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CHEVRON #94054 Page 2 of 2 2 Mediaspecifre Criteria: Petroleum Vapor Intrusion to Indoor Air - The site is considered /ow-threatint the vapor-iatruson-toairpaffiway i/sitespedficoonrOtlonssatisfy YES items 2a, 2b, or 2c - CLEAR SECTION EXEMPTION - Active Commercial Petroleum Fueling Facility r YES r N Does the site meet any of the Petroleum Vapor mansion to Indoor Air specific criteria scenarios? C YES r N 2a- Scenado 4Lmol1: Direct Measurement of Sail Gas Concentalions YES I Sol] Gas Sampling Locations— No Bicatlenua6on Zone: FY—ES - Beneath or adjacent 0 an existing building: Soil gas sample is mllecte l at least 5 feet belay the bottom of the buildrg foundation. r YES r N - FUWre construction: The soil gas.sample shall be collected from at least 5last below the ground surface (bgs). r YES r N h. Soil Gas Sampling Locations—with Bioagenuation Zone: The criteria in Column Ain the Sal Gas Criteria table (page 5 ofthe Policy) apply lithe falaKmg requirements for a o Noaticvtuation zone are satisfied: - Minimum a 5 feet of soil between the soil vapor measurement and the foundation of an existing or ground surface of future construction. r YES r N - TPH (TPHg + TPHd) is <100 mge g (measured in at least two Ceptha within the 5-ftzone) r YES r N - Oxygen isa4% measured m the bottom of the SB zone. r YES r N 3. Media Specific Criteria: Direct Contact and Outdoor Air Exposure - The site is considered low-threat for direct contact and outdoorair expos 2 if)tmeets 1, 2, or3below. NO EXEMPTION - The upper to feet of soil is free of petroleum contamination r YES r N Does the site meet any of the Direct Contact and Outdoor Air Exposure console scenarios? r YES re N ADDITIONAL QUESTIONS - Please indicate only those conditions that do not meet the policy criteria: ExpasureType : r Residential r Commercial r Utility W r Petroleum Constituents in Soil : C s 5 Feet bgs r >5 Feat age and <10 Feet one (' Unknown Soil Concentrations of Benzene : f > 1.9 mgrkg and a 2.0 mg/kg r > 2.8 non and < 8.2 mg/kg r > 8.2 mgrkg and a 12 mgmg r > 12 mg/kg and s 14 mgkg r > 14 mgk9 CUnknown Soil Concentrations of EthylBename : r > 21 mgfkg and s 32 mmHg r > 32 mg/kg and s 89 mgfkg r > 89 mgkg and s 134 mglkm r > 134 rnyag and s 314 mgfkg r > 314 mg/kg rUnknovm Soil Concentrations of Naphthalene : rf > 9.7 mien and < 45 mg/kg r > 45 mot and <219 mgrkn r > 219 mglkg rUnknovm Soil Concentrations of PAH : _ r > 0.083 mgfkg and < 0,68 ml r > 0.68 mg/kg and 54.5 mgfkg r > 4.5 mg/kg GUnkncwn Area a Impacted Soil ; C Area of Impacted Soil > B2 by 82 Feet CUnknoum Additional Infarmation Should Ws case be closed in spite of NOT meeting policy criteria? r YES R N Has Was LTCP Checklist been updated for F/ 14/15? r YES r N SPELLCHECK Save Form as Partlally Completed Save Fonn as Complete LOGGED N AS HENDERSONN a https:Hgeotracker.waterboards.ca.gov/regulators/screens/closure_policy.asp?global_id=TO. . . 4/13/2015