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Fags 0f2 <br /> i <br /> �'// <br /> /°O� <br /> DPS-gEDIPTIDN <br /> ` YI-U¢«:1299 EILSAESSER <br /> MAP THIS SWEIIRSOR:AORB«IE <br /> �b4 1 q UA �WCCS(REGIp1551-USE«:390339 <br /> CgDRALVALIF' y/9MSOR:COR CWJD0N <br /> • PA CASEWORKER�""'� 11 7 8 <br /> p BLI B CUF Amoua«ahb Sl 9 7 <br /> CUF CMim«:rAT9 IXIF Priomr Avipd; <br /> lam' 1 ®� W14004" �5212O1a12:1:upY- L��FOa P. SrM- <br /> �. �e pRpl[t;TN0.S VST W11H 1HESUBMITTAL APpRCVA <br /> THIS SI3ERAs waraTTAIS"Cl1CRl�ro��"I� �13 CHECKLIST Mil CA']7MJ CLDSUl POLICY HISTORY <br /> VERSION IS IN PROGRESS AS OF 32 <br /> THIS V92 NO <br /> RE POLICY — <br /> yNlnralcdteda- <br /> GeneralCriteria-The site saftsfes ihet y ofa ublic waters stem? .•RYES NO <br /> a.I authorized release located within the service area <br /> N of Wrtm Syst <br /> pefStarYlon Cv}ES r NO <br /> b.The unauthoraed release consists only of petroleum info- &-}a r NObertl stopped <br /> c.The unauthorized('P <br /> Pinery')release from the UST s stem has P tiol Encountered r YES r NO <br /> d.Free product has been removed to the Tax'mum eeztenPret.anE �me release has been developed Liyl <br /> g A conte lust site mode]that assesses the nature, <br /> Description(Check all that PPPIY): <br /> r GW Net Evaluated <br /> Groundwrter Assessment IncomPlele-Areal Extant of rmaron Net DNot Oefi <br /> med <br /> I+ Groundwater Assessment In y Mints Depth of Contamination Not peened <br /> r YES Q NO <br /> r Hydrogeology Not Adequately Mined <br /> r Poianii,Receptors Not Iderdi led <br /> F7 Soil Assessment Incomplrte-Areal Extent Not Corned <br /> 'r Soil Assessment Incomplete.Depth Unknown <br /> F-Soil Vapor Not Evaluated <br /> F_ <br /> Other re YESNO <br /> source has been removed to the extent practicable hd /y <br /> I,Secondary '«sed�F YES f NO <br /> g.Soil or groundwater has been tested for MTBE and results reported in accordance wdh Health and Safety Code Secbo^ r YES 5 W <br /> 25298.15. 13050. O <br /> h.Does a nuisance exist,as defined by'p t Codesem ob ecyves is Stable or decreasing in t and <br /> A j Vis .9V+E4 NO <br /> 1.Media-Speciflc Criteria:Groundwater-The fthefivecl saes thatexceedswater 9uaFty 1 <br /> meets it of the additional characteristics of one of the five classes -sites listed below.- L r y� ANO <br /> EXEMPTION-Soil Only Case(Release has 131 Affected Groundwater•tats) <br /> of the Groundwater specific criteria scenarios? �,l_L0 <br /> YES 4r.-NO <br /> Goes the site meet any IIq.rDr F <br /> co <br /> ADOITIONAL QUESTIONS <br /> please <br /> aselindicaner Gust Obco <br /> ject vonly theseas)ndltions that do 000 Feel th G'Unknown criteria: <br /> Plume Length( r z 2rcp peat and<1 000 Feel r'z 1, <br /> n z 100 Feet and<250 Feet <br /> Plume is Stable or Decreasing in AREAL Extent: <br /> r No F Unknown <br /> Free Product in GmundU laT: <br /> r yes r No <br /> rawn <br /> Free Product Has Been Removed to the Maximum Extent practicable 1 <br /> r No r Unknownfor 5-Years(Info): <br /> For sites with free product,the Plume Has Bean Stable or Decreasing <br /> C No r Unknownuired <br /> For sites with free product,owner Willing to Accept a Land Use Restriction(if req <br /> C No r Unknown <br /> Free Product Extends Offsite <br /> C Yes r Unknown <br /> Benzene Concentration: Y3 pp0 pg0 c U^known <br /> r.1 000 pgn and<3,000 pgll '� <br /> MTBE Concentration <br /> r z 1,000 light C' Unknown <br /> Nearest Supply Wall(From Plume Bounce Feet r U^k^OW^ f <br /> rs250Feet r'>250Fset and s1, <br /> Nearest Surface <br /> G 5250 FeetW_ ..r Body(From plum.Boundary) <br /> rUnknown <br /> 50 Feel and 5 1000 Feel <br /> Atr'The site is consi -b Sion-td-airpathwayifsite <br /> de2dlow-thetxIM�dPor- <br /> 1e—vaoor Intrualon o Io - <br />