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qu!N <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, 95205 <br /> �IFOR� <br /> (209)468-3420 • Fax: (209)464-0138 - Web: www.siigov.or_/W <br /> SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT <br /> CHECKLIST <br /> SITE LOCATION: 16696 NORTH LOCUST TREE ROAD, LODI PA#: <br /> REPORT DATE: 06-26-2020 <br /> S = Sufficient <br /> I = San Joaquin County Development Title Chapter 9-905, Section 9-905.12 <br /> 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 <br /> information. <br /> ® ❑ Previous address is 16790 & 16696 North Locust Tree Road, APN: 05112040, 41 <br /> • 10498 East HWY 12 <br /> ® ❑ 1.2 Description of proposed development. <br /> • Merge two parcels to make 40 acres and make a home site parcel. <br /> ® ❑ 1.3 Parcel location map. <br /> ® ❑ 1.4 Site map showing location of all items on parcel. (Examples: structures, drives, wells, septic systems, <br /> large trees, pastures, pools, natural drainage courses, ponds, waterways, etc.) <br /> 2.0 PAST, PRESENT AND PROPOSED FUTURE USES OF THE SITE SECTION <br /> ® ❑ 2.1 Discussion of past, present and proposed future uses at the site to assess potential problems. <br /> (Example sources of information: current and/or previous property owners, historical maps, insurance <br /> maps, previous land use applications, etc.) <br /> 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF <br /> CONTAMINATION <br /> ® ❑ 3.1 Discussions of the methods used to research and investigate the potential or known above and <br /> belowground sources of contamination at the project site. (Examples: Database search, EHD records <br /> search, agricultural 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 <br /> contamination identified at the project site. (Examples: Agricultural chemical handling/storage/use, <br /> aboveground/underground tanks, septic systems, injection wells, unsealed wells, ponds/lagoons, <br /> vehicle/machine repair/painting, buried or stockpiled solid waste, etc.) <br /> EHD 26-02-001 Page I of 2 Surface&Sub Checklist <br /> 7/14/2003 <br />