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State of California -California Environmentat Protection Agency <br />Departarent of ioxic Substances Control <br />TIERED PERMITTING PHASE I ENVIRONMENTAL ASSESSMENT CHECKLIST <br />13, ADDRESS OF FACILITY CONTACT PERSON: <br />STREET: 121 N. Guild Ave. <br />CITY: Lodi <br />STATE: CA. ZIP CODE: 95240 <br />SECTION IL FACTUTY HISTORY <br />Instructions: Complete this section regarding facility history based on reasonably available knowledge of the facility. This scctiouwill determine if hast <br />attlte facility indicate potential areas of contamination. Current and past cmptoyees who <br />operating practices and significant historical events that occurred <br />know about the facility's past operating practices can be an asset in completing this section of the checklist. es answers to these questions mean that <br />careful <br />attenti'on'.riiusi.bepaid to these r'cas•and consid6rations when completing the facility walk-througll inspection, <br />YES <br />NO <br />X <br />t, Has an environmental assessU ent and/or a site investigation report ever been completed <br />for the facility? If this assessment meets the criteria for substituting for this checklist <br />(see Instructions), use the Signature and Certification Page to record thisexentption. You <br />[Iced not release confidential assessments. However, if these reports indicate existing or <br />contamiaation, you must use the information relied on by the confidential report <br />potential <br />to help reach a conclusion in this assessmOnt. <br />X <br />2; To your knowledge, have areas orthe facility that contain hazardous niatcrials ever been <br />flooded? <br />3. To your knowledge, has the facility ever been damaged by an earthquake that could <br />X <br />cause contamination? <br />X <br />4, To your knowledge, has the location for the facility ever been used for industrial <br />purposes prior to its current use? If YES, then consider potential contamination from. the <br />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, of under the property? <br />X <br />6, To your knowledge, has the facility ever bad electrical transformers, capacitors, or <br />hydraulic equiptnent including, but not limited to elevators and auto lifts, at the facility <br />which may have released PCBs or oil to the envirorunent? (Not including stttalt quaz)tities <br />of fluorescent light ballasts and capacitors if these materials were.notdisposed of or <br />dismantled at tine facility) <br />I:f YES, was the equipment ever tested for the presence cf PCBs? <br />X <br />7, "fc your knowledge, has testing of any groundwater wells on the property ever revealed <br />possible contarnitlaC on? <br />X <br />g, Do you have in your possession, or do you know of the existence of any photographs, <br />geophysical reports, analytical test data, and/or air sampling data that indicates the <br />possible presence of hazardous inateriats and/or waste in unwarranted or unexpected <br />areas of the facility? <br />X <br />9. To your knowledge, has the facility ever had liquid/sludge containment area(s),surface <br />inipoundment(s), collection pond(s), and/or lagoon(s)? <br />pl case indicatetotal <br />nunbetOfpages_ <br />of <br />DTSC 1151 (GC/99) <br />