SR0087736_SSCR - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT . `. 3 04 E Weber Avenue 3rd Floor Stockton- CA 95202-2708 (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd ��FOR SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST PA#: Z`'\ 0 C)0 3 [FITOCATION: , �� o d Y uT F�rs� ( REPORT DATE: -\ S�13 `LPg2-1'A S = Sufficient San Joaquin County Development Title Chapter 9-905,Section 9-905.12 1 = 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. [�]/ ❑ 1.2 Description of proposed development. [f] ❑ 1.3 Parcel location map. [.� ❑ 1.4 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.) 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.) 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINATION Ff . ❑ 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.) E ❑ 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.) , ❑ 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). [I] ❑ 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.) FA ❑ 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. EHD 26-02-001 Page 1 of 2 Surface&Sub Checklist