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Environmental Assessment Questionnaire Los Angeles Harbor Department
Planning and Research Division425 S Palos Verdes Street, San Pedro, CA 90731
P.O. Box 151, San Pedro, CA 90733-0151310-732-3850 - www.portoflosangeles.org
Page 1 of 7
Jan/2006
Form #408
Applicant:
Project Title:
Project Location:
Project ScopeProject Description Summary (Attach Additional Documents, if necessary):
Project Location (Address/Berth), Attach Site and Location Map:
Lot Area of Property (in acres): Project Size (in sq. ft. or acres):
Land Uses on Adjacent Properties:
The Project Site is within ¼ mile of the following (check all that apply): Park/Recreation Area School Fire Station Medical Facility
Project Need: Proposed New Tenant/Use Administrative New Equipment Temporary/Special Event Redevelopment of Existing Use Maintenance Safety Upgrades Repairs/Replace Existing Expansion/Change of Use Other:
Current Use of Property: Container Terminal Passenger Terminal Marine Oil Terminal Other Liquid Bulk Breakbulk/Neobulk Terminal Dry Bulk Warehousing Storage Facility Marine Oil Service Station Public Facility Utility Rail Yard Office Restaurant Retail/Service Commercial Fishing Recreational/Educational Industrial/Ship Yard Marina Parks/Open Space Vacant Other:
Proposed Use of Property (if different from current):
Parks/Open Space Commercial Fishing Rail Yard Storage Facility Other Liquid Bulk
Marina Retail/Service Utility Warehousing Marine Oil Terminal
Other: Industrial/Ship Yard Restaurant Public Facility Dry Bulk Passenger Terminal
Recreational/Educational Vacant
Office Marine Oil Service Station Breakbulk/Neobulk Terminal Container Terminal
Environmental Assessment Questionnaire Los Angeles Harbor Department
Planning and Research Division425 S Palos Verdes Street, San Pedro, CA 90731
P.O. Box 151, San Pedro, CA 90733-0151310-732-3850 - www.portoflosangeles.org
Page 2 of 7
Jan/2006
Form #408
Previous application(s) has/have been made for this site: Yes No If Yes, indicate application #(s):
This application is part of a larger project to occur over the next 10 years:If Yes, describe project:
This project requires a new permit/entitlement or modification to an existing permit/entitlement:If Yes, describe request:
*Submit the Application for Permit to Use Port Property (Form # 412)
This project involves the use, manufacture, treatment, production, or storage of any hazardousmaterial or waste:
*Submit the Site Assessment Questionnaire (Form # 409)
This project involves site preparation activities, i.e., trenching, dredging, grading, excavating:*Submit the Site Assessment Questionnaire (Form # 409)
This project involves the bulk processing, handling, or storage of any hazardous material:*Submit the Risk Management Analysis Questionnaire (Form # 411)
Estimated Cost: $ Using Public Funds?: Amount: $
Other Permits/ApprovalsThe following government agencies will require a permit and/or approval for this project:Department of Building and Safety, City of Los Angeles
Not Applicable Need to Apply Application Pending Application Approved
City of Los Angeles Fire Department
South Coast Air Quality Management District
Regional Water Quality Board
County/State Department of Health Services
United States Army Corps of Engineers
Other:
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
Application Approved Application Pending Need to Apply Not Applicable
Application Approved Application Pending Need to Apply Not Applicable
Application Approved Application Pending Need to Apply Not Applicable
Application Approved Application Pending Need to Apply Not Applicable
Application Approved Application Pending Need to Apply Not Applicable
Application Approved Application Pending Need to Apply Not Applicable
Environmental Assessment Questionnaire Los Angeles Harbor Department
Planning and Research Division425 S Palos Verdes Street, San Pedro, CA 90731
P.O. Box 151, San Pedro, CA 90733-0151310-732-3850 - www.portoflosangeles.org
Page 3 of 7
Jan/2006
Form #408
Construction/DemolitionThe project involves the following (check all that apply) construction and/or demolition activities:Construction
If Yes: New Expansion of Existing Maintenance Repair Interior Exterior Other:
Type of Structure(s):Use of Structures:
DemolitionIf Yes: Evaluated for Asbestos/Mold/Lead Evaluation By:
Type of Structure(s):Age of Stucture(s):Material Disposal Site:Post-Demo Site Use:
DredgingIf Yes: Channel Berth
Location/Method:Depth:Volume Removed:Disposal Location:
FillIf Yes: In Harbor Water On Land
Location of Material:Location of Placement:Source of Material:Volume of Material:#/Size of Truckloads:Haul Routes to Site:Laydown Area:
Distance from Project Site: Size:Site Preparation:
If Yes: Grading Paving Boring Lighting Landscaping Compacting Trenching Fencing Excavating Pile Driving Other:
Utilities/Pipelines:If Yes: Above Ground Below Ground Public Private
New Extension Repair Capping RemovalProducts Carried:
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
Off-SiteOn-Site
Environmental Assessment Questionnaire Los Angeles Harbor Department
Planning and Research Division425 S Palos Verdes Street, San Pedro, CA 90731
P.O. Box 151, San Pedro, CA 90733-0151310-732-3850 - www.portoflosangeles.org
Page 4 of 7
Jan/2006
Form #408
Construction/Demolition
Work Force - During Construction/DemolitionSun Mon Tue Wed Thu Fri Sat
Start Time
End Time
# Workers
# Shifts
Schedule and Phasing of Construction/DemolitionPhase
(i.e. Site Preparation)Planned Start Date Duration
Equipment for Construction/DemolitionFuelEquipment
Type# Used on
Site Type Gal/HrConsumed
# Days/ WeekUsed
# Hours/Day Used
PhaseUsed
Utilities Used During Construction/DemolitionUtility Amount per Hour Hours per Day Duration
ElectricityNatural GasTelephoneWaterSewer or Septic TanksStorm Water DrainageSolid Waste DisposalOther:
Describe EnergyConservation Measures:Describe Recycling Measures:
Environmental Assessment Questionnaire Los Angeles Harbor Department
Planning and Research Division425 S Palos Verdes Street, San Pedro, CA 90731
P.O. Box 151, San Pedro, CA 90733-0151310-732-3850 - www.portoflosangeles.org
Page 5 of 7
Jan/2006
Form #408
Operation
Describe the following items as they relate to the ongoing operation of the project:
Work Force During Ongoing OperationEXISTING:
Sun Mon Tue Wed Thu Fri SatStart Time
End Time
# Workers
# Shifts
NEW (AS A RESULT OF THIS PROJECT):Sun Mon Tue Wed Thu Fri Sat
Start Time
End Time
# Workers
# Shifts
Utilities Used During Ongoing OperationEXISTING:
Utility Amount per Hour Hours per Day DurationElectricityNatural GasTelephoneWaterSewer or Septic TanksStorm Water DrainageSolid Waste DisposalOther:
NEW (AS A RESULT OF THIS PROJECT):Utility Amount per Hour Hours per Day Duration
ElectricityNatural GasTelephoneWaterSewer or Septic TanksStorm Water DrainageSolid Waste DisposalOther:
Describe Recycling Measures:Conservation Measures:Describe Energy
Environmental Assessment Questionnaire Los Angeles Harbor Department
Planning and Research Division425 S Palos Verdes Street, San Pedro, CA 90731
P.O. Box 151, San Pedro, CA 90733-0151310-732-3850 - www.portoflosangeles.org
Page 6 of 7
Jan/2006
Form #408
The ongoing operation of the project will result in changes from current conditions in the following:Transportation/Traffic
Vehicular Traffic# Vehicle Trips/Day:Parking# Spaces:Ship Traffic# Vessel Calls/Month:Rail Traffic# Trains/Month:
Hazardous MaterialsPotential for Explosion or Release of Hazardous Substances in the Event of an Accident/Upset
Description:Hazardous Materials/Waste Handling *Submit the Site Assessment Questionnaire (Form #409)
Description:Need for Public Services
Fire ProtectionDescription:Police Protection
Schools
Park Facilities
Maintenance of Public Facilities (Roads, etc.)
Air/Water EmissionsAir Emissions
Discharge/Runoff to Harbor Waters
OtherSignificant Light Sources
Public Recreational Facilities
Public Access to the Port
Line of Sight to and along Ocean and Scenic Coastal Areas
Noise Levels
*Submit the Risk Management Analysis Questionnaire (Form #411)
Description:
Description:
Description:
Description:
Description:
Description:
Description:
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Environmental Assessment Questionnaire Los Angeles Harbor Department
Planning and Research Division425 S Palos Verdes Street, San Pedro, CA 90731
P.O. Box 151, San Pedro, CA 90733-0151310-732-3850 - www.portoflosangeles.org
Page 7 of 7
Jan/2006
Form #408
The following Best Management Practices have been incorporated (check all that apply and describe):
Air QualityDescription:
Water Quality
Noise
Traffic
Other
Soil/Groundwater
Housekeeping
Hazardous Materials Handling
Public Access
Other
The following features of the project reduce or eliminate potential environmental impacts:
The following measures could be taken to further reduce or eliminate potential environmental impacts:
CertificationI hereby certify that the statements furnished herein and in any attached exhibits present the data and information required for this initial evaluation to thebest of my ability, and that the facts, statements, and information presented are true and correct to the best of my knowledge and belief.
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