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SAN '^AQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM <br /> CRITERIA FOR CLEAN-UP REFERRALS <br /> Situs Address Evaluato <br /> Phone: 209-466-6781 <br /> I. Product Identification <br /> Extremely Hazardous Substance 5 Points <br /> 3-4 Points <br /> B. Hazardous Substance 0-2 Points <br /> Designated Hazardous Substance <br /> II. Laboratory Analysis Results <br /> A. Extremely High (Free Product) 5 Points <br /> 3-4 Points <br /> High 2 Points 2 <br /> Moderate 1 Point <br /> D. Low 0 <br /> E. Non-detectable <br /> III. Distance to Water Supply Wells <br /> 5 Points <br /> A. 0-50 ft. 4 Points <br /> B. 51-100 ft. 3 Points <br /> IV101-200 ft. 2 Points <br /> 201-300 ft. 1 Point <br /> E. 301-500 ft. 0 <br /> F. Over 500 ft. <br /> IV. Documented Impact on Active Water Supply Wells <br /> A. Public Water Supply Well or two or more Domestic Wells 5 Points <br /> 4 Points <br /> B. Active Water Well (s) : � 200 ft. or off site <br /> C. Domestic Well (on site) 3 Points <br /> 2 Points <br /> D. Nondomestic Well : 100-200 ft. (on site) 1 Point <br /> Nondomestic Well : 100 ft. jon site) <br /> 0 <br /> F. No Active Well (s) Affected <br /> V. Depth of Groundwater <br /> 5 Points <br /> A. 0-25 ft. 4 Points <br /> B. 26-35 ft. 3 Points <br /> �., 36-50 ft. 2 Points <br /> (D',) 51-70 ft. 1 Point <br /> �� 71-100 ft. 0 <br /> F. Over 100 <br /> VI. Soil Type (Unified Soil Classification System) 5 points <br /> A. Gravels - GW, GP, GM, GC 3-4 Points 3 <br /> Sands - SW, SP, SM, SC 2 Points <br /> Silts/Clays (Low Liquid Limit) - ML, CL, OL 0-1 point <br /> D. Silts/Clays (High Liquid Limit) - MH, CH, OH <br /> E. Organic Soils - PT (Site Specific) <br />