Information
-
Client / Site
-
Conducted on
-
Prepared by
-
Weather Conditions During Site Reconaissance
-
Were any limiting conditions encountered during the site reconnaissance?
-
Identify Limiting Condition
Limiting Condition
-
- Locked Room or Building
- Snow on Ground
- Access denied
- Impenetrable vegetation
- Large acreage -transects only
- Other
-
Discussion/Comments
-
Limiting Condition Photos
General Description of Property
-
Add location
-
SITE ID (Tax Parcel No., GPIN, Other)
-
- Undeveloped
- Commercial-Retail
- Commercial - Office
- Agricultural
- Residential Single Family
- Residential Multi Family
- Industrial
- Mixed Use
- Institutional
- Other
-
Adjacent Properties
-
North
-
Adjacent Property North Photos
-
Northeast
-
Adjacent Property Northeast Photos
-
East
-
Adjacent Property East Photos
-
Southeast
-
Adjacent Property Southeast Photos
-
South
-
Adjacent Property South Photos
-
Southwest
-
Adjacent Property Southwest Photos
-
West
-
Adjacent Property West Photos
-
Northwest
-
Adjacent Property Northwest Photos
-
Are there onsite structures?
-
Itemize Structures
Structure
-
Describe Structure
-
Photos of structures
-
Utilities & Waste Disposal
- Electric
- Natural Gas
- Public Water Supply
- Well Water
- Heating Oil
- Generator
- Public Sewer
- Septic System
- Dumpsters
Hazardous Substances
-
Were Hazardous Substances Observed on site?
-
Substance Identity
substance
-
- Herbicides/Pesticides
- Solvents
- Oxidizers
- Reactive Agents
- Flammable
- Janitorial
-
Identify Location Where Hazardous Substance Was Observed
-
Product Name
-
Containers
- Pint
- Quart
- Gallon
- 5 gallon
- >5 <55 gallon
- 55 gallon drum
- Tote
- Various
- Other
-
Observable Sign of Release?
-
Discussion
-
Hazardous Substance Photos
Petroleum Products (Not in Tanks)
-
Were Petroleum Products (Not in Tanks) Onserved on Site?
-
Product
Petroleum Product
-
Identify Location Where Petroleum Product Was Observed
-
- Motor Oil
- Gasoline
- Diesel
- Heating Oil
- Jet Fuel
- Hydraulic Fluid
- Used Oil
- Other
-
Container
- Pint
- Quart
- Gallon
- 5 gallon
- >5 <55 gallon
- 55 gallon drum
- Tote
- Various
- Other
-
Observable Indication of Release?
-
Discussion/Comments
-
Photos (Petroleum Storage Not in Tanks)
Underground Storage Tanks
-
Known USTs on Site?
-
UST Identification
UST
-
Identify Location Where Known UST Was Observed
-
Contents
- Unknown
- Gasoline
- Diesel
- Kerosene
- Jet Fuel
- Heating Oil
- Other
-
Construction
- Steel
- Fiberglass
- Single Wall
- Double Wall
- Overfill Protection
- Cathodic Protection
- UNKNOWN
-
Capacity
- 280
- 500
- 1000
- 2000
- 3000
- 4000
- 5000
- 7500
- 10,000
- Other
-
Cathodic Protection
-
Leak Detection
- Inventory Control
- Automated
- Monitoring Wells
- Vapor
- Unknown
- NO LEAK DETECTION
- Other
-
Is There Reason to Suspect a Release?
- Unknown
- Vegetative stress at vent pipe
- Odor
- Leak Detection Result
- Other
-
Discussion / Comments
-
UST System Photos
-
Suspected USTs on Site?
Suspected UST
-
Identify Location Where Suspect UST Was Observed
-
Observed Condition
- Vent Pipe
- Fill Pipe
- Pump Island
- Fuel Dispenser
- Concrete or Asphalt Patch
- Pipe - Unknown Purpose
- Sunken or Raised Ground
- Other
-
Is There Reason to Suspect Release?
- Unknown
- Vegetative stress at vent pipe
- Odor
- Leak Detection Result
- Other
-
Discussion/Comments
-
Suspect UST Photos
Aboveground Storage Tanks
-
Aboveground Storage Tanks on Site?
-
AST Identification
AST
-
Identify Location Where AST Was Observed
-
Contents
- Motor Oil
- Gasoline
- Diesel
- Heating Oil
- Jet Fuel
- Hydraulic Fluid
- Used Oil
- Other
-
Capacity
- 280
- 500
- 1000
- 2000
- 3000
- 4000
- 5000
- 7500
- 10,000
- Other
-
Construction
- Steel
- Fiberglass
- Plastic
- Other
-
Secondary Containment
- None
- Berm
- Double Walled Tank
-
Observed Indication of Release
- None Observed
- Stained Equipment Exterior
- Stains Below Equipment
- Free Dielectric Fluid
-
Discussion/Comments
-
AST Photos
Suspect Containers
-
Suspect Containers on Site?
-
Suspect Container Identity
Suspect Container
-
Identify Location Where Suspect Container Was Observed
-
Container
- Pint
- Quart
- Gallon
- 5 gallon
- >5 <55 gallon
- 55 gallon drum
- Tote
- Various
- Other
-
Contents
-
Observed Indication of Release
- None Observed
- Stained Equipment Exterior
- Stains Below Equipment
- Free Dielectric Fluid
-
Discussion/Comments
-
Suspect Container Photos
Equipment Likely to Contain PCBs
-
Are Utility Owned Transformers on Site?
-
Are Utility Owned Transformers Labeled NON-PCB?
-
Observed Indication of Release
-
Discussion/Comments
-
Photos - Utility Owned Transformers
-
Was Other Equipment Having Potential to Contain PCBs Observed?<br>(Note - fluorescent light ballasts excluded)
-
Suspect PCB Equipment
Suspected PCB
-
Identify Location Where Suspect PCB Equipment Was Observed
-
Identify Suspect PCB Equipment
- Hydraulic Equipment
- Capacitor
- Non-Utility Owned Transformer
-
Observed Indication of Release
- None Observed
- Stained Equipment Exterior
- Stains Below Equipment
- Free Dielectric Fluid
-
Discussion/Comments
-
Suspect PCB Equipment Photos
Building Interior
-
Are There Buildings on Site?
-
Was Interior Staining or Corrosion Observed?
-
Identify Stain/Corrosion
Interior stain/corrosion
-
Identify Location Where Stain/Corrosion Was Observed
-
Discussion/Comments
-
Interior staining/corrosion photos
-
Were Sumps or Floor Drains Observed?
-
Identify Sump/Floor Drain
Sump/Floor Drain
-
Identify Location Where Sump/Floor Drain Was Observed
-
Discussion/Comments
-
Sump/Floor Drain Photos
-
Are Heating/Cooling Systems Present?
-
Describe System
Heating/Cooling System
-
- Heat Pump
- Oil Furnace
- Natural Gas Furnace
- Window Unit
- Boiler
- Industrial Chiller
- Other
-
Discussion/Comments
-
Heating/Cooling System Photos
Exterior Observations
-
Are there pits, ponds or lagoons on site?
-
Pit, Pond or Lagoon
Pit, Pond or lagoon
-
Identify Location Where Pit, Pond or Lagoon Was Observed
-
Describe
-
Pit, Pond Lagoon Photos
-
Are there storm water discharge structures on site?
-
Structure is
Structure
-
Identify Location Where Storm Water Structure Was Observed
-
- Ditch
- Storm Drain/drop inlet
- Catch Basin
- Oil/water Separator
- Other
-
Is there visible indication of disposal of petroleum or hazardous material in storm water structure?
-
Discussion/Comments
-
Storm water structure photos
-
Is there visible evidence of waste disposal on site?<br>EXCLUDING DUMPSTERS
-
Describe
Waste Disposal Area
-
Identify Location Where Waste Disposal Was Observed
-
- Inert Debris (e.g., Concrete)
- Wood
- Tires
- Appliances
- Litter (e.g. bottles, cans)
- Dirt, branches, stumps
- Drywall
- Shingles
- Tile
- Siding
- Drums
- Other
-
Discussion/Comments
-
Waste disposal photos
-
Is there stained soil or pavement on site?
-
Describe
Stained Soil or Pavement Area
-
Identify Location Where Stained Soil or Pavement Was Observed
-
Describe source (if known) and size of stain
-
Stained Soil or Pavement Photos
-
Is there stressed vegetation on site?
-
Describe
Stressed Vegetation Area
-
Identify Location Where Stressed Vegetation Was Observed
-
Discussion/Comments
-
Stressed Vegetation Area Photos
-
Are there wells on site?
-
Well type
Well
-
Identify Location Where Well Was Observed
-
-
Discussion/Comments
-
Well Photos
-
Are there wastewater outfalls on site?
-
Identify Outfall
Outfall
-
Identify Location Where Outfall Was Observed
-
Discussion/Comments
-
Outfall Photos
-
Were odors observed during site reconnaissance?
-
Identify Location Where Odor Was Observed
-
Describe Odors
Notes
-
NOTES AND ANY ADDITIONAL COMMENTS/DISCUSSION (Including Interviews Conducted On Site)
Signature Page
-
Signature of Person Conducting Site Reconnaissance