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F UNDERGROUND STORAGE TANK PROG <br /> R44 <br /> CRITERIA FOR CLEAN-UP REFERRALS <br /> Sitds Address Evaluator <br /> Phone: 209- t <br /> I. Product Identification <br /> A. Extremely Hazardous Substaace 5 Points <br /> A. <br /> Hazardous Substance 3-4 Points <br /> C. Designated Hazardous Substance 0-2 Points <br /> II. Laboratory Analysis Results <br /> A. Extremely High (Free Product) - 5 Points <br /> M High l D C-RhhSR 9LC- Ffon TAN-*-tom- '. 3-4 Points Nc� Sutsriu�. <br /> C. Moderate � 2. PointsD. tow P9�� _ <br /> 23oU ?'E6fi1 Point E. Non-detectable0 <br /> III. Distance to Water Supply Wells E f <br /> A. 0-50 ft. 5 Points <br /> B. 51-100 ft. 4 Points <br /> C. 101-200 ft. 3 Points <br /> 201-300 ft. 2 Points <br /> 301-500 ft. ftAx -)tWim-LJEwOs Aft-)W%- Ste 1 `Point <br /> Over 500 ft. ZY1µ,�r�� W�us--t►pfw ., u-Prc) 0 , <br /> Ce"YFqa-tS VU fcp <br /> IV. Documented Impact on Active Water Supply Wells <br /> A. Public Water Supply Well or two or more Domestic Wells 5 Points <br /> B. Acti ve Water Nell(s): N 200 ft. .or off site 4 Points <br /> C. Domestic Well (on site) 3 Points <br /> D. Nondomestic Well : 100-200 ft. -(on site) 2 Points <br /> E. • Nondomestic Well : 4 100 ft. (on site) 1 Point <br /> F. No Active Well (s) Affected 0 <br /> V. Depth of Groundwater <br /> 0-25 ft. l 5 Points <br /> B. 26-35 ft. 4 Points <br /> C. 36-50 ft. 3 Points <br /> D. 51-70 ft. 2 Points <br /> E. 71-100 ft. 1 Point <br /> F. Over 100 0 <br /> VI. Soil Type (Unified Soil Classification System) <br /> Gravels - GW, GP GM, GC 5 Points <br /> B. Sands - SW, SP, 65 SC 3-4 Points <br /> Silts/Clays (Low Liquid Limit) - M( Lam, CL, OL 2 Points <br /> D. Silts/Clays_jHigh Liquid Limit) - MH, CH, OH 0-1 Point <br /> E. Organic Soils - PT (Site Specific) <br />