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rod, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ::.I 304 E Weber Avenue 3`d Floor Stockton - CA 95202-2708 <br /> dlj-" (209)468-3420 •Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST <br /> SITE LOCATION: 1580 N. REPORT AVE.,STOCKTON PA#: 08-70(MS) <br /> REPORT DATE: 10/11/2007 <br /> S = Sufficient San Joaquin County Development Title Chapter 9-905, Section 9-905.12 <br /> 1 = Insufficient <br /> S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br /> ® ✓ ❑ 1.1 Description of site(report must address all parcels), including current and/or proposed zoning information. <br /> ® ✓ ❑ 1.2 Description of proposed development. <br /> ® V ❑ 1.3 Parcel location map. <br /> ® ✓ ❑ 1.4 Site map showing location of all items on parcel. (Examples: structures, drives, wells, septic systems, large trees, <br /> pastures, pools, natural drainage courses,,ponds, waterways, etc.) <br /> 2.0 PAST, PRESENT AND PROPOSED FUTURE USES OF THE SITE SECTION <br /> ® V ❑ 2.1 Discussion of past, present and proposed future uses at the site to assess potential problems. (Example sources <br /> of information: current and/or previous property owners, historical maps, insurance maps, previous land use <br /> applications, etc.) <br /> 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINATION <br /> ®-V ❑ 3.1 Discussions of the methods used to research and investigate the potential or known above and belowground <br /> sources of contamination at the project site. (Examples: Database search, EHD records search, agricultural <br /> chemical application search, site reconnaissance and survey, etc.) <br /> ® ❑ 3.2 Description of all past on-site potential and/or known above and below ground sources of contamination identified <br /> at the project site. (Examples: Agricultural chemical handling/storage/use, aboveground/underground tanks, <br /> septic systems, injection wells, unsealed wells, ponds/lagoons, vehicle/machine repair/painting, buried or <br /> stockpiled solid waste, etc.) <br /> ®✓ ❑ 3.3 Description of all current on-site potential and/or known above and below ground sources of contamination <br /> identified at the project site(see examples above). <br /> ® � ❑ 3.4 Description of all past off-site potential and/or known above and below ground sources of contamination identified <br /> in the area of the project site that has or may impact the project site. (Examples: Close proximity to a former <br /> landfill/former gasoline station, in area of known DBCP/Nitrate groundwater impact, etc.) <br /> ® v ❑ 3.5 Description of all current off-site potential and/or known above and below ground sources of contamination <br /> identified in the area of the project site. <br /> 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATIO IDENTIFIED <br /> AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION <br /> ❑ 4.1 Evaluation of each potential and/or known source of contamination identified (in the above section)for any real <br /> and/or potential threat to human health and the environment. This evaluation should take into consideration the <br /> proposed future uses of the project parcel. <br /> 5.0 CONCLUSIONS t�}AND RECOMM"IDATIQNS SECTION <br /> �GSts% t� —bo €24('�//7/d4?c r• it e ou each <br /> ounce s � <br /> ® ❑ ✓ 5.1 Disc sslon o the a v alua ion to either rule out each source as a real or potential threat or to recommend <br /> further action to mitigate or abate any real or potential threats identified. Recommendations may include <br /> additional site assessment(i.e. collection of soil/water samples)and/or mitigative measures(i.e., clean up of <br /> surface wastes). All recommendations for future work must include a time frame for implementation. <br /> ®✓ ❑ 5.2 The report was inclusive(i.e. all information referenced was included in this report—report should not reference <br /> other reports). <br /> ® l,/ ❑ 5.3 The report was signed, dated and stamped by a qualified environmental professional. <br /> ❑ 5.4 The report was prepared within six months of the date of the submittal of the land use application. <br /> ®� ❑ 5.5 The attachments/appendices contain sufficient documentation to support claims made in report. <br /> Reviewed By: Michael F. Escotto Reviewed Date: 3/27/2008 <br /> EHD 26-02-001 Page 1 of 2 Surface @ Sub Checklist <br /> In.1n 1 <br />