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SAN -"gQUIN LOCAL HEALTH )ISTRICT <br /> UNDERGROUND STORAGE TA4K PROGRAM - <br /> CRITERIA FOR CLEAN-UP REFERRALS <br /> Sitds A ress Eva uator <br /> e <br /> 1 <br /> o e.: 209-466-6781 <br /> I. Product Identification <br /> A. Extremely Hazardous Substance 5 Points <br /> B0. Hazardous Substance 3-4 Points <br /> Designated Hazardous Substance 0-2 Points <br /> II. Laboratory Analysis Results <br /> � . Extremely High (Free Product) - 5 Points . <br /> High 3-4 Points <br /> Moderate 2. Points <br /> D. .Low 1 Point <br /> E. Non-detectable 0 <br /> III. Distance to Water Supply Wells <br /> A. 0-50 ft. 5 Points <br /> B. 51-100 ft. 4 Points <br /> C. 101-200 ft. 3 Points <br /> D. 201-300 ft. 2 Points <br /> (E. 301-500 ft. 1 Paint <br /> F. 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): 'A 200 ft. or off site 4 Points <br /> C, -Domest.ic_Wel1_..(on_site)_ __, 3 Points <br /> D. Nondomestic Well : - 100-200 ft. (on site) 2 Points <br /> Nondomestic Well : e- 100 ft. . (on site) 1 Point �. <br /> �'. No Active Well (s) Affected 0 <br /> V. Depth of Groundwater QA. 0-25 ft. 5 Points 5 <br /> 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 /> A. Gravels - GW, GP, GM, GC 5 Points <br /> Sands - SW, SP, SM, SC 3-4 Points <br /> C Silts/Clays (Low Liquid' Limit) - ML, CL, 0 2 Points 2- <br /> .Silts/C.lays-_.(High. _Iri�qu.id-Limit) -.,MH, CH, H 0-1 Point <br /> E. Organic Soils - PT (Site"Specifid y <br />