SU0006411 SSCRPT - Laserfiche WebLink

Home Browse Search

'nyxn SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Avenue 3"Floor Stockton CA 95202-2708 (209)468-3420-Fax:(209)464-0138- Web:www.co.san-joaquin.ca.us/chd �If SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST SITE LOCATION: PA ` - REPoRTDATE: - OL S - SuRlciau San Joaquin County Development Title Chapter 9.905,Section 9-905.12 I - 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. �>y z ❑� ❑ 1.2 Description of proposed development. ( - a ❑ 1.3 Parcel location map. r't' K , El 1A Site map stowing location of all Items on parcel. (Examples:structures,drives,wells,septic systems,large trees, pastures,pools,natural drainage courses,ponds,waterways,etc.) "rwm - A 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.) Vi,( e.AI)I , r C- 3.0 IDENTIFICATION OF ALL PAST AND CURRENT SOURCES OF CONTAMINATION ❑ ❑ 3.1 Discussions of the methods used to research and investigate the potential or known above and belowground 1�� sources of contamination at the project site. (Examples: Database search, EHD records search,agricultural chemical application search,site reconnaissance and survey,etc.) 0 ❑ 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 handfing/storage/use,aboveground/underground tanks, septic systems,injection wells,unsealed wells,pondsAagoons,vehidelmachine 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). P `s'y ❑ 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 landfrNfommer gasoline station,in area of known DBCP/Nitrate groundwater impact,etc.) 9p g ❑- ❑ 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. . 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATIO IDENTIFIED AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION ❑ 4.1 Evaluation of each potential and/or known source of contamination identified(in the above section)for any real and/or potential threat to human health and the environment This evaluation should take into consideration the proposed future uses of the project parcel. R -1 5.0 CONCLUSIONS AND RECOMMENDATIONS SECTION ❑ 5.1 Discussion of the above evaluation to either rule out each source as a real or potential threat or to recommend further action to mitigate or abate any real or potential threats identified. Recommendations may include additional site assessment(i.e.collection of soilmater samples)and/or mitigative measures(Le.,dean up of surface wastes). All recommendations for future work must include a time frame for implementation. ❑ 5.2 The report was inclusive(.e.art information referenced was included in this report-report should not reference other reports). ❑�❑ 5.3 The report was signed,dated and stamped by a qualified environmental professional. ❑�- ❑ 5.4 The report was prepared within six months of the date of the submittal of the land use application. ❑" ❑ 5.5 The attachmentslaappendices contain sufficient documentation to support claims made in report. Reviewed By:�A�wr Gr 1/� _Reviewed Date: DID 2602-001 Page I of 2 surfxz&sub ce«krst 7114?003