Site History
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A Guide to Building Interagency Collaboration at Hazardous Waste Sites Getting to Know Your Site, Partners, and Community WORKSHEET: Site History and Description This worksheet has been duplicated from Appendix A in Assessment to Action: A Tool for Improving the Health of Communities Affected by Hazardous Waste (pp. 53–55). The worksheet addresses the following questions: Where is the site? What does it look like? What known hazardous substances might affect the community? Included are a description of the site, the contaminants, potential pathways of exposure, land use information, and characteristics of areas adjacent to the site. Some of the information needed to complete the worksheet may already exist and some may need to be collected. This worksheet could be used by an individual agency, prior to any collaborative effort, to catalogue existing information or to provide a brief overview to potential collaborating agencies or concerned individuals. Alternatively, this worksheet could be completed jointly by collaborating agencies as one of the first joint work efforts. Site History and Description Date:
Completed by: Site Name:
EPA ID:
Site Address/Location: EPA/ATSDR Region: If possible, get a map showing the area, mark off the site location, and attach to the worksheet. Type of Site: NPL (National Priorities List) RCRA (Resource Conservation & Recovery Act) NPL Number: RCRA Number: HRS (Hazardous Ranking System) Score: Brownfields: Other:
Contaminants of Concern Detected Contaminants of Concern Detected:
Methods of Measuring:
Quantities:
Dates:
Potential Exposure Pathways (record potential and known risk to the following media): Air:
Soil:
Water:
Community Members on Groundwater Wells: Yes How many? No Other:
Site Boundaries
Geographic/Geologic Description of Site
Past, Current, Future Land Use Past Land Use:
Current Land Use:
Proposed Future Land Use:
Other Site Details Current Site Owners:
Previous Site Owners (if the information is available and applicable):
Potentially Responsible Parties (PRPs):
Other Relevant Information:
Key Characteristics of Area Surrounding or Adjacent to Site Date:
Completed by: Site Name:
Key Characteristics of Area Surrounding or Adjacent to Site Characteristics of Immediate Neighborhood:
Area Schools/Child Care Facilities:
Community Buildings in Area (churches, libraries, senior housing, YMCA, etc.):
Office Buildings/Work Facilities:
Parks and Recreational Areas:
Wilderness/Wildlife Areas:
Community Medical Facilities:
Additional Industries in Area:
Other Potential Sources of Pollution in Area:
Other Relevant Information:
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