SU0006799_SSCRPT - Laserfiche WebLink

Home Browse Search

: SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 4 600 East Main Street, Stockton, CA 95202-3029 . Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd SURFACE AND SUBSURFACE CONTAMINATION REPORT REQUIREMENT CHECKLIST JJ (1 PA#: o cl— ao t Ox{Qin$) SITE LOCATION: 3 I �! S <�s;; 1 1 a c. REPORT DATE: S = Sufficient t Sa oaq�Countyeve p&e Title Chapter 9-905,Section 9-905.12 1 = Insufficient S 1 1.0 INTRODUCTION & PROPOSED DEVELOPMENT SECTION ® ❑ 1.1 Description of site(report must address all parcels), including current and/or proposed zoning information. ®' El 1.2 Des ription bf proposed development. y 0 ❑ 1.3 Parcel 1 ca on map. ®� ❑ 1.4 Site map showing location of all items on parcel. (Examples: structures,drives,wells,septic systems, large trees, pastures, pools, nalurraall 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.) f� G- r a 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 sources of contamination at the project site. (Examples: Database search, EHD records search, agricultural chemical application search, site reconnaissance and survey, etc.) 6 -;�7 ❑ 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.) (-71 ❑ 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 z� t: ❑ 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/Nit a e groundwat�{impact, etc.) ❑ 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. -3 7 4.0 EVALUATION OF PAST AND CURRENT SOURCES OF CONTAMINATIO IDENTIFIED AT OR NEAR THE SITE AND RECOMMENDATIONS FOR FURTHER ACTION ❑ i, 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. Cl �g 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 soil/water samples)and/or mitigative measures(i.e., clean up of surface wastes). All recommendations for future work must include a time frame for implementation. 1 2 ❑ 5.2 The report was inclAive(i.e. all 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 rep was preparey within six months of Te datejof the submittal of the land sepplication. ®, El 5.5 The attachmen s/ pendices contain fficient docurll tati u port c7dims made in report. Reviewed By: Reviewed Date: S 5 EHD 26-01 9/24/07 Pag SURFACE&SUB CKLST