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SU0005758 SSCRPT
Environmental Health - Public
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SU0005758 SSCRPT
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Last modified
5/7/2020 11:31:45 AM
Creation date
9/6/2019 10:10:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SU0005758
PE
2622
FACILITY_NAME
PA-0500697
STREET_NUMBER
2140
Direction
W
STREET_NAME
MICHIGAN
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
APN
12307006
ENTERED_DATE
11/4/2005 12:00:00 AM
SITE_LOCATION
2140 W MICHIGAN AVE
RECEIVED_DATE
11/4/2005 12:00:00 AM
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\M\MICHIGAN\2140\PA-0500697\SU0005758\SSC RPT.PDF
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EHD - Public
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1.01 <br /> TRANSACTION SCREEN QUESTIONNAIRE <br /> Page 2 of 3 <br /> 13. If the property is served by a private well or non-public water YES / Nul UNK <br /> system, have contaminants been identified in the well or system that �J <br /> exceed quidelines applicable to the water system or has the well been <br /> designated as contaminated by any qovernment environmental/health <br /> agency? <br /> ` 14. Does the owner or occupant of the property have any knowledqe YES NO UNK <br /> of environmental liens or qovernmental notification relatinq to past or <br /> recurrent violations of environmental laws with respect to the property <br /> or any facility located on the property? <br /> 15. Has the owner or occupant of the property been informed of the YES NO UNK <br /> past or current existence of hazardous substances or petroleum <br /> Products or environmental violations with respect to the property or <br /> any facility located on the property? <br /> 16. Does the owner or occupant of the property have any knowledqe YES /NO ) UNK <br /> ` of any environmental site assessment of the property or facility that <br /> indicated the presence of hazardous substance or petroleum products <br /> on, or contamination of, the property or recommended further <br /> assessment of the property? <br /> 17. Does the owner or occupant of the property know of any past, YES NO UNK <br /> threatened or Pendinq lawsuits or administrative proceedings <br /> concerninq a release or threatened release of any hazardous substance <br /> ` or petroleum products involving the property by any owner or occupant <br /> of the property? <br /> r, 18. Does the property discharqe waste water on or adjacent to the YES NO UNK <br /> property other than storm water into a sanitary sewer system? <br /> 19. To the best of your knowledge, have any hazardous substances or YESNO UNK <br /> petroleum products, unidentified waste materials, tires, automotive or <br /> industrial batteries or any other waste materials been dumped above <br /> grade, buried and/or burned on the property? <br /> 20. Is there a transformer, capacitor, or any hydraulic equipment for YES NO UNK <br /> which there are any record indicating the presence of PCBs? <br /> Explanation to "YES" answers: (Attach additional sheet if necessary) <br /> I` <br /> L <br />
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