MDA INCIDENT RESPONSE UNIT AgESA REPORT CHECKLIST
Information to record for each completed checklist.
- Site Name
- Report Date
- MDA project Number
- Name of individual that performed the checklist and their dated signature
| Item | Completed (Y/N) | Location (p.#) |
|---|---|---|
| 1. Environmental Database Search | ||
| a. Search Firm Used (if any) | ||
| b. Search includes AGSPILLS database, Site and 1/2-mile radius from perimeter | ||
| c. Search includes Target Property and 1/2-mile radius from perimeter | ||
| d. Discussion of MDA Incident files identified in the search | ||
| e. Copy of search report provided in appendix | ||
| 2. MDA's WIMN Agricultural Case File Search | ||
| a. Discussion of results in the report | ||
| b. Copy provided in appendix | ||
| 3. County Spills Report Review/Case File Search | ||
| a. Discussion of results in the report | ||
| b. Copy provided in appendix | ||
| 4. Facility File Review from MDA Practices | ||
| a. Discussion of results in the report | ||
| b. Copy provided in appendix | ||
| 5. Site Visit | ||
| a. Photos taken at the Site when ground surface uncovered | ||
| 6. List of Agricultural Chemicals Sorted, Handled, Mixed or Loaded (Past & Present) | ||
| a. Review included previous owner/operator (if applicable), old MDA files | ||
| b. Documentation provided in appendix | ||
| c. Results table (include product names, EPA product ID numbers, active ingredients, quantities/volumes, units of measure and area(s) of the site) |
||
| d. Discussion of results in the report | ||
| 7. Interviews of Current and Former Employees Knowledgeable of the Site | ||
| a. Discussion of results in the report | ||
| b. Copies of phone notes, info., etc. provided in appendix (if applicable) | ||
| 8. Review of Available Historical Aerial and/or Street View Photographs of the Site | ||
| a. Discussion of results in the report | ||
| b. Copies provided in appendix | ||
| 9. High Risk Areas for Potential Agricultural Chemical Contamination (Past & Present) | ||
| a. Identified and labeled on the Site Map(s) | ||
| b. Listed and described in the report text | ||
| 10. Other Agency(ies) Review(s) | ||
| a. Discussion of results in the report | ||
| 11. Data Gaps | ||
| a. If any searches cannot be completed or data obtained, noted in report text |
