Laserfiche WebLink
State of California -California Environmental Protec Agency 0 Department of Toxic Substances Control <br />TIERED PERNUTTING PHASE I ENVIRONMENTAL ASSESS CHECKLIST <br />_'ECTION II: FACILITY HISTORY <br />Instructions: Complete this section regarding facility history based on reasonably available knowledge of the facility. This section will determine if past operating <br />practices and significant historical events that occurred at the facility indicate potential areas of contamination. Current and past employees who know about the <br />facility's past operating practices can be an asset in completing this section of the checklist. Yes answers to these questions mean that careful attention must be paid <br />to these areas and considerations when completing the facility walk-through inspection. <br />YES NO <br />1. Has an environmental assessment and/or a site investigation report ever been completed for <br />X <br />the facility? If this assessment meets the criteria for substituting for this checklist (see <br />Instructions), use the Signature and Certification Page to record this exemption. You need <br />not release confidential assessments. However, if these reports indicate existing or potential <br />contamination, you must use the information relied on by the confidential report to help <br />reach a conclusion in this assessment. <br />2. To your knowledge, have areas of the facility that contain hazardous materials ever been <br />X <br />flooded? <br />3. To your knowledge, has the facility ever been damaged by an earthquake that could cause <br />X <br />contamination? <br />4. To your knowledge, has the location for the facility ever been used for industrial <br />X <br />purposes prior to its current use? If YES, then consider potential contamination from <br />the type of industry that the location was formerly used for. <br />5. To your knowledge, has there been any disposing of hazardous chemicals or hazardous <br />X <br />wastes in, on, or under the property? <br />To your knowledge, has the facility ever had electrical transformers, capacitors, or <br />X <br />hydraulic equipment, including, but not limited to elevators and auto lifts, at the <br />facility which may have released PCBs or oil to the environment? (Not including <br />small quantities of fluorescent light ballasts and capacitors if these materials were not <br />disposed of or dismantled at the facility) <br />If YES, was the equipment ever tested for the presence of PCBs? <br />7. To your knowledge, has testing of any groundwater wells on the property ever revealed <br />X <br />possible contamination? <br />8. Do you have in your possession, or do you know of the existence of any photographs, <br />X <br />geophysical reports, analytical test data, and/or air sampling data that indicates the <br />possible presence of hazardous materials and/or waste in unwarranted or unexpected <br />areas of the facility? <br />9. To your knowledge, has the facility ever had liquid/sludge containment area(s), surface <br />X <br />impoundment(s), collection pond(s), and/or lagoon(s)? <br />10. To your knowledge, have land -farming or bioremediation been used at the facility? <br />11. To your knowledge, has the facility ever burned hazardous wastes, unidentified waste <br />X <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 <br />X <br />facility? <br />DTSC 1151 (06/99) Please indicate total number of pages_ of <br />