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State of California -California .Environmental Protection Agency Department of Toxic Subshanccs Control TIERED PERMITTING PIIASF IENVIRONMENTAL ASSESS;•'IF.NT CHECKLIS.0 10. To your, knowledge, have Iand-farthing or bleremediataon been used at the facility? X 11. To your knowledge, has the facility ever burned hayardous wastes, unidentified waste X materials, tires, or automotive batteries at the facilit ? 12 . To your knowledge, have ash and/or combustion residuals been disposed of at the X facility? 13. To your knowledge, have any underground storage tank(s) been removed, abandoned, or taken outof service from the facility? '1•ank8 removed, abandoned, or taken out of service g under the oversight of a responsible agency need not be considered if the agoncy addressed potential contamination at the tank location. 14. To your knowledge, has any contaminated soil been discovered and/or remediated at the X facility without oversight by an aom-opiJate regulatory agency? 15 . To your knowledge, have there been fres and/or explosions at the faoillty which may have caused a release of hazardous waste or materials? 1-6. To your knowledge, has the facility ever received complaints from any employees, neighbors, or the public about the facility's practices for managing hazardous wastes, or X anv actual or potential releases to air water or soil or other envirctunental issues? 17. To your knowledge, have nearby residents complained to a governmental agency of any X type of illnesses or unusual illnesses as having been caused or suspectedly caused by or related to activities at the facility? (Note: this item does not require questioning the :Facility's neighbors) If 'YES, indicate below the person. and/or agen.ey who recorded the Complaint. If YES, to your knowledge, has any evidence been submitted to a physician to substantiate the claim? 18. `1'o your knowledge, are there any areas at the facility which were formerly used for hazardous waste or hazardous materials transfer (e.g. tank loading areas, drum transfer X areas)? 19. To your knowledge, are there, or have there been lawsuits or administrative proceedings concerning an actual, alleged, or threatened release of any hazardous substance against X the facility by another party? Only actions concluded by settlement or litigation need be considered. DTSC 1151 (06N9) Please indicate m5l number of pages _ of