Friday April 26, 2024
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5.2.3 Environmental Inspection Checklist
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EIS - ACREAGE
Acreage (more than 5 acres)
ENVIRONMENTAL INSPECTION CHECKLIST
As used herein, the term "hazardous waste" includes any substance, waste or material defined or designated as hazardous, toxic or dangerous (or any similar term) by any federal, state or local statute, regulation, rule or ordinance now or hereafter in effect.
Inspected by: ______________________________________________________
Name of Source: ___________________________________________________
Property Address: __________________________________________________
__________________________________________________
__________________________________________________
Owner/Tenant: _____________________________________________________
Address of Owner: __________________________________________________
__________________________________________________
__________________________________________________
Property Description: _________________________________________________
_________________________________________________
_________________________________________________
This property is: ____ Farm ____ Ranch ____ Dumpsite ____ Land ____ Other
1. If there are improvements on property:
Type of Structure (brick, frame, etc.): ________________________________________
Use: _________________________________________________________________
Evidence of Asbestos ______ Yes ______ No
Siding ______ Insulation ______ Pipe wrap ______
Evidence of underground storage tanks ______ Yes ______ No
Other evidence of contamination or hazardous materials ______ Yes ______ No
If any questions are "Yes," please describe:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. If the property is agricultural or unimproved land, please describe current use:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. When was the property acquired by the present owner:
a. Bought land in __________ (year) and added buildings in __________ (year).
b. Bought land and buildings in __________ (year).
4. Please provide the following names, addresses, and telephone numbers:
FORMER OWNER (land and building)
Name: ___________________________________________________________
Address: _________________________________________________________
_________________________________________________________
Telephone: ________________________________________________________
5. Describe all prior uses of the building and land. (e.g., agricultural land):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
6. Is there any reason to believe that asbestos was in the past or currently in present is any form in, on, or about the property:
______ Yes ______ No
7. Is there any reason to believe that the property, including the land and any existing or prior buildings, was at any time in the past or is currently contaminated by any toxic or dangerous substances? If "Yes," please explain:
______ Yes ______ No
___________________________________________________________________________
___________________________________________________________________________
8. An on-site inspection revealed the following: (Indicate "Yes" or "No" for each item)
....... Evidence of asbestos (sprayed on fire proofing, pipe wrap, friable ceiling tiles, acoustical plaster)
....... Discolored soil or pavement areas
....... Recently disturbed soil area
....... Areas of sparse, sick or dead vegetation
....... Discolored standing water
....... Unusual or noxious odors
....... Groundwater monitoring wells
....... Roads or tire tracks with no apparent destination
....... Drums or storage tanks (note type)
....... Evidence of PCBs (electrical transformers, capacitors)
....... Stored batteries
....... Septic system
....... Evidence of petroleum or oil products
....... Evidence of chemical spills/leaks (stains on floor, discolored paint)
....... Any source of air emission (paint booths, smoke stacks, chimneys)
....... Above-or under-ground storage tanks, vent or filler pipes
If any of these items are "Yes," explain details and exact location:
___________________________________________________________________________
___________________________________________________________________________
9. Do any current occupants of the property use, handle, or store any hazardous waste or material:
______ Yes ______ No
If "Yes," please explain.
___________________________________________________________________________
___________________________________________________________________________
10. Is there now or have there been in the past any underground tanks or pipelines (other than water, sewer, and natural gas utility lines) on the property:
______ Yes ______ No
If "Yes," please explain:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
11. Please list the name and nature of businesses which border the property on all sides:
East: _________________________________________________________________
West: ________________________________________________________________
North: ________________________________________________________________
South: ________________________________________________________________
12. To the best of your knowledge, have any of these adjoining businesses or landowners been involved in any matter described in Question 6 through 10:
______ Yes ______ No
13. Are there now or have there ever been oil and gas operations on this property? (Includes oil/gas wells, water injection wells, storage facilities, pipelines, refineries, etc.)
______ Yes ______ No
14. Has the water been tested within the last five (5) years:
______ Yes ______ No
By whom: ________________________________________________________
Results: __________________________________________________________
15. Has the soil been tested within the last five (5) years:
______ Yes ______ No
By whom: ________________________________________________________
Results: __________________________________________________________
16. Does any portion of this property lie within a 100 year flood plain:
______ Yes ______ No
17. Are there any streams which cross property:
______ Yes ______ No
18. Are there areas of the property which are subject to unregulated trash dumping and/or does trash wash across the property during heavy rains or flooding: _________________________
19. Are there any wells on the property:
______ Yes ______ No
Is water used for drinking or livestock or agricultural purposes from those wells?
______ Yes ______ No
If yes, specify: ________________________________________________________________
20. Have aerial spraying companies ever been engaged to spray crops on this land:
______ Yes ______ No
When: _________________________________________________________
Product used: ______________________________________________________
21. If this property is or has been a landfill, are all required permits current
______ Yes ______ No
If yes, give permit numbers: ______________________________________
22. What kind of records were kept of landfill dumping?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
23. Have any hazardous/toxic materials ever been dumped under permit":
______ Yes ______ No
24. What kind of fence surrounds landfill? ___________________________________
What kind of security is in place? _______________________________________
25. Does any off-site drainage cross the property, and, if "Yes," what is the source'?
______ Yes ______ No
Source: _______________________________________________________
26. Are there any fire hazards on the site?
______ Yes ______ No
27. Note here any information that could be helpful for further investigation, such as names of people you spoke with at the site, exact locations of suspect contamination, etc.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
28. Please note any other observations you have regarding past, current, or possible future contamination:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
29. All adjacent properties should be viewed. If any evidence of hazardous waste was discovered, please describe. Attach a plat showing (a) adjacent properties and (b) all commercial activities within a one (1) mile radius:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
30. 1 viewed all of the site, including yard areas, vacant land, etc.
______ Yes ______ No
If "No," list areas not seen.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
31. ...... Based on the evaluation of known environmental factors, there is no evidence of environmental contamination on this or neighboring properties and no further action is recommended.
...... Based on the evaluation of known environmental factors, there is evidence of possible environmental contamination on this or neighboring properties and further investigation is recommended.
I am familiar with the operations presently conducted on the property and hereby certify for the benefit of ____________________, to the best of my knowledge this information is true and correct.
_______________ ______________________________
(Date) (Signature)
______________________________
(Signature)
This report was made by:
_________________________
(Typed Name)
_________________________
(Signature)
Title: _________________________ Date: _______________
Reviewed by:
_________________________
General Counsel
EIS - COMMERCIAL
Commercial/Industrial
ENVIRONMENTAL INSPECTION CHECKLIST
As used herein, the term "hazardous waste" includes any substance, waste or material defined or designated as hazardous, toxic or dangerous (or any similar term) by any federal, state or local statute, regulation, rule or ordinance now or hereafter in effect.
Inspected by: ______________________________________________________
Name of Source: ___________________________________________________
Property Address: __________________________________________________
__________________________________________________
__________________________________________________
Owner/Tenant: _____________________________________________________
Address of Owner: __________________________________________________
__________________________________________________
__________________________________________________
This property is:
(a) ____ Rural ____ Urban (within an incorporated area)
(b) ____ Zoned commercial ____ Zoned industrial
(c) ____ No improvements ____ Developed
____ Improved - Describe extent of development _________________________________
___________________________________________________________________
(d) Type of Business: ______________________________
(e) Describe structure:
.
____________________________________________________________________
____________________________________________________________________
1. Type of Business: ______________________________________
2. Briefly describe business activity: _____________________________________
___________________________________________________________________________
3. When was the property acquired?
(a) Bought land in __________ (year)
(b) Bought land in __________ (year) and added the building in __________ (year)
(c) Leased building in __________ (year)
4. Please provide the following names, addresses, and telephone numbers:
ORMER OWNER (land and building)
Name: ___________________________________________________________
Address: _________________________________________________________
_________________________________________________________
Telephone: ________________________________________________________
BUILDING ARCHITECT
Name: ___________________________________________________________
Address: _________________________________________________________
_________________________________________________________
Telephone: ________________________________________________________
GEOTECHNICAL (Soils) ENGINEER
Name: ___________________________________________________________
Address: _________________________________________________________
_________________________________________________________
Telephone: ________________________________________________________
5. Describe all prior uses of the building and land (e.g., agricultural land, building occupied by an auto parts distributor, multi-tenant industrial occupancy, etc.).
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
6. Is there any reason to believe that asbestos was in the past or currently is present in any form in, on, or about the property?
______ Yes ______ No
Date building was built: _______________ Date of last remodeling: _______________
Nature and extent of remodeling: __________________________________________
___________________________________________________________________________
7. Is there any reason to believe that the property, including the land and any existing or prior buildings, was at any time in the past or currently contaminated by any toxic or dangerous substances? If "Yes," please explain
______ Yes ______ No
___________________________________________________________________________
___________________________________________________________________________
8. An on-site inspection revealed the following: (Indicate "Yes" or "No" for each item)
...... Discolored soil or pavement areas
...... Recently disturbed soil area
...... Areas of sparse, sick or dead vegetation
...... Discolored standing water
...... Unusual or noxious odors
...... Groundwater monitoring wells
...... Roads or tire tracks with no apparent destination
...... Drums or storage tanks (note type)
...... Above ground tanks
...... Evidence of PCB's (electrical transformers, capacitors)
...... Stored batteries
...... Septic system
...... Evidence of petroleum or oil products
...... Evidence of asbestos (sprayed on fire proofing, pipe wrap, friable ceiling tiles, acoustical plaster, floor tiles, siding, roofing, insulation)
...... Evidence of chemical spills/leaks (stains on floor, discolored paint)
...... Any source of air emission (paint booths, smoke stacks, chimneys)
...... Above-or-under-ground storage tanks, vent or filler pipes
If any of these items are "Yes," explain details and exact location:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
9. The following types of activities may generate hazardous waste or materials. Check if any are present in or on the property:
Comments
...... Building cleaning/maintenance
...... Chemical Manufacturing
...... Furniture/wood refinish
...... Dry Cleaners
...... Laboratories
...... Metal manufacturing
...... Paint Shop manufacturing
...... Vehicle maintenance automotive
...... Wood preserving
...... Service/gas station
...... Other (please explain) _________________________________________
(a) List all products/services manufactured/sold:
___________________________________________________________________________
___________________________________________________________________________
(b) List all by-products created:
___________________________________________________________________________
___________________________________________________________________________
(c) List all waste products:
___________________________________________________________________________
___________________________________________________________________________
10. Do any current occupants of the property use, handle, or store any hazardous waste or materials?
______ Yes ______ No
If "Yes," please explain
___________________________________________________________________________
___________________________________________________________________________
11. Are there now or have there been in the past any underground tanks or pipelines (other than water, sewer, and natural gas utility lines) on the property:
______ Yes ______ No
If "Yes," please explain
___________________________________________________________________________
___________________________________________________________________________
Provide evidence of permits.
___________________________________________________________________________
12. List of all the tenants and nature of business:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
13. What products are produced in each business?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
14. Note here any information that could be helpful for further investigation, such as names of people you spoke with at the site, exact locations of suspect contamination, etc.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
15. Please note any other observations you have regarding past, current, or possible future contamination.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
16. All adjacent properties should be viewed. If any evidence of hazardous waste was discovered, please describe. Attach a plat showing (a) adjacent properties and (b) all commercial activities within a 2 block radius.
East: _________________________________________________________________
West: ________________________________________________________________
North: ________________________________________________________________
South: ________________________________________________________________
17. To the best of your knowledge, have any of these adjoining businesses or landowners been involved in any matter described in Questions 6 through 11?
______ Yes ______ No
18. (a) I viewed all tenant spaces.
______ Yes ______ No
List of all the tenants and nature of business:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
List spaces not seen: _____________________________
Tenant Name/Suite No. _____________________________
(1) _____________________________________________________________________
(2) _____________________________________________________________________
(3) _____________________________________________________________________
(b) I viewed all of the site, including yard areas, vacant land, etc.
______ Yes ______ No
19. Interviewed fire department: ______ Yes ______ No;
health department: ______ Yes ______ No;
If "Yes," results: _______________________________________________________
20. Are aerial photos available?
______ Yes ______ No
If "Yes," date of photos ________________ Have they been reviewed? __________
21. Does current occupant have any permits from:
______ State Water Control ______ State Air Control ______ EPA
If any, describe purpose __________________________________________
22. How is waste water handled?
___________________________________________________________________________
___________________________________________________________________________
23. Are any chemicals stored on site?
___________________________________________________________________________
___________________________________________________________________________
24. Is this property listed on the National Priorities ("Superfund") List?
___________________________________________________________________________
EVALUATION
...... Based on the evaluation of known environmental factors, there is no evidence of environmental contamination on this or neighboring properties and no further action is recommended.
...... Based on the evaluation of known environmental factors, there is evidence of possible environmental contamination on this or neighboring properties and further investigation is recommended.
I am familiar with the operations presently conducted on the property and hereby certify for the benefit of _____________________ to the best of my knowledge this information is true and correct.
_______________ ______________________________
(Date) (Signature)
______________________________
(Signature)
This report was made by:
_________________________
(Typed Name)
_________________________
(Signature)
Title: _________________________ Date: _______________
Reviewed by:
_________________________
General Counsel
EIS - RESIDENTIAL
RESIDENTIAL (less than 5 acres)
ENVIRONMENTAL INSPECTION CHECKLIST
As used herein, the term "hazardous waste" includes any substance, waste or material defined or designated as hazardous, toxic or dangerous (or any similar term) by any federal, state or local statute, regulation, rule or ordinance now or hereafter in effect.
Inspected by: ______________________________________________________
Name of Source: ___________________________________________________
Property Address: __________________________________________________
__________________________________________________
__________________________________________________
Owner/Tenant: _____________________________________________________
Address of Owner: __________________________________________________
__________________________________________________
__________________________________________________
This property is: ............Rural ...........Urban (within an incorporated area)
1. If the property is rural, please describe current use.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. Type of structure (brick, frame, etc.)
___________________________________________________________________________
3. When was the property acquired by the owner?
a. Bought land and buildings in __________ (year).
b. Bought land in __________ (year) and added buildings in __________ (year).
4. FORMER OWNER (land and buildings)
Name: ___________________________________________________________
Address: _________________________________________________________
_________________________________________________________
Telephone: ________________________________________________________
5. Describe all prior uses of the building and land (e.g., agricultural land).
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
6. Is there any reason to believe that asbestos was in the past or currently is present in any form in, on, Or about the property?
______ Yes ______ No
7. Is there any reason to believe that the property, including the land and any existing or prior buildings, was at any time in the past or currently contaminated by any toxic or dangerous substances? If-"Yes," please explain.
______ Yes ______ No
___________________________________________________________________________
___________________________________________________________________________
8. An on-site inspection revealed the following: (Indicate "Yes" or "No" for each item)
...... Evidence of asbestos (sprayed on fire proofing, pipe wrap, friable ceiling tiles, acoustical plaster, siding, roofing, insulation)
...... Discolored soil or pavement areas
...... Recently disturbed soil area
...... Areas of sparse, sick or dead vegetation
...... Discolored standing water
...... Unusual or noxious odors
...... Groundwater monitoring wells
...... Roads or tire tracks with no apparent destination
...... Drums or storage tanks (note type) ___________________________
...... Evidence of PCB's (electrical transformers, capacitors)
...... Stored batteries
...... Septic System
...... Evidence of petroleum or oil products
...... Evidence of chemical spills/leaks (stains on floor, discolored paint)
...... Any source of air emission (paint booths, smoke stacks, chimneys)
...... Above-or under-ground storage tanks, vent or filler pipes
...... Other evidence of contamination or hazardous materials
If any of these items are "Yes," explain details and exact location:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
9. Do any current occupants of the property use, handle, or store any hazardous waste or materials?
______ Yes ______ No
If "Yes," please explain.
___________________________________________________________________________
___________________________________________________________________________
10. Are there now or have there been in the past any underground tanks or pipelines (other than water, sewer, and natural gas utility lines) on the property:
______ Yes ______ No
If "Yes," please explain
___________________________________________________________________________
___________________________________________________________________________
11. List the name and natures of businesses which border the property on all sides:
East: _________________________________________________________________
West: ________________________________________________________________
North: ________________________________________________________________
South: ________________________________________________________________
12. Have any of these adjoining businesses or landowners been involved in any matter described in Question 6 through 10?
______ Yes ______ No
13. Note here any information that could be helpful for further investigation, such as names of people you spoke with at the site, exact locations of suspect contamination, etc.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
14. Please note any other observations you have regarding past, current, or possible future contamination.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
15. All adjacent properties should be viewed. If any evidence of hazardous waste was discovered, please describe. Attach a plat showing (a) adjacent properties and (b) all commercial activities within a five (5) block radius.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
16. I viewed all of the site, including yard areas, vacant land, etc. ______ Yes ______ No. If "No,' list areas not seen.
___________________________________________________________________________
___________________________________________________________________________
1. ...... Based on the evaluation of known environmental factors, there is no evidence of environmental contamination on this or neighboring properties and no further action is recommended.
...... Based on the evaluation of known environmental factors, there is evidence of possible environmental contamination on this or neighboring properties and further investigation is recommended.
___________________________________________________________________________
___________________________________________________________________________
I am familiar with the operations presently conducted on the property and hereby certify for the benefit of ____________________, to the best of my knowledge this information is true and correct.
_______________ ______________________________
(Date) (Signature)
______________________________
(Signature)
This report was made by:
_________________________
(Typed Name)
_________________________
(Signature)
Title: _________________________ Date: _______________
Reviewed by:
_________________________
General Counsel
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