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State of California-California Environmental Protection Agency Depatinient of Toxic Substances Control <br /> TIERED PERMITTING PHASE I ENVIRONMENTAL ASSESSMENT CHECKLIST <br /> ...........................................................................----..........................---........................ ......................­­.-................. ............ --_........................................ .................................................. ............................................................................. <br /> ...............1.1--l1111............----................... ............... .......... . ........ ... ...................... . ................ .................... <br /> SECTION III: FACILITY WALK-THROUGI-I INSPECTION-SPECIFIC AREAS <br /> Instructions: List each area of the facility where hazardous materials are present, The listing area is divided into functional divisions for convenience. Individual units may be grouped oil the chart,but <br /> must be individually inspected. Cirefidly examine each of these areas during the walk-through inspection to determine the presence of releases or possible release,and record the results in the <br /> appropriate column,date and initial the entry. Complete a Release Information Data Sheet for each actual and possible release found. Using your best judgement,decide if any actual or suspected <br /> releases found require further investigation and record the results on the Release Information Data Shoe and in the appropriate column on this chart Ifuou need additional space,pliotocopy this sheet. <br /> --------------- ............... ............... ............................................................ <br /> HAZARDOUS MATERIAL AREA <br /> INSPECTED ACTUAL OR SUSPECTED <br /> REQUIRES FURTHER <br /> (Yes or No) RELEASE <br /> INVESTIGATION <br /> (Yes or No) (Yes or No) <br /> LOADING/UNLOADING AREAS Yes <br /> No No <br /> ...................................................................... ............. ................................................................ ....................................... <br /> .......... .......................... ........... ......... ... ................... <br /> ........................ ................................................... ............ ................................ ...............- <br /> ........................ ........................ ................... <br /> ..................................- ............... ................. .......................-..................... ..................................... <br /> ................... ........................ ............................ . ............................... ......... .................... .................. ................................ <br /> .................................. ................................... ................................................. ................................. ............................................................................. ................................................- .................................................................. ...................................................... ................................ <br /> .................... .......... <br /> ............... .................. ...................... ................................................ ............. ...................................................... ....................................... .................................. ....................................................................... ....................... ................................. ........................................................- <br /> HAZARDOUS MATERIALS USE AREAS Yes No No is <br /> .................- .......... ............. <br /> ................ <br /> ............................................ ...................... ..................... ........................... .............. ............... <br /> ...................................... ........................... ............................................. ..................................... <br /> ............ .......................- ........... ......................... ............. ............. <br /> ---—----------------------------------------- <br /> HAZARDOUS WASTE GENERATION AREAS Yes No <br /> No <br /> ..................................................................................... .................... .......................... ....................... <br /> .......................... ....................... .......................... ................ <br /> ............. ............. <br /> HAZARDOUS WASTE TREATMENT/STORAGEAREAS Yes No No <br /> ................ ................... ................ .............. ............... <br /> .......... <br /> Ei <br /> .............................. ..............f <br /> ............ <br /> ................... ................... <br /> DISC 1151(06199) Please indicate total number of pages )f <br />