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State of California-Califomia Environmental Prote Agency 0 Department of Toxic Substances Control <br />TIERED PE TING PHASE I ENVIRONMENTAL ASSESS CHECKLIST <br />3. To your knowledge, have any underground storage tank(s) been removed, abandoned, or <br />X <br />taken out of service from the facility? Tanks removed, abandoned, or taken out of <br />service 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 />X <br />facility without oversight by an appropriate regulatory agency? <br />15. To your knowledge, have there been fires and/or explosions at the facility which may <br />X <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 />X <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 />X <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 of 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 <br />X <br />hazardous waste or hazardous materials transfer (e.g. tank loading areas, drum transfer <br />areas)? <br />�. To your knowledge, are there, or have there been lawsuits or administrative proceedings <br />X <br />conceming an actual, alleged, or threatened release of any hazardous substances against <br />the facility by another party? Only actions concluded by settlement or litigation need <br />be considered. <br />DTSC 1151 (06/99) Please indicate total number of pages 4 of <br />