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L. �- <br /> LSurface/Subsurface Contamination Report Checklist <br /> NOA Project Number: E04146A <br /> Page 4 <br /> L13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> property? <br /> LYesED No ® None observed <br /> 6, b.Within 250 feet? <br /> Yes[Z] No One bucket observed to the west which appears to be filled witb water <br /> L <br /> 14. Identify any surface waters within 1,000 feet.of the subject property <br /> LMokelumne Diver ad oins properly to north <br /> 16. a. Identify the potable water supply source: <br /> ® Public Water System Other One domestic wellpresent <br /> Private Well None <br /> V <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes[:] No [Z] Welllikely at properly to west <br /> 6. <br /> 17. Identify the sewage disposal system: <br /> MPublic Sewer System Other Two septic systems present <br /> On-site septic system None <br /> L' 18. Are there any pits,ponds,or lagoons located on the property in connection with waste treatment or waste <br /> disposal? <br /> LYes Q No [M One decorative pond near residences <br /> I <br /> 19. a.Is there evidence that the subject property discharges waste water,other than storm water,directly into a <br /> ditch or sueam on or adjacent to the property? <br /> 6. YesE3 No ED <br /> L <br /> b.Any discharges observed within 200 feet? <br /> Yes Q No EM None observed <br /> L <br /> 6. "OA <br /> L <br />