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�cz SAN-JOAQUIN COUNT)C ENvIRONIMENTAL-HEALTH DEPARTMENT 304 E Weber Avenue 3rd Floor Stockton•CA 95202-2705 �. (209)46$-3426•Fir:(209)464-0138• Web:www.eosa>zytxiquin.ca.us/ehd SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREM ENT.CHECKLIST SITE I.00Amgw � o DS f' 40 •&19-*& r t--,&I r- - � `y PA#: Q4-3�3[rte REPORT DATE= 6 S a Suffrcicnt r k,A ervt.r•+�.�.-Q S.Ire- I - lud icicnt San Joaquin County Development Title Chapter 9-905,Section 9�05.i2 S - I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION G-1 ❑ 1.1 Description of site(report must address all parcels),including current and/or proposed zoning information. tiG•- 1�' ��.-7 ❑ 1.2 Description of proposed development t0 flk.d „e re r t ""D r�r'�'Ft� •r -04-a cvw• 14.42 � ttL 0 ❑ 1.3 Parcel location map. �x 4 E1 ❑✓ 1.4 Site map showing location of all items on parcel. (Examples:structures,drives,wells,septic systems,large trees,pastures,pools,natural drainage courses,ponds,waterways,etc) n��b,F ,4e- r wa!M.(cS -+�+cf+•--c c csso�ta w,Yw. ZD�+S fait .af At•4 sena. 2.0 PAST, PRESENT AND PROPOSED !F=UTURE USES OF THE SITE SECTION r' ' p i� _i 0 ❑ 2-1 Discussion of past,present and proposed future uses at the site to assess potential problems. (Example sources 1 of information:current ar'rdlor previous property yowners historical .insurance maps,previous land use applications,etc.) 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINATION r Pgz ❑✓ ❑ 3.1 Discussions of the methods used to research and investigate the potential or known above and belowrground l sources of oontamination at time project site. (Examples: Database search,EHD records search,agricultural chemical application search,site reconnaissance and survey,etc.) ❑N ❑ 3.2 Description of all past on-site potential and/or known above and below ground sources of contamination identified at,the project site. (Examples: Agricultural chemical handfing/storagetuse,aboveground/underground tanks, -�---- -- --- seep c systems,lnje�ion r+�is.unseated we[ls�nds7iag -�it�afmachine repairlpainting.buried-or---------—---- -- �� stockpiled solid waste,etc.) ❑r ❑ 3.3 Description-of all current on-site potential and/or known above and below ground sources of contamination mix identified.at the project site(see examples above). , ❑' ❑ 3.4 Description of all past off3ite potential and/or known above and below ground sources of contamination identified in the area of the project site that has or may impact the project site. (Examples: Close proximity to a former i i landfill/former gasoline station,in area of known DSCP/Nitrate groundwater impact,etc.) j1t ° d. M ❑ 3.5 Description of all current off-site potential and/or known above and below ground sources of contamination identified in the area of the project site. 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATIO IDENTIFIED AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION `� ❑ 4.1 Evaluation of each potential and/or known source of contamination identified(in the above section)for any real 71% and/or potential threat to human health and the environment. Tk is evaluation should take into consideration the proposed future uses of the project parcel. 5.0 CONCLUSIONS AND RECOMMENDATIONS SECTION 5.1 Discussion of the above evaluation to either rule out each source as a neat or potential threat or to recommend �9 '" ' t ❑,...s further action to mitigate or abate any real or potential threats Identified. Recommendations may include .r .---? additional site assessment(i.e.collection of soillwater samples)and/or mitigative measures(i.e.,dean up of 00 . surface wastes). AA recommendations for future work must include a lime frame for implementation. ❑ 5.2 The report was inclusive(.e.all information referenced was included In this report-report should not reference other reports). t S �� t. ❑ ❑'5.3 The report was signed,dated and stamped by a qualified environmental professional. � ❑ 5.4 The report was prepared within six months of the ate of the submittal of the land u appliicatior u do adde,_,c-,.,,,_,. 5, r-4 -nk4 Q is�r�b . r�o_� c1a1: lv��os- : ❑ ❑ 5.5 The attachments/appendices in 'ent documentation to support claims m de in report. Reviewed By: Reviewed Date: 1 Y d 6 i EHD?6-01-001 Page I of t Surface&Sub chedlist I N 14.+2003