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oPa�!1N SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95202-3029 c•p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd Q�iFOR� NITRATE LOADING STUDY REQUIREMENT CHECKLIST SITE LOCATION: t l Z.� 1�- VA 6-ra-,' PA #: �001pZZ 3 REPORT DATE: S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 I = Insufficient S I 1.0 CHEMICAL AND PHYSICAL PROPERTIES OF SOIL ,Z ❑ 1.1 Description of the chemical and physical properties of the soils underlying the site. ❑ 1.2 Description of the mass transport properties of the soils underlying the site with respect to nitrate and/or any other constituent of concern identified for the project site. 2.0 GROUNDWATER ANALYSIS p❑ 2.1 Description of: depth to groundwater, seasonal fluctuations of groundwater depth, directional flow and gradient. [] ❑ 2.2 Description/discussion of any existing or potential groundwater contamination issues in the general location of the site. ❑ 2.3 Description of the current use of groundwater at the site and of the future expected use of groundwater as related to the proposed development project. 3.0 SOURCES AND CALCULATED IMPACT OF NITRATE TO GROUNDWATER ❑ 3.1 Description of all current off-site sources of nitrate to soil and groundwater in the general up gradient area and the contribution of nitrate load from these sources to the project site. EHD 26-02 Pagel of 2 Surface & Sub Checklist 7/14/2003 ❑ 3.2 Description of impact of rainfall contribution of nitrate load to the project site. ❑ 3.3 Description of all current on-site sources of nitrate to soil and groundwater and the contribution of nitrate load from these sources to the project site. ❑ 3.4 Description of all proposed future on-site sources of nitrate to soil and groundwater and the contribution of nitrate !� load from these sources to the project site. ❑ 3.5 Calculated mass balance of nitrogen loading considering all potential sources identified. Use of /❑ Hanztch/Finnemore, or other appropriate formula/model, if applicable. I ] ❑ 3.6 Calculated impact of nitrogen loading from site project to down gradient wells, rivers, lakes etc. 4.0 DISCUSSION OF NITRATE LOADING RESULTS RELATIVE TO PROPOSED METHOD OF WASTEWATER DISPOSAL J, ❑ 4.1 Discussion of total nitrate impact from proposed project. ❑ 4.2 Description of the methods proposed to mitigate any known or future impact to soil and groundwater from nitrate, and/or anv other constituent of concern, at and/or around the prosect site. 5.0 CONCLUSIONS AND RECOMMENDATIONS SECTION ❑ 5.1 The report was signed, dated and stamped by a qualified environmental professional. [I ❑ 5.2 The attachments/appendices contain sufficient documentation to support claims made in the report. v I Reviewed By: Reviewed Reviewed Date: EHD 26-02 Pagel of 2 Surface & Sub Checklist 7/14/2003