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SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENTS CHECKLIST San Joaquin County Development Title Chapter 9-905,Section 9-905.12 PA# s=snMseisnt SITE REPORT 1.Ins0m<unt LOCATION — %/ _ "0140t•ppnesei , '"DATE rXi/ / aCk'1 . 8 1 INTRODUCTION AND PROPOSED DEVELOPMENT SECTION ❑ Description of site (report must address all parcels). Description of current and/or proposed future zoning. ❑ ❑ Site map showing the location, with dimensions, of the project parcels. Site map shows all improvements existing on the land. Site map shows all exisitng natural features, such as ephemeral drainage courses, creeks, etc. ❑ Description of proposed development . PAST, PRESENT AND FUTURE USES OF THE SITE SECTION ❑ ❑ Discussion of past, present and proposed future uses at the site . IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINTATION ❑ ❑ Discussion of the methods used to research and investigate the potential or realized above and below ground sources of contamination at the project site. (Database search, EHD records search, agricultural chemical application search, site reconnaissance and survey, etc.) ❑ ❑ Description of all past on-site potential or realized above and below ground soures of contamination identified at the project site. (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.) ❑ Description of all past off-site potential or realized soures of contamination that may impact the project parcels at some time in the future (i.e. next to a landfill/former gas station, in area of known DBCP impact, etc.) identified near the project site. ❑ ❑ Description of all current on-site potential or realized soures of contamination identified at the project site. ❑ ❑ Description of all current off-site potential or realized soures of contamination that may impact the project parcels at some time in the future (i.e. next to a landfill) identified near the project site. EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATION IDENTIFIED AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION ❑ ❑ Evaluation and discussion of each above/below ground potential or realized source of contamination (identified in the above section)for any real or potential threat to human health and the environment. This evaluation should take into consideration the proposed future uses of the project parcels. CONCLUSIONS AND RECOMMENDATIONS SECTION -D ❑ 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 mitigation measures (i.e. clean up of surface wastes). All recommendations for future work include a time frame for implementation. Q ❑ The report was signed and stamped by the appropriately registered individual. ❑ ❑ The attachments/appendices contain suffiecient documentation to support claims made in report. COMMENTS: REVIEWED BY REVIEWED DATE