Ozone Air Pollution (2008) Respiratory Diseases Research at NIOSH (2008) Evaluating Research Efficiency in the U.S. Environmental Protection Agency (2008) Hydrology, Ecology, and Fishes of the Klamath River Basin (2008) Applications of Toxicogenomic Technologies to Predictive Toxicology and Risk Assessment (2007) Models in Environmental Regulatory Decision Making (2007) Toxicity Testing in the Twenty-first Century: A Vision and a Strategy (2007) Sediment Dredging at Superfund Megasites: Assessing the Effectiveness (2007) Environmental Impacts of Wind-Energy Projects (2007) Scientific Review of the Proposed Risk Assessment Bulletin from the Office of Management and Budget (2007) Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues (2006) New Source Review for Stationary Sources of Air Pollution (2006) Human Biomonitoring for Environmental Chemicals (2006) Health Risks from Dioxin and Related Compounds: Evaluation of the EPA Reassessment (2006) Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006) State and Federal Standards for Mobile-Source Emissions (2006) Superfund and Mining Megasites—Lessons from the Coeur d’Alene River Basin (2005) Health Implications of Perchlorate Ingestion (2005) Air Quality Management in the United States (2004) Endangered and Threatened Species of the Platte River (2004) Atlantic Salmon in Maine (2004) Endangered and Threatened Fishes in the Klamath River Basin (2004) Cumulative Environmental Effects of Alaska North Slope Oil and Gas Development (2003) Estimating the Public Health Benefits of Proposed Air Pollution Regulations (2002) Biosolids Applied to Land: Advancing Standards and Practices (2002) The Airliner Cabin Environment and Health of Passengers and Crew (2002) Arsenic in Drinking Water: 2001 Update (2001) Evaluating Vehicle Emissions Inspection and Maintenance Programs (2001) Compensating for Wetland Losses Under the Clean Water Act (2001) A Risk-Management Strategy for PCB-Contaminated Sediments (2001) Acute Exposure Guideline Levels for Selected Airborne Chemicals (seven volumes, 2000-2009) Toxicological Effects of Methylmercury (2000) Strengthening Science at the U.S. Environmental Protection Agency (2000) Scientific Frontiers in Developmental Toxicology and Risk Assessment (2000) Ecological Indicators for the Nation (2000) Waste Incineration and Public Health (2000) Hormonally Active Agents in the Environment (1999) Research Priorities for Airborne Particulate Matter (four volumes, 1998-2004) The National Research Council’s Committee on Toxicology: The First 50 Years (1997) Carcinogens and Anticarcinogens in the Human Diet (1996) Upstream: Salmon and Society in the Pacific Northwest (1996) vii

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Science and the Endangered Species Act (1995) Wetlands: Characteristics and Boundaries (1995) Biologic Markers (five volumes, 1989-1995) Science and Judgment in Risk Assessment (1994) Pesticides in the Diets of Infants and Children (1993) Dolphins and the Tuna Industry (1992) Science and the National Parks (1992) Human Exposure Assessment for Airborne Pollutants (1991) Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991) Decline of the Sea Turtles (1990) Copies of these reports may be ordered from the National Academies Press (800) 624-6242 or (202) 334-3313 www.nap.edu viii

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Preface Two water-supply systems on the Marine Corps Base Camp Lejeune in North Carolina were con- taminated with the industrial solvents trichloroethylene (TCE) and perchloroethylene (PCE). The con- tamination appears to have begun in the middle 1950s and continued until the middle 1980s, when con- taminated supply wells were shut down. The sources of the contamination were an off-base dry-cleaning establishment and on-base industrial activities. Contaminated water was distributed to enlisted-personnel family housing, barracks for unmarried personnel, base administrative offices, schools, a hospital, indus- trial areas, and recreational areas. Many former residents and employees of the base have raised questions about whether health problems that they or members of their families have experienced could be related to their exposure to the contaminated water. A few studies have been performed on former residents of the bases, but they were focused only on selected birth and childhood health outcomes. As directed by Congress, the U.S. Navy requested a study by the National Research Council to review the scientific evidence on associations be- tween historical data on prenatal, childhood, and adult exposures to contaminated water at Camp Lejeune and adverse health effects. In response to the Navy’s request, the National Research Council convened the Committee on Contaminated Drinking Water at Camp Lejeune, which prepared this report. The members of the commit- tee were selected for their expertise in epidemiology, toxicology, exposure analysis, environmental health, groundwater modeling, biostatistics, and risk assessment (see Appendix A for biographic information on the members). To help the committee in its review, meetings were held in September and November 2007 and September 2008 to gather information from scientists and those who chose to inform the committee re- garding their experiences in relation to the water contamination at Camp Lejeune. The committee is grate- ful to the people who gave presentations on their investigations into the contamination of the water sup- plies at Camp Lejeune and on general issues related to groundwater modeling, including a series of responses to followup queries from members of the committee: Frank Bove and Morris Maslia, of the Agency for Toxic Substances and Disease Registry (ATSDR); Richard Clapp, of Boston University and a member of ATSDR’s community-assistance panel; Marcia Crosse, of the U.S. Government Accountabil- ity Office; and Mary Hill, of the U.S. Geological Survey. The committee also thanks the many former residents of and workers at Camp Lejeune who contributed their time to attend the public meetings and share their experiences and concerns (see Appendix B). In particular, the committee acknowledges Jerry Ensminger and Jeff Byron, who served as representatives of people who were unable to attend the meet- ings. The committee is thankful for the useful input from Amy Kyle, of the University of California at Berkeley, in the early deliberations of this study. It would also like to acknowledge the advice that it re- ceived from Michael Luster, formerly with the National Institute for Occupational Safety and Health, who was a consultant to the committee on immunotoxicity issues. The U.S. Marine Corps provided the committee with support throughout the study. Kelly Dreyer and Scott Williams helped to coordinate a meeting at Camp Lejeune and responded to the committee’s requests for background information. The committee is grateful to the staff of the Installation and Envi- ronment Department at Camp Lejeune for providing a guided tour of the areas of the base where the sup- ix

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x Preface ply wells and water-treatment plants were and of the residential and work areas that were served by the contaminated water systems. This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of the independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following for their review of this report: John L. Adgate, University of Minnesota; Mary P. Anderson, University of Wisconsin; Richard Clapp, Boston University; Mary C. Hill, U.S. Geo- logical Survey; Margot Krauss, consultant; Lawrence H. Lash, Wayne State University; Rosalind A. Schoof, Integral Consulting, Inc.; Michael A. Stoto, Georgetown University; Clifford Weisel, University of Medicine and Dentistry of New Jersey; and Raymand S. Yang, Colorado State University. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by the review coordinator, George M. Rusch, Honeywell Inc., and the review monitor, George M. Hornberger, Vanderbilt University. Ap- pointed by the National Research Council, they were responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution. The committee is grateful for the assistance of National Research Council staff in preparing the report. In particular, Susan Martel, who served as project director, skillfully coordinated the project and contributed to the committee’s report, devoting patient, concerted effort to resolving the many controver- sies that evolved through the course of the project. Other staff members who contributed are James Reisa, director of the Board on Environmental Studies and Toxicology; Norman Grossblatt, senior editor; Mir- sada Karalic-Loncarevic, manager of the Technical Information Center; Tamara Dawson, program asso- ciate; and Patrick Baur, research assistant. The committee members devoted substantial effort to the development of this report through rounds of discussion, deliberation, writing, and rewriting. They came to their task with a wide variety of perspectives based on disciplinary training, research pertaining to the chemicals and health effects of con- cern, and ideology; but all shared a commitment to bring the best knowledge possible to bear on impor- tant health issues and to assist the sponsor and former Camp Lejeune residents by offering an assessment and a scientific perspective that can help to bring this long-standing and sometimes contentious concern closer to a resolution. This report focuses on what scientific evidence can say about the causal relationship of past expo- sures and health outcomes. It is important to understand the difference between how scientific evidence is used in this context, compared to how it is used in the context of regulatory risk assessment and preven- tion. We should be clear that the evaluation we conducted was not for the purposes of regulatory risk as- sessment, and the prepublication version of this report may not have made this distinction clear enough to all readers. The following excerpt from the 2003 Institute of Medicine report, Gulf War and Health Vol- ume 2 provides a useful explanation of this important distinction.2 Most laws enforced by regulatory agencies permit the agencies wide latitude in the choice of data used to prevent future disease or injury. In the present case, however, the goal is not prevention of risk, but rather the use of the best available data to categorize evidence for a relationship be- tween a chemical exposure and the occurrence of an adverse health outcome in humans. Here, precautionary policies have no substantial role (at least not the same way that they have in regu- 2 This paragraph was added after the release of the prepublication to clarify an issue that confused some readers of the prepublication.

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Preface xi lation). Therefore, studies in human populations played the dominant role for the committee in identifying the relevant associations. Experimental evidence may or may not provide support for epidemiologic conclusions. David A. Savitz, Chair Committee on Contaminated Drinking Water at Camp Lejeune

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Abbreviations ALL acute lymphocytic leukemia ALS amyotrophic lateral sclerosis ATSDR Agency for Toxic Substances and Disease Registry AWWA American Water Works Association BMI body-mass index BTEX benzene, toluene, ethylbenzene, and xylene CHAMPS Naval Health Research Center’s Career History Archival Medical and Personnel System CI confidence interval CLW Camp Lejeune water CNS central nervous system CYP cytochrome P-450 DCA dichloroacetic acid DCE dichloroethylene DCVC S-(1,2-dichlorovinyl)-L-cysteine DCVCS DCVC sulfoxide DCVG S-(1,2-dichlorovinyl)glutathione DCVT S-(1,2-dichlorovinyl)thiol DEP Department of Environmental Protection DNAPL dense nonaqueous-phase liquid DOD U.S. Department of Defense DP dipeptidase EEG electroencephalograpic EPA U.S. Environmental Protection Agency FMO3 flavin-containing monooxygenase 3 GAO U.S. Government Accountability Office GIS geographic information system GST glutathione S-transferase IARC International Agency for Research on Cancer IFN-γ interferon gamma IL-4 interleukin-4 ILO International Labor Organization IOM Institute of Medicine JEM job-exposure matrix LBW low birth weight LMP last menstrual period LOAEL lowest-observed-adverse-effect level MC methylene chloride MCAS Marine Corps Air Station MCL maximum contaminant level xiii

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xiv Abbreviations MCLG maximum contaminant level goal MOR mortality odds ratio MS multiple sclerosis NCDNRCD North Carolina Department of Natural Resources and Community Development ND not detected NHL non-Hodgkin lymphoma NOAEL no-observed-adverse-effect level NR not reported NRC National Research Council NTP National Toxicology Program OR odds ratio OU operable unit PAH polycyclic aromatic hydrocarbon PCE perchloroethylene PDD personal delivered dose PPARα peroxisome-proliferator-activated receptor alpha PPT parts per trillion PSOpS Pumping Schedule Optimization System PVC polyvinyl chloride RDD relative delivered dose RI remedial investigation RR relative risk SES socioeconomic status SGA small for gestational age SIR standardized incidence ratio SLE systemic lupus erythematosus SMR standardized mortality ratio SRR standardized rate ratio SSFL Santa Susana Field Laboratory STROBE strengthening the reporting of observational studies in epidemiology SVOC semivolatile organic compound TAL target analyte list TCA trichloroacetic acid TCE trichloroethylene TCE-O-CYP trichloroethylene-oxide-cytochrome P-450 complex TCL target compound list TCOG trichloroethanol glucuronide TCOH trichloroethanol TCVC S-(1,2,2-trichlorovinyl)-L-cysteine TCVCS S-(1,2,2-trichlorovinyl)-L-cysteine sulfoxide TCVG S-(1,2,2-trichlorovinyl) glutathione TLBW term low birth weight UST underground storage tank VA Department of Veterans Affairs VC vinyl chloride VHL von Hippel-Landau VLBW very low birth weight VOC volatile organic compound

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Contents ABBREVIATIONS .................................................................................................................................. xiii PUBLIC SUMMARY AND CONTEXT ................................................................................................... 1 SUMMARY ............................................................................................................................................... 14 1 INTRODUCTION ....................................................................................................................... 23 Investigations, 24 Committee’s Task, 25 Committee’s Approach, 26 Organization of the Report, 27 2 EXPOSURE TO CONTAMINANTS IN WATER SUPPLIES AT CAMP LEJEUNE ........ 28 Exposure Assessment for Epidemiologic Studies, 28 Water-Supply Contamination at Camp Lejeune, 29 Committee’s Water-Supply Evaluation Approach, 36 Tarawa Terrace Water Supply, 38 Hadnot Point Water Supply, 50 Water Use Patterns and Behaviors, 61 Exposure Pathways, 62 Affected Study Population, 62 Exposure Assessment in Studies of Health Effects of Water-Supply Contamination at Camp Lejeune, 63 Conclusions, 64 Recommendations, 65 3 SYSTEMIC EXPOSURES TO VOLATILE ORGANIC COMPOUNDS AND FACTORS INFLUENCING SUSCEPTIBILITY TO THEIR EFFECTS ............................. 67 Environmental Contamination, 67 External Exposure, 68 Internal Exposure, 69 Potentially Sensitive Populations, 78 Interactions, 86 Summary, 87 4 REVIEW OF TOXICOLOGIC STUDIES ................................................................................ 90 Trichloroethylene, 90 Perchloroethylene, 108 Summary, 119 xv

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xvi Contents Hazard Evaluation of Trichloroethylene and Perchloroethylene Exposure for Selected End Points, 127 Allowable Limits of Volatile Organic Compounds in Drinking Water, 132 Conclusions, 132 5 REVIEW OF EPIDEMIOLOGIC STUDIES .......................................................................... 134 Evaluating the Epidemiologic Literature, 134 Studies of Trichloroethylene and Perchloroethylene, 136 Conclusions, 164 6 EPIDEMIOLOGIC STUDIES OF SOLVENT-CONTAMINATED WATER SUPPLIES .................................................................................................................................. 165 Methods, 165 Results, 178 Discussion, 178 Conclusions, 179 7 INTEGRATION OF FINDINGS FROM THE TOXICOLOGIC AND EPIDEMIOLOGIC LITERATURE ........................................................................................ 180 Cancer Outcomes, 180 Noncancer Outcomes, 181 Conclusions, 183 8 STUDIES OF THE CAMP LEJEUNE POPULATION ......................................................... 184 Completed Studies, 184 Current Studies, 188 Future Studies, 191 Findings of Completed, Current, and Future Studies, 195 Conclusions and Recommendations, 196 REFERENCES ........................................................................................................................................ 198 APPENDIXES A BIOGRAPHIC INFORMATION ON THE COMMITTEE ON CONTAMINATED DRINKING WATER AT CAMP LEJEUNE ....................................... 237 B PARTICIPANTS AT PUBLIC SESSIONS ............................................................................. 241 C SUPPLEMENTAL AND SUPPORTING DATA FOR CHAPTER 2 ................................... 243 D REVIEW OF OTHER CHEMICAL CONTAMINANTS OF CONCERN .......................... 258 E DETAILS OF EPIDEMIOLOGIC STUDIES ON TRICHLOROETHYLENE AND PERCHLOROETHYLENE ............................................................................................ 272

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Contents xvii BOXES, FIGURES, AND TABLES BOXES 1 Five Categories Used by IOM to Classify Associations, 6 2 Categorization of Health Outcomes Reviewed in Relation to TCE, PCE, or Solvent Mixtures, 8 5-1 Five Categories Used by IOM to Classify Associations (IOM 2003), 135 FIGURES 1 Conceptual Model of a Camp Lejeune Water System, 3 2-1 Water-Distribution systems serving U.S. Marine Corps Base Camp Lejeune, Camp Lejeune, North Carolina, 30 2-2 Geologic Cross Section of Camp Lejeune, 32 2-3 Conceptual Model of DNAPL Transport, 34 2-4 Conceptual Model of a Camp Lejeune Water System, 36 2-5 Simulated Water Level and Direction of Groundwater Flow, and Distribution of Tetrachloroethylene (PCE), Model Layer 1, December 1984, Tarawa Terrace and Vicinity, U.S. Marine Corps Base Camp Lejeune, North Carolina, 46 2-6 Designated Hazardous-Waste Remedial Investigation Sites at Hadnot Point, 53 3-1 Environmental Contamination from Solvents and Exposure Pathways, 68 3-2 Metabolism of Trichloroethylene, 75 3-3 Metabolism of PCE by P-450 Pathway, 76 3-4 Metabolism of PCE by Glutathione Conjugation Pathway, 77 4-1 Effects of Exposure to TCE by Inhalation, 121 4-2 Effects of Exposure to PCE by Inhalation, 121 4-3 Effects of Exposure to TCE by Ingestion, 122 4-4 Effects of Exposure to PCE by Ingestion, 122 TABLES 1 Similar Health Effects Found in Epidemiologic and Toxicologic Studies, 11 2-1 Water Supply of Housing Areas, Camp Lejeune, North Carolina (1941-2000), 35 2-2 Contaminants found in Soil or Groundwater at Hazardous Waste Sites Near Water Supply Wells, 37 2-3 Observed Concentrations on PCE in Tarawa Terrace Water-Supply Wells, 40 2-4 Summary of Selected Analyses for PCE, TCE, and trans-1,2-DCE in Water Samples Collected at Tarawa Terrace Water-Treatment Plant and Tarawa Terrace Addresses, 41 2-5 Benzene and Toluene Concentrations in Water Samples Collected at Tarawa Terrace Water-Treatment Plant, 43 2-6 Assumed Thickness and Layer of Castle Hayne Aquifer Units, 44 2-7 Calibrated Model Parameter Concentrations Used to Simulate Groundwater Flow and Contaminant Fate and Transport in Tarawa Terrace and Vicinity, 45 2-8 Simulated and Observed PCE Concentrations at Water-Supply Wells and Calibration Target Range, Tarawa Terrace and Vicinity, 47 2-9 Installation Restoration Sites in the Hadnot Point Water Supply Area, 52 2-10 Contaminant Concentrations in Supply Wells of Hadnot Point Water Systems, 55 2-11 Hadnot Point Water-Supply Quality Measurements (October 1980-February 1985), 56

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xviii Contents 2-12 Summary of Data on Water Samples from Hadnot Point Water System Recorded as Not Detected or Not Quantified in Table 2-11, 57 2-13 Characteristics of the Hadnot Point Supply Wells with at Least One Contaminated Sample Taken between October 1980 and February 1985, 58 2-14 Concentrations of Contaminants in Mixed Water Samples Collected from Hadnot Point Water-Distribution System during Period of Documented Well Cycling, 59 2-15 Potential Sites of Nonresidential Exposure to Contaminants in the Tarawa Terrace and Hadnot Point Water Systems, 1943-1985, 63 4-1 Animal Cancer Studies of PCE with Positive Outcomes, 111 4-2 Animal Cancer Studies of PCE Determined to be Negative, Inadequate, or Incomplete, 111 4-3 LOAELs from Animal Studies Used for Comparison with Estimated Daily Human Doses to TCE Related to Water Supply Measured Concentrations, 129 4-4 from Animal Studies Used for Comparison with Estimated Daily Human Doses to PCE Related to Water Supply Measured Concentrations, 129 6-1 Summary of Epidemiologic Studies Involving Drinking-Water Contamination with TCE, PCE, and Other Solvents, 166 6-2 Summary of Reported Water-Monitoring Data in Published Epidemiologic Studies, 173 C-1 Characteristics of Remedial Investigation Sites Outside Tarawa Terrace and Hadnot Point Water-Supply Areas, 244 C-2 Documents That Contain Water-Quality Testing Information, 246 C-3 Concentrations of Contaminants in Hadnot Point Mixed and Finished Water Samples Collected in October 1980–February 7, 1985, 250 C-4 Concentrations of Contaminants in Hadnot Point Supply Well Water Samples Collected in October 1980–February 7, 1985, 252 C-5 Positive Detection Summary, Deep Monitoring Wells, Hadnot Point Installation Restoration Sites 78, 6, 9, and 82, Remedial Investigation Sampling Efforts, 1992-1993, 254 C-6 Estimated Number of Residences by Water-Treatment Plant, 1942-2000, 257 E-1 Exposure Information on Epidemiologic Studies Involving Exposure to TCE or PCE, 273 E-2 Studies of Cancer End Points and Exposure to TCE, 283 E-3a Studies of Noncancer End Points and Exposure to TCE, 302 E-3b Studies of Neurologic Effects and Exposure to TCE, 303 E-4 Studies of Cancer End Points and Exposure to PCE, 304 E-5a Studies of Noncancer End Points and Exposure to PCE, 316 E-5b Visual Contrast Sensitivity and Visual Acuity, 318

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