HomeMy WebLinkAboutPSD PROSPECT SCHOOL SITE SITE PLAN ADVISORY REVIEW - SPA190002 - SUBMITTAL DOCUMENTS - ROUND 1 - ENVIRONMENTAL REPORTPhase I Environmental Site Assessment
Approximately 91.11 Acres Within Section 15,
Township 7 North, Range 68 West,
Fort Collins, Colorado 80524-80525
Prepared for:
2445 LaPorte Avenue
Fort Collins, Colorado 80521
Western Environment and Ecology, Inc.
2217 West Powers Avenue
Littleton, Colorado 80120
(303) 730-3452
(303) 730-3461 (fax)
westernenvironment.com
TABLE OF CONTENTS
1.0 INTRODUCTION 1
2.0 SITE DESCRIPTION 2
3.0 RECORDS REVIEW 5
3.1 Results 6
3.2 Aerial Photography Review 6
3.4 Historical Topographic Maps 7
3.5 Governmental Inquiries 7
4.0 SITE INSPECTION / INTERVIEWS 8
5.0 CONCLUSIONS 10
5.1 Deviations 10
FIGURES
FIGURE 1 PROJECT LOCATION MAP 3
FIGURE 2 SITE MAP 4
APPENDICES
APPENDIX A References List
APPENDIX B Aerial Photography Documentation
APPENDIX C Environmental Inquiry Requests and Supporting Documentation
APPENDIX D Western Environment and Ecology, Inc, Statement of Qualifications
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -1-
Western environment and ecology, inc.
1.0 INTRODUCTION
The purpose of this Phase I Environmental Site Assessment (ESA) is to identify, to the
extent feasible, recognized environmental conditions associated with the subject property. A
Phase I Environmental Site Assessment has four components: Records Review, Site
Reconnaissance, Interviews, and a Report. These specific activities are further defined by the
American Society for Testing and Materials (ASTM 1527-13, Standard Practice for
Environmental Site Assessments; Phase I Environmental Site Assessment Process, December,
2013).
The U.S. Environmental Protection Agency issued a final rule governing “All
Appropriate Inquiries” (AAI) under the Comprehensive Environmental Response,
Compensation, and Liability Act (CERCLA) on November 1 st , 2006 (40 C.F.R. Part 312). The
EPA has determined that a Phase I Environmental Site Assessment prepared in accordance with
ASTM 1527-13 meets the AAI requirements.
The following document was prepared at the request of Mr. Brendan Willits, Planning
Manager for the Poudre Valley School District, the current owner of the site. Mr. Willits
indicated that the report was in response to potential development of the property.
On September 11 th , 2019, Western Environment and Ecology, Inc (Western
Environment) provided Mr. Willits an Owner and User Environmental Questionnaire. This
questionnaire requests copies of past environmental assessment reports and asks for any
information regarding environmental issues, liens, covenants, or hazardous material spills
associated with the site.
On September 16 th , 2019, Mr. Willits returned the Owner Questionnaire, indicating the
School District has owned the property for 20 years. Mr. Willits indicated that the property is
currently vacant, previously utilized as agricultural land and contained a single family residence
prior to 2012. Additionally, he stated that “abatement” and removal of the residence occurred in
2012. He was unaware of any other environmental issues associated with the site.
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -2-
Western environment and ecology, inc.
2.0 SITE DESCRIPTION
This Phase I Environmental Site Assessment was conducted for Approximately 91.11
acres within Section 15, Township 7 North, Range 68 West, Fort Collins, Colorado (Figure 1).
The site is located northwest of the intersection of East Prospect Road and South County Road 5
(Figure 2). According to the City of Fort Collins, the property is currently vacant, zoned as Urban
Estate (UE) and Industrial (I) in the extreme southwest corner of the site. The Cache La Poudre
Reservoir Inlet is present along the southern border, and bisects the southwest corner of the site.
Adjacent properties are occupied by single family development to the north, east, and south, and
agricultural land to the west and south. The property is within the Fort Collins Utilities
wastewater district, the East Larimer County Water District, and the Xcel Energy natural gas and
electric service area.
The site occurs at an approximate elevation of 4920 feet above sea level (USGS Fort
Collins 7.5 Minute Quadrangle, 2016). The topography of the site is flat, with a slight slope
toward the Cache La Poudre River to the southwest. The National Resources Conservation
Service (NRCS) classifies site soils as predominantly Loveland clay loam on 0 to 1 percent slopes
overlying. Geology of the site consists of Quaternary Age gravels and alluviums overlaying the
Cretaceous Age Pierre Shale Upper Unit (Ogden Tweto, 1979).
Records maintained by the Colorado Division of Water Resources (DWR) identified four
irrigation wells (Permit # 10550-R, 10551-R, 15993-R, and 19362-R), a permit for eight
dewatering wells (Permit # 46828-DW) associated with the construction of the Greeley Bellvue
Water Transmission System pipeline, and one domestic well (Permit # 23885-) associated with
the property. Lithologic logs for the domestic well identified gravel from the surface to 16 feet
below grade, where clay was encountered. Sandstone was present from 36 to 50 feet, where
yellow clay was observed to the total depth of 60 feet. Groundwater was encountered at 20 feet
below grade with a sustained yield of 10 gallons per minute. Review of the Federal Emergency
Management Agency (FEMA) flood insurance maps listed that the property is not located within
the 100-year flood plain.
WESTERN ENVIRONMENT
AND ECOLOGY, INC.
2217 West Powers Avenue
Littleton, Colorado 80120
Figure 1 - Project Location Map
91.11 Acres in Section 15,
Township 7 North, Range 68 West
Fort Collins, Colorado 80524-80525
USGS Timnath Quadrangle 7.5 Minute Series 2016
Approximate Scale in Miles
0 0.5 1.0
Subject Site
WESTERN ENVIRONMENT
AND ECOLOGY, INC.
2217 West Powers Avenue
Littleton, Colorado 80120
Figure 2 - Site Map
91.11 Acres in Section 15,
Township 7 North, Range 68 West
Fort Collins, Colorado 80524-80525
Approximate Scale in feet
0 500 1000
Interlocken Loop
Metro Airport Avenue
Subject Property
Former Single Family Residence
Cache La Poudre Reservoir Inlet
E Prospect Road
South County Road 5
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -5-
Western environment and ecology, inc.
3.0 RECORDS REVIEW
The purpose of the records review is to obtain and review information that will help
identify the potential for recognized environmental conditions in connection with the property.
Availability of records varies from information source to information source, including
governmental jurisdictions. Western Environment did not identify, obtain, or review every
possible record that might exist with respect to the property. Instead, record information from
reasonably ascertainable standard sources was reviewed. The approximate minimum search
distance incorporated in the review, the resources utilized, and the number of sites found are listed
below:
Lists Reviewed ASTM Standard Minimum
Search Distance
Number of Site Within Search
Distance
Federal and State NPL List 1.0 mile 0
Federal Delisted NPL site List 0.5 mile 0
Federal and State CERCLIS List 0.5 0
Federal RCRA TSD Facilities List 1.0 0
Federal RCRA Generators List Property and Adjoining Property 0
Federal RCRA Corrective Action List 1.0 0
Federal and State Institutional
Control/Engineering Control Registry
Property and Adjoining Property 0
Federal ERNS List Property and Adjoining Property 0
State Landfill and/or Solid Waste
Disposal Site List
0.5 0
State Leaking UST List 0.5 2
State Registered UST List Property and Adjoining Property 0
State Brownfield / Voluntary Cleanup
List
0.5 0
Definitions:
NPL: National Priority List (Superfund)
CERCLIS: Comprehensive Environmental Response, Compensation and Liability Information System
RCRA: Resource Conservation and Recovery Act
TSD: Hazardous Waste Transport, Storage, and Disposal
UST: Underground Storage Tank
ERNS: Emergency Response Notification System
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -6-
Western environment and ecology, inc.
3.1 Results
Western Environment reviewed records maintained by the Coloroad Department of Labor
and Employment, Oil and Public Safety Division (OPS) for the underground storage tank
(UST) sites with activity and proximity to the subject property. Two leaking UST (LUST) events
were identified associated with the United Rentals facility, located approximately 2,500 feet
southwest of the subject property at 1926 Interstate 25 Frontage Road. Both events are listed as
inactive, with No Further Action (NFA) determinations issued on September 9 th , 1993 and
January 7 th , 2013. Based on the distance of the facility, and the NFA determinations, it is unlikely
that these releases will impact the subject property.
3.2 Aerial Photography Review
Historic aerial photography was reviewed to document past uses of the property. The
earliest photograph available for review, dated September 23 rd , 1953, showed the subject site was
in agricultural production. East Prospect Road bordered the site to the south, and the Lake Canal
was present approximately 400 feet south. Surrounding properties consisted of agricultural land.
The next photo, dated November 25 th , 1969, showed a single family residence was present on the
southern portion of the subject property. The Cache La Poudre Inlet had been constructed along
the southern border, and bisected the southwestern corner of the site. The Inlet connected to the
Timnath Reservoir, constructed approximately 1 mile to the southeast. South County Road 5 had
been built along the eastern border. Additional single family residences were located adjacent to
the south, southeast, and southwest, across East Prospect Road. A residential development was
observed adjacent to the south in the July 8 th , 1978 photo. No significant changes were observed
in the August 8 th , 1985 photo.
Google Earth images were reviewed for years following 1985. The October 3 rd , 1999
image showed residential development adjacent to the north. A tree nursery was observed
adjacent to the south. No significant changes were present in the images dated October 22 nd , 2005
and July 22 nd , 2011. In the September 7 th , 2016 image, the single family residence located on the
property had been removed.. No significant changes were observed in the most recent image,
dated October 14 th , 2017. A list of the aerial photographs reviewed is presented as Appendix B.
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -7-
Western environment and ecology, inc.
3.4 Historical Topographic Maps
Western Environment reviewed historic topographic maps to evaluate past use of the
property. The earliest map, dated 1960, showed a single family residence on the southern portion
of the subject property. The Cache La Poudre Reservoir Inlet comprised the southern border, and
bisected the southwestern corner. East Prospect Road and South County Road 5 were present
along the southern and eastern borders, respectively. Single family residences were located
adjacent to the south and southwest. Residential development was observed adjacent to the south
in the map dated 1971. The most recent map, dated 2016, showed the single family residence had
been removed from the subject property. Additional residential development was present adjacent
to the north.
3.5 Governmental Inquiries
Western Environment submitted an Environmental issues inquiry to the Larimer County
Health Department regarding records associated with the property. On September 16 th , 2019, Ms.
Tammy Seneff, of the Larimer County Health Department, responded, indicating there were no
files associated with the property. Western Environment reviewed records maintained by the Fort
Collins Building Department and the Larimer County Building Department for documentation of
the demolition of the single family residence on the property. However, no documentation was
available. On September 16 th , 2019, Mr. Willits, representative for the owner, indicated
“abatement” was required during the removal of the residence. He stated this could have been in
response to potential asbestos containing material; however, he was unaware of any existing
documentation of removal. Additionally, Mr. Willits indicated that the septic system associated
with the residence was drained and collapsed. Western Environment contacted the Colorado
Department of Public Health and Environment regarding asbestos abatement; however, no records
of the site were available.
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -8-
Western environment and ecology, inc.
4.0 SITE INSPECTION / INTERVIEWS
The purpose of a site inspection is to obtain information indicating the likelihood of
identifying recognized environmental conditions in connection with the property. On a visit to the
site on September 5 th , 2019, Western Environment personnel visually and physically observed the
property to the extent not obstructed by bodies of water, vegetation, adjacent buildings or other
obstacles and debris.
Western Environment staff evaluated the project specifically for evidence of the site
features listed in the following table. Those features which were observed on the site are also
discussed in further detail below:
Storage Tanks Placed Fill or Imported Soils
Vent Piping/Air Emissions Sources Stockpiles of Soil or Debris
Unidentified Piping X Surface Water, Streams, Pits, Ponds, Lagoons
Drains, Sumps X Waste Water and/or Storm Water Discharge
Stained Soil and/or Pavement Waste Treatment Processes
Stressed Vegetation Septic Systems or Leach Fields
Solid Waste or Disposal Areas X Wells (Agricultural, Water Supply, Monitoring)
Hazardous Material Storage Wells (Petroleum Production Facilities)
Petroleum Products Storage Petroleum Pipelines
Drums High Power Transmission Lines
Unidentified Substance Containers X Transformers (Potential PCB)
Vehicle Maintenance Areas Odors
At the time of the inspection, the subject property was a fallow field with unmanaged
native grasses and invasive weeds located in the southwest corner of the site. Vegetation included
cheatgrass (Bromus tectorum), curly dock (Rumex crispus), and sparse populations of sunflowers
(Helianthus sp.).
A concrete lined irrigation canal bordered the property to the north and northeast. Two
irrigation wells were observed adjacent to the canal. Overhead powerlines bordered the site to the
north, with an unlabeled pole mounted transformer located to the northeast. according to PCB
management regulations (40 CFR 761), unlabeled equipment, without other testing information,
should be considered to contain between 50 to 499 ppm PCBs.
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -9-
Western environment and ecology, inc.
The Cache La Poudre Reservoir Inlet ditch was located along the south border and
bisected the southwest corner of the site. The City of Greeley Bellvue Water Transmission
System underground pipeline was present along the ditch. Surface water was observed within
the ditch. Stormwater and irrigation run-off was discharged into the Cache La Poudre Reservoir
Inlet through several outfalls.
Adjacent properties included single family residences to the north, vacant land to the east,
single family residences, Just Trees Retail and Wholesale Nursery to the south, and agricultural
land to the west and northwest.
View of the property from the southeast
Phase I Environmental Site Assessment: 91.11 Acres in S15, T7N, R68W, Fort Collins, CO 80524-80525 Page -10-
Western environment and ecology, inc.
5.0 CONCLUSIONS
We have performed a Phase I Environmental Site Assessment in conformance with the
scope and limitations of ASTM Practice E 1527-13 of Approximately 91.11 Acres Within Section
15, Township 7 North, Range 68 West, Fort Collins, Colorado. Any exceptions to, or deletions
from, this practice are described in Section 5.1 of this report. This assessment has revealed no
evidence of recognized environmental conditions (REC’s) in connection with the property,
except:
• No documentation was available for the reported “abatement” of the single family
residence on the subject property. Mr. Willits indicated that this could have been in
reference to asbestos containing material (ACM). Without documentation of proper
removal and disposal, the demolition of the structure with possible ACM is a
potential hazardous material spill and constitutes a REC.
5.1 Deviations
None.
.
Page -11-
Western environment and ecology, inc.
APPENDICES
Page -12-
Western environment and ecology, inc.
APPENDIX A
Reference Lists
Poudre School District R-1
40.569018644422165, -104.9892463684095
Prepared for: Brendan Willits
Ref: 848-001-01
Wednesday, September 04, 2019
Environmental Radius Report
Summary
< 1/4 1/4 - 1/2 1/2 - 1
National Priorities List (NPL)
CERCLIS List
CERCLIS NFRAP
RCRA CORRACTS Facilities
RCRA non-CORRACTS TSD Facilities
Federal Institutional Control / Engineering Control Registry
Emergency Response Notification System (ERNS)
US Toxic Release Inventory
US RCRA Generators (CESQG, SQG, LQG) 5
US ACRES (Brownfields)
US NPDES 2 12
US Air Facility System (AIRS / AFS) 1
CO Underground Storage Tanks 9
CO Superfund - National Priorities List
CO Uranium Mill Tailings Sites
CO Solid Waste Sites
National Priorities List (NPL)
This database returned no results for your area.
The Superfund Program, administered under the Comprehensive Environmental Response, Compensation, and
Liability Act (CERCLA) is an EPA Program to locate, investigate, and clean up the worst hazardous waste sites
throughout the United States. The NPL (National Priorities List) is the list of national priorities among the known
releases or threatened releases of hazardous substances, pollutants, or contaminants throughout the United States
and its territories. The NPL is intended primarily to guide the EPA in determining which sites warrant further
investigation. The boundaries of an NPL site are not tied to the boundaries of the property on which a facility is located.
The release may be contained with a single property's boundaries or may extend across property boundaries onto
other properties. The boundaries can, and often do change as further information on the extent and degree of
contamination is obtained.
CERCLIS List
This database returned no results for your area.
The United States Environmental Protection Agency (EPA) investigates known or suspected uncontrolled or
abandoned hazardous substance facilities under the Comprehensive Environmental Response, Compensation, and
Liability Act (CERCLA). EPA maintains a comprehensive list of these facilities in a database known as the
Comprehensive Environmental Response, Compensation and Liability Information System (CERCLIS). These sites
have either been investigated or are currently under investigation by the EPA for release or threatened release of
hazardous substances. Once a site is placed in CERCLIS, it may be subjected to several levels of review and
evaluation and ultimately placed on the National Priority List (NPL).
CERCLIS sites designated as "No Further Remedial Action Planned" (NFRAP) have been removed from CERCLIS.
NFRAP sites may be sites where, following an intitial investigation, no contamination was found, contamination was
removed quickly without the need for the site to be placed on the NPL, or the contamination was not serious enough to
require Federal Superfund Action or NPL consideration.
CERCLIS NFRAP
This database returned no results for your area.
As of February 1995, CERCLIS sites designated "No Further Remedial Action Planned" NFRAP have been
removed from CERCLIS. NFRAP sites may be sites where, following an initial investigation, no contamination was
found, contamination was removed quickly without the site being placed on the NPL, or the contamination was not
serious enough to require Federal Superfund action or NPL consideration.
EPA has removed these NFRAP sites from CERCLIS to lift unintended barriers to the redevelopment of these
properties. This policy change is part of EPA"s Brownfields Redevelopment Program to help cities, states, private
investors and affected citizens promote economic redevelopment of unproductive urban sites.
RCRA CORRACTS Facilities
This database returned no results for your area.
The United States Environmental Protection Agency (EPA) regulates hazardous waste under the Resource
Conservation and Recovery Act (RCRA). The EPA maintains the Corrective Action Report (CORRACTS) database of
Resource Conservation and Recovery Act (RCRA) facilities that are undergoing "corrective action." A "corrective action
order" is issued pursuant to RCRA Section 3008(h) when there has been a release of hazardous waste or constituents
into the environment from a RCRA facility. Corrective actions may be required beyond the facility"s boundary and can
be required regardless of when the release occurred, even if it predated RCRA.
RCRA non-CORRACTS TSD Facilities
This database returned no results for your area.
The United States Environmental Protection Agency (EPA) regulates hazardous waste under the Resource
Conservation and Recovery Act (RCRA). The EPA"s RCRA Program identifies and tracks hazardous waste from the
point of generation to the point of disposal. The RCRA Facilites database is a compilation by the EPA of facilities that
report generation, storage, transportation, treatment, or disposal of hazardous waste. RCRA Permitted Treatment,
Storage, Disposal Facilities (RCRA-TSD) are facilities which treat, store and/or dispose of hazardous waste.
Federal Institutional Control / Engineering Control Registry
This database returned no results for your area.
Federal Institutional Control / Engineering Control Registry
Emergency Response Notification System (ERNS)
This database returned no results for your area.
The Emergency Response Notification System (ERNS) is a national computer database used to store information
on unauthorized releases of oil and hazardous substances. The program is a cooperative effort of the Environmental
Protection Agency, the Department of Transportation Research and Special Program Administration"s John Volpe
National Transportation System Center and the National Response Center. There are primarily five Federal statutes
that require release reporting: the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA)
section 103; the Superfund Amendments and Reauthorization Act(SARA) Title III Section 304; the Clean Water Act of
1972(CWA) section 311(b)(3); and the Hazardous Material Transportation Act of 1974(HMTA section 1808(b).
US Toxic Release Inventory
This database returned no results for your area.
The Toxics Release Inventory (TRI) is a publicly available EPA database that contains information on toxic chemical
releases and other waste management activities reported annually by certain covered industry groups as well as
federal facilities. TRI reporters for all reporting years are provided in the file.
US RCRA Generators (CESQG, SQG, LQG)
This database returned 5 results for your area.
The United States Environmental Protection Agency (EPA) regulates hazardous waste under the Resource
Conservation and Recovery Act (RCRA). EPA maintains a database of facilities, which generate hazardous waste or
treat, store, and/or dispose of hazardous wastes.
Conditionally Exempt Small Quantity Generators (CESQG) generate 100 kilograms or less per month of hazardous
waste, or 1 kilogram or less per month of acutely hazardous waste.
Small Quantity Generators (SQG) generate more than 100 kilograms, but less than 1,000 kilograms, of hazardous
waste per month.
Large Quantity Generators (LQG) generate 1,000 kilograms per month or more of hazardous waste, or more than 1
kilogram per month of acutely hazardous waste.
US RCRA Generators (CESQG, SQG, LQG)
Location 40.56304, -105.0008
Distance to site 3883 ft / 0.74 mi SW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110002971589
EPA Identifier 110002971589
Primary Name CASE POWER & EQUIPMENT
Address 1926 SE FRONTAGE RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80525
Programs RCRAINFO:COD148570575
Program Interests UNSPECIFIED UNIVERSE
Updated On 03-DEC-2014 15:11:04
Recorded On 01-MAR-2000 00:00:00
Location 40.57442, -105.0025
Distance to site 4166 ft / 0.79 mi W
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110003002447
EPA Identifier 110003002447
Primary Name NORMANDIN LANDSCAPE INC
Address 1101 SMITHFIELD DR
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
Programs RCRAINFO:COR000015867
Program Interests CESQG
Updated On 26-JAN-2012 14:24:55
Recorded On 01-MAR-2000 00:00:00
US RCRA Generators (CESQG, SQG, LQG)
Location 40.5798, -104.9946
Distance to site 4206 ft / 0.8 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110031443711
EPA Identifier 110031443711
Primary Name ABOUND SOLAR
Address 4557 DENROSE CT STE B
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
NAICS Codes 334413
SIC Codes 3674
SIC Descriptions SEMICONDUCTORS AND RELATED DEVICES
Programs AIR:CO0000000806900431, AIRS/AFS:0806900431, EIS:12848311,
NPDES:COR900696, RCRAINFO:COR000216655
Program Interests AIR EMISSIONS CLASSIFICATION UNKNOWN, AIR MINOR, ICIS-NPDES
NON-MAJOR, STORM WATER INDUSTRIAL, UNSPECIFIED UNIVERSE
Updated On 01-JUN-2017 17:18:51
Recorded On 22-OCT-2007 18:50:41
NAICS Descriptions SEMICONDUCTOR AND RELATED DEVICE MANUFACTURING.
Location 40.56077, -105.001
Distance to site 4437 ft / 0.84 mi SW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110002971375
EPA Identifier 110002971375
Primary Name JACKSON BROOKS AND COMPANY
Address 2028 SOUTHEAST FRONTAGE ROAD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80525-9717
Programs RCRAINFO:COD139492334, RCRAINFO:COD983769209
Program Interests CESQG, UNSPECIFIED UNIVERSE
Updated On 28-MAR-2014 21:23:20
Recorded On 01-MAR-2000 00:00:00
US RCRA Generators (CESQG, SQG, LQG)
Location 40.57505, -105.0039
Distance to site 4620 ft / 0.88 mi W
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110014369566
EPA Identifier 110014369566
Primary Name PRECISION MACHINED PRODUCTS
Address 1017 SMITHFIELD DR
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
NAICS Codes 332710, 339999
Programs OSHA-OIS:336987383, RCRAINFO:COR000205336
Program Interests CESQG, OSHA ESTABLISHMENT
Updated On 22-JUL-2014 17:31:46
Recorded On 18-MAY-2003 00:12:58
NAICS Descriptions ALL OTHER MISCELLANEOUS MANUFACTURING., MACHINE SHOPS.
US ACRES (Brownfields)
This database returned no results for your area.
Brownfields are real property, the expansion, redevelopment, or reuse of which may be complicated by the
presence or potential presence of a hazardous substance, pollutant, or contaminant. Cleaning up and reinvesting in
these properties protects the environment, reduces blight, and takes development pressures off greenspaces and
working lands. The Assessment, Cleanup and Redevelopment Exchange System (ACRES) is an online database for
Brownfields Grantees to electronically submit data directly to The United States Environmental Protection Agency
(EPA)
US NPDES
This database returned 14 results for your area.
The NPDES module of the Compliance Information System (ICIS) tracks surface water permits issued under the
Clean Water Act. Under NPDES, all facilities that discharge pollutants from any point source into waters of the United
States are required to obtain a permit. The permit will likely contain limits on what can be discharged, impose
monitoring and reporting requirements, and include other provisions to ensure that the discharge does not adversely
affect water quality.
US NPDES
Location 40.56978, -104.9805
Distance to site 2433 ft / 0.46 mi E
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110070255147
EPA Identifier 110070255147
Primary Name KITCHEL LAKE
Address NE OF MAIN ST AND PROSPECT RD
City TIMNATH
County LARIMER
State CO
Zipcode 80524
SIC Codes 1799
SIC Descriptions SPECIAL TRADE CONTRACTORS, NOT ELSEWHERE CLASSIFIED
Programs NPDES:COG076329
Program Interests ICIS-NPDES NON-MAJOR
Recorded On 03-AUG-2018 11:52:50
Location 40.56978, -104.9805
Distance to site 2433 ft / 0.46 mi E
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110070102927
EPA Identifier 110070102927
Primary Name KITCHEL LAKE
Address NE OF MAIN ST AND PROSPECT RD
City TIMNATH
County LARIMER
State CO
Zipcode 80524
SIC Codes 1623, 1629
SIC Descriptions HEAVY CONSTRUCTION, NOT ELSEWHERE CLASSIFIED, WATER,
SEWER, PIPELINE, AND COMMUNICATIONS AND POWER LINE
CONSTRUCTION
Programs NPDES:COR03R797
Program Interests ICIS-NPDES NON-MAJOR
Recorded On 01-SEP-2017 14:51:56
US NPDES
Location 40.57353, -105.0017
Distance to site 3818 ft / 0.72 mi W
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110067029094
EPA Identifier 110067029094
Primary Name LAKE CANAL SIPHON
Address 1143 SW FRONTAGE RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80521
SIC Codes 1623
SIC Descriptions WATER, SEWER, PIPELINE, AND COMMUNICATIONS AND POWER
LINE CONSTRUCTION
Programs NPDES:COR03O704
Program Interests ICIS-NPDES NON-MAJOR
Updated On 01-APR-2016 18:24:51
Recorded On 07-DEC-2015 20:48:51
Location 40.57353, -105.0017
Distance to site 3818 ft / 0.72 mi W
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110064582241
EPA Identifier 110064582241
Primary Name LAKE CANAL SIPHON AT BOXELDER CREEK DRAINAGE
Address 1143 SW FRONTAGE RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 1799
SIC Descriptions SPECIAL TRADE CONTRACTORS, NOT ELSEWHERE CLASSIFIED
Programs NPDES:COG075204
Program Interests ICIS-NPDES NON-MAJOR
Updated On 11-JAN-2016 14:58:22
Recorded On 07-AUG-2015 14:15:52
US NPDES
Location 40.5798, -104.9946
Distance to site 4206 ft / 0.8 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110031443711
EPA Identifier 110031443711
Primary Name ABOUND SOLAR
Address 4557 DENROSE CT STE B
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
NAICS Codes 334413
SIC Codes 3674
SIC Descriptions SEMICONDUCTORS AND RELATED DEVICES
Programs AIR:CO0000000806900431, AIRS/AFS:0806900431, EIS:12848311,
NPDES:COR900696, RCRAINFO:COR000216655
Program Interests AIR EMISSIONS CLASSIFICATION UNKNOWN, AIR MINOR, ICIS-NPDES
NON-MAJOR, STORM WATER INDUSTRIAL, UNSPECIFIED UNIVERSE
Updated On 01-JUN-2017 17:18:51
Recorded On 22-OCT-2007 18:50:41
NAICS Descriptions SEMICONDUCTOR AND RELATED DEVICE MANUFACTURING.
Location 40.5811, -104.9895
Distance to site 4409 ft / 0.84 mi N
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110070073080
EPA Identifier 110070073080
Primary Name FOX GROVE SUBD
Address CARRIAGE PKWY AND MULBERRY ST
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 1521, 1799
SIC Descriptions GENERAL CONTRACTORS-SINGLE-FAMILY HOUSES, SPECIAL TRADE
CONTRACTORS, NOT ELSEWHERE CLASSIFIED
Programs NPDES:COG075930, NPDES:COR03R445
Program Interests ICIS-NPDES NON-MAJOR
Recorded On 10-JUL-2017 09:34:45
US NPDES
Location 40.5785, -104.9993
Distance to site 4435 ft / 0.84 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110070045420
EPA Identifier 110070045420
Primary Name GRIT ATHLETICS
Address 846 SE FRONTAGE RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 1542
SIC Descriptions GENERAL CONTRACTORS-NONRESIDENTIAL BUILDINGS, OTHER
THAN INDUSTRIAL BUILDINGS AND WAREHOUSES
Programs NPDES:COR03Q978
Program Interests ICIS-NPDES NON-MAJOR
Recorded On 11-APR-2017 15:13:12
Location 40.5804, -104.997
Distance to site 4671 ft / 0.88 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110070147836
EPA Identifier 110070147836
Primary Name MAVERICK 520
Address 651 SE FRONTAGE RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 1799
SIC Descriptions SPECIAL TRADE CONTRACTORS, NOT ELSEWHERE CLASSIFIED
Programs NPDES:COG076107
Program Interests ICIS-NPDES NON-MAJOR
Recorded On 03-DEC-2017 08:11:39
US NPDES
Location 40.58041, -104.9972
Distance to site 4706 ft / 0.89 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110070073212
EPA Identifier 110070073212
Primary Name MAVERIK 520 FORT COLLINS
Address 651 S E FRONTAGE RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 5541
SIC Descriptions GASOLINE SERVICE STATIONS
Programs NPDES:COR03R597
Program Interests ICIS-NPDES NON-MAJOR
Recorded On 10-JUL-2017 09:35:08
Location 40.57636, -105.0038
Distance to site 4834 ft / 0.92 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110070072916
EPA Identifier 110070072916
Primary Name SMITHFIELD AND STOCKTON AND CANAL ST RECONS
Address CANAL ST AND SMITHFIELD DR
City FT COLLINS
County LARIMER
State CO
Zipcode 80521
SIC Codes 1611
SIC Descriptions HIGHWAY AND STREET CONSTRUCTION, EXCEPT ELEVATED
HIGHWAYS
Programs NPDES:COR03R240
Program Interests ICIS-NPDES NON-MAJOR
Recorded On 10-JUL-2017 09:34:11
US NPDES
Location 40.5812, -104.9962
Distance to site 4841 ft / 0.92 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110039169958
EPA Identifier 110039169958
Primary Name SYSTEM REPAIR
Address 4228 E MULBERRY ST
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 1629
SIC Descriptions HEAVY CONSTRUCTION, NOT ELSEWHERE CLASSIFIED
Programs NPDES:COG073118
Program Interests ICIS-NPDES NON-MAJOR
Updated On 11-JAN-2016 08:27:51
Recorded On 24-AUG-2009 17:13:28
Location 40.56667, -105.0071
Distance to site 5035 ft / 0.95 mi W
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110064582232
EPA Identifier 110064582232
Primary Name EAST PROSPECT RD BRIDGE
Address 3855 E PROSPECT RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 1799
SIC Descriptions SPECIAL TRADE CONTRACTORS, NOT ELSEWHERE CLASSIFIED
Programs NPDES:COG075203
Program Interests ICIS-NPDES NON-MAJOR
Updated On 11-JAN-2016 16:10:21
Recorded On 07-AUG-2015 14:15:51
US NPDES
Location 40.56667, -105.0071
Distance to site 5035 ft / 0.95 mi W
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110069210598
EPA Identifier 110069210598
Primary Name BOX ELDER CREEK OUTFALL AND PROSPECT RD
Address 3855 E PROSPECT RD
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 1622, 1799
SIC Descriptions BRIDGE, TUNNEL, AND ELEVATED HIGHWAY CONSTRUCTION,
SPECIAL TRADE CONTRACTORS, NOT ELSEWHERE CLASSIFIED
Programs NPDES:COG075573, NPDES:COR03P312
Program Interests ICIS-NPDES NON-MAJOR
Updated On 03-SEP-2016 10:17:36
Recorded On 03-JUN-2016 17:35:46
Location 40.57649, -105.0055
Distance to site 5267 ft / 1 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110046328158
EPA Identifier 110046328158
Primary Name ROLLING FRITO LAY - FT COLLINS
Address 3824 S CANAL DRIVE
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
SIC Codes 4214
SIC Descriptions LOCAL TRUCKING WITH STORAGE
Programs NPDES:COR900114
Program Interests ICIS-NPDES NON-MAJOR, STORM WATER INDUSTRIAL
Updated On 05-MAR-2013 10:29:57
Recorded On 31-JUL-2012 12:50:49
US Air Facility System (AIRS / AFS)
This database returned 1 results for your area.
The Air Facility System (AIRS / AFS) contains compliance and permit data for stationary sources of air pollution
(such as electric power plants, steel mills, factories, and universities) regulated by EPA, state and local air pollution
agencies. The information in AFS is used by the states to prepare State Implementation Plans (SIPs) and to track the
compliance status of point sources with various regulatory programs under Clean Air Act.
US Air Facility System (AIRS / AFS)
Location 40.5798, -104.9946
Distance to site 4206 ft / 0.8 mi NW
Info URL http://ofmpub.epa.gov/enviro/fii_query_detail.disp_program_facility?p_regist
ry_id=110031443711
EPA Identifier 110031443711
Primary Name ABOUND SOLAR
Address 4557 DENROSE CT STE B
City FORT COLLINS
County LARIMER
State CO
Zipcode 80524
NAICS Codes 334413
SIC Codes 3674
SIC Descriptions SEMICONDUCTORS AND RELATED DEVICES
Programs AIR:CO0000000806900431, AIRS/AFS:0806900431, EIS:12848311,
NPDES:COR900696, RCRAINFO:COR000216655
Program Interests AIR EMISSIONS CLASSIFICATION UNKNOWN, AIR MINOR, ICIS-NPDES
NON-MAJOR, STORM WATER INDUSTRIAL, UNSPECIFIED UNIVERSE
Updated On 01-JUN-2017 17:18:51
Recorded On 22-OCT-2007 18:50:41
NAICS Descriptions SEMICONDUCTOR AND RELATED DEVICE MANUFACTURING.
CO Underground Storage Tanks
This database returned 9 results for your area.
Underground Storage Tanks (UST) containing hazardous or petroleum substances are regulated under Subtitle I of
the Resource Conservation and Recovery Act (RCRA). The Colorado Department of Labor and Employment/Division
of Oil and
Public Safety maintains a list of registered aboveground and underground storage tanks.
CO Underground Storage Tanks
Location 40.58119, -104.9984
Distance to site 5111 ft / 0.97 mi NW
Tank ID 17996
Facility ID 6762
Capacity 2000
Product 4 - Diesel
Facility SUNSTATE EQUIPMENT CO LLC<br>4228 E MULBERRY ST<br>FORT
COLLINS 80524
Owner SUNSTATE EQUIPMENT CO LLC
Location 40.58119, -104.9984
Distance to site 5111 ft / 0.97 mi NW
Tank ID 18000
Facility ID 6762
Capacity 4000
Product Gasoline
Facility SUNSTATE EQUIPMENT CO LLC<br>4228 E MULBERRY ST<br>FORT
COLLINS 80524
Owner SUNSTATE EQUIPMENT CO LLC
Location 40.58119, -104.9984
Distance to site 5111 ft / 0.97 mi NW
Tank ID 17997
Facility ID 6762
Capacity 2000
Product 4 - Diesel
Facility SUNSTATE EQUIPMENT CO LLC<br>4228 E MULBERRY ST<br>FORT
COLLINS 80524
Owner SUNSTATE EQUIPMENT CO LLC
Location 40.58119, -104.9984
Distance to site 5111 ft / 0.97 mi NW
Tank ID 17998
Facility ID 6762
Capacity 4000
Product Gasoline
Facility SUNSTATE EQUIPMENT CO LLC<br>4228 E MULBERRY ST<br>FORT
COLLINS 80524
Owner SUNSTATE EQUIPMENT CO LLC
CO Underground Storage Tanks
Location 40.58119, -104.9984
Distance to site 5111 ft / 0.97 mi NW
Tank ID 18001
Facility ID 6762
Capacity 10000
Product Gasoline
Facility SUNSTATE EQUIPMENT CO LLC<br>4228 E MULBERRY ST<br>FORT
COLLINS 80524
Owner SUNSTATE EQUIPMENT CO LLC
Location 40.58119, -104.9984
Distance to site 5111 ft / 0.97 mi NW
Tank ID 17999
Facility ID 6762
Capacity 4000
Product Gasoline
Facility SUNSTATE EQUIPMENT CO LLC<br>4228 E MULBERRY ST<br>FORT
COLLINS 80524
Owner SUNSTATE EQUIPMENT CO LLC
Location 40.58119, -104.9984
Distance to site 5111 ft / 0.97 mi NW
Tank ID 17995
Facility ID 6762
Capacity 500
Product 6 - Used Oil (Waste Oil)
Facility SUNSTATE EQUIPMENT CO LLC<br>4228 E MULBERRY ST<br>FORT
COLLINS 80524
Owner SUNSTATE EQUIPMENT CO LLC
Location 40.57653, -105.005
Distance to site 5151 ft / 0.98 mi NW
Tank ID 19393
Facility ID 7333
Capacity 10000
Product 4 - Diesel
Facility FRITO-LAY<br>3824 CANAL DR<br>FORT COLLINS 80524
Owner UNKNOWN #2
CO Underground Storage Tanks
Location 40.57676, -105.0052
Distance to site 5240 ft / 0.99 mi NW
Tank ID 12179
Facility ID 4331
Capacity 10000
Product 4 - Diesel
Facility COLORADO BORING CO<br>3813 CANAL DR<br>FORT COLLINS 80524
Owner JON AND LONNIE JACOBS
CO Superfund - National Priorities List
This database returned no results for your area.
This data is provided by the Colorado Department of Public Health and Environment created from the US
Environmental Protection Agency National Priorities List (NPL). The purpose was to improve the location of superfund
sites from point data to a polygon.
These large sites are also known as National Priority List (NPL) sites. These sites are being remediated jointly by the
State of Colorado and the U.S. EPA under the Comprehensive Environmental Response, Compensation, and Liability
Act (CERCLA), This law created Federal authority to respond directly to releases or threatened releases of hazardous
substances that may endanger public health or the environment. These sites are undergoing or have completed long-
term remedial response actions, that permanently and significantly reduce the dangers associated with releases or
threats of releases of hazardous substances that are serious, but not immediately life threatening. Some of the sites
have also undergone short-term removals, where actions may be taken to address releases or threatened releases
requiring prompt response.
CO Uranium Mill Tailings Sites
This database returned no results for your area.
There were nine uranium mill tailings sites in Colorado designated for cleanup under the federal Uranium Mill
Tailings Radiation Control Act. These nine sites, know commonly as UMTRA sites, were remediated jointly by the State
of Colorado and the U.S. Department of Energy during the late 1980's and early 1990's. Mill tailings were removed from
8 of the mill sites and relocated in engineered disposal cells. A disposal cell is designed to encapsulate the material,
reduce radon emanation, and prevent the movement of water through the material. At one site, Maybell, CO, the
tailings were stabilized in-place at the mill site. After remediation of the tailings was completed, the State and DOE
began to investigate the residual impacts to groundwater at the mill sites. The groundwater phase of the UMTRA
program is on-going.
CO Solid Waste Sites
This database returned no results for your area.
The Colorado Solid Waste Act requires that solid waste be disposed of in designated facilities. Disposal facilities
receive their designation from the local government after the Colorado Department of Public Health and Environment
makes a recommendation that the proposed facility can meet the required rules. The solid waste sites depicted in this
dataset include landfills, surface impoundments, scrap tire disposal sites, incinerators, landfarming, and specified
composting facilities. This dataset does not depict all historic landfills in Colorado. Transfer stations are not required to
obtain a designation but are cited in this dataset where the information is available.
Page -13-
Western environment and ecology, inc.
Appendix B
Air Photo Documentation
Page -14-
Western environment and ecology, inc.
Date of Image Source of Image
9/23/1953 U.S. Geological Survey
11/25/1969 U.S. Geological Survey
7/8/1978 U.S. Geological Survey
8/8/1985 U.S. Geological Survey
10/3/1999 GoogleEarth
10/22/2005 GoogleEarth
7/22/2011 GoogleEarth
9/7/2016 GoogleEarth
10/14/2017 GoogleEarth
Page -15-
Western environment and ecology, inc.
Appendix C
Environmental Issues Inquiry and Supporting Documentation
Western Environment and Ecology, Inc.
Owner Questionnaire for a Phase I Environmental Site Assessment, ASTM 1527-13
Subject Property Address or Description:
Parcel # 8715000904 , Larimer County, Colorado
In order to qualify for one of the Landowner Liability Protections (LLPs) offered by the
Small Business Liability Relief and Brownfields Revitalization Act of 2001, The user of
a Phase I Environmental Site Assessment must provide the following information (if
available) to the environmental professional. Failure to provide this information could
result in a determination that “all appropriate inquiry” is not complete.
1. Environmental cleanup liens that are filed or recorded against the site:
Are you aware of any environmental cleanup liens against the subject property that are
filed or recorded under federal, tribal, state, or local law? _______________________
If yes, please describe the lien and provide supporting documentation:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. Activity and land use limitations (AULs) that are in place on the site or that have
been filed or recorded in a registry:
Are you aware of any AULs, such as engineering controls, land use restrictions, or
institutional controls that are in place at the subject property and/or have been filed or
recorded in a registry under federal, tribal, state, or local law? ______________________
If yes, please describe the AUL and provide supporting documentation:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
No
No
Western Environment and Ecology, Inc.
Owner Questionnaire for a Phase I Environmental Site Assessment, ASTM 1527-13
3. Specialized knowledge or experience of the person seeking to qualify for the LLP
As the owner of the subject property, do you have any specialized knowledge or
experience related to the subject property or nearby properties? For example, are you
involved in the same line of business as the current or former occupants of the property or
adjoining property so that you would have specialized knowledge of the chemicals,
processes, etc., used by this type of business?
_________________________________________________________
If yes, please describe this specialized knowledge or experience:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. Relationship of the purchase price to the fair market value of the subject
property if it were not contaminated.
Has the purchase price of this property been lowered below fair market value because of
any contamination or some type of environmental issue? __________________________
If yes, please describe the reasons for the lower purchase price:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Commonly known or reasonably ascertainable information about the property.
Are you aware of commonly known or reasonably ascertainable information about the
property that would help the environmental professional to identify conditions indicative
of releases or threatened releases? For example, as the owner:
A. Do you know the past uses of the property? (if "Yes", what?)
_____________________________________________________________
B. Do you know of chemicals that are present or once were present at the
property? ______________________________________________________
No
No
Yes, agricultural use
No
. Residential / farm house prior to 2012.
Western Environment and Ecology, Inc.
Owner Questionnaire for a Phase I Environmental Site Assessment, ASTM 1527-13
C. Do you know of any petroleum based products that are present or were once
present on the subject property (in 5-gal or greater size containers, barrels, or
tanks)?________________________________________________________
D. Do you know of any spills or other chemical releases that have taken place at
the property? ___________________________________________________
E. Do you know of any environmental cleanups that have taken place at the
property? ______________________________________________________
If yes, please describe the information:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. Do you know of any special permits need for the operation of the business or
businesses that have occupied the subject property?
Waste water discharge permit? ___________________________________
Air emissions permit? ___________________________________________
Any other type of permits? _______________________________________
7. The degree of obviousness of the presence of contamination at the property, and
the ability to detect the contamination by appropriate investigation.
As the owner of the subject property, based on your knowledge and experience related to
the property, are there any obvious indicators that point to the presence or likely presence
of contamination at the property?
_______________________________________________
If yes, please describe the information:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
No
No
Yes
Previous residential structure was removed and abated in 2012.
No
No
No
No
Western Environment and Ecology, Inc.
Owner Questionnaire for a Phase I Environmental Site Assessment, ASTM 1527-13
8. Are you aware or have you ever been notified that another property around
yours has caused or had an environmental impact to your property.
____________________
If yes, please describe which property and a brief description of the issue: ____________
________________________________________________________________________
________________________________________________________________________
9. Are there any prior environmental reports concerning the subject property or
related addresses? _____________
If yes, can you provide copies of these reports or know where there are copies of these
reports? ___________________________________________________________
_______________________________________________________________________
Additional Information
How long have you owned the subject property? _______________________________
Description of current activity on the subject property? __________________________
______________________________________________________________________
Do you have any knowledge of past ownership or activity on the subject property that
would be of environmental concern? __________________________________________
________________________________________________________________________
What is the reason the Phase I is being conducted? _______________________________
List all parties who will rely on the Phase I ESA report:
________________________________________________________________________
________________________________________________________________________
Completed by:
Signature: __________________________________
Printed Name: __________________________________
Date: __________________________________
No
No
20 Years
Unused field. Preparing to
construct a middle school / high school on the site to open in 2022.
Residential house was removed from the property.
The house required abatement prior to tear down and removal.
Required for City Process (SPAR)
Poudre School District R-1, City of Fort Collins Colorado (for the SPAR - Site Plan
Advisory and Review Process)
Brendan Willits
9/16/2019
Western Environment and Ecology, Inc.
Owner Questionnaire for a Phase I Environmental Site Assessment, ASTM 1527-13
Additional Notes:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
USGS The National Map: Orthoimagery. Data refreshed April, 2019.
National Flood Hazard Layer FIRMette
0 250 500 1,000 1,500 2,000 Feet
Ü
104°59'24.67"W
40°34'16.77"N
104°58'47.22"W
40°33'49.44"N
SEE FIS REPORT FOR DETAILED LEGEND AND INDEX MAP FOR FIRM PANEL LAYOUT
HAZARD SPECIAL FLOOD AREAS
Without Zone A, V, Base A99 Flood Elevation (BFE)
With BFE or Depth Zone AE, AO, AH, VE, AR
Regulatory Floodway
0.of 2% 1% Annual annual Chance chance Flood flood with Hazard, average Areas
depth areasdrainage of less less than than one one foot square or with mile
Zone X
Future ChanceAnnual Conditions Flood Hazard 1%
Zone X
Area Levee.to with See Reduced Notes. Flood Risk due
Zone X
Area with Flood Risk due to LeveeZone D
NO SCREEN Area of Minimal Flood Hazard Zone X
Area of Undetermined Flood Hazard Zone D
Channel, Culvert, or Storm Sewer
Levee, Dike, or Floodwall
Cross Sections with 1% Annual Chance
17.5 Water Surface Elevation
Coastal Transect
Coastal Transect Baseline
Profile Baseline
Hydrographic Feature
Base Flood Elevation Line (BFE)
Effective LOMRs
Limit of Study
Jurisdiction Boundary
Digital Data Available
No Digital Data Available
Unmapped
This digital map flood complies maps if with it is FEMA's not void standards as described for the below. use of
The accuracy basemap standards shown complies with FEMA's basemap
The authoritative flood hazard NFHL information web services is derived provided directly by FEMA. from This the map
was reflectnot exported changes on or 9/amendments 4/2019 at 3:51:subsequent 31 PM and to this does date and
time. becomeor The superseded NFHL and effective by new data information over time. may change
This elementsmap map image do not is appear: void if basemap the one or imagery, more of flood the following zone labels,
legend, FIRM panel scale number, bar, map and creation FIRM effective date, community date. Map identifiers,images for
unmapped regulatoryfor purposes. and unmodernized areas cannot be used
Legend
OTHER FLOOD AREAS HAZARD OF
OTHER AREAS
STRGUECNTUERREASL
FEATURES OTHER
MAP PANELS
8
1:6,000
B 20.2
The point pin selected displayed by the on the user map and is does an approximate not represent
an authoritative property location.
81961 ( ( (
j ( 1
Rev.) . iAN 251881 STATE OF COLORADO NE1JL D lll EI
D ISION OF WATER RESOURCES
OFFICE OF THE STATE ENGINEER, GROUND WATER SECTIWR 7 - 1960
REGISTRATION NO. / cy 9c; / F WELL 0-2.1
GROUND WATER SECT
Registrant R000L / M FARMS INC. Date
TAT GI
6
Rte 3 Box 223 K
P. O. Address, Fort Collins, CoIor000
WELL DATA
Depth p k- ft. Diameter S in.
Casing : 4„ k',. - ft. PlainW.ny^ ft. Perfor.
80521 Colo.
WELL LOCATION
County X
5
Section^ / 5'
Static Water Level f—t. from top
5--T9
Yiel )( cfs froma=d2 a,.,,, £ t.
Uaed for / on /at
7 &' 5 E Y 5,- fE „/ n s /.e 7A'
legal description of la l or site]
Water conveyed c,re/ by O° 1P'", size lZ
PUMPETA
Type ry As >,&- Size
Driven at / 8 o c RPM j
Well was first used—
for using
gpnm
Well enlarged 19_ to
deepened
gpm)(cfs)(ft)
Twp. %/ V Rge. 6,?W, ,_'_ PM
N
I
1
1 1
W I
1
1
1
I
1
I I
S
E
WELL TO RE LOCATED AS ACCUR-
ATELY AS POSSIBLE WITHIN A
SMALL SQUARE WHICH REPRESENTS
40 ACRES; OR IF IN A TOWN OR
SUBDIVISION FILL IN THE FOLLOW-
ING:
LOG SHOULD BE GIVEN ON REVERSE
SIDE IF AVAILABLE Town or Subdivision
Street address or Lot and Block
The above well ( has not) been registered in the Office of the State Engineer prior
I/ 4F" \- I
Al
60
tr/ j t -,. j s:, &
r-z
41
I/ 4F" \- I
Al
60
tr/ j t -,. j s:, &
r-z
r1-1 Rev. STATE OF COLORADO
9 iJ?10M APPLICATION FOR:
A PERMIT TO USE GROUND WATER
IXX' A PERMIT TO CONSTRUCT A WELL
Applicant
P. O. Address ' 1
Quantity applie for gpm or
AF Storage
W
Used for 6- )T` , Z4 Purposes
on /at k, d
legal description of land site) " 3
PERMIT NO. 23885
ISSUED:
DATE MAY 19 1965 19
INVIF RD
MAY IS 4965
GROUND WATER SECT.
LO ATION OF WELL
County
r,
E of Sect., Twp. 7,
Rge. l
P. M. OR
Street Address or Lot & Block No.
Town or Subdivision
I
S
Locate
well in
40 acre
E (
small)
square
as near
as possible.
Large square
is one section.
25. 00 fee required for uses other
than Domestic or Livestock. , " 1
Applican 7f i
Agent or f / ,
Driller , r. 1%. 1 u a No.
Address
NOTE — SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION
w
Total acreage irrigated and other rts. $
ESTIMATED DATA OF WELL °
Hole size: /! in. to ft.
in. to ft.
Casing Plain- 4—in. fromRTto ."t. -5 ft.
1 14 bn
in. from to ft. 0) a
open or Perin. from Lto " 5 ft. wy
in. from to ft.
PUMP
n
Type
5Clet a
DATA: ` HP_L_ Size_L 4
AUG 2 4 1966
Y%
Orrrt' C' 1Rev. 1
10- 63
Indus No- -- -- - - 99 - --- 6 - -- - --
IDWD---- --- --- - --1-- - -- 3 - - ---
Use_ -----------------------
119910end --- --- ^
2 r
For State, Engineer's Use)
Driller
STATE OF COLORADO
DIVISION OF WATER RESOURCES
OFFICE OF THE STATE ENGINEER
GROUND WATER SECTION
LOG AND HISTORY OF WELL
PERMIT NO°? m- 51—
No. ,
C0Ig.
Use of Water_ L c
No
On or By— Acres . -..._
erlpden ofyte er land)
J_
Date Started
Date Completed-- 19
Yield GPM or— _.._ —_. _ CFS
1714th 7 #'141 a1JiC -]: I!
Depth to Water .— ft. Total Depth lg6 ft.
measured fryryr"^ ground surface)
from a = ft., lain.
Hole
from_— ___..,_ f—t. fa ft., in.
Diameter
from ft. to ft., ____ in.
TEST DATA:
How Tested__.. --..--- Pump or ~ Bailed
Date Tested— , 19 Length_._._ hrs.
Rate___/ j:__ GPM Drawn Down ft.
PUMP DATA:
Pump Type Outlet Size —
in.
Driven by —__/ HP w___....—
CASING RECORD:
Plain Casing
A/
Size /` Kin -, from ft. to ft.
Size! Kind from__.._._ _ ft, to ft.
Size , Ki to......._. —ft.
Perforated Casing
Size, Ki fromft. tft
Size Kind from - - - ft. to-___.,._.._ ft
Size , Kind from. __ ft.
HEW_ 7
JUN 21 1965
GROUNA WATER SECT,
COiDM
STATE EWMEEK
WELL LOCATION
unty
WELL LOG
Ground Elevation ... ( if known) How Drilled i44<- ,
FROM To
FEET I FEET
TYPE OF MATERIAL
REMARKS
such as Cementing,
Packing, Shut sit, etc.) 3
I&
Au
IF more space is required on additional shoal)
WELL DRILLER' S STATEMENT
This well was drilled under my supervision and the above information is true and Correct to the best of my
knowledge and belief.
Signed RUDOLPH P1 IMP AND E0
1
P
7b8-b049 02
RECEIVED
cwsaz NOTICE OF INTENT TO CONSTRUC~T~ DEIWA~TERING WELL(S) ~~ 3 ~ ~~
mrzooe Please type
or P~ le9 NY
WA(FR RFSDUR[R (
p
SiRI(tGl ( R^
Well Owners Nams r o .,, l ~ - Tr4 + '~-nr, : LocNton: W~ Y~ ~_'/•, Sedior7'~~`
TownMip~N®Q3,
Range~(E ] W_~ PM
Landoemers NameF/To ~ (~ t!rvT_o. p'~`_ OP8 Loeatlon In UTM format ~- optloml)(:
Name 8 tMatling Addtws of
Authorized IndlvWusl or Driller:
Name ~ - ~ ~' 1\'~ -- <
Please check one end complete es indicated:
pollar Licer»ad in Colorado - Irc. No.
Professional Engineer Regrotered in
Colorado -Rep. No.
Professional Geologist per CRS 3a-201(1- 3)
Company 1.S ~ at ~=~ ~ ~' 1) ) Rc • . ~-T~ =~
Address ~' o Ba ~ 3a 7'
CIIy,ip SbteS2' y:e.~~ e-rt_ E ~ ~~~~~ ~
Phone 80G1u?37F~s 7- _ Fax boa-yl.X049 ~'
tie) GPS unit to true n(xth, datum NAD93,
and use
maters for the distance unite, pZone 12
or ne 13.
Fasting 5~ /~ NoMing qlQ~ _ ~</
of DewaEerirtg WNI(a) to bs sortetructad: $_
Eatlmabd peplh~_ FL, AquHer
P/rpose u~ of dawabrlny ~ '
l.vC . C iee~aw
1_rLP.r) .nr-IJi~nG..~ nel:YYI.' ~ . tluS~- Lr1~ CaA/
Mtlcipabd Dab of Construedon: 1`Y Ir.~
Period of use: ~ a+o - r~ tta o3 r~S rc
Prlttt Neme:1~7~~~ c.eele` I~/ 1( I'
ACKNOWLEDGEMENT FROM STATE ENGINEER'S FICE
FDR OFFICE UsE ONLr
0 4 6 8 2 8 . ~W PROCESSED 9r
DN.CNTr ~ Lo.rv~CY` r,WD ° 3 bnTEACiwrnnn.D Enc~ 1~~ '~~
t5 MD GROUND EtEV
USGS MnP #
CONDITIONS OF DEWATERING 11VELL ACKNOWLEDGEMEM'
A COPY OF THE WRITTEN NOTICE OR ACKNOWLED(SHIU.iiEMENT' L
BE AVAItJ1BLE AT THE DRILLINO SITE.
f) Notice was provided to the State Engineer
at least 3 days Prior to consWtdion of the dewatering well(s).
2) Consbudion of the
well(s) must ba completed
within 90 days of
the data notlw was given to the State
Engineer.
3) Diversion of water through the
dewatering well(s) is limited to
tElL~fSO(Dl8 !~ .~•~~ ^ O^ ~•
Water diverted
from the dewatering welt(s) he11 $ ~
be used for treneAael purposes and all ground
water pumped
Page -16-
Western environment and ecology, inc.
APPENDIX D
western Environment and Ecology, Inc.
Statement of Qualifications
“We declare that, to the best of our professional knowledge and belief, we meet the definition of
Environmental professional as defined in 40 CFR 312 and we have the specific qualifications
based on education, training, and experience to assess a property of the nature, history, and setting
of the subject property. We have developed and performed the appropriate inquiries in
conformance with the standards and practices set forth in 40 CFR Part 312.”
Page -16-
Western environment and ecology, inc.
REAL ESTATE TRANSFER ENVIRONMENTAL AUDIT (RETA)
In response to provisions contained within the Comprehensive Environmental Response
Compensation and Liability Act (CERCLA) and the Resource Conservation and Recovery Act
(RCRA), lending institutions, firms and individuals involved with property transfers have become
painfully aware of the costs associated with environmental liabilities. In an attempt to make
informed decisions and potentially avail themselves of the "innocent purchaser defense" as
defined in CERCLA, lending institutions are requiring the completion of an environmental audit.
Previously, the completeness and the thoroughness of these audits varied as greatly as the cost.
However, in late 1992, the American Society of Testing and Materials (ASTM) adopted specific
standards for completion of Phase I audits. The ASTM standards (E-1527 and E-1528) are quite
specific as to the level of investigation necessary to complete the audit. Western
Environment and Ecology, INC. has performed Real Estate Transfer
Environmental Audits to ASTM standards long before the standards were adopted. Additionally,
Western Environment and Ecology, Inc. personnel have
provided training to FDIC regional offices on environmental compliance and financial institution
liabilities. This familiarity with lending institutions and more than fifteen years of experience in
performing RETA's allows Western Environment and Ecology,
Inc. to provide efficient and complete reports meeting short time frame requirements.
SERVICES
*Historical Photo Records Search *Lead-Based Paint Survey
*Environmental Records Search *Asbestos Survey
*Interviews *Radon Survey
*On-site Inspection *PCB Survey
SELECTED CLIENT LIST
Community Development Group Denver, Colorado
City of Aurora, Aurora, Colorado
City of Wheat Ridge, Colorado
Shively, Strommen & Holst, Longmont, Colorado
Town of Lyons, Colorado
Grant & Grant, Longmont, Colorado
Page -17-
Western environment and ecology, inc.
GREG D. SHERMAN, P.G.
President
PROFESSIONAL CAPABILITIES:
Mr. Sherman has more than 39 years of professional experience. He is currently President
of Western Environment and Ecology, Inc. Prior to his current
position, he was the Principal Geologist with SEACOR in its Lakewood, Colorado office and
Project Director with Roy F. Weston also in Lakewood.
Duties performed in these capacities involved responsibility for CERCLA RI/FS studies
and RCRA investigations. His professional assignments include project management and
technical direction of the design and installation of the 2,000-foot long the 881 Hillside
Groundwater Interception trench at the Rocky Flats Nuclear Weapons Plant in Jefferson County,
Colorado. Mr. Sherman was Field Operations Manager for the installation of 75 groundwater
extraction wells and vapor extraction and sparging points. This work was completed on the
Stanford Research Park Superfund site in Palo Alto, California. Recently, he has concentrated on
VOC remediation system design and installation utilizing on-site re-injection of treated
groundwater and enhanced oxygenation systems. Mr. Sherman was lead investigator for the City
of Wheat Ridge regarding the characterization of the Jay Street Park. This project, which was
submitted to the Colorado Voluntary Clean-Up Program, received a grant from the Colorado
Department of Public Health and Environment for innovative use of a Brownsfields site. Mr.
Sherman and Western Environment and Ecology, Inc. was selected by the Cities of Aurora and
Lakewood as their approved USEPA Brownsfields contractor.
Mr. Sherman is past Chairman of the Rocky Mountain Section of the Association of
Engineering Geologists. He has served as Chairman of Executive Enterprises Seminars on
Sampling and Data Analysis. He has extensive experience in geotechnical and geological
investigations, groundwater studies, UST testing and evaluation, construction materials testing
and mineral resource evaluation.
Mr. Sherman is recognized in the region as one of the leading experts in underground
storage tank management and mine subsidence. He has placed special emphasis on the
application of geophysical techniques to environmental and geotechnical investigations. Clients
for these projects range from Federal, state and local governments to private industry and
commercial developments. The project types included petroleum distribution facilities, nuclear
power plants, highways and streets, dams and reservoirs, transmission lines, sewage treatment
plants and sewage systems, hazardous and industrial waste disposal areas, and mining facilities, as
well as residential and commercial developments. Mr. Sherman has performed geotechnical and
geological investigations in Alaska, Arizona, California, Colorado, Idaho, Illinois, Montana, New
Mexico, New York, Nevada, North Dakota, South Dakota, Texas, Utah and Wyoming.
Additionally, he has international evaluation experience in the Middle East and Mexico.
Page -18-
Western environment and ecology, inc.
REGISTRATION/CERTIFICATION
Wyoming Professional Geologist #2296
Indiana Certified Geologist #786
Certified Professional Geologist, CPG #6586
Petro Tite Training Course, 1986
40-Hour OSHA Training Course, 1987
8-Hour OSHA Supervisor Course, 1987
Nuclear Density Gauge Operation and Safety Training Course, 1984
NRC Quality Assurance Training, 1978
Asbestos Inspector, 1996
EXPERIENCE
Western Environment and Ecology, Inc., Littleton, Colorado; President, 1994.
SEACOR, Inc., Lakewood, Colorado; Principal Scientist, 1992-1993.
Roy F. Weston, Inc., Lakewood, Colorado; Principal Geologist, 1990-1992.
ATEC Associates, Inc., Denver, Colorado; Environmental Division Manager, 1985-1990.
Tierra Consultants, Inc., Denver, Colorado; President, 1982-1985.
Apache Energy and Minerals, Denver, Colorado; Senior Project Geologist, 1979-1982.
Dames and Moore, Denver, Colorado; Project Geologist, 1977-1979.
Resource Associates of Alaska, Fairbanks, Alaska; Staff Geologist, 1976.
Uranerez U.S.A., Inc., Casper, Wyoming; Staff Geologist, 1975-1976.
Amoco Production Company, Denver, Colorado; Lab Technician, 1974.
Cities Service Company, Durango, Colorado; Field Technician, 1973.
EDUCATION
B.S., Geology, University of Northern Colorado, 1975
Graduate Studies, New Mexico Institute of Mining and Technology, 1977
AWARDS
Rocky Mountain Associate of Geologists, Outstanding Senior, 1975
Who's Who in the West, 1988
Colorado Wildlife Federation, 1996 Conservationist of the Year (Owl Mountain Partnership)
PROFESSIONAL ASSOCIATIONS
Association of Engineering Geologists
American Institute of Professional Geologists
Senior Scientist Colca Canyon Scientific Expedition, 1990
Colorado School of Mines, Non-facility Senior Design Team Advisor
Western environment and ecology, inc.
PUBLICATIONS/PRESENTATIONS
Sherman Greg D.,“Mine Subsidence Assessment, Boulder-Weld Coal Field, Using British National
Coal Board Methods” The Mountain Geologist, Volume 46, Number 1 January 2009.
Sherman Greg D. and Brian R. Partington., “Abandoned Mine Subsidence Prediction Using
British National Coal Board Methods, Boulder/Weld Coal Field, Denver, Colorado”
Proceedings for the International Association of Engineering Geologists, 2006 Meeting
Nottingham, United Kingdom. September 2006.
Sherman, Greg D., "Sampling and Data Analysis”; Executive Enterprises Seminar, Chairman, May
1992.
Sherman, Greg D., "Statistical Design of Sampling Plans”; Executive Enterprises Seminar, June
1990.
Sherman, Greg D., "Impact of the EPA UST Regulations”; Tri-State Petroleum Marketer, December
1988.
Sherman, Greg D., "Variables Effecting Volumetric Leak Detection Methods for Underground
Storage Tanks”; Paper given to the Colorado Section, American Society of Civil Engineers,
1988.
Sherman, Greg D., "The Impact of Underground Storage Tank Regulations on Industry”; Extended
Abstracts, American Institute of Chemical Engineers, National Meeting, 1988.
Sherman, Greg D., "Assessment of Subsidence Damage to Existing Structures in Louisville,
Lafayette, Colorado”; Proceedings of the Colorado Governor's Conference on Subsidence,
1985.
Sherman, Greg D., "Geology and Mining History of the Boulder/Weld Coal Field”; Paper given at
Denver Coal Club Meeting, 1985.
Sherman, Greg D., "The New Mexico Gold Belt Regional Structural Implications”; Proceedings of
the Western Mining Association, 1982 Convention.
Sherman, Greg D., "Colorado Front Range Uranium Deposits, A Possible Origin”: in review.
Sherman, Greg D., "Origin of Monoclinal Folding Near Livermore, Colorado”; The Mountain
Geologist, April 1976
must De discharged to the otte9m
system without consump8ve use, Induding eveporatrve
losses: The owner of the well(s)
le roaponsibb for
obtaining permit(s) and
comptying wNh sll rules and raguleGons pertaining
to the discharge
oT tlulds prodttced.
4) AN work must comply
with the Water WeN Construction Rules, 2 CCR 402-2.
5) Wall Construction and Test
Report(s) GWS,( 91) must be
submitted to this orrice Dy
the licensed oordredor or authorized indivbusl
within ~ days of
the completion o1 Ure wwk.
8) Unless a well pemtN
is obtained, the vrall(s) must be
plugged end sealed wHhin one (1) year attar conatrudion. An Aberdonmerd
Report form (GWS-9) must be submNted within !0daysof )
plugging & sealing. Note that
a vadenoe from the Water Well Construction
Rules wAl be necessary to obtain
a well permit if minimum
consVUdlon etendardo for water wells (Rule 10)
are not met.
n Tire owner of the
well(s) should maintain records of water
qualify testing and submit this data Oo th Slate
Engineer upon request.
e) The show: dewatering
weN (DW) number, owner's structure
name, and well owrrers'nameandaddressmustbeprovidedonallwell
permit epplirallon(s)well , eonstrudlon end abendonmerd
reports.
8) THIS ACKNOWLEDGEMENT OF NOTICE DOE8 NOT
INDICATE THAT WELL PERMIT(S)
CAN BE APPROVED.
Addidorrel Conditions
COLORADO DIVISION OF WATERr{1313SHERMAN iESOURCES-
ST-RM 8Zf-CO90203 DENVER- 303860-F'AX303806.3bB1/ 3589
f sl rA of Sect. / s-
Twp. 6/
Rge... PM
West
Ner1h
East
Southr
ABOVE DIAGRAM REPRESENTS ONE FULL SEC-
TION. LOCATE WELL ACCURATELY IN SMALL
SQUARE REPRESENTING 40 ACRES.
or
If the above is not applicable fill in:
No. street
City or Town
or
Lot , Block
Subdivision
include filing or number)
TO BR MADE OUT IN QUADRUPLICATE:
Original Blue and Duplicate Green Copy
must be filed with the State Engineer within
30 days after well is completed. White
copy is for the Owner and Yellow copy for
the Driller. SIGN BLUE COPY
II
i
I
IIII
i
I
i 1i
East
Southr
ABOVE DIAGRAM REPRESENTS ONE FULL SEC-
TION. LOCATE WELL ACCURATELY IN SMALL
SQUARE REPRESENTING 40 ACRES.
or
If the above is not applicable fill in:
No. street
City or Town
or
Lot , Block
Subdivision
include filing or number)
TO BR MADE OUT IN QUADRUPLICATE:
Original Blue and Duplicate Green Copy
must be filed with the State Engineer within
30 days after well is completed. White
copy is for the Owner and Yellow copy for
the Driller. SIGN BLUE COPY
Use initiation date S
Use Supplemental p es for additional data) r
AV
PERMIT NO. 23885
ISSUED:
DATE MAY 19 1965 19
INVIF RD
MAY IS 4965
GROUND WATER SECT.
LO ATION OF WELL
County
r,
E of Sect., Twp. 7,
Rge. l
P. M. OR
Street Address or Lot & Block No.
Town or Subdivision
I
S
Locate
well in
40 acre
E (
small)
square
as near
as possible.
Large square
is one section.
25. 00 fee required for uses other
than Domestic or Livestock. , " 1
Applican 7f i
Agent or f / ,
Driller , r. 1%. 1 u a No.
Address
NOTE — SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION
S
Locate
well in
40 acre
E (
small)
square
as near
as possible.
Large square
is one section.
25. 00 fee required for uses other
than Domestic or Livestock. , " 1
Applican 7f i
Agent or f / ,
Driller , r. 1%. 1 u a No.
Address
NOTE — SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION
to May 1, 1957. If Registered give Filing No.
If NOT Registered prior to May 1, 1957, a $ 5. 00 filing fee accompanies this form.
Tl Ab6ve statements are true and correct to the best of my knowledge and belief.
Subscrib4-and Sworn before me
this _# L—- day of
7__
1940. _
My commisp! expires ` f Reg trant
FOR ST TE ENGINEER' S USE
Located in 1- 3 district, County for
Registration No. in / y 3_ on