Attachment_12-_Environmental_Checklist.pdf

ENVIRONMENTAL CHECKLIST

Project proponent completes all sections. Please print clearly or type. Submit to Environmental Office for review.

Any questions Call: 839-4129 Environmental Chief

Section 1: General Information Project#

Project Title:

Phone:

Phone:

Phone:

Dept:

Date:

Proponent/Department:

Proj. Mgr:

Prepared by:

Section 2: Project Site Information

Planned Start Date: Planned Completion Date:

Purpose of the project (include any description of operations, functions, and activities associated with the project which will change or occur due to the project):

Environmental Checklist Page 1 of 4 30 Jan 2014

Describe the location and area of the proposed project:

Total Acreage Developed: Acres Disturbed:

Total Length of Trench:

Excavation Area & Depth:

Trench Depth:

Acres Paved:

Describe the size and staging location of soil borrow/stock piles:

Describe where excess soil/ fill material will be disposed?:

Describe laydown areas, locations and duration of use:

Section 3: General Project Questions (Check positive responses.)

Is the project a new facility?

Has the project area been mapped, labeled, or distinguished?

Is additional future development or phases planned?

Provide additional project location data not requested elsewhere:

Section 4: Specific Project Questions (Check positive responses.)

Dewatering of a construction site?

Facility renovation or alteration?

Building demolition, renovation, or retrofit?

Installation of electrical equipment, e.g. transformers, switches or capacitors?

Equipment alteration or relocation?

Placement of new equipment?

Installation, repair or removal of fuel storage tanks?

Routine use of fuels or oils?

New fuel storage or distribution facilities?

New heating units or boilers?

Emergency generators or other stationary internal combustion engines?

New sources of air emissions (e.g. paint booths, blasting operations)?

New drinking water services?

Water for fire protection?

Generation or Disposal of domestic wastewater (e.g. rinsewater, washdowns, pressure washing, etc.)?

Concrete?

Involve Solid wastes such as:

Asphalt?

Topsoil?

Electrical equipment?

Recyclable materials (e.g. steel, cardboard, wood, etc.)?

Increase in outfall water or untreated runoff entering Storm water system?

Asbestos or Asbestos containing building materials?

Involve disturbance or use of Hazardous substances such as:

Mercury?

PCBs?

Lead Based Paint?

Other?

Cleaners or solvents?

Excavation, trenching, or disturbance of soils?

Disturbance of any threatened or endangered species (e.g. Burrowing Owl, etc.)?

Loud and/or sustained noise above 70dB?

Environmental Checklist Page 3 of 4 03 Jan 2014

Hazardous material storage required?

Involve use or storage of Hazardous materials:

Storage of HM more than 55 gal?

Will there be temporary or permanant storage of HM?

Installation or alteration of potable water backflow prevention devices?

Would this proposal cause any concerns from the neighbors (e.g. dust, noise, view)?

NEPA Required

Project Title:

REC/SCS EA EIS None

Additional Project Requirements

EMS Inspection HM inventory update

Air Emissions Permits

Haz Waste Site Specific Training

Est. Completion Time and Notes

Storm water permits

Meetings and Coordination

Site Visit Requested Prior to Construction Site Visit Requested During Construction

Contractually required Environmental Protection Plan? Review Specific Environmental Requirements with Contractor?

Additional Environmental Requirements/ comments:

Project #

Prepared by: Phone:Date:

ENVIRONMENTAL REQUIREMENTS

General Conformity Calculations

Section 106/NHPA Land Use Controls notification

This page to be completed and returned by the Environmental Department

Environmental Checklist Page 4 of 4 30 Jan 2014

Hazardous Waste Disposal

Environmental Officer review

ENVIRONMENTAL CHECKLIST

Project proponent completes all sections. Please print clearly or type. Submit to Environmental Office for review.

Any questions Call: 839-4129 Environmental Chief Section 1: General Information Section 2: Project Site Information Purpose of the project (include any description of operations, functions, and activities associated with the project which will change or occur due to the project):

Environmental Checklist Page 1 of 4 30 Jan 2014 ..\My Pictures\dlalogo.jpg Describe the location and area of the proposed project:

Describe the size and staging location of soil borrow/stock piles:

Describe where excess soil/ fill material will be disposed?:

Describe laydown areas, locations and duration of use:

Section 3: General Project Questions (Check positive responses.)

Provide additional project location data not requested elsewhere:

Section 4: Specific Project Questions (Check positive responses.)

Involve Solid wastes such as:

Involve disturbance or use of Hazardous substances such as:

Environmental Checklist Page 3 of 4 03 Jan 2014 Involve use or storage of Hazardous materials:

NEPA Required Additional Project Requirements Meetings and Coordination ..\My Pictures\dlalogo.jpg

ENVIRONMENTAL REQUIREMENTS

This page to be completed and returned by the Environmental Department Environmental Checklist Page 4 of 4 30 Jan 2014 8.2.1.4029.1.523496.503679

2. Considering the previous soil removal action in this area for petroleum hydrocarbons from the UST and the SVE operations for TCE, soil in this area should be considered Non-Hazardous.

3. Must comply with the general conformity air regulations.