SU0010729 SSCRPT - Laserfiche WebLink

Home Browse Search

PaUIN SAN JOAQVIN COUNTY o......... c kw I ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-3029 i4-6RN� / ( � ( ) lg g r..— *3'c Telephone: 209 468-3420 Fax: 209 468-0333 Web:www.s ov.or /ehd q�I SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST PA#: / +S "doZg/ s> �ESITELOCATION: 3139K x REPORT DATE: S = Sufficient I = Insufficient San Joaquin County Development Title Chapter 9-905, Section 9-905.12 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION PT ❑ 1.1 Description of site(report must address all parcels), including current and/or proposed zoning information. ❑ 1.2 Descript on of proposed development. z �f ❑ 1.3 Parcel location map. AN ❑ 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.) 2.0 PAST, PRESENT AND PROPOSED FUTURE USES OF THE SITE SECTION ® ❑ 2.1 Discussion of past, present and proposed future uses at the site to assess potential problems. (Example sources of information: current and/or previous property owners, historical maps, insurance maps, previous land use applications, etc.) -2� 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINATION ❑ 3.1 Discussions of the methods used to research and investigate the potential or known above and belowground sources of contamination at the project site. (Examples: Database search, EHD records search,agricultural chemical application search, site reconnaissance and survey,etc.) 2":5: ❑ 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 handling/storage/use, aboveground/underground tanks, septic systems, injection wells, unsealed wells, ponds/lagoons,vehicle/machine repair/painting, buried or stockpiled solid waste, etc.) t, _5� ❑ 3.3 Description of all current on-site potential and/or known above and below ground sources of contamination identified at the project site (see examples above). s S ® ❑ 3.4 Description of all past off-site 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 landfill/former gasoline station, in area f known DBCP/Nitrate groundwater impact, etc.) ❑ 3.5 Description of all current off-site poled 9d/or known above and below ground sources of contamination identified in the area of the project site. z -_ 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATION 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 and/or potential threat to human health and the environment. This evaluation should take into consideration the proposed future uses of the project parcel. 5- 5.0 CONCLUSIONS AND RECOMMENDATIONS SECTION ,® ❑ 5.1 Discussion of the above evaluation to either rule out each source as a real or potential threat or to recommend further action to mitigate or abate any real or potential threats identified. Recommendations may include additional site assessment(i.e.collection of soil/water samples)and/or mitigative measures(i.e.,clean up of surface wastes). All re6remmendations for future work must include a time frame for implementation. Ind ❑ 5.2 The report was inclusive(i.e. all information referenced was included in this report—report should not reference �T other reports). ❑ 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 date of the submittal of the land use application. f ❑ 5.5 The attachments/appendices contain sufficient documentation to support claims made in report. Reviewed By: Reviewed Date: 1 1� 6 EHD 26-01 Page 1 of 2 Surface&Sub Checklist