SU0005935 SSCRPT - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY Z` ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 C o Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd q5/do RN.' SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST Fs ITE LOCATION: 2 TJ 7y 11 / A / PA#: L O✓1� A �C !✓7C4�flJv�- REPORT DATE: /_-;-? E; S = Sufficient I = Insufficient San Joaquin County Development Title Chapter 9-905,Section 9-905.12 S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ❑ 1.1 Description of site (regrxt mustaddress all parcel ) Igding current and/or proposed zoning information. F-11.2 Description of proposed developme t. . Ly ❑ 1.3 Parcel location map. 2- �v—L„- ) [� ❑ 1.4 Site map showing to f o of all items on parcel. (Examples:structure rives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) A,j"z.4jd ' 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: currentInd/or previous property owners, historical maps, insurance maps, previous land use applications, etc.) 2-e- 31 A -I C _) 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 r ords s�ch, a ncultur�l chemical application search, site reconnaissance and survey, eta f J"-yOr �S�Cry , 7 [� ❑ 3.2 Description of all past on-site potential and/or known above and low 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.) � tc' E ❑ 3.3 Description of all current on-site It ten'fial and/or known above and below ground sources of contamination identified at the project site (see examples above y fy I u 131/ F-13.4 Description of all past off-site potential and/or kno n 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 p oximit)to a former �/ landfill/former gasoline station, in area of known DBCP/Nitrate groundwater impact, etc.) (`6 l/ LJ ❑ 3.5 Description of all current off-site potential and/or known above and below ground source of contamination identified in the area of the project site. 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATION IDENTIFIED / AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION E ❑ 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 t"env`onment. This evaluation should take into consideration the proposed future uses of the project parcel. ("y. 4 ) 5.0 CONCLUSIONS AND RECOMMENDATIONS SECTION ❑ 5.1 Discussion of the above evaluation to either rule out each source as a a 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. EK ❑ 5.2 The report was inclusive(i.e. all information referenced was included in this report-report should not reference 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.- [3/ ❑ 5.5 The attachmentsla ntain sufficient documentation to support claims made in report. Reviewed By- Reviewed Date: �y EHD 26-01 Pagel of 2 Surface&Sub Checklist L