STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HAZARDOUS MATERIALS DISCLOSURE DOCUMENT - DISPOSAL
ENV-0001-D ( NEW 03/2009)
This document provides written disclosure that the referenced property, as shown on the map(s) attached, has been reviewed by the District Hazardous Waste Technical Staff (located in Environmental or Environmental Engineering) and provides direction regarding property disposal based upon that review.
DATE
APPRAISAL MAP NO.
MAP DATE
DIST/CO/RTE/PM (KP)
EA
PROJECT NAME OR DESCRIPTION
04/01/22 08/SBD/15 PM 14-R16.4/215 PM 16-17.8
503S 08-0K710
n/a I-15/I-215 DEVORE INTERCHANGE IMPROVE
RW PARCEL NUMBER(S):
RW PARCEL NUMBER(S):
Segment 1, Segment 2, Segment 3, Segment 4, Segment 5, Segment 6 RW PARCEL NUMBER(S):
See subsequent pages for detailed information regarding property condition and status.
Form Prepared By:
Approved by District Hazardous Waste Supervisor Date
These Parcels Can NOT Currently Be Sold or Exchanged:
These Parcels Can Be Sold or Exchanged With Full Information Disclosure:
These Parcels Can Be Sold or Exchanged:
ACTION SUMMARY
04/05/2022
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HAZARDOUS MATERIALS DISCLOSURE DOCUMENT - DISPOSAL
ENV-0001-D ( NEW 03/2009)
HAZARDOUS MATERIALS DISCLOSURE DOCUMENT- DISPOSAL DETAIL Parcel #s
( ) 1. Based upon an Initial Site Assessment, the referenced parcel(s) are considered free of significant hazardous materials (describe potential sources of minor contamination in the Comments section).
Subject parcel(s) can be sold or exchanged.
2. The referenced parcel(s) do not require cleanup cost estimates, but have been identified as having:
( ) (a) minor soil contamination. A hazardous waste Site investigation [ ] been performed on the referenced parcel(s) (if not performed explain the source of knowledge in the Comments section). Subject parcel(s) can be sold or exchanged.; has not has /
( ) (b) contaminated groundwater under the property. A hazardous waste Site investigation [ ] been performed on the referenced parcel(s) (if not performed explain the source of knowledge in the Comments section). The source of contamination has been determined not to be attributed to the Caltrans property or operations (an indemnification letter from the local, state or federal regulatory authority [ ] attached). Subject parcel(s) can be sold or exchanged.;
has not has /
is not is /
( ) (c) contaminated groundwater under the property. A hazardous waste Site investigation [ ] been performed on the referenced parcel(s) (if not performed explain the source of knowledge in the Comments section). However, the source of contamination has been removed or remediated to regulatory cleanup levels (attach closure letter). Subject parcel(s) can be sold or exchanged with full information disclosure.;
has not has /
see above( ) (d) lead soil contamination, probably as a result of aerial deposition of vehicular gasoline emissions. A project specific hazardous waste Site Investigation [ ] been performed on the referenced parcel(s) (if not performed explain the source of knowledge in the Comments section).
Subject parcel(s) can be sold or exchanged with full information disclosure.; has not has /
( ) (e) hazardous materials previously present on the referenced parcel(s) that have been sufficiently remediated. A hazardous waste Site Investigation [ ] been performed on the referenced parcel(s) (if not performed explain the source of knowledge in the Comments section). A regulatory closure letter, if appropriate, is attached. The subject parcel(s) can be sold or exchanged with appropriate and full information disclosure and/or deed restrictions. has not has /
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
HAZARDOUS MATERIALS DISCLOSURE DOCUMENT - DISPOSAL
ENV-0001-D ( NEW 03/2009)
( ) 3. This document includes, as an attachment, a hazardous waste Site Investigation report stating the nature and extent of contamination and cleanup cost estimates for the referenced parcel(s). However, cleanup is not required pursuant to state or federal law. The subject parcel(s) can be sold or exchanged with appropriate and full information disclosure and/or deed restrictions.. ( ) 4. This document includes the hazardous waste Site Investigation work schedule or cleanup plans, schedule, and current status for the referenced parcel(s), as an attachment. The work will be completed by [ ]. The subject parcel(s) can not be sold or exchanged until remediation is complete The District must request a Category 2D Environmental Hold on the subject parcel(s). (Note: Attach this Hazardous Materials Disclosure Document - Disposal to the Application to Hold Excess Land request form - RW 16-3). a responsible party Caltrans /
( ) 5. The referenced parcel(s) have been identified as containing or potentially containing, hazardous materials and can not be sold or exchanged. The District must request a Category 2D Environmental Hold on the subject parcel(s). (Note: Attach this Hazardous Materials Disclosure Document - Disposal to the Application to Hold Excess Land request form - RW 16-3). The Hazardous Materials Disclosure Document - Disposal will be updated when the parcel can be sold or exchanged. In addition:
( ) (a) an appropriate hazardous waste Site Investigation must be performed to determine the nature and extent of contamination, and remedial cost estimates. Proper charging codes and expenditure authorization (EA) need to be provided to the District Hazardous Waste Technical Specialist. Site Investigation is anticipated to be completed by (date).; Comments
ADL is present on site and must be appropriately handled. ( ) (b) a hazardous waste Site Investigation, for potentially contaminated adjacent property, will be scheduled by the District Hazardous Waste Technical Specialist when a permit to enter is obtained by the District/Region Right of Way Office. The permit request was submitted on (date) and the Site Investigation is anticipated to be completed by (date).; ( ) (c) hazardous waste Site Investigation studies are complete and either a regulatory case closure is being obtained or the site requires cleanup or long-term monitoring. Resolution is expected by (date).;
( ) Other: Explain in the Comments section below. (NOTE: Disposal of property without adequate investigation is an unacceptable risk. If adequate investigation has not been completed, use #4 or #5 above).
6. ADA NoticeFor individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms ManagemUnit at (279) 234-2284, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.