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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 DATASHEET <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 rzy <br />of ier known or suspected ralenses. 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 sheet 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 115t (06/99) PIcaseindicate totatnumberofpages _ of <br />