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State of California-California Environmental Protection Agency Department of Toxic Substances Control TIERED PERMITTING PHASE I ENVIRONMENTAL ASSESSMENT CHECKLIST 13. ADDRESS OF FACILITY CONTACT PERSON: l/ STREET: ��9,t , 7 0?J( s/e V, CITY: 5 1 U L�--o cJ STATE: c el-- ZIP CODE: SECTION II: FACILITY HISTORY Instructions:Complete this section regarding facility history based on reasonably available knowledge of the.facility. This section will determine if pas(operating practices and significant historical events that occurred at the facility indicate potential areas of contamination. Current and past employees who know about the facility's past operating practices can bean asset in completing this section of the checklist. Yes answers to these questionsmean that careful attention must be paid to these areas and considerations when completing the facility walk-through inspection. YES NO 1. Hasan environmental assessment and/or a site investigation report ever been completed for the facility? If this assessment meets the criteria for substituting for this checklist (see Instructions),use the Signature and Certification Page to record this exemption.. You need not release confidential assessments. However,if these reports indicate existing or potential contamination,you must use the inf nall relied on by the confidential report to help reach a conclusion in this assessment. KC-t' {� )dAN(QO (�20 t(.�0't'r'_,_ 2. To your knowledge,have areas of the facility that contain hazardous materials ever been K flooded? 3. To your knowledge,has.the facility ever been damaged by an earthquake that could }( cause contamination? 4. To your knowledge,has the location for the facility ever been used for industrial X purposes prior to its current use? If YES,then consider potential contamination from the type of industry that the location was formerly used for. 5. To your knowledge,has there been any disposing of hazardous chemicals or hazardous x wastes in,on,or under the property? 6. To your knowledge,has the facility ever had electrical transformers,capacitors,.or hydraulic equipment including,but not limited to elevators and auto lifts,at the facility which may have released PCBs or oil to the environment? (Not including small quantities of fluorescent light ballasts and capacitors if these materials were not disposed of or dismantled at the facility) If YES,was the equipment ever tested for the presence of PCBs? 7. To your knowledge,has testing of any groundwater wells on the property ever revealed possible contamination? 8. Do you have in your possession,or do you know of the existence of any photographs, geophysical reports,analytical test data,and/or air sampling data that indicates the y possible presence of hazardous materials and/or waste in unwarranted or unexpected (` areas of the facility? 9. To your knowledge,has the facility ever had liquid/sludge containment area(s),surface im oundment s ,collection pond(s),and/or lagoon(s)? DTSC 1151(06/99) Please indicate total number of pages of