| Copyright (c) Queen's Printer, Victoria, British Columbia, Canada | License Disclaimer |
| B.C. Reg. 375/96 O.C. 1480/96 | Deposited December 16, 1996 effective April 1, 1997 |
[includes amendments up to B.C. Reg. 13/2019, January 24, 2019]
[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 20 | Schedule 1 | Schedule 1.1 | Schedule 2 | Schedule 2.1 | Schedule 3 | Schedule 3.1 | Schedule 3.2 | Schedule 3.3 | Schedule 3.4 | Schedules 4 to 7 | Schedule 8 | Schedules 9 to 11
Copyright (c) Queen's Printer, Victoria, British Columbia, Canada