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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/chd NITRATE LOADING STUDY REQUIREMENT CHECKLIST PA#: D -5 --6 0-6 7z� SITE LOCATION: �j �i �irt.G/[ . REPORT DATE: S = Sufficient San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 1 = Insufficient S 1 1.0 CHEMICAL AND PHYSICAL PROPERTIES OF SOIL [N ❑ 1.1 Description of the theP/sransport and physical properties of the soils underlying the site. c 91 ❑ 1.2 Description oft a ma properties of the soils underlying the site with respect to nitrate and/or any other constituent of concern identified for the project siteWL 2.0 GROUNDWATER ANALYSIS a ❑ 2.1 Description 5)depth to groundwater, seasonal fluctuations of groundwater depth,directional flow and gradient. ❑ 2.2 Descrii n/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. Ci ❑ 3.2 Descri ion of impact rfalj contribution of nitrate load to the project site. ® F13.3 Description of Arrent site sources of nitrate to soil and groundwater and the contribution of nitrate load from these sources to the project site �S)�t) ®- E] 3.4 Description of all proposed futur .on-site urces of nitrate to soil and groundwater and the contribution of nitrate load from these sources to the project site. W 5 0 ❑ 3.5 Calculated mass balance of nitrogen loading considering all potential sources identified. Use of Hanztch/Finnemore, or other appropriate formula/model, if applicabt�C'S,6 ;�) KIZ ❑ 3.6 Calculated impact of nitrogen loading from site project to down gradient wells, rivers, lakes etc.*r5' 4.0 DISCUSSION OF NITRATE LOADING RESULTS RELATIVE TO PROPOSED METHOD OF WASTEWATER DISPOSAL ❑ 4.1 Discussion of total nitrate impact from proposed project [:1 7 ❑ 4.2 Description of the methods proposed to mitigate any known or future impact to soil and group water fr nitrate, and/or any other constituent of concern, at and/or around the proiect site-7) 5.0 CONCLUSIONS AND RECOMMENDATIONS SECTION ❑ 5.1 The report was signed, dated and stamped by a qualified environmental professional. E ❑ 5.2 The attachments/appendices contain sufficient documentation to support claims made in the report. ReviewedB Reviewed Date: 23 u Y EHD 26-02 Pagel of 2 Surface&see Checklist 7/14/2003