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State of California-California Environmental Protection Agency DepardnentofToxieSubstances Control <br /> TIERED PERMIT'T'ING PHASE I ENVIRONMENTAL ASSESSMENT CIIECKLIST <br /> AREA OF CONCERN DATASIIEET <br /> tnstmetions:Complete the roftowing questions in detail for EACH release or suspected release identified in Section III FACILITY WALK- <br /> THROUGH INSPECTION-SPECIFIC AREAS orSI CTION IV FACILI'T'Y WALK-TA ROCJGH INSPECTION.OTHER AREAS and z--1y <br /> of ier known or suspected rclenses. 1)o not include areas t rat Lave been orate being ren�ec fated under t c on:sight o an appropriate <br /> agency. <br /> If answers to questions are not known,then state"unknown". <br /> 1. Facility name: Cepheid Bldg.2 <br /> 2. This street is being completed for a: No Known releases or suspected releases were identified <br /> Known release_.. Suspected release <br /> 3. How was this release or suspected release discovered? <br /> During the walk-through inspection?— Previously known release? <br /> What checklist question(s)are related to this rcicase(section/question) <br /> 4. When did the release occur? <br /> 5. What was released and how touch? <br /> 6. What caused the release? <br /> 7. Indicate the approximate area of the release(o.g.3 feet in diameter,5 feet X 4 feet.) <br /> S. Was the release remediated? If YES,explain how.(Note; A datasheet need not be completed for <br /> releases remediated or being remediated under the oversight of an appropriate agency, <br /> 9. Were samples collected?If yes,what were the results? <br /> 10. List any environmental reports or studies performed on the area of concern and attach copies or summaries of <br /> the reports not submitted to the Department. <br /> Mame ofpreparer: <br /> Title of preparer: <br /> Date: <br /> D'I'SC 115l(06/99) PIcase indicate tolat numberofpages— of <br />