VCP_App-1460 by pengxiang

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									State of California – California Environmental Protection Agency




           Request for Agency Oversight of a Brownfield Site
The purpose of this application is to provide the Department of Toxic Substances Control and the Regional
Water Quality Control Board sufficient information to determine which agency will be the appropriate lead
agency to provide oversight for the assessment and/or remediation of this Brownfield site. The detailed site
information requested in this application will also help the appropriate lead agency to expedite the
development of a cost recovery agreement for the site, so that the site applicant can begin site work in a
timely and efficient manner. Please use additional pages, as necessary, to complete your responses.

                                        SECTION 1
                         APPLICANT/PRIMARY CONTACT INFORMATION

The person/organization requesting oversight must possess all necessary rights and access to the site so
that they can carry out any and all activities that the oversight agency may require in making its regulatory
decisions.

Applicant Name:

Applicant Point of Contact Name:

E-mail Address:

Phone: (            )         -

Address, City, County & Zip Code:

Applicant's relationship to site: Current Owner or Operator
Local Agency       Prospective Purchaser     Developer
Other (please describe):


Consulting Firm Name:

Consultant Point of Contact Name:

E-mail Address:

Phone: (            )         -

Address, City, County & Zip Code:

Agency‟s Primary Point of Contact for this Site: Applicant Contact                      or Consultant
Contact




DTSC Form 1460            Rev July 2011                                                                         1
State of California – California Environmental Protection Agency




                                 Request for Agency Oversight of a Brownfield Site



                                                    SECTION 2
                                                SITE INFORMATION

If applicable, the applicant may supplement the responses to this section with information from a Phase 1
Environmental Assessment or other site investigation reports available for the site.

1. Is this site listed on Envirostor? Yes                No       and/or Geotracker? Yes       No     

2. Name of Site:

3. Address City County ZIP:

4. APN(s):

5. Provide a Site Location Map and a Site Diagram showing significant features

6. Describe the site property (include approximate size & description of features):

7. Describe the surrounding land use (including proximity to residential housing, schools,
churches, etc):


8. Current Owner
Name:

Address, City, County & Zip Code:

Phone (            )         -                          E-mail Address:

9. Background: Current & Previous Business Operations
Name:

Type:

Years of Operation:

10. If known, list all previous businesses operating on this property:
    1.
    2.
    3.
    4.
    5.

11. What hazardous substances, pollutants, or contaminants have been associated with
the site?




DTSC Form 1460            Rev July 2011                                                                     2
   State of California – California Environmental Protection Agency




                                   Request for Agency Oversight of a Brownfield Site


   12. Describe any information on the known or suspected discharge of hazardous
   substances, pollutants, or contaminants at the Site.


   13. What environmental media is/was/may be contaminated (check all that apply)?
   Soil Air Groundwater Surface water

   14. Has sampling or other investigation been conducted? Yes
   Specify:


   15. If Yes, what hazardous substances, pollutants, or contaminants have been detected
   and what were their maximum concentrations exceeding screening levels, e.g.,
   Preliminary Remediation Goals or California Human Health Screening Levels?


   16. Is there currently a potential of exposure of the community or workers to hazardous
   substances, pollutants, or contaminants at the site?
   Yes      No    If Yes, explain


   17. Provide a description of known or possible water quality impacts at the property.
   Also, provide information about the type(s) of water supply for the property and, if
   known, any information on municipal, domestic, agricultural or industrial water supply
   wells that are either on the property or within a 1-mile radius of the project area:


   18. Are any Federal, State or Local regulatory agencies currently involved with the site?
   Yes No

   19. If Yes, state the involvement, and give contact names and telephone numbers

                                 Agency Involvement Contact Name Phone

Agency                          Involvement                           Contact Name         Phone Number
                                                                                       (     )     -
                                                                                       (     )     -
                                                                                       (     )     -

   20. What is the future proposed use of the site?

   21. If the Site is not cleaned-up to unrestricted standards, will the property owner accept
   land use restrictions?




   DTSC Form 1460            Rev July 2011                                                         3
State of California – California Environmental Protection Agency




                                Request for Agency Oversight of a Brownfield Site

22. What oversight service is being requested of the Lead Agency (check all that apply)?
Initial Investigation/Preliminary Endangerment Assessment
  emedial Investigation/Feasibility Study
Removal Action/Remedial Action
Case Closure
Document Review
Other (describe the proposed project):


23. Provide a general description of the nature of the project, including a general timeline
for development, redevelopment or transfer of the site, and the expectations of the
Agreement:


24. Provide information about the potential benefits of the project, if available:

Anticipated number of jobs created/retained:
Anticipated number of proposed residential units:
Anticipated square footage of planned commercial space:
Anticipated square footage of planned open space:
Anticipated acres made ready for re-use by proposed Site cleanup:

25. Provide information on the environmental documents produced for the Site to date.
Note that copies may be requested by the designated Lead Agency.
       Preliminary Endangerment Assessment, dated
       Phase 1 Environmental Assessment, dated
       Phase 2 Environmental Assessment, dated
       Health Risk Assessment, dated
       Other, describe and provide date
       Other, describe and provide date
       Other, describe and provide date
       Other, describe and provide date

26. Provide any other pertinent Site information not covered in this Application:




DTSC Form 1460            Rev July 2011                                                   4
State of California – California Environmental Protection Agency




                                Request for Agency Oversight of a Brownfield Site



                                           SECTION 3
                                 COMMUNITY PROFILE INFORMATION

1. What are the demographics of the community (e.g., socioeconomic level, ethnic
composition, specific language considerations, etc.)?


2. Local Interest
Has there been any media coverage?


3. Past Public Involvement
Has there been any past public interest in the site as reflected by community meetings,
ad hoc committees, workshops, fact sheets, newsletters, etc.?


4. Key Issues and Concerns
Have any specific concerns/issues been raised by the community regarding past
operations or present activities at the site?


5. Are there any concerns/issues anticipated regarding site activities?

6. Are there any general environmental concerns/issues in the community relative to
neighboring sites?


7. Describe the visibility of activities and any known interest the site:




DTSC Form 1460            Rev July 2011                                                   5
State of California – California Environmental Protection Agency




                                Request for Agency Oversight of a Brownfield Site



                                                   SECTION 4
                                                 CERTIFICATION

The signatories below are authorized representatives of the Project Applicant and certify
that the preceding information is true to the best of their knowledge.


____________________________ ________________ _______________________

Applicant Representative                           Date                 Title




                                           FOR OFFICE USE ONLY


1. Received by:

2. Date Received:

3. Date Other Agency Notif:

4. Lead Determination:

5. Lead Determination Date:

6. Lead Determination Database Updated by                          on

7. Other Notes:




DTSC Form 1460            Rev July 2011                                                 6
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application


 Please complete this form ONLY if you are an eligible entity applying for a
     California Land Reuse and Revitalization Act (CLRRA) Agreement

1. Are you applying as a/an:
    Bona fide purchaser
    Contiguous property owner
    Innocent Landowner
    Prospective purchaser
    Bona ground tenant
(Refer to Addendum for definitions)

2. Is the property located outside an infill area* in an urban area*?
Yes           No

3. Is the property solely impacted by petroleum from an underground storage
tank and eligible for reimbursement from the Underground Storage Tank Cleanup
Fund*?
Yes           No

*If you answered YES to either question 2 or 3, the property is likely ineligible to
participate under CLRRA. Please contact a Brownfields Coordinator for further
discussion.

4. Current zoning and planned use of the property:

5. Did the owner conduct due diligence or All Appropriate Inquiry (AAI) prior to
acquiring property? Yes     No

          Date All Appropriate Inquiries* was conducted ____________.

6. Did the owner take reasonable steps with regard to the contamination at the
site? Yes    No

7. Do you own the property? Yes                             No

8. Date the property was purchased (Title was transferred) ___________

*See attached definitions. Attach copy of the Phase I Environmental Assessment
as part of the “All Appropriate Inquiries” required under CLRRA; for
nongovernmental or noncommercial owners of residential property up to 4 units,
attach site inspection report and title search.
** Reasonable steps with regard to contamination at the site includes, as


DTSC Form 1460            Rev July 2011                                                       7
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

appropriate; stopping continuing releases, preventing threatened releases, and
preventing or limiting human, environmental or natural resource exposure in to
earlier hazardous substance releases




DTSC Form 1460            Rev July 2011                                                       8
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

Applicant’s Disclosure Statement:

In submitting this application, I verify that, to the best of my knowledge, I can
meet the requirements for a Bona Fide Purchaser*, Contiguous Property Owner*
Innocent Landowner*, Prospective Purchase* or Bona Fide Ground Tenant* set
forth in HSC Division 20, Chapter 6.82 (commencing with section 25395.60) and,
upon request by the oversight agency, will submit documentation that I meet
each of the following conditions in accordance with Health and Safety Code
section 25395.80:

On or before the date of property acquisition, I made “All Appropriate Inquiries”*
into the previous ownership and uses of the site; and

I am not potentially liable or affiliated with any other person who is potentially
liable through any direct or indirect familial relationship, or through any
contractual, corporate, or financial relationship unless that relationship was
created by the instrument by which title or possession to the site was conveyed
or financed or was a contract for the sale of goods or services, or through the
result of a reorganization of a business entity that was potentially liable for the
release or threatened release of hazardous materials at the site.

The undersigned represents and certifies to the best of his/her knowledge and
belief that the information contained in this application, including any additional
attachments, is true and complete and accurately describes the Applicant, the
Property and related conditions. Applicant agrees to promptly inform the agency
of any changes that occur in the information contained in this application.



Signature of Applicant:

                   __________________________________________

Date:
                   __________________________________________

Name & Title:
            __________________________________________

Address:
                   __________________________________________

*See attached definitions


DTSC Form 1460            Rev July 2011                                                       9
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

ADDENDUM

The Addendum provides definitions of terms used in the CLRRA Application
Form. Many of these definitions are from Article 2 “Definitions,” and Article 6,
“Streamlined Site Investigation and Response Plan Agreements,” Chapter 6.82,
Division 20 of the Health and Safety Code (commencing with section 25395.60).

“Bona fide Purchaser”

(a) A person, or a tenant of a person, who acquires ownership of a site on or
after January 1, 2005, and who establishes all of the following by a
preponderance of the evidence:
(1) All releases of the hazardous materials at issue at the site occurred before
the person acquired the site, except as described in paragraph (2).
(2) All of the conditions of Section 25395.80 to qualify as a bona fide purchaser
have been met.
(3) The person is not potentially liable, or affiliated with any other person who is
potentially liable, for the release or threatened release at the site through any of
the following circumstances:
(A) Any direct or indirect familial relationship.
(B) Any contractual, corporate, or financial relationship, unless the contractual,
corporate, or financial relationship is created by the instrument by which title or
possession to the site is conveyed or financed or a contract for the sale of goods
or services.
(C) The result of a reorganization of a business entity that was potentially liable
for the release or threatened release of hazardous materials at the site.
(b) For purposes of this section, „„release‟‟ does not include passive migration.

“Contiguous Property Owner”

(a) A person who owns a site that is adjacent to or otherwise similarly situated
with respect to another site that is, or may be, contaminated by a release or
threatened release of a hazardous material and that is not owned by that person,
and who demonstrates, by a preponderance of the evidence, all of the following:
(1) The person did not cause, contribute, or consent to the release or threatened
release.
(2) At the time the person acquired the property, the person made all appropriate
inquiries and did not know and had no reason to know of the release or
threatened release at the site.
(3) All of the conditions of Section 25395.80 to qualify as a contiguous property
owner have been met.




DTSC Form 1460            Rev July 2011                                                       10
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

(4) The person is not potentially liable, or affiliated with any other person who is
potentially liable, for the release at issue through any of the following
circumstances:
(A) Any direct or indirect familial relationship.
(B) Any contractual, corporate, or financial relationship, unless the contractual,
corporate, or financial relationship is created by the instruments by which title or
possession to the site is conveyed or financed or a contract for the sale of goods
or services. (C) The result of a reorganization of a business entity that was
potentially liable for the hazardous materials.
(b) For purposes of this section, „„release‟‟ does not include passive migration.

"Databases"

Databases may include: U.S. Environmental Protection Agency's CERCLIS or
RCRIS; Department of Toxic Substances Control's - Hazardous Water
Management Program RCRA database, Site Mitigation and Brownfields Reuse
CalSites database (www.dtsc.ca.gov/database/Calsites/Index.cfm); and/or on
State Water Resources Control Board's Geotracker database as a Leaking
Underground Fuel Tank (LUFT) or a Spills Leaks Investigation and Cleanups
(SLIC) Program site (www.swrcb.ca.gov).

“Innocent Landowner”

(a) A person who owns a site, did not cause or contribute to a release or
threatened release at the site, meets the conditions to qualify as an „„innocent
landowner‟‟ specified in Section 25395.80, and is any one of the following:
(1) A person who, at the time the person acquired the property, made all
appropriate inquiries and did not know and had no reason to know of the release
or threatened release at the site.
(2) A government entity that acquired property by escheat, or through any
another involuntary transfer acquisition, or through the exercise of eminent
domain authority by purchase or condemnation, or by means of a lien arising
from delinquent taxes, assessments, or charges.
(3) A person who acquired the property by inheritance or bequest.
(4) A person who qualifies for the defense from liability under Section 107(b) of
the federal act (42 U.S.C. Sec. 9607(b)).
(b) For purposes of this section, „„release‟‟ does not include passive migration.

“Prospective Purchaser”
(a) A person, or a tenant of a person, who is in contract to acquire a site through
a purchase agreement, option agreement or otherwise, and who establishes all
of the following by a preponderance of the evidence:



DTSC Form 1460            Rev July 2011                                                       11
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

(1) All releases of the hazardous materials at issue at the site occurred before
the person acquired the site, except as described in paragraph (2).
(2) All of the conditions of Section 25395.80 to qualify as a bona fide purchaser
have been met.
(3) The person is not potentially liable, or affiliated with any other person who is
potentially liable, for the release or threatened release at the site through any of
the following circumstances:
(A) Any direct or indirect familial relationship.
(B) Any contractual, corporate, or financial relationship, unless the contractual,
corporate, or financial relationship is created by the instrument by which title or
possession to the site is conveyed or financed or a contract for the sale of goods
or services.
(C) The result of a reorganization of a business entity that was potentially liable
for the release or threatened release of hazardous materials at the site.
(b) For purposes of this section, „„release‟‟ does not include passive migration.

“Bon Fide Ground Tenant”
(a) A person who establishes by a preponderance of evidence and maintains all
of the following:
  (1) The person acquires a nonfee interest in, and control of, the real property at
a site on or after January 1, 2007, pursuant to one of the following:
  (A) A ground lease with a term of 25 years or more.
  (B) An easement with a term of 25 years or more.
  (C) Any other legal means for site access and use that provides for a term of
25 years or more, and is acceptable to the agency entering into an agreement
pursuant to this article.
  (2) The person is in compliance with subdivisions (c), (d), (e), and (f) of Section
25395.80.
  (3) All releases of hazardous materials at the site occurred before the person
obtained legal access to and control over the site, except for a release that is of a
type, nature or amount that does not require reporting to a regulatory authority
pursuant to applicable law or other applicable statutory or regulatory reporting
requirements and for which the agency determines all appropriate
actions have been taken.
  (4) The person did not cause or contribute to a release of hazardous materials
at the site, other than a release that is of a type, nature or amount that does not
require reporting to a regulatory authority pursuant to applicable law or other
applicable statutory or regulatory reporting requirements.
  (5) (A) The person has contractually agreed with one or more persons or
entities set forth in subdivision (a) of Section 25395.103 that either of the
following revenue sources be dedicated to, or pledged to secure a loan the
proceeds of which are dedicated to, implementation of the response plan
approved pursuant to this article:


DTSC Form 1460            Rev July 2011                                                       12
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

  (i) All payments by that person to the site owner, at least until such time as a
response plan has been approved by the agency and the agency has determined
that something less than all of the payments are sufficient to implement the
response plan.
  (ii) Any alternate assets or revenue streams that are acceptable to the agency.
  (B) To ensure that the revenue stream required by subparagraph (A) remains
available to implement the response plan approved pursuant to this article, the
person may utilize an Internal Revenue Code Section 468B settlement trust or
other acceptable security mechanism that allows the agency to utilize the
earmarked funds to complete the cleanup if there is a default by a party that is
contractually obligated to implement the response plan pursuant to an agreement
under this article. Agreements pursuant to this article shall permit subordination
of the security mechanism to permit financing for site cleanup.
  (6) The person is not potentially liable, or affiliated with a person who is
potentially liable, for the release at issue through any of the following
circumstances:
  (A) A direct or indirect familial relationship.
  (B) A contractual, corporate, or financial relationship, unless the contractual,
corporate, or financial relationship is created by the instruments by which the
person obtains control and implements the development of the site, or is created
by a contract for the sale of goods or services.
  (C) The result of a reorganization of a business entity that was potentially liable
for the hazardous substances at issue.

“All Appropriate Inquiries”

(a) All appropriate inquiries has the following meanings: (a) Except as provided
in subdivision (c), until the date when the standards and practices established by
the Administrator of the United States Environmental Protection Agency pursuant
to Section 101(35)(B)(ii) of the federal act (42 U.S.C. Sec. 9601(35)(B)(ii)) are
adopted and take effect, „„all appropriate inquiries‟‟ means:
(1) For property acquired on or before December 1, 2000, compliance with
American Society for Testing and Materials Standard El 527-97 entitled
„„Standard Practice for Environmental Site Assessment‟‟: Phase 1 Environmental
Site Assessment Process.
(2) For property acquired after December 1, 2000, compliance with American
Society for Testing and Materials Standard El 527-00.
(b) Except as provided in subdivision (c), on and after the date when the
standards and practices established by the Administrator of the United States
Environmental Protection Agency pursuant to Section 101(35)(B)(ii) of the federal
act (42 U.S.C. Sec. 9601(35)(B)(ii)) are adopted and take effect, „„all appropriate
inquiries‟‟ means compliance with those standards, except that any portion of the



DTSC Form 1460            Rev July 2011                                                       13
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

inquiry that includes the practice of engineering or the practice of geology shall
be carried out in conformance with applicable state statute.
(c) Pursuant to Section 25395.80 on or before the date on which the person
acquired the site, the person made all appropriate inquiries within one year prior
to the date of acquisition, and the following components must be refreshed within
180 days of acquisition:
(1) Interviews with past and present owners, operators, and occupants (see
312.23);
(2) Searches for recorded environmental cleanup liens (see 312.25);
(3) Reviews of federal, tribal, state, and local government records (see 312.26);
(4) Visual inspections of the facility and of adjoining properties (see 312.27); and
(5) The declaration by the environmental professional (see 312.21(d)).

“Appropriate Care”

"Appropriate care" means either of the following:
(a) The performance of a response action, with respect to hazardous materials
found at a site, for which the agency makes the determination specified in
paragraph (1) of subdivision (c) of Section 25395.96 and that meets all of the
following conditions:
(1) The response action is determined by an agency to be necessary to prevent
an unreasonable risk to human health and safety or the environment, as defined
in Section 25395.90. (2) The response action is performed in accordance with
a response plan approved by the agency pursuant to Article 6 (commencing with
Section 25295.90).
(3) The approved response plan includes a provision for oversight and approval
of the completed response action by the agency pursuant to Article 6
(commencing with Section 25295.90).
(b) A determination that no further action is required pursuant to Section
25395.95.

“RCRA”

“RCRA” means the federal Resource Conservation and Recovery Act of 1976, as
amended, 42 U.S.C. sections 6901 et seq., as administered by the Department
of Toxic Substances Control under Chapter 6.5, Division 20 of the HSC
(commencing with section 25100).

“Site”

Real property located in an urban infill area for which the expansion,
redevelopment, or reuse may be complicated by the presence or perceived
presence of hazardous materials. “Site” does not include any of the following:


DTSC Form 1460            Rev July 2011                                                       14
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application



(1) A facility that is listed or proposed for listing on the National Priorities List
established under Section 105 of the Comprehensive Environmental Response,
Compensation and Liability Act of 1980, as amended (42 U.S.C. Sec. 9605).
(2) A site on the list maintained by the department pursuant to Section 25356.
(3) A site that is solely impacted by a petroleum release from an underground
storage tank eligible for reimbursement from the California Underground Storage
Tank Cleanup Fund.

“National Priority List (NPL)”

The NPL is the list of the United States Environmental Protection Agency‟s
highest priority sites among the known releases or threatened releases of
hazardous substances, pollutants, or contaminants throughout the United States
and its territories. The NPL is compiled by US EPA pursuant to CERCLA section
105. The NPL is intended primarily to guide the United States Environmental
Protection Agency in determining which sites warrant further investigation.
(Source: United States Environmental Protection Agency Web page and 40 CFR
section 300.5)

“Infill Area”

A vacant or underutilized lot of land within an urban area that has been
previously developed or that is surrounded by parcels that are or have been
previously developed.

“Urban Area”

Means either of the following:
(A) An incorporated city.
(B) An unincorporated area that is completely surrounded by one or more
incorporated cities that meets both of the following criteria:
(i) The population of the unincorporated area and the population of the
surrounding incorporated cities is equal to a population of 100,000 or more.
(ii) The population density of the unincorporated area is equal to, or greater than,
the population density of the surrounding cities.

“Underground Storage Tank Fund”
Federal and state laws require every owner and operator of a petroleum
underground storage tank (UST) to maintain financial responsibility to pay for any
damages arising from their tank operations.
The Barry Keene Underground Storage Tank Cleanup Fund Act of 1989 was


DTSC Form 1460            Rev July 2011                                                       15
State of California – California Environmental Protection Agency




                           Request for Agency Oversight of a Brownfield Site
              Supplemental Attachment: California Land Reuse and Revitalization Act (CLRRA)
                                          Application

created by the California Legislature under Health & Safety Code section
25299.50, and is administered by the California State Water Resources Control
Board, to provide a means for petroleum UST owners and operators to meet
federal and state requirements. The Fund also assists a large number of small
businesses and individuals by providing reimbursement for unexpected and
catastrophic expenses associated with the cleanup of leaking petroleum USTs.
In addition, the Fund provides money to the Regional Water Quality Control
Boards and local regulatory agencies to abate emergency situations or to
cleanup abandoned sites that pose a threat to human health, safety, and the
environment, as a result of a petroleum release from a UST. (Source: State
Water Resources Control Boards‟ Web page and the Health and Safety Code.)




DTSC Form 1460            Rev July 2011                                                       16

								
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