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FILE: J_ENVIRO SITE ASSESSMENT (TM) Field Picklist PAGE 1
(when you see the letters: "ckme" - that means: "check me for...".)
*===== Top of Picklist =====* [_] ckme PCBs regs. T.S.C. ACT 15
----------------------------------- Transformers ___type ?__
PREVIOUS PICKLIST * I_RECORD [_] yes (not leaking)
[_] yes (leaking)
ENVIRONMENTAL [_] yes (leaking unknown)
----------------------------------- Capacitor ___type ?__
PRESENT USE (by inspection) [_] yes (not leaking)
====== INSIDE OF ====== [_] yes (leaking)
BUILDINGS and/or STRUCTURES [_] yes (leaking unknown)
Hydraulic Equipment __?__
POSSIBLE CHEMICAL STAINS [_] yes (not leaking)
----------------------------------- [_] yes (leaking)
[_] ckme Chemical Stains Observed [_] yes (leaking unknown)
[_] wall(s) Automobile Lift(s)
[_] floor [_] yes (not leaking)
[_] ceiling(s) [_] yes (leaking)
[_] floor drain(s) [_] yes (leaking unknown)
[_] sink drain(s) Elevator(s) ___type ?__
[_] other [_] yes (not leaking)
[_] ckme Staining suggests... [_] yes (leaking)
[_] yes (leaking unknown)
CORROSION
----------------------------------- HEATING
[_] ckme Corrosion Observed -----------------------------------
[_] wall(s) Equipment
[_] floor [_] forced hot air furnace
[_] floor drain(s) [_] radiant floor heat
[_] plumbing drain pipe(s) [_] radiators (hot water/steam)
[_] sink drain(s) Fuels
[_] on concrete in the ____ area [_] natural gas
[_] on steel in the ____ area [_] propane gas
[_] other [_] coal
[_] ckme Corrosion may suggest... [_] oil
[_] wood
ODORS inside structure [_] electric
----------------------------------- [_] steam (from outside source)
Strength of Odor
[_] strong ABANDONED MFG. EQUIPMENT
[_] pungent -----------------------------------
[_] noxious Attached - inside structure
Origin of Odor [_] no environmental hazards
[_] sewers [_] is an environmental hazard
[_] walls Free-standing inside struct.
[_] floors [_] no environmental hazards
[_] other [_] is an environmental hazard
DRAINS and SUMPS inside UNKNOWN RESIDUE
----------------------------------- -----------------------------------
[_] ckme Drains / sumps paragraph Observed inside structure
Stains or Residue Observed [_] around sewer drains
[_] chemical stains observed [_] sump pit
[_] chemical residue observed [_] cistern
[_] equipment
PCB's inside structure [_] floors
----------------------------------- [_] splashed on walls
FILE: J_ENVIRO SITE ASSESSMENT (TM) Field Picklist PAGE 2
UNKNOWN POOL of LIQUID [_] Hazardous wastes
-----------------------------------
Observed inside structure DISPOSAL SAFE / UNSAFE
[_] on the floor in the __?__ area -----------------------------------
[_] under___?___ equipment Disposal (safe)
[_] hazardous substances
[_] petroleum products
*** PRODUCTION ACTIVITIES *** [_] hazardous chemicals
----------------------------------- [_] hazardous waste
TIME FRAME Disposal (unsafe)
[_] present use(s) [_] hazardous substances
[_] past use(s) [_] petroleum products
[_] hazardous chemicals
LOCATION of ACTIVITIES [_] hazardous waste
-----------------------------------
[_] building structure (interior) STORAGE SAFE / UNSAFE
[_] site grounds (exterior) -----------------------------------
Storage (safe)
PRODUCTION SAFE / UNSAFE [_] hazardous substances
----------------------------------- [_] petroleum products
Use (safe) [_] hazardous chemicals
[_] hazardous substances [_] hazardous waste
[_] petroleum products Storage (unsafe)
[_] hazardous chemicals [_] hazardous substances
[_] hazardous wastes [_] petroleum products
Use (unsafe) [_] hazardous chemicals
[_] hazardous substances [_] hazardous waste
[_] petroleum products
[_] hazardous chemicals **** CONTAINERS ****
[_] hazardous wastes -----------------------------------
Location of Containers
TREATMENT SAFE / UNSAFE [_] building structure (interior)
----------------------------------- [_] site grounds (exterior)
Treatment materials (safe) Present Number of Units
[_] hazardous substances [_] ___ containers observed?
[_] petroleum products Made Of ?
[_] hazardous chemicals [_] steel
[_] hazardous wastes [_] metal
Treatment materials (unsafe) [_] aluminum
[_] hazardous substances [_] plastic
[_] petroleum products [_] glass
[_] hazardous chemicals [_] wood
[_] hazardous wastes [_] oak wood
[_] tin
GENERATED SAFE / UNSAFE [_] copper
----------------------------------- [_] stainless steel
Generated (safe) [_] iron
[_] hazardous substances [_] galvanized steel
[_] petroleum products [_] paper
[_] hazardous chemicals [_] cardboard
[_] Hazardous wastes [_] animal products
Generated (unsafe) Type?
[_] hazardous substances [_] drums
[_] petroleum products [_] barrels
[_] hazardous chemicals [_] cartons
FILE: J_ENVIRO SITE ASSESSMENT (TM) Field Picklist PAGE 3
[_] sacks [C]urrent - [P]ast
[_] bins [S]ubject - [A]djoining.)
[_] canisters TIME FRAME
[_] cans Present Use
[_] jars [_] present use (inspection)
[_] bottles [_] present key site mgr./inspect.
[_] jugs Past Use
[_] bags [_] past use (owner)
[_] dispenser [_] past use (past owner)
[_] piping [_] past use (tenant)
[_] tanks [_] past use (past tenant)
[_] silos [_] past use (records)
[_] dumpsters
[_] other SITE BEING INSPECTED
Quantity (size) -----------------------------------
[_] one gallon [_] subject site grounds
[_] five gallons [_] adjoining site
[_] fifty-five gallons WHICH ADJOINING SITE ?
[_] one liter [_] north
[_] nineteen liters [_] east
[_] two hundred-eight liters [_] south
[_] ____ square feet [_] west
[_] ___ cubic feet
[_] ___ square yard ODORS (outside)
[_] ___ cubic yard -----------------------------------
[_] ___ square meter Strength of
[_] ___ cubic meter [_] strong
Identification [_] pungent
[_] identified as ______?______ [_] noxious
[_] unidentified hazardous substan Origin of
[_] unidentified petroleum product [_] sewers
[_] unidentified unknown product [_] soil
Open/Unopen [_] holes in the ground
[_] open [_] other source
[_] unopened
Leakage DRAINS and SUMPS (outside)
[_] yes -----------------------------------
[_] no Number of
[_] yes (one ground drain)
Special Purpose [_] yes (__ ground drains)
----------------------------------- [_] yes (one sump pit) storage of?
[_] processing only [_] yes (__ sump pits) storage of?
[_] storage only [_] yes (one sump pit) collecting?
[_] processing and storage [_] yes (__ sump pits) collecting?
[_] other Stains Observed
[_] yes
[_] no
** EXTERIOR AREAS **
----------------------------------- PCB's exterior to structures
=== SPECIAL INSTRUCTIONS === -----------------------------------
(Go through the rest of [_] ckme PCBs regs. T.S.C. ACT 15
this picklist once for Transformers __type ?__
for each of the following [_] yes (not leaking)
options. Use a letter to [_] yes (leaking)
mark each check box. [_] yes (leaking unknown)
FILE: J_ENVIRO SITE ASSESSMENT (TM) Field Picklist PAGE 4
Capacitor __type ?__ -----------------------------------
[_] yes (not leaking) Known / Not a Problem
[_] yes (leaking) [_] stressed vegetation
[_] yes (leaking unknown) Not Known / Could be Problem
Hydraulic Equipment __?__ [_] stressed vegetation
[_] yes (not leaking)
[_] yes (leaking) WASTE WATER
[_] yes (leaking unknown) -----------------------------------
Automobile Lift(s) Kind of Discharge
[_] yes (not leaking) [_] stormwater discharge
[_] yes (leaking) [_] wastewater discharge
[_] yes (leaking unknown) [_] unknown liquid discharge
Elevator(s) __type ?__ Discharged Into
[_] yes (not leaking) [_] into stormwater drain
[_] yes (leaking) [_] into ditch
[_] yes (leaking unknown) [_] into stream
[_] into parking lot
ABANDONED MFG. EQUIPMENT [_] into a ___________?___________
-----------------------------------
Attached to Ground-outside WELLS
[_] free of environmental hazards -----------------------------------
[_] it's an environmental hazard Type
Unattached to Ground-outside [_] dry well
[_] free of environmental hazards [_] irrigation well
[_] it's an environmental hazard [_] injection well
[_] abandoned well
DISTILLATION RESIDUE outside Status
----------------------------------- [_] covered with a _______?______.
Observed in/on/around [_] working properly
[_] parking lot drains [_] broken
[_] around sewer drains [_] abandoned
[_] sump pit
[_] cistern (concrete) SEPTIC SYSTEM
[_] cesspool -----------------------------------
Type
UNKNOWN RESIDUE [_] on-site septic system
----------------------------------- [_] cesspool
Observed in/on/around Status
[_] around sewer drain [_] in good working order
[_] sump pit [_] nonfunctional
[_] cistern
[_] cesspool POOL of LIQUID
[_] ground -----------------------------------
[_] splashed on walls Observed
[_] standing water
STAINED SOIL AND PAVEMENT [_] pool unknown substance
----------------------------------- [_] pit
Stain Known / Not a Problem [_] pond
[_] soil [_] lagoon
[_] paving Problems
Not Known / Could be Problem [_] no problem observed
[_] soil [_] odors
[_] paving [_] discolored
[_] oily surface sheen
STRESSED VEGETATION [_] stagnated
FILE: J_ENVIRO SITE ASSESSMENT (TM) Field Picklist PAGE 5
[_] other [_] present use info. by tenant
[_] past use info. present owner
SOLID WASTES(Suspect Terrain) [_] past info. previous inspection
----------------------------------- Property Being Inspected
Not A Natural Terrain [_] subject property
[_] mounds [_] adjoining property (see below)
[_] depression Which Adjoining Property ?
[_] fill dirt [_] north
[_] graded areas [_] east
[_] irregular grade elevations [_] south
Fill Dirt [_] west
Origin of Tank Betrayal Items Found
[_] good fill (by testing) Pipes/Access Ways/etc.
[_] bad fill (by testing) ckme & skip-to> SITE LOCATION
[_] unknown source [_] ckme vent pipes> SITE LOCATION
WASTES AND DEBRIS FOUND [_] ckme fill pipes> SITE LOCATION
[_] ckme Introduction To Wastes [_] ckme access ways>SITE LOCATION
All ckme Items Will Be Listed [_] ckme cover plate>SITE LOCATION
[_] discarded batteries Tank(s) Found
[_] junk motor vehicles do each item below don't skip
[_] junk marine equipment Number of Tanks Each Location
[_] piles of debris [_] (___)# tank(s) found
[_] scattered garbage & trash Made Of
[_] raw material waste [_] steel
[_] construction debris [_] aluminum
[_] medical waste [_] iron
[_] asbestos [_] fiberglass
[_] lead paint [_] copper
[_] manufacturing by products [_] galvanized steel
[_] empty drums [_] stainless steel
[_] unknown tank(s)
WASTES CATEGORICALLY LISTED Size
----------------------------------- [_] size unknown
[_] ckme INTRODUCTION TO WASTES [_] (______)? gallons each tank
Waste Found on the Site [_] (______)? liters each tank
[_] biological wastes [_] (______)? barrels each tank
[_] chemical wastes [_] various sizes
[_] combustible wastes Tank(s) Elevations
[_] commercial wastes [_] aboveground storage tank(s)
[_] discharge wastes [_] underground storage tank(s)
[_] domestic wastes Used For
[_] heavy metals wastes [_] petroleum products
[_] industrial wastes [_] hazardous substances
[_] pesticide wastes [_] chemicals
[_] (PCB) wastes [_] unknown use(s) substances
[_] sludge wastes [_] unknown use(s) petro. products
[_] solid wastes [_] gasoline
[_] solvent wastes [_] oil
[_] toxic wastes [_] kerosene
[_] diesel fuel
**** STORAGE TANKS **** [_] unknown chemical
----------------------------------- [_] water
Time Frame [_] chemicals (____________)?
[_] present use info. inspection Status
[_] present use info. by owner [_] tank(s) currently in place
FILE: J_ENVIRO SITE ASSESSMENT (TM) Field Picklist PAGE 6
[_] tank(s) NO (removed)
[_] tank(s) YES contents NO
[_] tank(s) exist / filled w/sand
** SITE LOCATION of TANK(S) *
Time Frame
[_] presently located
[_] were located
Direction From Landmark
[_] east side
[_] north side
[_] west side
[_] south side
Direction Reference/Landmark
[_] front of
[_] rear of
[_] side of
Landmark Status
[_] existing
[_] removed
Landmark
[_] service station.
[_] ___ ? ___ store.
[_] ___ ? ___ factory bldg.
[_] ___ ? __ retail outlet.
STORAGE TANK DATA
-----------------------------------
[_] NO registration found
[_] YES registration found
[_] /not in compliance
[_] /are in compliance
[_] and no inventory records
[_] and has inventory records
Tank(s) Not Leaking
[_] No leak no monitor wells
[_] No leak /has monitor well
Tank(s) Leaking
[_] Yes leak/has monitor wells
[_] Yes leak no monitor wells
Tank(s) Leaks Unknown
[_] Unknown leaks/monitoring wells
[_] Unk leaks/ no monitoring wells
Overfill Protection
[_] No overfill protection
[_] Yes overfill protection
NEXT PICKLIST IS * M_APPNDX
-----------------------------------
*===== End of Picklist =====*
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