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1 <br /> _Y NDERGROUND STORAGE YANK PROGF+ <br /> CRITERIA FOR CLEAN-UP REFERRALS <br /> Situs Address Eva1u for <br /> Loh <br /> _.. { <br /> Phone: 209 <br /> I. Product Identification <br /> A. Extremely Hazardous Substance 5 Points j <br /> Hazardous Substance '1-D +7d 8 3-4 Poi,nts <br /> -2 Points <br /> C. Designated Hazardous Substance -TV I— <br /> II . Laboratory Analysis Results <br /> A. Extremely High (Free Product) 5 Points <br /> B. High 3-4 Points <br /> CModerate �� a�r 2. Points <br /> R 1 Point <br /> D. Low <br /> E. Non-detectable 0 <br /> III. Distrince to Water Supply Wells <br /> A. 0-50 ft. lam` 5 Points <br /> B. 51 -100 ft. n. l SIJ 4 Points <br /> C. 101 -200 ft. 3 Pori nts <br /> D. 201-300 ft. 2 Points <br /> E 301-500 ft. 1 Poi nt <br /> Over 500 ft. 0 <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. Active Water Well (s) : -* 200 ft. or off site 4 Paints <br /> s 3 Points <br /> C. Domestic Well (on site) 1. <br /> D. Nondomestic Well : 100-200 ft. (on site) 2 Points <br /> E. Nondomestic Well : 100 ft. (on site) 0 Point <br /> = No Active Well (s) Affected <br /> V. Depth of Groundwater <br /> A. 0-25 ft. 5 Points <br /> 26-35 ft. 4 Points <br /> 36-50 ft. 3 Paints <br /> D. 51 -70 ft. 2 Paints Q <br /> E. 71 -100 ft. 1 Point <br /> F. Over 100 0 <br /> vI. Soil Type (Unified Soil Classification System) 3 <br /> A. Gravels - GW, GP, GM, GC 5 Points <br /> B Sands - SW SP, SM. SC 3-4 Points <br /> Silts/Clays (Low Liquid' Limit) - ML. CL; OL 2 Points <br /> D. Silts/ClaysAHigh Liquid Limit) - MH, CH, OH 0-1 Point <br /> E. Organic Soils - PT (Site Specific) <br /> ii <br />