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State of California-California iron ntat Protection Afl�cY Depar t of Toxic substances Control <br /> `• ./ <br /> TIERED PERMITTING PHASE I ENVIRONMENTAL ASSESSMENT CHECKLIST <br /> SECTION H: FACILITY LOCATION <br /> Instructions: For owners/operators applying for Permit-by Rule or Conditional Authorization, complete this <br /> section. Standardized Permit applicants do not need to complete this section. This section will be used by <br /> the Department to identify environmentally sensitive areas surrounding the facility. <br /> YES NO <br /> 18. Is the facility located in a 100 year floodplain? This information can be obtained by <br /> contacting a local insurance company and requesting information regarding the <br /> National Flood Insurance Program produced by the Federal Insurance NO <br /> Administration Map (California Code of Regulations, Title 22, Section <br /> 66270.14(b)(11)(C)). <br /> 19. Are there any residences, streams, rivers, major storm water courses, ditches, <br /> wetlands, bodies of water, low lying areas, and/or shallow ground depressions NO <br /> located on or within 500 feet of the facility property.jine? <br /> 20. Are there any schools, day care centers, nursing homes, senior citizen communities, <br /> hospitals, or restaurants located within 1500 feet of the facility property line? NO <br /> 21. Are there any critical habitats for sensitive, threatened, or endangered plant and/or <br /> animal species located within 1500 feet of the facility? The Department of Fish and NO <br /> Game has a Natural Diversity Data Base (916) 324-3812 with information regarding <br /> endangered plants and animal species for the State of California. <br /> 22. Are there any private, commercial, municipal, or agricultural groundwater wells <br /> located on or within 1000 feet of the facility? This information can be obtained <br /> from the Department of Water Resources as follows (additional information is <br /> attached on the next page): NO <br /> Statewide Contact: (916) 327-8861 <br /> Northern District: (916) 529-7368 <br /> Central District: (916) 322-7159 <br /> San Joaquin District: (209) 445-5038 <br /> Southern District: (818) 543-4600 Ext. 225 <br /> i <br /> I <br /> Please indicate total number of pages: Page 3 of <br /> DTSC 1151 (6194) WORKSHOP DRAFT 7 <br />