B.C. Reg. 375/96
O.C. 1480/96 and M271/2004
Deposited December 16, 1996
effective April 1, 1997

Environmental Management Act

Contaminated Sites Regulation

Note: Check the Cumulative Regulation Bulletin 2014
for any non-consolidated amendments to this regulation that may be in effect.

[includes amendments up to B.C. Reg. 4/2014, January 31, 2014]

Point in Time

Schedule 1

[am. B.C. Regs. 17/2002, ss. 15 to 19; 343/2008, s. 10.]

Site Profile

All Information Must be Provided and All Questions Answered

I. CONTACT IDENTIFICATION

A. Name of Site Owner:

Last .................................................... First ....................................... Middle Initial(s) ................... (and / or, if applicable)

Company ........................................................................................................................................................................

Owner's Civic Address .....................................................................................................................................................

City ...................................................................... Province/State ................................................................

Country ................................................................ Postal Code/ZIP ..............................................................

B. Person Completing Site Profile Leave blank if same as above:

Last .................................................... First....................................... Middle Initial(s) ................... (and / or, if applicable)

Company .......................................................................................................................................................................

C. Person to Contact Regarding the Site Profile:

Last .................................................... First....................................... Middle Initial(s) ................... (and / or, if applicable)

Company ........................................................................................................................................................................

Mailing Address ...............................................................................................................................................................

City ...................................................................... Province/State ...............................................................

Country ................................................................ Postal Code/ZIP .............................................................

Telephone (...........) ................. -................................ Fax (...........) ................ -..........................................

II. SITE IDENTIFICATION

Please attach a site location map

All Property:

Coordinates (using the North American Datum 1983 convention) for the centre of the site:

Latitude: Degrees ............................ Minutes .......................... Seconds ................................

Longitude: Degrees ............................ Minutes .......................... Seconds ................................

Please attach a map of appropriate scale showing the boundaries of the site.

For Legally Titled, Registered Property

Site Street Address

 ....................................................................................................................................................................

City ..................................................................... Postal Code .....................................................................

PID numbers and associated legal descriptions. Attach an additional sheet if necessary.

PID Legal Description
........................................................ ......................................................................................................................
........................................................ ......................................................................................................................
........................................................ ......................................................................................................................
........................................................ ......................................................................................................................
........................................................ ......................................................................................................................

Total number of titled parcels represented by this site profile is: ..............................

For Untitled Crown Land

PIN numbers and associated Land Description. Attach an additional sheet if necessary.

PIN Land Description
........................................................ ......................................................................................................................
........................................................ ......................................................................................................................
........................................................ ......................................................................................................................
........................................................ ......................................................................................................................

Total number of untitled, crown land parcels represented by this site profile is: ......................

(and, if available)

Crown land file numbers. Attach an additional sheet if necessary.

III. COMMERCIAL AND INDUSTRIAL PURPOSES OR ACTIVITIES

Please indicate below, in the format of the example provided, which of the industrial and commercial purposes and activities from Schedule 2 have occurred or are occurring on this site.

EXAMPLE:

Schedule 2 Description
Reference
E1 appliance, equipment or engine repair, reconditioning, cleaning or salvage
F10 solvent manufacturing or wholesale bulk storage
...................................................................................................................................................................................
Please print legibly. Attach an additional sheet if necessary
Schedule 2 Description
Reference
........................... ......................................................................................................................................................
........................... ......................................................................................................................................................
........................... ......................................................................................................................................................
........................... ......................................................................................................................................................
........................... ......................................................................................................................................................
IV. AREAS OF POTENTIAL CONCERN
  Is there currently or to the best of your knowledge has there previously been on the site any(please mark the appropriate column opposite the question): YES NO
A Petroleum, solvent or other polluting substance spills to the environment greater than 100 litres?    
B Residue left after removal of piled materials such as chemicals, coal, ore, smelter slag, air quality control system baghouse dust?    
C Discarded barrels, drums or tanks?    
D Contamination resulting from migration of substances from other properties?    
V. FILL MATERIALS
  Is there currently or to the best of your knowledge has there previously been on the site any deposit of(please mark the appropriate column opposite the question): YES NO
A Fill dirt, soil, gravel, sand or like materials from a contaminated site or from a source used for any of the activities listed under Schedule 2?    
B Discarded or waste granular materials such as sand blasting grit, asphalt paving or roofing material, spent foundry casting sands, mine ore, waste rock or float?    
C Dredged sediments, or sediments and debris materials originating from locations adjacent to foreshore industrial activities, or municipal sanitary or stormwater discharges?    
VI. WASTE DISPOSAL
Is there currently or to the best of your knowledge has there previously been on the site any landfilling, deposit, spillage or dumping of the following materials (please mark the appropriate column opposite the question): YES NO
A Materials such as household garbage, mixed municipal refuse, or demolition debris?    
B Waste or byproducts such as tank bottoms, residues, sludge, or flocculation precipitates from industrial processes or wastewater treatment?    
C Waste products from smelting or mining activities, such as smelter slag, mine tailings, or cull materials from coal processing?    
D Waste products from natural gas and oil well drilling activities, such as drilling fluids and muds?    
E Waste products from photographic developing or finishing laboratories; asphalt tar manufacturing; boilers, incinerators or other thermal facilities (e.g. ash); appliance, small equipment or engine repair or salvage; dry cleaning operations (e.g. solvents); or from the cleaning or repair of parts of boats, ships, barges, automobiles or trucks, including sandblasting grit or paint scrapings?    
VII. TANKS OR CONTAINERS USED OR STORED, OTHER THAN TANKS USED FOR

RESIDENTIAL HEATING FUEL
  Are there currently or to the best of your knowledge have there been previously on the site any(please mark the appropriate column opposite the question): YES NO
A Underground fuel or chemical storage tanks other than storage tanks for compressed gases?    
B Above ground fuel or chemical storage tanks other than storage tanks for compressed gases?    
VIII. HAZARDOUS WASTES OR HAZARDOUS SUBSTANCES
  Are there currently or to the best of your knowledge have there been previously on the site any(please mark the appropriate column opposite the question): YES NO
A PCB-containing electrical transformers or capacitors either at grade, attached above ground to poles, located within buildings, or stored?    
B Waste asbestos or asbestos containing materials such as pipe wrapping, blown-in insulation or panelling buried?    
C Paints, solvents, mineral spirits or waste pest control products or pest control product containers stored in volumes greater than 205 litres?    
IX. LEGAL OR REGULATORY ACTIONS OR CONSTRAINTS
  To the best of your knowledge are there currently any of the following pertaining to the site(please mark the appropriate column opposite the question): YES NO
A Government orders or other notifications pertaining to environmental conditions or quality of soil, water, groundwater or other environmental media?    
B Liens to recover costs, restrictive covenants on land use, or other charges or encumbrances, stemming from contaminants or wastes remaining onsite or from other environmental conditions?    
C Government notifications relating to past or recurring environmental violations at the site or any facility located on the site?    

X. ADDITIONAL COMMENTS AND EXPLANATIONS

(Note 1: Please list any past or present government orders, permits, approvals, certificates and notifications pertaining to the environmental condition, use or quality of soil, surface water, groundwater or biota at the site.

Note 2: If completed by a consultant, receiver or trustee, please indicate the type and degree of access to information used to complete this site profile):

XI. SIGNATURES

The person completing the site profile states that the above information is true, based on the person's current knowledge as of the date completed.

......................................................................... ...........................................................................
Signature of person completing site profile Date completed: (YY-MM-DD)

Contents  |  Parts 1 to 18  |  Schedule 1  |  Schedule 1.1  |  Schedule 2  |  Schedule 3  |  Schedule 4  |  Schedule 5  |  Schedule 6  |  Schedule 7  |  Schedule 8  |  Schedule 9  |  Schedule 10  |  Schedule 11