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E= SAN JOAQUIN COUNTY `.auk ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue Stockton • CA 95205-6232 (209) 468-3420 • Fax: (209) 468-0333 • Web: www.sjgov.orQ ehd Preliminary Site Assessment/Final Report Checklist SITE LOCATION: f �Aj par�er —;Z40— f t D . APN: `/9,2 I S PR #: -S - I C' REPORT DATE: 2-, s = sufficient California Health and Safety Code Section 25400.37 I = Insufficient S I 1.0 INTRODUCTION & DESCRIPTION OF PROPERTY ❑ 1.1 Description of location of property, including the street address and mailing address of the contaminated property, the owner of record and mailing address, a legal description of the property. [ ❑ 1.2 Report includes a parcel vicinity location map with clear directions for locating the property. ❑ 1.3 Report includes a site map showing the location of all items on property (i.e., structures, drives, wells, septic systems, large trees, pastures, pools, natural drainage courses, ponds, waterways, etc.). ❑ 1.4 Report includes a diagram of the contaminated property that includes the floor plans of all affected buildings, the location of damage and contamination. 2.0 SAMPLING SUMMARY AND DISCUSSION ❑ 2.0 Report includes a diagram showing the location of sampling points used in the preliminary site assessment. All sampling point locations shall be keyed to the sampling results and remediation recommendations. ❑ 2.1 Description of the sampling methods and analytical protocols used in the preliminary site assessment. ❑ 2.2 Description of the sampling results, including in tabular format. ❑ 2.4 Description and discussion relating to the background samples and results obtained. 3.0 REMEDIATION/REMOVAL SUMMARY AND DISCUSSION ❑ 3.1 Discussion of the methods used to remediate (cleanup and/or removal) each specific area. ❑ 3.2 Summary and discussion of the post remedial sampling results. ❑ 3.3 Discussion of the methods used to dispose of any materials removed and/or wastewater generated during the remediation process. Copies of disposal receipts/manifests included in report. 4.0 ADDITIONAL RECOMMENDATIONS — Initial Work/Sampling Shows Remaining Contamination ❑ 4-1 Specific recommendations, including methods (decontamination, removal, demolition, and disposal), for any additional remedial actions required to meet the human occupancy standards. ❑ 4.2 Description of the plan for any additional post remediation site assessment, including specific sampling requirements and methodologies, and locations at which samples are to be obtained. ❑ 4.3 Any additional work proposed will require the submittal of an Addendum to the Preliminary Assessment Report or Final Report. a 5.0 FINAL REPORT CONCLUSIONS — Initial Work/Sampling Shows Occupancy Standards Met ❑ ❑ 5.1 Summary and discussion of the project results that demonstrate and conclude the regulatory occupancy standards have been successfully met. 6.0 REPORT SIGNATURE ❑ 6.1 Report included the notarized signatures of the authorized contractor and a certified industrial hygienist. Reviewed By: , REHS Reviewed Date: r:2 2 " EHD 25-_-_ Page I Of 2 Preliminary Site Assessment Report Checklist O 11/20/2017