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4`2 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ' 1304 E Weber Avenue 3'd Floor Stockton.CA 95202-2708 \r�:., qi (209)468-3420•Far:(209)464-0138 • Web:www.co.san-ioaquin.ca.us/ehd \i%St, SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST PA#: 0400316 SRE LOCATION: /`�-�U n j .26 REPORT DATE: 5 - 5utficirnt San Joaquin County Development Title Chapter 9-905,Section 9-905.12 1 - Imuftl<icnt - S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION Elcur❑ 1.1 Description of site(report must address all parcels),including rent and/or proposed zoning information.Aci pyo/ ❑ 1.2 Description of proposed development f cj I ❑ ❑ 1.3 Parcel location map. (\V ff V-C1 X Q ❑ 1.4 Site map showing location of all hems on parcel. (Examples:structures,drives,wells,septic systems,large trees, pastures,pools,natural drainage courses,ponds,waterways,etc.) Y, 2.0 x 2.0 PAST, PRESENT AND PROPOSED FUTURE USES OF THE SITE SECTION ❑ ❑ 2.1 .Discussion of past,present and proposed future uses at the she to assess potential problems. (Example sources of information:current and/or previous property owners,historical maps,insurance maps, previous land use applications,etc.) N 1 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINATION ❑ ❑ 3.1 Dgcussions 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,eta) rcr- /— Z Lai 3.2 Description of all past on-site potential and/or known above and below ground sources of contamination identified at the project she. (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.) )9 ® ❑ 3.3 Description of all current on-site p y potential and/or known above and below ground sources of contamination identified at the project site(see examples above).P4 Z ® El 3.4 Description of all past off-she 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 she. (Examples: Close proximity to a former � landfill former gasoline station,in area of known DBCP/Nitrate groundwater impact,etc.) ve/ 2 L�I ❑ 3.5 Description of all current off-site potential and/or known above and below ground sources of contamination identified in the area of the project site. 9 7- 4.0 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATIO IDENTIFIED AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION lim Lf,J ❑ 4.1 Evaluation of each potential and/or known source of contamination Identified(n the above section)for any real and/or potential threat to human health and the envimnmen� This evaluation should take into consideration the proposed future uses of the project parcel. 6 by-A!(10 9 too Z- 5.0 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(.e.,dean up of surface wastes). All recommendations for future work must include a time frame for implementation. f5 2- 5.2 5.2 The report was inclusive(.e.all information referenced was included in this report-report should not reference other reports). ,y Z © ❑ 5.3 The report was signed,dated and stamped by a qualified environmental professional.^r 3 ❑ 5.4 The report was prepared within six months of the date of the submittal of the land use application. ® ❑ 5.5 The attachments/appendices conlain�ocumentation to support claims made in report Reviewed By. Reviewed Date: ab �� EHD7&02-W1 Page I oft S.d.x &SOCmMist 7/IN-M