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Pp N SAN JOAQUIN COUNTY zy ENVIRONMENTAL HEALTH DEPARTMENT .a 1868 East Hazelton Avenue, Stockton, 95205 (209)468-3420 • Fax:(209)464-0138 • Web:www.sjszov.oro/ehd ��/FORS SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST PA#: 2000067—S00013220 SITE LOCATION: 3510 MOURFIELD AVENUE,STOCKTON REPORT DATE:APRIL 1,2020 S = Sufficient San Joaquin County Development Title Chapter 9-905,Section 9-905.12 I = Insufficient S I 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ® ❑ 1.1 Description of site(report must address all parcels), including current and/or proposed zoning information. • 0.44 Acres/Residential low densitv ® ❑ 1.2 Description of proposed development. • Subdivsion ® ❑ 1.3 Parcel location map. ® ❑ 1.3 Site map showing location of all items on parcel. (Examples: structures, drives,wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds,waterways, etc.) Empty Lot 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: current and/or previous property owners, historical maps, insurance maps, previous land use applications, etc.) • Has been empty lot for 10 years,future use is residential 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 records search, agricultural chemical application search, site reconnaissance and survey,etc.) • No record of UST or Agricultural Chemical use onsite ® ❑ 3.2 Description of all past on-site potential and/or known above and below 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.) • No UST or Ag chems, septic tank was destroyed. ® ❑ 3.3 Description of all current on-site potential and/or known above and below ground sources of contamination identified at the project site(see examples above). • None, bare lot ® ❑ 3.4 Description of all past off-site 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 site. (Examples: Close proximity to a former landfill/former gasoline station, in area of known DBCP/Nitrate groundwater impact, etc.) • None residential neighborhood, no nearby LUST or Contaminated site. ® ❑ 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. • Low potential for contamination, Residential Neighborhood 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATION IDENTIFIED AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION ® ❑ 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 the environment. This evaluation should take into consideration the proposed future uses of the project parcel. • Ground water 40 feet below surface grade • Minimal impact to ground water • Public services provided. 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(i.e., clean up of surface wastes). All recommendations for future work must include a time frame for implementation. • None, low potential for contamination EHD 26-02-001 Page 1 of 2 Surface&Sub Checklist