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State of California-California Envirorune taction Agency Dep of Toxic Sub$Wm Control <br /> TIERED PERMITTING PHASE I ENVIRONMENTAL ASSESSMENT CHECKLIST <br /> 10. To your knowledge,have land-fxrmjnjZ or bioremediation been used at the facility? ✓ <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 <br /> facili 7 r/ <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 cdntaminated soil been discovered and/or remediated at the <br /> facilily without oversight by an appropriate re ato a ? I <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? t/ <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 /> an actual or otential 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? L <br /> ty (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 /> I <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 /> hazardous waste or hazardous materials transfer(e.g.tank Ioading areas,drum transfer t/ <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 /> nrsC 1 ist til <br /> Pla indieat®total uumbot of pages of 6 <br />