Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .. ,. '. 304 E Weber Avenue 311 Floor Stockton- CA 95202-2708 <br /> . (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> A�tFORa <br /> SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST <br /> PA*_ 1 3 <br /> SITE LOCATION: '� ` ` 1 -`/� V R1=Pow DATE: <br /> S = Sufficient San Joaquin County Development Title Chapter 9-905,Section 9-905.12 <br /> I = 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 information. <br /> 7� ❑ 1.2 Description of proposed development. <br /> [� ❑ 1.3 Parcel location map. <br /> [� ❑ 1.4 Site map showing location of all items on parcel. (Examples:structures, drives,wells,septic systems,large trees, <br /> pastures, pools,natural drainage courses,ponds,waterways, etc.) <br /> 2.0 PAST, PRESENT AND PROPOSED FUTURE USES OF THE SITE SECTION <br /> Ef ❑ 2.1 Discussion of past, present and proposed future uses at the site to assess potential problems. (Example sources <br /> of information: current and/or previous property owners, historical maps, insurance maps, previous land use <br /> applications, etc.) <br /> 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINATION <br /> i <br /> ❑ [] 3.1 Discussions of the methods used to research and investigate the potential or known above and belowground <br /> sources of contamination at the project site. (Examples: Database search, EHD records search, agricultural <br /> chemical application search, site reconnaissance and survey,etc.) <br /> i <br /> d ❑ 3.2 Description of all past on-site potential and/or known above and below ground sources of contamination identified <br /> at the project site. (Examples: Agricultural chemical handling/storageluse, aboveground/underground tanks, <br /> septic systems, injection wells,unseated wells, ponds/lagoons,vehicle/machine repair/painting, buried or <br /> stockpiled solid waste, etc.) <br /> ❑ 3.3 Description of all current on-site potential and/or known above and below ground sources of contamination <br /> identified at the project site(see examples above). <br /> ❑ 3.4 Description of all past off-site potential and/or known above and below ground sources of contamination identified <br /> in the area of the project site that has or may impact the project site. (Examples: Close proximity to a former <br /> landfill/former gasoline station,in area of known DBCP/Nitrate groundwater impact, etc.) <br /> d ❑ 3.5 Description of all current off-site potential and/or known above and below ground sources of contamination <br /> identified in the area of the project site. <br /> EIID 26-02-001 Page 1 of 2 Surface&Sub Checklist <br />