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p*.., Pt]ti31 N\ ,�-,; - ..co SAN JOAQUIN COUNTY AiENVIRONMENTAL HEALTH DEPARTMENT �. c. 600 East Main Street, Stockton, CA 95202-3029 -•P Telephone:(209)468-3420 Fi (209)464-0138 Web:www.sjgov.org/ehd SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST I SITE LocATION: �j �f PAM 13 4tsREPORT DATE: 5 - Sufficient San Joaquin County Development Title Chapter 9-905,Section 9-905.12 i I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION 0- ❑ 1.1 Description of site(report must address all parcels), including current and/or proposed zoning information. a El 1.2 DescriI ption of proposed development. tZ ❑ 1.3 Parcell tion. p. B ❑ 1.4 Site mal':"% nnng location of all items on parcel. (Examples:structures,drives,wells, septic systems,large trees, pastures, pools, natural drainage courses,ponds,waterways,etc.) E 2.0 PAST,PRESENT AND PROPOSED FUTURE USES OF THE SITE SECTION a ❑ 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.) • i 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.) '5 ❑ 3.2 Description of all past onstte potential and/or known above and below ground sources of contamination identified at the project site-(Examsles: Agricultural chemical handling/storage/use, aboveground/underground tanks, I� septic systems, injection wells, unsealed wells, ponds/lagoons,vehicle/machine repair/painting, buried or stockpiled solid waste,etc.) 10 F13.3 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). T ® ❑ 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: Gose proximity to a former landfill/former gasoline station, in area of known DBCP/Nitrate groundwater impact,etc.) ffl ❑ 3.5 Description of all current off-site potential and/or knot hol a and/below ground sources of contamination identified in the area of the project site. ? } 10 11 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. . 17 _ // 5.0 CONCLUSIONS AND RECOMMENDATIONS SECTION EL ❑ 5.1 Discussion of the above evaluation to either rale 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 recommendations for future work must include a time frame for implementation. ❑ 5.2 The report was inclusive(i.e. all information referenced was included in this report-report should not reference other reports). fO ❑ 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. 0- ❑ 5.5 The attachments/ end' s contain sufficient documentation to support claims made in report. Reviewed By: ' :Reviewed Date: a iI EHD 2"1 Paget of 2 Surface&Sub Checklist •,n nnnm