Environmental Site Assessment Guidelines - Ohio Department of ...

Environmental Site Assessment Guidelines - Ohio Department of ... Environmental Site Assessment Guidelines - Ohio Department of ...

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15.12.2012 Views

APPENDIX E Environmental Site Assessment Screening Checklist Form xix

ENVIRONMENTAL SITE ASSESSMENT SCREENING CHECKLIST NAME: DATE: TITLE: DISTRICT: COUNTY/ROUTE/SECTION: PID: PROJECT DESCRIPTION: Parcel No./Owner/Address: Project Right-of-Way (Row) Requirements From Parcel: No New ROW Strip ROW Minor Take Whole Parcel Take Not Available LAND USE: Current Land Use (For Commercial/Industrial land use, specify type and tenant): Past Land Use (For Commercial/Industrial land use, specify type and tenant): Environmental Records (Date queried) (Result) National Priority List (NPL) Comprehensive Environmental Response, Compensation and Liability Information System (CERCLIS) OEPA Master Site List (MSL) Resource Conservation and Recovery Act (RCRA) Bureau of Underground Storage Tank Regulation (BUSTR) Other State/Local Lists NPL/CERCLIS/OEPA MSL in vicinity (type of facility and location in relation to project): Visual Inspection UST’s Surface Staining AST’s Sheens Drums Damaged Vegetation Landfills Odors Pond/Lagoon Other(specify) Phase I ESA required Yes No

APPENDIX E<br />

<strong>Environmental</strong> <strong>Site</strong> <strong>Assessment</strong> Screening<br />

Checklist Form<br />

xix

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