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State of California-California rnvironmenlal Protection Agency Department of Toxic Substances Control <br /> TIERED PERMITTING PHASE I ENVIRONMENTAL ASSESSMENT CHECKLIST <br /> 10. To your knowled e,have land-farmin or bioremediation been used at the facilit <br /> 11. To your knowledge,has the facility ever burned hazardous wastes,unidentified waste <br /> materials,tires,or automotive batteries at the facility? <br /> 12. To your knowledge,have ash and/or combustion residuals been disposed of at the J <br /> facility? T <br /> 13. To your knowledge,have any underground storage tank(s)been removed,abandoned,or <br /> taken out of service from the facility? Tanks removed,abandoned,or taken out of service �( <br /> under the oversight of a responsible agency need not be considered if the agency <br /> addressed potential contamination at the tank location. <br /> 14. To your knowledge,has any contaminated soil been discovered and/or remediated at the / <br /> facility without oversight by an appropriate re ulato agency? <br /> / <br /> 15. To your knowledge,have there been fires and/or explosions at the facility which may <br /> have caused a release of hazardous waste or materials? <br /> 16. To your knowledge,has the facility ever received complaints from any employees, <br /> neighbors,or the public about the facility's practices for managing hazardous wastes,or <br /> any actual or potential releases to air,water,or soil or other environmental issues? <br /> 17. To your knowledge,have nearby residents complained to a governmental agency of any <br /> type of illnesses or unusual illnesses as.having been caused or suspectedly caused by or �( <br /> related to activities at the facility? (Note:this item does not require questioning the <br /> facility's neighbors) If YES,indicate below the person and/or agency who recorded the <br /> complaint. <br /> If YES,to your knowledge,has any evidence been submitted to a physician to <br /> substantiate the claim? <br /> 18. To your knowledge,are there any areas at the facility which were formerly used for V <br /> hazardous waste or hazardous materials transfer(e.g.tank loading areas,drum transfer P <br /> areas)? <br /> 19. To your knowledge,are there,or have there been lawsuits or administrative proceedings <br /> concerning an actual,alleged,or threatened release of any hazardous substance against <br /> the facility by another party? Only actions concluded by settlement or litigation need be <br /> considered. <br /> UTSC 1151(06/99) Please indicate total number of pages 3 of 1 <br />