HomeMy WebLinkAbout_196 Suburban Hazmat DocsI
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SITE CHARACTERIZATION REPORT
SBC FACILITY
196 SUBURBAN ROAD
SAN LUIS OBISPO, CALIFORNIA
Prepared for:
Mr. Jim Stehr
SBC Services, lnc.
2600 Camino Ramon, Room 3E000
San Ramon, California 94583
Prepared by:
Shaw Environmental, lnc.
4005 Port Chicago Highway
Concord, California 94520
Shaw Project No. 844915.37
February 2004
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CNCD\O:S HARE\USTU.t-0026.doc
Table of Contents
List of Tables
List of Figures...
List of Appendices .......
1.0 Introduction.....
1.1 SiteDescription.........
1.2 Site Background
A. 1995 UST Removal
B.2OO3 UST Removal.... .. ...
2.0 Scope of Work
3.0 Work Performed.
3.1 Work Plan, Permitting, and Health and Safety Plan
3.2 Underground Utility Location
3.3 Soil Borings and Sampling..................
3.4 Soil Sample Analytical Results
3.5 GroundwaterSampling
3.6 Groundwater Sample Analysis and ResuIts....................
3.7 Well Abandonment....
4.0 Conclusions
5.0 References.....
6.0 Signatures
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List of Tables
Tahle
List of
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Title
Soil Sample Analytical Results - January 2004
Groundwater Sample Analytical Results- January 2004I
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Figure Title
Site Vicinity Map
Tank Pit Excavations March 1995
Tank Pit Excavation June 2003
Boring Locations
Soil Sample Analytical Results
Groundwater Sample Analytical Results
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List of
Appendix Title
A
B
C
D
Correspondence from RWQCB
Approved Well Permit Applications
Soil Boring Logs
Laboratory Analytical Reports and Chain of Custody
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1.0 lntroduction
This report presents the results of site characteization activities conducted by Shaw
Environmental, Inc. (Shaw) on behalf of SBC at its facility located at 196 Suburban Road, San
Luis Obispo, California (Figure 1). The activities were required by the Central Coast Regional
Water Quality Control Board (RWQCB) to evaluate subsurface conditions in the vicinity of a
dual compartment unleaded gasoline and diesel underground storage tank (UST), that was
recently removed from the site.
The investigation involved the advancement of fifteen direct-push soil borings, collection of soil
and groundwater samples,from the borings, sample analysis and data evaluation- Field activities
presented in this report were performed by Shaw on January 27 and28,2004.
1.1 Site DescriPtion
The SBC property is located in a predominately industrial section of San Luis Obispo, California.
The central portion of the site is occupied by a one-story building housing offices and telephone
maintenance equipment. A fleet vehicle maintenance garage is also located in the center of the site,
with a vehicle wash area immediately to the east of the garage. The remainder of the site contains
parking for SBC fleet and personal vehicles and cable reel storage.
A dual-compartment UST and associated dispenser island used for the refueling of SBC fleet
vehicles were located within the western portion of the site. The UST contained an 8,000-gallon
compartment containing unleaded gasoline and a 2,000-gallon compartment containing diesel fuel.
The tank was removed in June 2003, after SBC decided to perform all further vehicle fueling at
offsite, third party facilities.
1.2 Site Background
A. 1995 UST Removal
In March lggs,two 10,000-gallon gasoline USTs and a 4,000-gallon diesel UST were removed
by ATEC Associates, Inc., from two separate onsite excavations located southwest of the main
SBC building (ATEC, 1995). Upon removal, one of the gasoline USTs was reportedly
accidentally punctured, causing the release of some of the contents of the UST into the
excavation. March 1995 tank pit excavations are depicted in Figure 2.
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Analysis of groundwater samples collected from the gasoline excavation indicated elevated total
petroleum hydrocarbons as gasoline (TPH-G) and benzene, toluene, ethylbenzene, and xylenes
(BTEX) constituents. Analysis of the groundwater sample collected from the diesel UST
excavation indicated no detectable petroleum hydrocarbons.
Following removal of the tanks, a backfill well was set into the former gasoline tank excavation.
In September 1995, the well was sampled by ATEC personnel (ATEC, 1996). TPH-G was
encountered in the water sample at a concentration of 600 parts per billion (ppb); no BTEX
constituents were detected. Due to the minimal amount of water present in the well
(approximately I inch at a depth of 1O.22 feet below surface grade [bsg]), development or
purging of the well prior to sampling was not performed.
An onsite water well was sampled at the request of the RWQCB, to further evaluate site water
quality, as the presence of methyl tertiary butyl ether (MTBE) has been encountered in local
groundwater. Analysis of water well samples collected in July L997 and October 2002 indicated
no detectable MTBE. In July 2003, the backfill well was decommissioned at the request of the
RWQCB (Shaw, 2003a).
A. 2003 UST Removal
In June 2003, the 10,000-gallon dual compartment UST was removed. The June 2003 tank pit
excavation is depicted in Figure 3. Analysis of soil samples collected from the excavation
detected total petroleum hydrocarbons as diesel (TPH-D) at concentrations up to 6.6 parts per
million (ppm). MTBE was also encountered in one of the soil samples at a concentration of
0.0067 ppm. TPH-G, BTEX, and the fuel oxygenates tert-amylmethyl ether (TAME), ethyl tert-
butyl ether (ETBE), di-isopropyl ether (DIPE), or tert-butyl alcohol (TBA) were not detected in
any of the soil samples. Groundwater was not encountered in the excavation (Shaw, 2003b).
Upon receipt of the soil analytical results, an additional 160 cubic yards of soiVfill material was
over-excavated. During over-excavation activities, groundwater was encountered at a depth of
L3r/zfeetbsg. Analysis of the confirmation soil samples collected reported TPH-D at
concentrations up to 4.5 ppm. No TPH-G, BTEX constituents, or fuel oxygenates (including
MTBE) were detected in the analysis of the soil samples. No TPH-D, TPH-G, BTEX
constituents, or fuel oxygenates were detected in the groundwater sample collected.
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The Regional Water Quality Control Board-Central Coast Region (RWQCB) requested
additional assessment of soil and groundwater quality in the area of the UST. A work plan
(Shaw, 2003c) was submitted to the RWQCB and subsequently approved on November 19, 2003
(Appendix A). The plan was implemented in January 2004. The results of the assessment
activities are presented in this report.
2.0 Scope of Work
The investigation included drilling and sampling of fifteen direct push soil borings, collection and
analysis of soil and groundwater samples, and evaluation of the field and analytical data.
3.0 Work Pertormed
The work included the following activities:
3.1 Work Plan, Permitting, and Health and Safety Plan
A work plan was developed to outline procedures for the field investigation and submitted to the
RWQCB for approval (Shaw, 2003c). Upon approval from the RWQCB, the County of San Luis
Obispo, Public Health Department (SLOPHD) was notified of the proposed drill date. Permits
were required by the SLOPHD for the installation of the fifteen direct push soil borings. Copies
of the approved well permit applications are included in Appendix B. A site-specific health and
safety plan was developed and reviewed in a tailgate health and safety meeting, conducted the
day of the field work to review safety measures.
3.2 Underground UtilitY Location
Underground Service Alert (USA) was contacted and notified of the anticipated drilling locations
and date of field activities. Additionally, Subdynamic Locating of San Jose, California was used
to locate underground utilities near the anticipated drilling locations.
3.3 Soil Borings and SamPling
On January 27 and28,2004, Vironex of San kandro, California, advanced fifteen direct-push
soil borings at the site, under the direction of Shaw personnel.
Fifteen soil borings, labeled SB-1 through SB-15, were advanced utilizing direct-push sampling
equipment. Soil boring locations are depicted in Figure 4. The boring locations were selected in
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order to evaluate the lateral and vertical extent (if any), of fuel constituent migration from the former
UST system.
All borings were advanced to a total depth of 16 feet bsg. They were continuously cored using a
48-inch long core sampler lined with clear lexan sample tubes. Soil cores were logged, when
feasible, by a Shaw geologist in accordance with the ASTM visual- manual method of soil
classification. In general, native soils encountered in the borings were characteized as clayey
silts and silty sands underlain by chert gravel to the termination of the borings. Soil boring logs
are located in Appendix C. Soil samples were collected for laboratory analysis of petroleum-
hydrocarbon impact. No visual or olfactory indications of petroleum-hydrocarbon impact were
noted during handling of the soil samples.
The soil samples were sealed with teflon tape and plastic end caps, labeled, and placed in an
insulated chest with ice, pending transport to the laboratory. Sample collection, handling, and
transport were documented using chain of custody procedures.
In order to minimize the potential for cross contamination between borings, the down hole
equipment was washed after each boring. Drill cuttings were stored in labeled 55-gallon drums
for on-site storage pending disposal.
3.4 Soil Sample Analytical Results
A total of thirty soil samples were submitted for analysis to McCampbell Analytical Inc., an
ElAP-certified laboratory located in Pacheco, California. Soil samples were analyzed for
TPH-G and TPH-D by EPA method 8015 (modified) and for BTEX constituents by EPA method
8020. The samples were further analyzed for the fuel oxygenates MTBE, TAME, ETBE, DIPE,
and TBA by EPA method 82608.
TPH-D was detected in twelve of the thirty soil samples at concentrations up to 7.9 ppm in
sample SB-14(5'). Ethylbenzene and xylene were detected in three soil samples at
concentrations up to 0.034 ppm and 0.18 ppm, respectively. None of the remaining soil
samples contained detectable concentrations of petroleum hydrocarbon analyes including the
fuel oxygenates. Table 1 and Figure 5 summarize the laboratory analytical data for soil. A copy
of the laboratory analytical report and chain of custody is included in Appendix D.
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3.5 Groundwater SamPling
Temporary PVC well casings were placed in the borings. Five-foot lengths of 0.010-inch slot
well screen and unperforated lengths of riser casing were placed in each boring. Groundwater
entered each well to approximate depths ranging from 13 to 15 feet bsg. Grab groundwater
samples were collected from the temporary wells using new tubing equipped with a check ball.
No petroleum sheen or odors were noted during sample collection. The groundwater samples
were labeled and placed in an insulated chest with ice, pending transport to the laboratory. One
field blank sample was collected for quality assurance purposes. Sample collection, handling,
and transport were documented using chain of custody procedures.
3.6 Groundwater Sample Analytical Results
A total of fifteen groundwater samples were submitted for analysis to McCampbell Analytical
lnc. Groundwater samples were analyzed for TPH-G and TPH-D by EPA method 8015
(modified) and for BTEX constituents by EPA method 8020. The samples were further analyzed
for the fuel oxygenates MTBE, TAME, ETBE, DIPE, and TBA by EPA method 82608-
TPH-D was detected in all groundwater samples collected at concentrations ranging from 87 ppb
in sample SB-5W to 2,600 ppb in sample SB-9W. Xylenes were detected in samples from only
two wells, SB-IW (1.9 ppb) and SB-4W (2.S ppb). MTBE was detected only in sample SB-3W,
at a concentration of 1.1 ppb. None of the remaining groundwater samples contained detectable
concentrations of petroleum hydrocarbon analytes. Table 2 andFigure 6 summarize the
laboratory analyical data for groundwater. A copy of the laboratory analytical report and chain
of custody is included in Appendix D.
3.7 Well Abandonment
Upon completion of the sampling and withdrawal of the temporary well casings, each borehole
was backfilled with a cement-bentonite grout and patched with cement.
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4.0 Conclusions
Based on the field observations and laboratory analytical data presented in this report, Shaw
concludes the following:
Groundwater depths ranged between 13 and 15 feet bsg.
TPH-D was detected in twelve of the thirty soil samples at concentrations up to
7.9 ppm in sample SB-14(5'). Ethylbenzene and xylenes were detected in three
soil samples at concentrations up to 0.034 ppm and 0.18 ppm, respectively.
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MTBE was not encountered in any of the soil samples
TPH-D was detected in all gtoundwater samples collected at concentrations
ranging from 87 ppb in sample SB-5W to 2,600 ppb in sample SB-9W. Xylenes
were detected in only two samples from wells SB-IW (1.9 ppb) and SB-4W (2.8
ppb)
MTBE was only detected in groundwater sample SB-3W at a concentration of
1.1 ppb. This concentration is below all published groundwater action levels or
risk thresholds.
Elevated TIIP-D groundwater concentrations were detected in samples from
adjacent locations that were east of and removed from the 2003 UST excavation.
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5.0 References
ATEC Environmental Consultants (ATEC, 1995), Report of Findings, Underground Storage
Tank Removal, Pacffic Bell, 196 Suburban Road, San Luis Obispo, California, June 21, 1995.
ATEC Environmental Consultants (ATEC,1996), Groundwater Monitoring Report, September
1995, Pacifi.c Bell, 196 Suburban Road, San Luis Obispo, Califurnia, February 16,1996.
Shaw Environmental, Inc. (Shaw, 2003a), Letter Report for Well Destruction Activities, SBC
Facility, 196 Suburban Road, San Luis Obispo, Califurnia, August 7,2003.
Shaw Environmental, Inc. (Shaw, 2003b), Underground Storage Tank Removal Report, SBC
Facility, 196 Suburban Road, San Luis Obispo, Califurnia, August 2003.
Shaw Environmental,Inc. (Shaw, 2003c), Work Planfor Sensitive Receptor Survey and Site
Characterization Activities, SBC Facility, 196 Suburban Road, San Luis Obispo, Califurnia,
October 2003.
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6.0
The interpretations and conclusions contained in this report represent our professional opinions.
These opinions are based on currently accepted engineering ilractices at this time and for this specific
site. No additional warranty is implied or intended.
Report prepared by:
Project Geologist
Shaw Environmental, Inc.
Report reviewed by:
Program Assurance
Shaw Environmental, Inc.
Report reviewed by:
Dan Wynne, R.G., C.E.G., C.H.G
Califomia Registered Geologist
Shaw Environmental, Inc.
The work described in this report was performed under the direct supervision of a State of California
Registered Geologist.
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Tables
CNCD\O: SHARE\UST\M-0026.doc
IL-TABLE 1Soil Sample Analytical Results - January 2004SBC FacilitY196 Suburban RoadSan Luis Obispo, CaliforniaNotes:bsg- below surface gradeTPH-G- total petroleum hydrocarbons as gasolineTPH-D- total petroleum hydrocarbons as dieselMTBE- methyl tertiary butyl etherFour Fuel Oxygenates - tert-amyl methyl ether (TAME), ethyl tert-butyl ether (ETBE), di-isopropyl ether (DIPE), and tert-butyl alcohol (TBA)ND*- not detected above "x" laboratory detection limits--- - not analyzedTPH.GTPH.DBenzeneTolueneEthylbenzeneXylenesMTBEFour FuelOxygenatesresultsinmillion)NDs.sq5-e.s25NDg.se5-e.s25ND6.6e54.625ND6.665-s.s25ND6.665-6.e25NDo.oo5-0.025ND6.665-6.s25NDe.s95-e.e25NDs.965-e.s25ND6.ss5a.625NDs.oo5-e.e25ND6.665-s.e25NDe.so5-6.e25NDs.ee5-q.e25NDe.ee5-e.s25ND6 665-6 625NDo.oo5NDo.oo5NDo.oosND6.665NDooosNDo.oo5NDs.so5NDo.oo5NDo.oo5NDo.oosNDo.oosNDo.oo5ND6.665NDe.qe5ND6.s65ND6 n650.18ND6.6650.081NDo.oosNDo.oo5NDs.oo50.071NDe.so5NDo.oo5NDo.oo5ND6.se5NDs s65NDo.oo5ND6.665NDs.6s5ND6.6650.034ND6.s650.014ND6.665ND6.665NDo.oo50.011ND6.665NDs.oo5ND6.665NDo.oo5ND6665NDo.oo5NDo.oosNDo.oo5ND6.665ND6.665NDe.so5NDs.ss5NDo.oo5NDo.oo5NDo.oo5NDs.se5ND6.665ND6.665NDe.s65ND6.665NDooo5ND6.6s5NDe.sq5NDo.oosND6665ND6.ss5ND6.665NDo.oo5NDqoo5NDo.oo5NDe.ee5NDo oo5NDo.oosNDe.6e5NDo.oo5NDs.ee5NDo.oo5NDe.ee5NDo.oosNDe.ee5NDo.oos1.6ND1.ot.4NDro1.0ND1.62.3ND1.qt.4NDr.oNDr.oNDr oNDr.oNDr.oNDroNDr.oNDr.oNDr.oNDr.oNDroNDr.oNDr.oNDr oND1.oNDr.oND1.oNDr.oNDr.oNDr,oNDr oNDr.oND1 6Date CollectedU2712004r/27/2004r/27/2004v2'7t2004u27t2004U27t2004u27t2004t/27t2004u27t2004U27t2004u27t2004U27/2004U27t2004U27t2004r/2712004U27/2004Sample Depth(bss)5 feet10 feet5 feet10 feet5 feetl0 feet5 feet10 feet5 feet10 feet5 feetl0 feet5 feet10 feet5 feet10 feetSample LocationSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSample I.D.sB-r (s')sB-1 (10')sB-2 (5')sB-2 (10')sB-3 (s)sB-3 (10)sB-4 (s)sB-4 (10)sB-s (s')sB-s (i0)sB-6 (s')sB-6 (10')sB-7 (5')sB-7 (10')sB-8 (s')sB-8 (10')
TABLE 1Soil Sample Analytical Results - January 2004SBC FacilitY196 Suburban RoadSan Luis Obispo, CaliforniaNotes:bsg- below surface gradeTPH-G- total petroleum hydrocarbons as gasolineTPH-D- total petroleum hydrocarbons as dieselMTBE- methyl tertiary butyl etherFour Fuel Oxygenates - tert-amyl methyl ether (TAME), ethyl tert-butyl ether (ETBE), di-isopropyl ether (DIPE), and tert-butyl alcohol (TBA)ND*- not detected above "x" laboratory detection limits--- - not analyzedTPH.GTPH.DBenzeneTolueneXylenesMTBEFour FuelOxygenatesresultslnND6.e65-e.e25NDs.e65a.q25NDs.oo54.s25NDs.ss5-s.625ND6.665-6.625NDo.ooso.o2sNDe.qq54.e25NDe.ss5-e.s25NDe.so54.e25NDe.es5-s.s25NDs.oo5-e.625NDo.oos-0.025NDo.oos-o.ozsNDo.oo5-0.025NDo.oosNDo.oo5NDo.oosNDs.oo5NDo.oo5NDs.so5ND6.6e5NDs.se5NDs.so5NDo.oosNDs.ss5ND6.e65ND6.sq5NDs.so5NDo.oo5NDo.oo5NDo.oo5NDs.eq5NDe.qs5NDo.oosNDs.oo5NDooo5NDo.oosNDs.se5NDo.oosNDo.oo5ND6.6e5NDo.oosND6.665NDe.so5NDe.es5ND6.665NDs.oo5NDe.ee5ND6.665NDsoo5ND6.6e5NDe.ss5NDs.oo5NDe.ee5ND6.ss5ND6.665ND6.s65NDs.qo5ND6.s65NDo.oo5ND6.665NDooo5NDo.oo5ND6.665NDo.oosNDo.oosNDo.oo5NDo.oo5NDs.665NDe.es5NDo.oo5ND6.6s5NDe.so5NDe.s65ND6.ss5ND6.se5ND6.ss5NDs.ee5NDo.oo5NDq.ee5ND6.665NDs.ee5ND6.665NDe.6s5NDr.o1.21.8NDr.oNDl.oND1.6ND1.6ND1.o2.41.57.92.7ND1.6r.2ND1.oNDroND1.sNDr.oND1.oNDroNDr.oNDr.oNDr.oNDr.oNDl oND1.oNDt.oNDr.oDate CollectedU28t2004U28t2004v28t2004L/28t2004u2812004U28t2004U28t2004U28t2004U28t2004U28t2004t/28t2004u2812004u28/2004u28t2004Sample Depth(bsg)5 feetl0 feet5 feet10 feet5 feet10 feet5 feet10 feet5 feet10 feet5 feet10 feet5 feet10 feetSample LocationSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSample I.D.sB-9 (s)sB-9 (10)sB-10 (s')sB-10 (10')sB-11 (5)sB-rl (10')sB-12 (5')sB-12 (10')sB-13 (s')sB-13 (10)sB-14 (s)sB-14 (10)sB-1s (s')sB-ls (10)
)TABLE 2Groundwater Sample Analytical Results - January 2004SBC Facility196 Suburban RoadSan Luis Obispo, CaliforniaNotes:bsg- below surface gradeTPH-G- total petroleum hydrocarbons as gasolineTPH-D- total petroleum hydrocarbons as dieselFour Fuel Oxygenates - tert-amyl methyl ether (TAME), ethyl tert-butyl ether (ETBE), di-isopropyl ether (DIPE), and tert-butyl alcohol (TBA)MTBE- methyl tertiary butyl etherND^- not detected above "x" laboratory detection limits--- - not analyzedTPH.GTPH.DBenzeneTolueneEthylbenzeneXylenesMTBEFour FuelOxygenates(All resultslnNDs.5-5.6NDq.5-5.6NDo.5-5.0NDs.5-5.sNDo.s-s.oNDe.5-5 sNDs.5-5.eNDo.s-s.oNDo.5-5.0NDo.5-5.0NDo.5-5.0NDs.5-5.eNDo.s-s0NDo.s-s.oNDs.5-5.eNDo.5-5.0NDo.5ND6.51.1NDo.5NDo.5NDosNDo.5NDo.sNDosNDosNDo5NDo.5NDo.sNDo.sNDo.sNDo.s1.9NDo.sNDo.52.8NDo.sNDo.5NDo.5NDosNDo.sNDo5NDo.5NDo.sNDo.sNDo5NDosNDo.sNDo.5NDosNDosNDe.5NDo.5NDo.5NDs.5NDo.5ND6.5NDo.5ND6.5NDe.5NDo.sND6.5NDo.sNDo.5NDo.5ND6.5NDo5NDo.5NDo5NDo.5NDo.5NDo.5NDo.5NDo.5NDo.5NDo.5ND65NDo.5NDo.sNDo.5NDo.5NDo.5NDo.5NDo.5ND6.5NDo.5ND6.5NDo.sNDo.sNDosNDo.sNDo.sNDosND6.5NDo.5NDo.s3201003301300873201200180026005408901800790200620370ND50ND5eND50ND50NDsoNDsoND5oND50ND56ND5oNDsoND56NDsoND56NDsoNDsoDate CollectedU27t2004t/27t2004U27t2004U27t2004U2',1t2004u27t2004u2712004r/27/2004U28/2004L/28t2004!28t2004U28t2004u28t2004v2812004U28t2004t/28t2004Sample Depth(bsg)13.5 feet13 feet13 feet15 feet14 feet14 feetl4 feet13 feet13 feet13 feet14 feet1 3 feet14 feetI 3 feet13 feet13 feetSample LocationSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSoil BoringSample I.D.SB-IWSB-2WSB-3WSB-4WSB-5WSB-6WSB-7WSB-8WsB-9WsB-10wsB-1lWsB-12WsB-13WsB-l4wsB-l5wFB.I
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Figures
CNCD\O:SHARE\UST\04-0026.doc
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SAN RAMON, CALIFORNIA
FIGURE 3
TANK PIT EXCAVATIONS JUNE,
2003
SBC FACILITY
I96 SUBURBAN ROAD
SAN LUIS OBISPO, CALIFORNIA
CHAIN-LINK
FENCE
f ASPHALT-PAVED
PARKING LOT
APPROXIMATE EXTENT
OF EXCAVATION
r--
GARAGE
L
ER IO.OOO-GALLON
SPLIT-WALL
cAsoLrNE/DtEsEL UST
(REMOVED JUNE 11. 2003)
SUBURBAN ROAD
SCALE
0
tdo
E
(,
SBC OFFICE BUILDING
BLOCK WALL
{-
ASPHALT-PAVED
PARKING LOT
70 140 FEET
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SAN RAMON, CALIFORNIA
Shaw E&l,lrn
BORING LOCATIONS
SBC FACILITY
196 SUBURBAN ROAD
SAN LUIS OBISPO, CALIFORNIA
FIGURE 4
CHAIN-LINK
FENCE
ASPHALT_PAVED
PARKING LOT
sB-14to
sB- rbI
irr-,0 =r-.,,loo
SB-13o
sB-r2o
APPROXIMATE EXTENT
OF EXCAVATION
SB-a
SB-8 1-7 SB-9
GARAGEo
SB
J
FORMER 4.OOO_GALLON
DIESEL UST
(REMOVED MARCH, 199s)
REPUCED BY FORMER
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(REMOVED JUNE 11, 2003)
a
SB_5
O
SB_4
O SB-3
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IO.OOO GALLON USTS
(REMOVED MARCH, 1995)
O SB-2O SB-I
DERBLOCK WALL
ASPHALT_PAVED
PARKING LOT
SUBURBAN ROAD
LEGEND
o BoRTNG LOCATIoN
SCALE
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SAN RAMON, CALIFORNIA
Shaw E&l,lnc
sa"
FIGURE 5
SOIL SAMPLE ANALYTICAL
RESULTS
SBC FACILITY
I96 SUBURBAN ROAD
SAN LUIS OBISPO, CALIFORNIA
SB_15
( I -28-04)
sB-r4
(l -28-04)
SB-14
SB_I5
SB-10 59-1 1
SB_I3
(t -28-04)
SB-13
sB-12
APPROXIMATE EXTENT
OF EXCAVATION
sB-8
SB-7 SB-9
ASPHALT_PAVED
PARKING LOT
l -28-04)
5'
ND
WALL
CHAIN-LINK
FENCE
GARAGE
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(1 -28-04)
SB_9
(1 -28-04)
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r--
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(1 -27 -O4)
sB- I
(1 -27 -O4)
LEGEND
o
ND
TPH_G
TPH-D
BTEX
MTBE
FUEL OXY
4
SB-5
SB-3
GA sB- 1 SB-2
sB-2
(1 -27 -O4)
ASPHALT-PAVED
PARKING LOT
BORING LOCATION SUBURBAN ROAO
TOTAL PETROLEUM HYDROCARBONS AS GASOLINE
TOTAL PETROLEUM HYDROCARBONS AS DIESEL
BENZENE, TOLUENE, ETHYL BENZENE, AND XYLENES
METHYL TERTIARY BUTYL ETHER
TERT_AMYL METHYL ETHER, DI-ISOPROPYL ETHER'
ETHYL TERT BUTYL ETHER, T_BUTYL ALCOHOL
NOT DETECTED
ALL RESULTS REPORTED
IN PARTS PER MILLION
SCALE
70 1 40 FEET
SB-3
(1 -27-O4)
'lr
JL
0
ND-73.ND
NL}
I NU
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SAN RAMON, CALIFORNIA
FIGURE 6
GROUNDWATER SAMPLE
ANALYTICAL RESULTS
SBC FACIUTY
196 SUBURBAN ROAD
SAN LUIS OBISPO, CALIFORNIA
TPH-G ND
-D
t-G
t-D
ND
sB-l5W
(i -2s-04)
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(1 -28-04)
sB-1JW
(1 -28-04)
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SB-4
sB-t2w(1-28-04)
sB-t lw
(1 -2E-04)
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PARKING LOT
CHAIN_UNK
FENCE
sB-8W
L
sB-t0w(r-28-04)
sB-6W(1-27-o4)
sB-7W(1-27-o4)
SB-5W(1-27-o4)
LEGEND
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SB-15
10
f
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-04)-27(1
sB-l 1
---t
sB-6 sB-7
sB-gW
(1 -28-04)
sB-3
'lr
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TPH-G
TPH-D
BTEX
MTBE
FUEL OXY
SB_1 SB-2
BORING LOCATION SUBURBAN ROAD
TOTAL PETROLEUM HYDROCARBONS AS GASOLINE
TOTAL PETROLEUM HYDROCARBONS AS DIESEL
BENZENE, TOLUENE, EI-HYL BENZENE, AND XYLENES
METHYL TERTIARY BUTYL ETHER
TERT_AMYL METHYL ETHER, DI-ISOPROPYL ETHER,
ETHYL TERT BUTYL ETHER, T-BUTYL ALCOHOL
NOT DETECTED
ALL RESULTS REPORTED
IN PARTS PER BILLION
ND
SCALE
70o 1 40 FEET
TPH-G
TPH-D
tt
T
F
x
MIt'L ND
TPH-G ND
-ll
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TD-TD-
TPH-G ND
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ND-ND-
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(
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ASPHALT-PAVED
PARKING LOT
TPH-G
{-F'
tL NU
rl
l
Appendix A
Correspondence from RWQCB
CNCD\O: SHARE\UST\04-0026.doc
Dec 24 03 O9:43a RLTQCB Central t-oast UUJ iIJ UJ:' /F- r
Arnold Schwrrzcueggcr
GovenorTrmmlnen
7^n-urylor
umaatal
rroleclion
California Regional Water Quality Control Board
Central Coast Region
1
I
\
I
lfl tcmct Addrcss: h(F://www-swrcb.ce.gov/rwqcb3
895 Aemvista Placc, Suitc l0l. Sun Luis Obispo. California 93401
Phonc (805) 549-l l4? ' FAX (t05) 541439?
November 19, 2003
Post-at" Fax Note 7671
SBC
Mr. Andy TaYlor
P-O. Box 5095, Room 3E000P
San Ramon, CA 94583-0995
Dear Mr. TaYlor:
I ucT: 196 SUBURBAN ROAD, SAN LUIS OBTSPO COUNTY; PACrFtc BELL
I naCtLITy - woRK PLAN C6NCURRENCE (RwQcB cAsE No. 3s18)
Regional Board has reviewed Shaw Environmental and Infastructure's, (Shaw) October 2003'
WJ* pbn for Sensitive Receptor Survey and Site Characterization Activities for the
underground storage tank (UST) site referenced above, and discussed the proposed scoPe of work
;ith ;; torrr,rltilt, Mr. Rob Delnagro. The work plan proposes the following: conduct a
sensitive receptor survey to identify *it"r welis and off-site petroleum sources; drill and sample
approximately fifteen,Lit Uori.gs to an estimated depth of 16 feet below ground surface (bgs);
ciitect and analyze soil samples at five and ten foot bgs; convert borings to temporary groundwater
monitoring *"ilr, sample groundwater, and anallze samples; analpg,soil.and groundwater
samples 6r total peholeum hydrocarbons reported as gasoline (TPH-g), benzene, toluene,
ethylbenzene, and xyL"nes (BTiX), antl methyl tcrtinry-butyl ether (MTBE). In addition, the
location of proposed soil borings/temporary rnonitotiog wells has been revised as discussed with
Mr. Delnagro io incorporate former iJst-1rr.oved March 1995) excavation, dispenser islands
and down gradient area. Please provide revised Boring Location Figure and include the March
1995 UST excavation, dispenser islands and piping locations.
please provide a comnlete soil and sroundwater investigation renort to this offrce and San
Luis oiispo city . Authority for thil request is made
pursuant tt ttre provisions-of section 13267 of the California Water Code (CWC). Pursuant to
section 1,3268 of the CWC, a violation of a rcquost made pursuant to CWC section 13267 may
subject you to civil liabiliry of up to $1,000 pir day. The Regional Board needs the required
informaiion in order to evaluate water quality at the site and to provide technical and regulatory
oversight for the investigation and cleanup of impacted groundwater. You are being required to
submit this information -as the rosponsible party ior the unauthorized release discovered beneath
the subject facility. More detailed informaiion is available in the Regional Board's public file on
this matter. Any person affected by this actiou of the Regional Board may-petition the State
Water Resources Control Board (State Board) to review tlie action in accordance with section
13320 of the cwc and Title 23, califomia code of Regulations, section 2050. The state Board
must rereive the petition within 30 days of the date of this order. copies of the law and
regulations applicable to filing petitions will be provided upon request.
Enviro n m ental P rotectio n Age n qt
P"h f\rTo n[tfi N Fro", C$'ru,r t 0 a[< h
Co./Depl.Co-\
Phone f Phone d
r"' * cf l.s ga1 -^Olq Fax #
Caldornla
€Reqc'ld Papcr
t2/24/03 lvED 09:23 ITX/RX NO 65371 @001
Dec 24 ()3 O9:44a RIdQCB Central Coast IJUS 5+3 UJJ /P-€.
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2 November 19' 2003
"1
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In addition, pursuant to section 25296.20 of the California Health and Safety Code (CH&SC) the
R"gion"t rioara is required to notify all current fee title holders of the subject site prior to
ooririaerirrg correctivelction or case closure. Since you are identified as the curtent primary or
active responsible party for corrective action and cleanup at the subject site, we are requesting
that you provide u. *iti. a complete mailing list of all record fee title holders for the subject site. '
If you trave any questions, please contact Corev Walsh at.(805) 512-4781' Please provide this
ofi". with 48 hours notice prior to the start of any fieldwork activities'
Sincerely,
Mr. Andy Taylor
196 Suburban Rd.
Briggs
Officer
S:\|CB\USA\Corey\San Luis Obispo\196 Suburban\WorkPlanApp'doc
go
Mr. Rob Delnagro
Shaw Environmental, [nc-
4005 Port Chicago HwY
Concord, CA 94583
Mr. Kerry Boyle
City of San Luis Obispo
City Fire Department
2160 Santa Barbara Avenue
San Luis Obispo, CA 93401'5240
Mr. Mark Matranga
State.Water Resources Control Board
Division of Clean Water
Underground Storage Tank Cleanup Fund
P.O. Box 944212
Sacramento, CA 9 4244-21'20
Enviro nmentdl Protectio n Agen qt
lw,
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California
€!fueq'cld Papt
L2/24/03 WED 09:23 ITX/RX NO 6537I @OOZ
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s
Appendix B
Approved Well permit Applications
CNCD\O: S HARE\UST\04-0026.doc
.. couNTY qF sAN LU|S OBTSPO
PUBLIC FIEALTH DEPARTMENT
Environrnental Health Services
2156 Siera Way . p.O. eox t4AS
San Luis Obispo, CA 93/()6_1489
Phone: (B0S) 281_5544 FAX: (805) 781_4211
-j^ t i-.
Application Approved E } \('
.-tl\. t&/i. Y ,.,f.ji
OFFICE USE
Permit t, --
^'fr" of Drilling Contractor
jilling Company Name
WELL PERMIT APPLICATION
By:
Phone No.
C-57 License No. '7 f> Tq ,."1-7
? ';Phone No t{} -/t.: !
Business Address
WellType
Construction
'*f*
i t',V; r,{,l."l t^.;{e..
1d, {+" 4- Casing Diameter
drilling into a water bearing formation that has the
Annular Seal Depth
potential to degrade a higher qualig aquifer?Yes n No Fl
USE Y
FeePaid$ **l Ci -*-Check #*,--r(
r
W
Drilling Method
-pstruction
n!OailModify
tnbctivation
!tr
utr
Rotary
Reverse Rotary
Air Rotary
Cable Tool
Other
I
foRosed Depth
*$ you anticipate
lf yes, please
ithere any known
jlenium, hydrogen
potential to encounter a water bearing formation where levels of water quality constituents suchsulfide, boron, organics , etc., are a concern?Yes !No F_tf yes,please explai
as nitrate,
agree to comply with all applicable laws and regulations of the County of San Luis Obispo and the State of Californiaingto well construction, d estruction, repair or modification Within fifteen days after completion of the well, lwillfurnishEqvironmental
lvironmental
1
Health Services with a completed well log. This application becomes a va lid permit following sign off byHealth Services.
Sign
1
. hceived By Date
Well
'ie_1
Com ments for Drilling Contractor
Site Approved yes Eftto g By
Letter
Well SealWitnessed? yes I No f]
lell Site ApprovatGpS Coordinates
.,iell Seal GPS Coordinates
Date t
I
X-Conn Letter
Quality Testing Conducted? yes I No I Constituents Tested for
By Date
cipal Letter Sent? yes Date Comments
ROM ISSUANCE
SealDepth
Page 1 of 2
W
W
N
N
5'** I
of Well
Domestic Ptivate
Domestic Public
lrrigation
SoilTesting
Cathodic
lndustrial
Test Well
n!
repro I 184
No
PERMIT IS VALID FOR SIX M ONTHS F
0 \DOCUMENfv.icjnvve:i perm:: Atpli€tionl d€ :2-Maroz
d;i' *jq
, couNTY OF SAN LU|S OBtsPo
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . p.O. Box 1489
San Luis Obispo, CA 93406_1489Phone: (B0S) 781_SS44 F/'Jt: (SOS)781_4211
WELL PERII/IIT APPLICATION
OFFICE USE
Permit No.,icntF-iLrr-u *
-f':l
t
Application Approved E*''i I
Date I :?1 a?
By:
W
Cable Tool
Other
i t"d: "i]--.'
r r
Phone No-
\{>/1Itlme of Drilling Contractor
Jtting Company Name
) lstruction: ,pair/Modify
ndctivation
C-57 License No.-Vr:,a; .r .?
3usiness Address ti vd €r-^.llP hone No.t'..T': -,#
WeltType
lonstruction Drilling Method
Rotary
Reverse Rotary
Air Rotary ':.{_
' ltRoseO Depth
-J you anticipate
/{p -{ee4 Casing Diameter Annular Seal Depth
f yes, please expla
drilling into a water bearing formation that has the potential to degrade a higher quality a quifer? Yes No ELD
|here any known
lenium, hydrogen
potential to encounter a water bearing formation where levels of water quality constituents such as nitrate,sulfide, boron, organics, etc.,are a concern? yes tr tto Ef rr yes, please explain
comply with all applicable laws and regulations of the County of San Luis Obispo and the State of Californiaconstruction,destruction, repair or modification Within fifteen days after completion of the well, I will furnishHealth Services with a completed well This application becomes a valid permit following sign off byHealth Services.
Date 1 I l<' lu'lSigned
US Y
By Date { =)FeePaid$ *i t-1 Check #
trtr
1-i
nyironmental
,vrronmental
By
Quality Testing Conducted? yes
Date tXn Letter Special Requirements and/or
I I r.top
ByVellSealWitnessed? yes ! No I
lll Site ApprovalGpS Coordinates
- Jtt Seat GpS Coordinates
Constituents Tested for
Date SealDepth
W
W
N
N
I Letter Sent? yes Date Comments
CE Page 1 of2
d.E- I-r LJ 6.
of WellPu
Domestic Public
lrrigation
Cathodic
lndustrlal
Test Well
D
Dom estic Private Soil
repro I t84
No
PERMIT IS VALID FOR SIX MONTHS FROM ISSUAN
O:\DOCUMfNnricttv.Je!i perm;i F.rgticat:o111 6o^ ?2-Mar{z
:.$
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 78'14211
WELL PERMIT APPLICATION
OFFICE USE
Permit noJtX]l{-J.rLl *
Apptication Approved d;;l :;-'
-5).r)i-)
By:V,'#^-
t
i W\L Phone No.
"Jr"
jlling
of Drilling Contractor i '.- I.r ,1 i r )in
Company Name
Business Address
C-57 License No. .7f: ::i"? J ?
)Phone No. ';"!ij- "i"!:L"{ - }t,,}frt
Area of County
Range !;tr Section , { j
N W
il Well Site Address
Parcel No. l1$'.1*."-13',i- ilj ..i . Township
(acJes) *t ; q= ln Coastal Zone? fuO GPS Coordinates
Note: The "Well Permit Plot Plan'shallbe attached to this application and indicate within a two hundred foot radius around the
I pposed well the following items: A) Proper$ lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
: ]rer concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses, E)
srjrface water drainage pafter.n of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
surveyor's stake labeled "WellSite.' Drilling shallnot commence untilthis application is approved
WellType Drilling Method
Alsessor's
I jrcelSize
Sonstruction
l- lstruction
I jnair/Modifv
lnactivation
Rotary
Reverse Rotary
Air Rotary
n other- T.i,,rcc+ tr-iih
Tool
ii)
bi
posed Depth ig* {eei Casing Diameter Annular Seal Depth
you anticipate drilling into a water bearing formation that has the potential to degrade a higher quality aquifer? Yes D NoEl
lf yes, please expla
and regulations of the County of San Luis Obispo and the State of California
r or modification. Within fifteen days after completion of the well, I will furnish
becomes a valid permit following sign off by
Date lll-{ lu*l
t there any known potential to encounter a water bearing formation where levels of water quality constituents such as nitrate,
i|enium,hydrogensulfide,boron,organics'etc.,areaconcern?Yes[NoE1lfyes,pleaseeXplain-
lI ]ereby agree to comply with all applicable laws
cehaining to well construction, destruction, repai
Flvironme
t jvironme
ntal Health Services with a completed This application
ntal Health Services.
sig
ONLY
l
t.Jceived By Date
tr
Fee Paid $Check #
Date iir: li, y
Special Requirements and/or
")
es El'{.lo By
X-Conn Letter
Contractor
t-Quality Testing Conducted? Yes f| tto I
0/ell SealWitnessed? Yes I No I By
r btt Site Approval GPS Coordinates
r-.bll Seal GPS Coordinates
Letter Sent? Yes Date Comments
ANCE
SealDepth
Page 1 of 2
Constituents Tested for
Date
N
N
W
W
Purpose of Well
Domestic Private
Domestic Public
lrrigation
SoilTesting
Cathodic
lndustrial
TestWell
utr
Monitori
repro I 184
No
PERMIT IS VALID FOR SIX MONTHS FROM
OIDOCUMENT\.ichiVVe!: Perm:i Ailplicatlon 1.dG 22-Mar 42
rr&$
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . p.O. Box 14g9
San Luis Obispo, CA 93406-l/tggPhone: (80S) 781-5544 FAX: (SO5) 781_421,1
WELL PERMIT APPLICATION
OF USE
Permit
Application Approved
Date O-/
By:
Phone No.
C-57 License No. ln:;Q,s-s
- Ltii -
E-c {n
(*,
ii Ef'tme of Drilling Contractor
t jtting Company Name ilir t'i\.i{-.
hi
. -T:
Business Address
WellType
Construction
Srlr fr {f 7-}Phone No. S7**.!iT-t*71o 7 (F
W
r ]struction
JOair/Mooiry
Rotary
Reverse Rotary
Air Rotary
Method
Gable
Other
Tool
n
t
ioosed Depth
t-,tJ you anticipate
tf yes, please expla
lhere any known
ienium, hydrogen
l{" ,fe*{ casing Diameter
drilling into a water bearin g formation that has the
Health Services with a
Health Services
sig ned
I Date
Annular Seal Depth f\,
potential to degrade a higher quality aquifer?Yes *oE
potential to encounter a water formation where levels of water quality constituents such as nitrate,sulfide, boron, organics, etc.,
bearing
are a concern? yes fJ wo S[ tf yes,please
agree to comply with allapplicable laws and regulations of the County of San Luis Obispo and the State of Californiapertaining to well construction destruction, repair or modification.Within fifteen days afterFlvironmentalI Vironmental
J
l.Jceiveo ey
completion of the well, I will furnishwellThisapplicationbecomes a valid permit following sign off by
Date I I rI
ONLY
\
Fee Paid $ i. I --*
By
X_Conn Letter
Quality Testing Conducted? yes I No f]Constituents Tested for
Check #
Date I tAs
/'.
Special Requirements and/or
I
ffell Seal Witnessed? yes n
itt Site Approvat GpS Coordi
-, btt Seat GpS Coordinates
I Letter Sent?Date Comments
UANCE
SealDepth
Page 'l of 2
No fl By
nates
Date
W
W
N
N
Purpose of Well
Domestic Public
lrrigation
Cathodic
lndustrial
Test Well
n D
Domestic Private Soil
reoro I r84
Yes No
PERMIT tS VALID FOR SIX MONTHS FROM ISS
O:\DOCUMENT\rich\yve;i perm:: Aneticationl.doc Z2-Mat42
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . p.O. Box i4g9
San Luis Obispo, CA 93406-1489phone: (80s) 281_s5i4 rnx: tabsj'id14211
WELL PERMIT APPLICATION
OFFTCE USE
Permit Ho;=f' a1 { :'|L:il{., _
Application Approved g{. 1c1
Date I t j:, tr>.J
By:
me of WellOwner
Mailing Address
t'1me of Drilling Contractor
illing Company Name
Business Address
WellType
lonstruction
'tstruction;pair/Modify
nactivation
I
I Phone No.
C-57 License No.
Rotary
Reverse Rotary
Air Rotary
Phone No ::.;f *:!bE_:_? :ie&z_
W
Drilling Method
Cable Tool
Other
i iz,
' pRos"o Depth
,.1you anticipate
r- / t1i,:, -i etl'* Casing Diameter Annular Seal Depth
f
drilling into a water bearing formation that has the I to degrade a higher quality aquifer? yesI NoEl
potential to encoun ter a water bearing formation where levels of water quality constitue nts such as nitrate,sulfide, boron, organics, etc.,are a concern? yes n ruo S] tf yes, please
agree to comply with all applicable laws and regulations of the Cou nty of San Luis Obispo and the State of California:ertaining to well construction,destruction, repair or modification. Withinilvironmental: ]vironmentalj
Health Services with a completed
Health Services.
fifteen days after completion of the well , lwillfurnishwell log. This application becomes a valid permit.fol lowing sign off by
I
Date i lt o
Gheck #
Date
By -*'L t--
USE
Fee Paid $
Y
Date
/rrplt
.t:f
Site Approved yes [-no tr
Letter
By
n Letter
lomments for Drilling Contractor
Quality Testing Conducted? yes n No!Constituents Tested forUell Seal Witnessed? yes I r.to 3 By
J
Special Requirements and/or
l:tt
..Lrr
Site ApprovalGpS Coordinates
SealGPS Coordinates
Date SealDepth
Page 1 of 2
N
N
al Lefter
W
WSent? Yes Date Comments
ISSUANCE
*i,3-
Purpose of Well
Domestic Public
lrrigation
SoilTesting
Cathodic
lndustrial
TestWelt D
Domestic Private
Mon
reoro ilR4
No
PERMIT IS D FOR SIX MO NTHS FROM
O1DOCUMENTviclttn/eii perm:i A.rti.atiori.l dtr 22-MarO?
€4
t
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Siera Way . p.O. Box i489San Luis Obispo, CA 93406-14g9Phone: (805) 781_ss44 FAX: (805) iil<ztt
OFFICE USE
Permitto,q[I...{'{;[-\LU
Application Approved U;'t::
,l;t -] I *Ll
By:
WELL PERMIT APPLICATION
|r" orWettowner
Mailing Address
Business Address
WellType
Phone No.
!l r f.
fme of Drilting Contractor
iilling Company Name
"-T'r i
j."'
'7-^)C-57 License No.
?Phone No. 5/{J*-.. irac{ -
Dril Method
Tool
Other
'-:'
.fI {rj
-7fu'
W
lonstruction
bstruction
)pair/Modify
nactivation
jono""o Depth
Jo you anticipate
yes, please expla
jthere any known
Jlenium, hydrogen
Reverse Rotary
Air Rotary
| {b i€ e4- casing Diameter Annular SealDepth
dri lling into a water bearing formation that has the potential to degrade a higher quality aquifer?Yes u NoEil
potential to encounter a water bearing formation where levels of water quality constituents such as nitrate,sulfide, boron, org anics, etc., are a concern?Yesn ruoE tr yes, please explain
ag ree to comply with all applicable laws and regulations of the County of San Luis:Obispo and the State of Californiato wellconstruction destruction,repair or modification Within fifteen days after
rt l-i ' <-t1
t
rertaining:lvironmental
Jvironmentat
Health Services with a
Health Services.
completion of the well, I will furnishwelllog. This application becomes a valid permit following sign off by
Date
LY
Fee Paid $ "'*-l .l Gheck #C
Date
n Letter Special Requirements and/or
Constituents Tested for
Date SealDepth
Comments
ISSUANC 1 of2
Sig
By Date
Site Approved yes E iVo tr By
Letter
lomments for Drilling Contractor
r Quality Testing Conducted? yes
n'Fl'
je
f/ellSealWitnessed? yes I No I
ltt Sit" Approvat GpS Coordinates
r*bll Seal GpS Coordinates
I t'tog
By
N
N
W
W
Date
a,1n/\at trc1tn..i^r
513- b
of WellP
Domestic Private
Domestic Public
lrrigation
Cathodic
lndustrial
Test Well
tr
Soil Testing
alLetter Sent? Yes No
PERMIT IS VALID FOR SIX MO NTHS FROM
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . p.O. Box 1489San Luis Obispo, CA 93406-i4C9phone: (80s) 781_s544 FeX: (sos)'iC14211
WELL PERMIT APPLICATION
C-57 License No.
oFF_|CE USE
Permimlo.dl {-. {/ _f,ii.t
Application Approved gt tt,'
By:
W
Cable
Other
'
lr" of Wel owner
Mailing Address
Business Address
WellType
l:struction
,.rpair/Modiff
Phone No.
)JPhone.No.t.
WellSite Address
Drill ing Method
Rotary
Reverse Rotary
Air Rotary
ih -ie< I Casing Diameter Annular Seal Depthdrilling into a water bearing formation that has the potential to degrade a higher quality aquifer?Yes I No NlpotentiaI to encounter a water bearing where levels of water quality constituents such as nitrate,
formationsulfide, boron, organics , etc., are a concern?Yes D t'ro EL lr yes, please
agree to comply with all applicable laws and regulations of the County of San Luis Obispo and the State of Californiapertaining to well construction
1"1
Con
' loRoseO Depth
u6 you anticipate
tf
I
tr lvironmental
ivironmentalj Health Services
destruction , repair or modification Within fifteen days after completion of the weil , lwillfurnishHealth Services with a com pleted well log.This apptication becomes a val id following sign otf by
Signed
Date I -+:l:r*.{J Fee Paid $ *JBy
Yes El-No D By
Comments for Drilling Contractor
I
Date I
permitls u'l
Y
Check #
Date
{_j
n Letter Special Requirements and/or
. Jater Quatity Testing Conducted? yes n No fl Constituents Tested forl/ellSeal Witnessed? yes n No fJ By Date!.rl
rJeil
Site Approval GPS Coordinates
SealGPS Coordinates
Date Cornments
SealDepth
W
W
N
N
CE Page 1of 2
/\{nnil tiar{rn.,i^r
Purpose of Well
Domestic Public
lrrigation
Domestic
lndustrial
Well
Letter Sent?Yes No
PERMIT IS VALID FOR S IX MONTHS FROM I
o usECOUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 781-4211
Application Approved Etr'\]
o^t"-L t-;3 1clY-
Permit ll
By:
*- /
/fLr'"\*.
WELL PERMIT APPLICATION
of WellOwner 5VC-Phone No
Mailing Address ,..Ji*{Y} f--aiir,l rrrO ECli1 rr:rf -ii-frsr}?1
-"",F ,}t)d}'-i6.r-r ?-r*,t'rr.::*r Cy'i QL/:; E 3
of Drilling Contractor **t*i
r *\r..Cr t,-, hrrlg ''C-SZ ticense wo.0
Company Name LJ i r{}r-r.€X . 'T,I+JC.,
Business Address ,.iA\# y'+\c-.rnt3 ,/\ve., aca' i L<ryri':r;irrl, {l ?t'fTphone No. ,';10- E;&x*- -7t* lh
Well Site Address Area of County
-l{:. Ranse lag Section i i',
''?r"
litting
Alsessor's
IircelSize
)
ParcelNo.Township
(acres) 4 d q ln Coastal Zone? {v C, GPS Coordinates
Note: The'Well Permit Plot Plan" shall be attached to this application and indicate within a two hundred foot radius around the
pposed well the following items: A) Proper$ lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
jrer concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses, E)
Srlrface water drainage pattern of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
surveyor's stake labeled "Well Site.' Drilling shall not commence until this application is approved
WellType Method
N W
Construction
)struction
;!pair/Modify
lnactivation
/* l* *4 Casing Diameter Annular Seal Depth
drilling into a water bearing formation that has the potential to degrade a higher quality aquifer? Yes f] No Ef
tf
to encounter a water bearing formation where levels of water quality constituents such as nitrate,
boron, organics, etc., are a concern? Yes No M lf yes, please explain
agree to comply with all applicable laws and regulations of the Coun$ of San Luis Obispo and the State of California
pertaining to well construction, destruction, repair or modification. Within fifteen days after completion of the well, I will furnish
mental Health Services with a completed well This application becomes a valid permit following sign off by
Rotary
Reverse Rotary
Air Rotary
Cable Tool
Other
dr rru{ .Du-lLr
loposeo Depth
,A ro, anticipate
tr qviron
Jrvlron
I
l
I
'.Eceived By
mentalHealth Services
Date t lt; )u'',
-"tli r-"Date
tr By
USE ONLY
FeePaid$ *iq *Check# ':{' l.-i ... 1-_. , -.. -j\J. ;:11-t( \
Date
Special Requirements and/or
wfil
ite,l
Site Approved Yes E/tto
Letter Lefter
Comments for Drilling Contractor
I Quality Testing Conducted? Yes f| No I
Well SealWitnessed? Yes I No I By
Constituents Tested for
Date SealDepth
1""
*Jell
Site Approval GPS Coordinates
SealGPS Coordinates
N
N
W
W
trinal Letter Sent? Yes I tlo I Date Comments
PERMIT IS VALID FOR SIX MONTHS FROM ISSUANCE Page 1 of2
of Well
Domestic Private
Domestic Public
lrrigation
Cathodic
lndustrial
TestWellMon
Soil
QA l:-tn(tal lf, tFNnri.rr\rn/a:: o6'a:i 4^,rri^-ri^.r1
5F.{-
ifv
trtr
'poo."o Depth trl.r {e.g{ Casing Diametert-
-,J you anticipate drilling into a water bearing formation that
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 7814211
WELL PERMIT APPLICATION
OFFICE USE
Perm it Hq*j(4jjlLi i.r -
Application Approved 6f-;iil'
By:
W
Phone No
]
'l
C-57 License No. 7m sQ*]
3usiness Address Phone No. 17p: .T r*'F, * "7 !a"7 (r:
Well Site Address f?f,* SuL
'
.' r h.r*r ri-1 , .1;: l .e}, d- "l Area of County
Aqsessor's
IlrcelSize
I
Parcel No. {::;g^ ,15-} * C#?Township
(acres) 4 A r? ln Coastal Zone? ${} GPS Coordinates
Range l.; €Section t
N
Nqte: The "Well Permit Plot Plan" shallbe attached to this application and indicate within a two hundred foot radius around the
pposed well the following items: A) Propefi lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
1er concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses, E)
sdrface water drainage pattern of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
surveyor's stake labeled 'Well Site.' Drilling shall not commence until this application is approved.
WellType Drilli Method
lonstruction
,rstruction
,!Oair/MoO
Rotary
Reverse Rotary
Air Rotary
Cable ToolOther trd.vrcJ 1],r rlr
nactivation
Annular Seal Depth k$fr
has the potentialto deg rade a higher quality aquifer? "Y"r tr N" E
t
to encounter a water bearing formation where levels of water quality constituents such as nitrate,
lf yes, please explain_boron, organics, etc., are a concern? Yes n No Et
agree to comply with all applicable laws and regulations of the County of San Luis Obispo and the State of California
rertaining to well construction, destruction, repair or modification. Within fifteen days after completion of the well, I will furnish
with a completed well log. This application becomes a valid permit following sign off by
Date lu*
OFFICE ONLY
=lvironmental Health Services
i
fironmental
Health Services
By Date
Site Approved Yes trl{o D By
Letter
Fee Paid $Check
Date
#
l/ell.1.:a
,.J
n Letter Special Requirements and/or
lomments for Drilling Contractor
Quality Testing Conducted? Yes n ruo I
A/ell SealWitnessed? Yes fl No D By
Constituents Tested for
Date SealDepth
itt Site ApprovalGPS Coordinates
,"-bll Seal GPS Coordinates
W
W
N
N
:iqalLetter Sent? Yes I No I Date Comments
PERMIT IS VALID FOR SIX MONTHS FROM ISSUANCE Pagb 1 of2 .
9P.*1
of WellPu
Domestic
Domestic Public
lrrigation
SoilTesting
Cathodic
lndustrial
Test Well
r !Q4 1\.tnfra, ritcNn.,i^rrrrAr^r: o^.6:
." .+i t
)*"
lrstruction
;!Oair/ModitV
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Siera Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 781-4211
WELL PERMIT APPLICATION
-fv i".ri.-.,;* l*r \n r
By:
Phone No
C-57 License No.7*d?
OFFICE USE
Permit **fic,aL-u.tt
Application Approved dlot
sv
W
of WellOwner
Vlailing Address
t
BusinessAddress .ltt{} A.#,rtr:: Av*. 5.ri'r L$r,* ,,.r..1 s.r dA q45 } } Phone No. i"J{}- ,;-{nY- 7ln}{n
WellSite Address CA Area of CountyrJgParcel No. f}: S- J t? - C"]..3
*) Township '-t,
I Range Section {a$sessor's
IircelSizel (acres) 4eq ln Coastal Zoae? NO GPS Coordinates N
Note: The "WellPermit Plot Plan" shall be aftached to this application and indicate within a two hundred foot radius around the
uposed well the following items: A) Property lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
her concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses; E)
Stlrface water drainage pattern of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
surveyo/s stake labeled "WellSite." Drilling shall not commence untilthis application is approved
Wetl D Method
Rotary
Reverse Rotary
Air Rotary
Cable Tool
Other
ec{
SealDepth Nff+loposeo Depth { {n {ee{ Casing Diameter U I .4 Annular
,J,o,anticipate@aringformationthathasthepotentialtodegradeahig
tf
her quality aquifer? Yes I No fffi
I to encounter a water bearing formation where levels of water quali$ constituents such as nitrate,
boron, organics, etc., are a concern? Yes tr tto EI lf yes,please explain_
agree to comply with
pertaining to well construction
allapplicable
, destruction,
laws and regulations of the County of San Luis Obispo and the State of California
nvironmental
1'rvironmental
il
By
Comments for Drilling Contractor
F
repair or modification. Within fifteen days after completion of the well, I will furnish
Health Services with a completed well log. This application becomes a valid permit following sign off by
Health Services.tlslDate
ONLY
sig
- ''t-J Date .::i Fee Paid $
wpll
lr"Lefter
Site Approved Yes g'ltlo tl By
lL-l *Check #
Date r 1-> /r,u
-)
Letter Special Requirements and/or ,
r Quali$ Testing Conducted? Yes f| No I
vVellsealWitnessed? Yes I No I By
lett Site RpprovalGPS Coordinates
r,.lell Seal GPS Coordinates
Sent? Yes Date Comments
PERMIT IS VALID FOR SIX MONTHS FROM ISSUANCE
Constituents Tested for
Date SealDepth
N
N
W
W
Page 1 of 2
Purpose of Well
Domestic Private
Domestic Public
lrrigation
Monitorinq
Untr
SoilTesting
Gathodic
lndustrial
Ktruutr Test Well
\
I lqi
No
() \nnll lirFNn.i.lr\t#aii oarmi: A^'rli^rti^.al ^^.
1? tr^.i?
GOUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 7814211
WELL PERMIT APPLICATION
OFFICE USE
Permit *..lC*f3--ff.r " -
Application Approved W tt"
Dare__!_t_23_J_W__
By:
:)v-,( ,Phone No.
Business Address
)
C-57 License No. 3r1 f'q a.
?*ff lPhone No. : #- :;-{*F - }!,:b'7 {*
Area of County
Range ,AC Section lfi
r Well Site Address
Agsessor's Parcel No. O q-3 * i.t I - $J ? T
'rrcel Size (acres) 4 .J 9 ln Coastal Zone?
l-
Construction
^ estruction
!pair/Modify
lnactivation
ownship ir
#A GPS Coordinates N
Note: The'WellPermit Plot Plan" shallbe attached to this application and indicate within a two hundred foot radius around the
- pposed well the following items: A) Properly lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or.any
per concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses, E)
srirFace water drainage pattern of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
stake labeled "Well Site.' Drilling shall not commence untilthis application is approved.
Well Drilling Method
boron, organics, etc., are a concern? Yes I tto lR tf yes,
W
please explain_
loposed Depth
,J you anticipate
lf yes, please explai
Rotary
Reverse Rotary
Air Rotary
un
Cable Tool
Other
'-{rgFf l'':r .q.c. i -l
t lo-{e* } Casing Diameter u/.fr Annular Seal Depth *",1#
drilling into a water bearing formation that has the potential to degrade a higher quality aquifer? Yes No H.
to encounter a water bearing formation where levels of water quality constituents such as nitrate,Ithere any known potential
flenium, hydrogen sulfide,
1jereby agree to
pdrtaining to well
Eqvironmental
ivironmental
l
l
.Jceiveo
comply with all applicable laws and regulations of the County of San Luis Obispo and the State of California
construction, destruction, repair or modification. Within fifteen days after completion of the well, I will furnish
I'lealth Services with a completed well log. This application becomes a valid permit following sign off by
Heatth Services.
o"t"_l_fuS_/Gc_
By Date i - $-:i -{-*{ FeePaid$
'{- g '}-,} r?
*lr I *Check# .I
Yes [14{otr By
Lefter
ng Contractor
Quality Testing Conducted? Yes fl tto I
WellsealWitnessed? Yes n No I By
tell Site ApprovalGPS Coordinates
, "bll Seal GPS Coordinates
Letter Sent? Yes
Constituents Tested for
Date SealDepth
N
N
W
W
Comments
IS VAI-ID FOR SIX MONTHS FROM ISSUANCE Page '1 of 2
Purpose of Well
Domestic Private
Domestic Public
lrrigation
Monitorinq
!trnn
SoilTesting
Cathodic
lndustrial
TestWell
Ehtrntl
!lQi
No
PE
Date
/){nntl lMrNnri.rrgjia:: pprm:r Ar^li.rtlNl I l- a?-ita.-n?
:rd;.i. * i
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (8O5) 781-5544 FAX: (805) 781-42'11
WELL PERMIT APPLICATION
OFFICE USE
Permit noq}{*rlL- fu\|.' -
AppficationApproved V"'o'
c)'/
"1me of Dri
llling Com
lling Contractor --Ty , f.,i v.t \-,.-"r l'i!
By:F*z"f-*
Phone No.
C-57 License No. 7f? "; E.J
Range i ;)' f:" section I {::,
Other
pany Name
SusinessAddress,titfl liclcrrtr*Ave "ri,-r iu.r:rr"r{fcl {.AqV3-?'? PhoneNo '7{*
WellSite Address A Area of County-i
Parcel No j*Township it l:\lsesso/s
lrcelSize
)
(acres) 4 rl? ln Coastal Zone? i/6 GPS Coordinates WN
tlote: The "Well Permit Plot Plan" shall be attached to this application and indicate within a two hundred foot radius around the' pposed well the following items: A) Property lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
ier concentrated sources of pollution, D) All interrnittent or perennial, natural or artificial water bodies or water courses, E)
;drface water drainage pattern of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
surveyor's stake labeled "Well Site.' Drilling shall not commence untilthis application is approved.
WellType Drilling Method
Rotary
Reverse Rotary
Air Rotary
Tooltrtr
]>Rosec Depth t iC {eg L Casing Diameter
.J you anticipate Oriffrg into a water bearing formation that
Annular Seal Depth
has the potential to degrade a higher qualig aquifer? Yes f] No tr
lonstruction
" istruction
,iOair/ModifV
nactivation
f yes, please explain
|here any known
lenium, hydrogen
potential to encounter a water bearing formation where,levels of water quality constituents such as nitrate,
sulfide, boron, organics, etc., are a concern? Yes No EL lf yes, please explai
Ipreby agree to comply with all applicable laws and regulations of the County of San Luis Obispo and the State of California
rc-rtaining to well construction; destruction, repair or modification. Within fifteen days after completion of the well, I will furnish
ntalHealth Services with a completed well log. This application sign off by
ntalHealth Services.
Sign
ilvironme
. lvlrOnme,i
Nell
L
.,1
By Date
Site Approved Yes El-tto g By
Lefter
OFFICE USE ONLY
Fee Paid $ -*i( i.-.. t Check #
Date
X-Conn Letter Special Requirements and/or
)omments for Drilling Contractor
I Quality Testing Conducted? Yes D No I
A/ell SealWitnessed? Yes I No I By
Constituents Tested for
Date SealDeplh
iil
'-.$tt
Site Approval GPS Coordinates
SealGPS Coordinates
W
W
N
N
Lefter Sent? Yes Date Comments
PERMIT IS VALID FOR SIX MONTHS FROM ISSUANCE Page 1 of 2
of Well
Domestic Private
Domestic Public
lrrigation
SoilTesting
Cathodic
lndustrial
Test Well
trtr
No
1\'rn/r;'r r(rrrrn..i^r
*l
usECOUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Siera Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 781-4211
Permit Lt- -
EltLApplication Approved
Date_Lt-}i t_&'/
By:
WELL PERMIT APPLICATION
Phone No
r{/a f/r.r'.,'',rr\,1 iir'.v.i.,/*1 "*,'='rr'vt "}E ,-]{y1 '-rrr-} *1c-rrl:c;n { A t'r'f X lt
il1me of Drilling
Jlling Compan
c C-57 License No. 2 CI 5* ';-1y Name
Jusiness Address Phone No. 5E)* :*r{t|f* 7e7 G
lqsessor's
lrrcel Sizel
ParcelNo. fJ:l l.i^ J :;-l- rrJ?Township
(acres) idrX? ln CoastalZone? ArC) GPS Coordinates N
{ote: The "Well Permit Plot Plan' shall be attached to this application and indicate within a two hundred foot radius around the
--pposed well the following items: A) Property lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
irer concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses, E)
>drface water drainage paftem of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
11oseo surveyor:s stake labeled "Well Site.' Drilling shall not commence untilthis application is approved.
WellType Drilling Method
WellSite Address Area of Coun$
Range l;i:- Section
W
Cable Tool
Other
,-], rr rti i ll:r r!,1'r
i{o ** +Casing Diameter Annular Seal Depth #/f+
drilling into a water bearing formation that has the potential to degrade a higher quali$ aquifer? Yes [] NOET
-rI \
lonstruction Rotary
Reverse Rotary
Air Rotary
n
potentia I to encounter a water bearing formation where levels of water quality constituents such as nitrate,
sulfide, boron, organics, etc., are a concern? Yes No Rlf yes, please
n
' iRoseo Depth
-J you anticipate
f yes, please explai
$here any known
ienium, hydrogen
1
,lereby agree to comply with all applicable laws and regulations of the County of San Luis Obispo and the State of California
idrtainingio well consiruction, destiuction, repair or modification. Within fifteen days after completion of the well, I will furnish
Health Services with a completed well log. This application becomes a valid permit following sign off byirlvironmental
. lvironmentalj Health Services.
t lts l,:1Date
Ii-Jceived By
-t:tl n--, Date i - ,
OFFICE
r Li Fee Paid $
ONLY
i1
By
Check #
Date
Letter Requirements and/or
I Quality Testing Conducted? Yes I No I
/Vell SealWitnessed? Yes I No I By
tall Site ApprovalGPS Coordinates
,- bll Seal GPS Coordinates
Date Comments
PERMIT IS VALID FOR SIX MONTHS FROM ISSUANCE
Constituents Tested for
Date SealDepth
W
W
N
N
Page 1 of 2
3E*l
of Well
Domestic Private
Domestic Public
lrrigation
Cathodic
lndustrial
TestWell
Testing
Letter Sent? Yes No
().\nfiat lMFNnri.rlrvJa:: po.m;i A5nla..li^,11 de 1?-lia.-n"
4
i.r$
COUNTY OF SAN LUIS OBISPO
PUBLIC HEALTH DEPARTMENT
Environmental Health Services
2156 Sierra Way . P.O. Box 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 781-4211
WELL PERMIT APPLICATION
OFFICE USE
Permit Ho.'rJ{r- q ^ f4tU-
Application Approved
'- "--,\ ..?
i ..r-J, ',w*-
By:)'rti*"
-1
J*"
Vlailing Address
lonstruction
lstruction
Ipair/Modify
nactivation
of Welt Owner *R{-Phone No.
J
7#5q )
No. s'le- s &'7'- 7e7 &
Well Site Address Area of County
ParcelNo. #5'3.* J f 7- O;?Township
'Jli,Range i .; € Section I {-';^isessor'sl
ircel Size (acres) 4,].q ln Coastal Zone? Y# GPS Coordinates WN
tlote: The "Well Permit Plot Plan" shall be attached to this application and indicate within a two hundred foot radius around the
itposed well the following items: A) Proper$ lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
Jer concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses, E)
3urface water drainage paftern of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
surveyor's stake labeled "Well Site.' Drilling shall not commence until this application is approved.
Well Drilling Method
.t'D
I
JO
posed Depth
you anticipate
tic *i*.q-\: Casins Diameter
drilling into a water bearing formation that
Rotary
Reverse Rotary
Air Rotary
f*i#+ Annular Seal Depth
t
has the potential to degrade a higher quality
Cable Tool
aquifer?,Yes I No H
f
to encounter a water bearing formation where levels of water quality constituents such as nitrate,
boron, organics, etc., are a concern? Yes I tto ffi" tryes, p lease explain_
I
. ,breby agree to comply with all applicable laws and regulations of the County of San Luis Obispo and the State of California
tertaining to well construction, destruction, repair or modification. Within fifteen days after completion of the well, I will furnish
lVt
,vt
/
ronmental Health Services with a completed well log. This application becomes a valid permit following sign off by
ronmental Health Services
Signed
ONLY
By \ Date Fee Paid $
Date i/rsJuJ
'-
i L i
n'P,l:L
.t
Site Approved Yes p-No I By
Letter
Date t A, lu
n Letter Special Requirements and/or
lomments for Drilting Contractor
Quality Testing Conducted? Yes ! No fl
A/ell SealWitnessed? Yes n No I By
Constituents Tested for
Date
'prr
^[tt
Site Approval GPS Coordinates
SealGPS Coordinates
W
W
N
N
Date Comments
Purpose of Well
Domestic Private
Domestic Public
lrrigation
SoilTesting
Cathodic
lndustrial
TestWell
D!tr
M
al Letter Sent? Yes No
PERMIT IS VALID FOR SIX MONTHS FROM ISSUANCE
SealDepth
Page 1 of 2,
; lt ' t
,,COUNTY OF SAN LUIS OBISPO
PUBLIC HCAITH DEPARTMENT
Environmental Health Services
2156 Sierra Way . P.O- Bqx 1489
San Luis Obispo, CA 93406-1489
Phone: (805) 781-5544 FAX: (805) 7814211
WELL PERMIT APPLICATION
OFFICE USE
Permit No,i}+Yai:-$"{ Li-l r
Application Approved Ei-ali
Mailing Address
of Drilling Contractor "flv ir.i.-'1,^ L r \^ , '\, *'.C-57 License No.
Company Name
Business Address
v
Phone No.
Phone No. -543a :!A_:_Z{rt*z
Area of County
Range l.] L,'Section i
By:
-
1*"
l"ame
, l,,,ns
of WellOwner
WellSite Address I
")A lsessor's
\rcelsize
I
ParcelNo. ny 1-.J 1' l- {1i -.; Township
(acres) .,{}{+ ln CoastalZone? irf) GPS Coordinates N
Note: The'Well Permit Plot Plan'shall be aftached to this application and indicate within a two hundred foot radius around the
1 r2posed well the following items: A) Property lines, B) Sewage disposal and/or sewer lines, C) Animal enclosures and/or any
: jrer concentrated sources of pollution, D) All intermittent or perennial, natural or artificial water bodies or water courses, E)
Sdrface water drainage paftern of the site, F) Existing wells, G) Access roads. The proposed site shall be designated with a
surveyor's stake labeled "Well Site.' Drilling shall not commence until this application is approved
Well Method
W
0onstruction
i lrstruction
ipai/Modify
lnactivation
Reverse Rotary
Air Rotary
Cable Tool
Other
\
I fRosed Depth
i-rd you anticipate
Casing Diameter i,i i$
drilling into a water bearing formation that
'7
has the potential
Anhular Seal Depth
to degrade a higher quality aquifer? Yes fJ No s[
tf
I to en counter a water bearing formation where levels of water quality constituents such as nitrate,
boron, organics, etc., are a concern? Yes n No Rlf yes, please explain_
l, ,iereby agree to comply with all applicable laws and regulations of the County of San Luis Obispo and the State of California
oertaining to well construction, destruction, repair or modification. Within fifteen days after completion of the well, I will furnish
F ronmental Health Services with a completed well This application becomes a valid per:mit following sign off bylvl
JVI
i
ronmental Health Services.
Site Approved Yes F"ttto tl By
Letter
sig ned
USE ONLY
\ Date i _. .-+-] i r.i Fee paid $ '" I q
-r{^* i.-,1/
Date
I
i
i'.Jceived
vlrell
iF
Check #
Date t J-, /^u
By
x-C;ffi le[tei--" :Special Requirements and/or
Comments for Drilling Contractor
t-Quality Testing Conducted? Yes I No I
/Vell SealWitnessed? Yes I No I By
Constituents Tested for
Date
, i,-'tt Site Approval GPS Coordinates
r..bll Seal GPS Coordinates
N
N
W
W
Date Comments
Purpose of Well
Domestic Private
Domestic Public
lrrigation
Monitorino
trnnn
Cathodic
lndustrial
TestWell
Mutru
TestingSoil
al Letter Sent? Yes No
PERMIT IS VALID FOR SIX MONTHS FROM ISSUANCE
SealDepth
Page 1 of2
T]1lo2
o
X
Appendix C
Soil Boring Logs
l
CNCD\O: SHARE\UST\04-O026.doc
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SB_ 1
FIELD GEOLOGIST J. 8a[on
N.
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DATE EEGAN 7 /)7 /6t
BORING NO
COORDINATES:
SAMPLE
DATE FTN|SHED 1/27/o4
SURFACE ELEV.TOTAL DEPTH 16-0'
CHECKED 8Y
APPROVED BY
sc
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3m no
cl
(s')
(s)-t
9m I Ctroqndroter mcountsed ot 1J,5,
TOIAL DEP1H Of EORING IS 16.0 FEET
DRAW{ BY TRS CHECKED 8Y <-oq
OATE 2/t1 /o4 APPROVED BY KD o{oRAWNC NO. : 6449t5-A148
DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 84491S-JTOOOOOO
PAGE 1 OF I
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10
8
9
11
12
13
14
15
16
17
Shaw Environmental, lnc.A
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COORDINATES: N.
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FIELD GEOLOGIST .l Bcllon DATE EEGAN t h7 /o4
DAlf FINISHED 1 /27 /O4.l Belldn
r6 0'
BORING NO
SURFACE EtEV.-
SAMPLE DIA.-
CHECKED BY
APPROVED BY
TOTAL DEPTH
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WELL CONSTRUCTION
TSPFAIT.
sc
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2.O'
cl
CLAYEY SILI; dork broun, mcdium ploslic, mtdum strll, slrgnlly morsr.
7.O'
-SAND; StT /ND CHERT GRAVEL; loose, moist.
9.0
gm
sc
CLAYEY SAND| light b.orn, sott. toB ploslrc, morst.
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sAND, S|LI ANO CHERT GRAVEL: toosc.
!,&@nd*otd ocounlsed ol lJ.O
(5)
(r0')
9m
TOTAL DEPTH OF EORING IS 16.0 FEET
CHECKED BY 4ORAW{ BY IRS
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4
5
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7
8
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10
11
12
13
14
15
16
17
DRILLER : K.C. Wood
DRILLING CO, : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
A Shaw Envkonmental, lno.oRAWNG NO. : E44915-4149
DATE 2/1t /O1 APPROVEO BY
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COORDINATES:N
FIELD GEOLOGISI .l Flclldn DATE BEGAN t h7 /O4
.l Rpllon DATE FINISHEO 1 /27
16 r)'
CHECKEO BY
APPROVEO BY
TOTAL DEPIH
SURFACE ELEV.-
SAMPLE DIA.--
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ASPHALI
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SAND AND GRAVEL FILL.
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CLAYEY SILI; dork bro{n. modtum plcslic. madum strrl. slrgnlly moEt.
5.O'
8.O
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(5)
3C
CLAYEY SAND: Iight brosn. solt. lor plostrcrty, morst.
- Groundrola ancdntc.cd ot lJ.o'r3.o
SAND. gLT ANo CHERT GRAVEL: coorsc Aroinad. loose.
9m
TOTAL DEPTH OF SORING IS 16.0 FEEI
DRAWN 8Y TRS CHECKED BY =4
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4
6
7
8
9
10
1l
12
13
14
15
16
17
DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
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"A Shaw Environmental, lnc.DRAWNG NO. : 8,[4915-,t150
DATF 2 /11 /O1 APPROVEO BY
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COORDINATES: N.
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FIELD GEOLOGIST .t Bellon DATE EEGAN t h7 /o4
DATE FINISHED 1 /27 /O4.l Bclldn
BORING NO
SURFACE ELEV.
-
SAMPLE DIA.-TOTAL DEPTH 16.0.
CHECKED BY
APPROVED BY
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IVELL CONSTRUCTION
TSFHATI-
6'
SAND AI{O GRAIGL FILL.
t.o3C
-CLAETS|-; dark brot'l1 msdium plo3tic, madium still. slightly moist.
7.O,
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CLAYEY SAND; brof,n, soll. lot plosticity, moisl.
o Gr@ndHolar cncdntcred ot l5.O'.r5.o
9m
SANO, gLT AND CHERI GRA\EL: coorsc Aroincd, loosc.
(ro')
(5)
TOTAI DEPTH OF BOSING IS 16.0 FEET
.4DRAW}I BY TRS CHECKEO BY
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4
5
6
7
8
9
10
11
12
13
14
15
16
17
DRILLER : K.C. wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE I OF 1
A Shaw Environmental, lnc.oRAwlNG NO- : 8tt49l5-Al5t
DATE 2/11 /O1 APPROVED BY
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SB_ 5BORINGNO.
DATE FINISHED I/27/O4
SAMPLE DIA.
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J. Bellon
F
FIELD GEOLOGIST DATE EECAN 1 /)J /6a
COORDINATES:
CHECKED 8Y
APPROVED 8Y
TOTAL DEPTH
sc
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(r0')
9m
TOIAL OEPIH OF BORING IS 16.0 FE€I
DRAW! 8Y IRS CHECKED 8Y
DATE z/tt,/o1 APPROVED BY DRAWNG NO- : 84t9t5-At52
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12
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14
15
16
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DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE I OF I
S shaw Environrn€ntar, rnc.
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cooR DINATES: N.
FIELD GEOLoGIST J. Eellon DATE BEGAN
.t Ralldn OATE FINISHED 1 /27 /64
16.0'
E.
1 /27 /O4
CHECKEO BY
APPROVEO 8Y
TOTAL DEPTH
SURFACE ELEV,-
SAMPLE DIA.-
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ASPHALI.
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CLAYEY SILI: brorn. mcdium stilf. loe plostic. slighuy moist.
4.o'
sAND, SILI AND CHEIII GRAVLL; IOOSC.
8()
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SANDY SILT: light brown, lor plosticity. solt, moisl.
ar^,.dw^r* d.a,^r.r.d .l 1l n't{-o
TAND. S|LI AND CHIRI GI{AVLL; cocrsc gromcd, lOOSe.
(r0)
(5)
9m
TOTAL DEPTH OF BORING IS 16.0 FEET
4DRAWN 8Y rRs CHECKED 8Y DRAWNG NO. : 84a915-Al5J
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DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF 1
"A Shaw Environmental, lnc.
OATE 2/1t /O1 APPROVED BY
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COOROINATES: N.
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DATE FINISHED 1 /27 /O4
FIELD GTOLOGIST J- Bellon DATT BEGAN 1 /t7 /O4
J. Bellon
SAMPLEr6.o'
BORING NO
SURFACE ELEV.-_
CH€CKED BY
APPROVED 8Y
TOTAL DEPTH
Asph
ASPHALT.
6'
sc
SAND AND GRAVEL fILL,
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CLAYLY SlL t; dOrl( Daotn. me('um plosllclry. mooom s(111. silgntly mqlsr.
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SILTY SAND: brorn, solt, mcdaum plostac. morst.
s8-7
(r0)
(s)
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TOTAL OEPTH OF BORING IS 16.0 FEET
ORAW! BY TRS CHECKEO BY DRAWNG NO. : 8{a915-4154
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DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 'I OF 1
'A Shaw Environmental, lno.
DATE 2 /1t /O1 APPROVED BY
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COORDINATES:N
FIELD GEOLOGIST J Bellon DATE EEGAN t h7 /O1
J. Eellon DATE TINISHED
'r6.o'
1 /27CHECKED BY
APPROVED BY
]OTAL DEPTH
SURFACE ELEV.-
SAMPLE OIA.-
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CLAYEY SILI: dork brown. modium ploslrcrly. meoum slrlr, srrgnrry moFl.
J.0.
5.0'
chert growls.
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SLIY SANO: bro*n, medium plostacaty. solt. slrghtly morsl.
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CLAYEY SILI; brorn. mcdium plosticily. mcdaum stall, slighlly mo'sl.
slitt.
(r0')
TOT^L OEPTH OF EORING IS 16.0 FEET
CHECKED BYDRAWN BY IRS
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7
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12
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14
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DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
A Sharrtr Environmental, lnc.
APPROVFD BY
DRAWING NO. : 844915-4t55
OAlE 2/lt /O4
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BORING NO. SB-9
COORDINATES: N.
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FIELD GEOLOGIST .l fl.lld^DATE EEGAN t /2a/o4
.l Salldn 1/)e/o1
SAMPLE DIA.-TOTAL DEPTH 16.0.
CHECKED BY
APPROVED BY
DATE FINISHED
SURFACE ELEV.
ASPHAL T
6'
sc
sANU ANU UXAYt.L TILL.
't.o'
cl
CLAYEY SILI; dork bro{n. madium slilt. m€dium plostcity. slightly moist.
r2.o
9m
5ANU, StLt ANU UHLKI tt(AVLL; rSSCr SUOOngUrOr. poffy SqIeO,
r {irdtndrartr aacaral*arJ al 1,1 O'r3,0
sm
;slllY 5ANU; DrOSnr solt. maOrum progtrc.
(s)
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TOIAL OTPIH OF EORING IS 16.0 FEET
DRAUN BY TRS CHECKED 8Y
FUUL
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15
16
17
DRILLER : K.C. Wood
ORILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
A Shaw Environmental, lnc.
DATE 2ltt /o1 APPROVED 8Y
DRAWNG NO. : Et{915-A156
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DATE EEGAN t hB/o1
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COORDINATES:
SURFACE ELEV.-
SAMPLE DIA.-TOTAL DEPIH T6.0.
CHECKED BY
APPROVED BY
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CLAYEY SILI: brown. mcdium still. m"dium ploslrc. slrghlly morst.
6^0'
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SLIY SAND; light brosn, medium plosticity, 3oll, mo.sl.
crdradrdlrr mcounlared ot l3.O'-t3.0'
9m
€AND. SILT AND CHERT GRAVEL; coorse groinad. loose. subongulor, potrly
sdtcd.
TOTAL DEPTH OF EORING IS 16.0 FEET
/-DRAWIV BY TRS CHECKEO BY
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4
5
6
7
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11
12
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14
15
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DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF 1
"A Shaw Envkonmental, lnc.
DATF 2 /17 /Oa APPROVED BY
DRAWNC NO. : 8a4915-A157
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BORING NO
SAMPLE DIA.--r6.0'
CHECKED BY
APPROVED 8Y
TOTAL DEPTH
DATE FINISHEO
SURFACE ELEV
gUo
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ORAW! BY IRS CHECKEO BY oRAWNG NO. : 84,1915-4158
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2
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11
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13
14
15
16
17
DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
A Shaw Environmental, lnc.
DATE 2/11 /O1 APPROVED BY
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FIELD GEOLOGIST .l Flplldn DATE BEGAN t /2a/o4
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BORING NO
TOTAL DEPTH T6.0.
CHECKED 8Y
APPROVED BY SURFACE ELEV.-
SAMPLE DIA.-
ASPHALT
6'
3m
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(5)
-t
TOTAL OEPTH OF BORING IS 16.0 FEET
DRAWN BY IRS CHECKEO 8Y
FUU
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IF
o-Uo
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2
3
4
5
6
7
8
9
10
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12
15
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i6
17
DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE I OF I
A Shaw Enuronmental, lnc.
DATE 2 /1r /Ol APPROVED BY -!DRAWNG NO. : E4,r9l5-At59
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COORDINATES:N
FIELD CEOLOGIST .l Fl.ll^n DATE EEGAN t hR /O1
DATE FINISHED.l Rell.d 1 /2A
r6.0'
SURFACE ELEV.--
SAMPLE DIA.-
CHECKED BY
APPROVED 8Y
TOTAL DEPTH
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DRAWN BY TRS CHECKED BY
FuUL
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2
3
4
6
7
8
9
10
11
12
13
14
15
16
17
DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
s Shaw Environmental, lnc,DRAWING NO. : 84,t915-A16O
DATE 2/11 /O1 APPROVED BY
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.l Bplldn OATE FINISHID 1
16 0'
COORDINATES: N.
E.
CHECKED BY
APPROVED BY
TOIAL OEPTH
SURFACE ELEV.-
SAMPLE DIA.-
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WELL CONSTRUCTION
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il.5
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n/d'.dgdls a.d^ldad dl l3-O'.r5.0'
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3m
TOTAL OEPTH OF BORINC IS 16.0 FE€T
zDRAW! 8Y TRS CHECKED BY
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o-Uo
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2
1
4
5
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7
8
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12
13
14
15
16
17
DRILLER : K.C. Wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION ;
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
'A Shaw Environmenial, lnc.DRAWING NO. : 84il9l5-Al6l
OATE 2/11 /O1 APPROVED BY
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COORDINATES: N.
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FIELD GEOLOGIST J^ Bellon DATE BEGAN 1/2A/O4
.l Flallnn t ha/o1
16.O'
BORING NO
SAMPLE DIA.-
CHECKED BY
APPROVED 8Y
TOTAL DEPTH
OATE FINISHEO
SURFACE ELEV.
E
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TOTAL DEPTH OF EORING IS T6.0 FEET
DRAWN 8Y IRS CHECKEO BY 1 DRA$JING NO. : 84/1915-A162
FuIJL
=IF(LUo
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2
3
4
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6
7
8
9
10
11
12
13
14
15
16
17
DRILLER : K.C. wood
DRILLING CO. : Vironex
DRILLING METHOD : Geoprobe
SAMPLING METHOD :
PROJECT : SBC-SLO
LOCATION :
PROJECT NO. : 844915-37OOOOOO
PAGE 1 OF I
s Shaw Environmental, lnc.
DATE 7 /lt /O1 APPROVED BY
lllls2
ox
gP vf"Campbell Analytical lnc.
1 l0 2nd Averue Soudr, #D7, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax : 925-798-1622
htto://www.rmcanrobellcom F-mail: mah@rnccannbell.mm
QC SUMMARY REPORT FOR SW8021B/8015Cm
Matrix: W WorkOrder: 0306368
EPAMethod: SWB021B/8015Cm Extraction: SW5030B BatchlD:7409 Spiked Sample lD: 0306362{084
Sample Spiked MS-MSD-MS-MSD*LCS LCSD .CS.LCSD Acceptance Criteria (%)
ug/L us/L % Rec.% Rec.o/o RPD o/o Rec.% Rec.% RPD Low High
TPH(btex)r ND 60 110 103 5.93 l13 n3 0 7o 130
MTBE ND l0 tt4 tt4 0 96.s 95.5 1.05 70 130
Benzene ND t0 105 101 3.56 108 108 0 70 130
Toluene ND 10 9s.2 92.5 2.96 100 100 0 70 130
Ethylbenzene ND t0 106 l0l 4.66 107 108 0.154 70 130
Xylenes ND 30 100 93 7.25 100 100 0 70 130
%SS:94.6 100 96.9 96.5 0.354 100 101 0.460 70 130
All target compounds in the Method Blank of this extraction batch were ND less than the method RL with the following exceptions:
NONE
Recovery = 100' (MS-Sample) / (Amount Sp'ked); RPD = 100' (MS - MSD) / (MS + MSD) * 2.
= not enough sample to perform matrix spike and matrix spike duplicate.
= analyte mncenhation in samde exceeds spike amount for soil matrix or exce€ds 2x spike amountforwater matrix or sample diluted due to high matrix or
= Matrix Spike; MSD = Matrix Spike Duplicate; LCS =Percent
content.
near 0% it a)
interferes with
andMS or MSD recovenes benot 100%near theor RPDs the ts containsAND concentrations ofspikemaysampleinhomogenoussignificant
theto amountrelative or thattt matrix recovery.spikespiked,b)samplespecific
TPH(btex) = surn of BTEX areas from the FlD.
cluftered cfiromatogram; sample peak coelutes with surogate peak.
l
,l
g$ t""u*obell AnalYtical Inc.
I l0 2nd Avenue Souft, #D7, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax : 925-798-1622
htto://w.mccamobell.cour E-mail: main@.rnccamobell-mm
QC SUMMARY REPORT FOR SW8015C
Matrix: W WorkOrder: 0306368
EPA Method: SW8015C Extraction: SW3510C BatchlD:7400 Spiked Sample lD: N/A
Sample Spiked MS-MSD"MS-MSD LCS LCSD -cs-LcsD Acceptance Criteria (%)
ug/L t g/L o/o Rec.7o Rec.% RPD % Rec.% Rec.% RPD Low High
TPH(d)N/A 7500 N/A N/A N/A 102 99.7 2.33 70 t30
ToSS:N/A 100 N/A N/A N/A l0r 99.5 1.57 70 130
All target compounds in the Method Blank of this exftaction batch were ND less than the method RL with the following exceptions:
NONE
Recovery = 100 - (Ms-Sample) / (Amount Spiked); RPD = 100 . (MS - MSD) / (MS + MSD)' 2.
MS and / or MSD spike recoveries may not be near 100% or the RPDS near 0% if a) the sample is inhomogenous AND contains significanl concentrations of
relative to lhe amount spiked, or b) if that speciftc sample matrix interferes with spike recovery
= analyte concentration in sample exceeds spike amount for soil matrix or exceeds 2x spike amount for water matrix or sample diluted due to high matrix or
Control Sample; LCSD = Laboratory Control Sample Duplicate; RPD =
content
= not enough sample to perform matix spike and matrix spike duplicate.
"-.1
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S!# t"aumPbell AnalYtical Inc-
I l0 2nd Avenue South, #D?, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax :, 925-198-1622
http://w.mccampbell.com E-mail: main@,rnccamptrell.corn
QC SUMMARY REPORT FOR SW8260B
Matrix: W WorkOrder: 0306368
EPA Method: SW8260B Extraction: SW5030B BatchlD:7408 Spiked Sample lD: 0306358-0088
Sample Spiked MS"MSD"MS-MSD LCS LCSD LCS-LCSD Acceptance Criteria (%)
pg/L ug/L o/o Rec.o/o Rec.% RPD % Rec.% Rec.% RPD Low High
tert-Amyl methyl ether (TAME)ND l0 93.9 95.7 1.98 90.s 92 1.68 70 130
Diisopropyl ether (DIPE)ND 10 lt6 118 1.58 tt7 ll9 t.il 70 130
Ethyl tert-butyl ether (ETBE)ND l0 98.s 99.s r.06 98-3 97.r l t8 70 130
Methyl-t-butyl ether (MTBE)ND r0 99.7 101 t.02 98.3 97.5 0.749 70 130
%SS1:lll 100 ll5 LT7 2.10 llt tt2 0.750 '10 130
All target compounds in the Method Blank of this exhaction batch were ND less than the method RL with the following exceptions:
NONE
= Matrix Spike; MSD = Matrix Spike Duplicate; LCS = Laboratory Control Sample; LCSD = Laboratory
Recovery = 100 - (Ms-Sample) / (Amount Spiked); RPD = 1 00 * (MS - MSD) / (MS + MSD) . 2.
MS and / or MSD spike recoveries may not be near 100% or the RPDS near 0% if: a) the sample is inhomogenous AND contains significant concentrations of
relative to the amount spiked, or b) if that specific sample rnatrix interferes with spike recovery
= not enough sample to perform matrix spike and matrix spike duplicate.
= analyte concentration in sample exceeds spike amount for soil matrix or exceeds 2x spike amount for water matrix or sample diluted due to high matrix or
solvenls such as chloride and acetone in the method blank at low levels.
content-
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gp fr,f"Campbetl Analytical Inc.
I l0 2nd Avenue South, #D7, Pacheco, CA 94553-5560
Telephone : 925 :198-1620 Fax : 925-798-1622
http://www.mccamobell.com E-mail: main@mccampbell.com
QC SUMMARY REPORT FOR E200.9
Matrix: W WorkOrder: 0306368
EPA Method: E200.9 Extraction: E200.9 BatchlD: 7413 Spiked Sample lD: N/A
Sampte Spiked MS*MSD*MS-MSD LCS LCSD LCS-LCSD Acceptance Criteria (%)
mg/L mg/L % Rec.o/o Rec.% RPD % Rec.% Rec.% RPD Low High
Lead N/A 0.010 N/A N/A NiA 97.8 101 2.78 70 130
Atl target compounds in the Method Blank of this exhaction batch were ND less than the method RL with the following exceptions:
NONE
Recovery = 100 . (MS-Sample) / (Amount Spiked); RPO = 1 00 - (MS - MSD) / (MS + MSD) - 2.
MS and / or MSD spike recoveries may not be near 100% or he RPDs near 0% it a) the sample is inhomogenous AND contains signilicant concentrations of
relative to the amount spiked, or b) if thal speciftc sample matrix interferes with spike recovery.
= not applicable to this method.
= analyte conc€ntration in sample exceeds spike amount for soil matrix or exceeds 2x spike amount for rvater matrix or sample diluted due to high matrix or
content
" -ivlcfn-nr p B ErrA NA iry'l'tc_A[ I N fi*--.l lo 2"d Avl::Nt,l: sot]t'll. f/t)7I'ACt ilico, cA 94551^5560'l'eloile:925798- I 620Fnx:798-t622TUI{N AROUND l'IMERuslSt-toRernas:tlffi24nContntents21 ;",{arOtherd,o€NoianN(-{rtaINt-EdpJt----vy'*?oFu.Jw-J3uF.U<>66orN6N€4o-trJ3!zo-LzoF-NN€Art!ct6Nboa{Qrtra{\oFitr,uest-lzoaudoooo66o6o.ulocoo€oAd^Nor.l3d{tr.lIz6IrlFcoooaA.tr,€rtqFdIto"t,>.E)0obosoFr{hddtrl(>Ng,oguo{otr)gboA.€Ff00{19},rrl()€oddXln {nUIHf6.t.ooRoakp.,!Frc0*t_lJxku!oz!d6xME',t'ilOt)I'RESERVEI)0)oTlit,aq!,b/)tI6kaMAI'RIXd)(dFh0doU(,AFv&rnkAJ11GIIo(.J*t:_6-lfcceived By1 "- l-RaanaibtlI illtelz79ar ,'l'irrrel'l'irue:'l'irrrcrSAMPLINGllill 'l'o: SOrn f -.oDateb-\'l-6--l)rtcr[)nteiDntc6.t*r9LOCAI lONt,fAnlco,fIt NarrreFax:'1'e le:CornProsnest#:t LocatSAMPI-E ID'W- \ f r)'iz')-Effiu-itticd Dy: l/-Reiinqnisiied ny:4tt-ilffiuiililtl Uy:Sto *-b57? cet/*
tIWorkOrder: 0306368Date Received:Date Printd:lMcCampbell Analytical Inc.I l0 Second Avenue South, #D7Pacheco, CA 94553-5560(92s) 798-1620Client:Shaw Environmental4005 Port Chicago HwYConcord, CA 94520GIIIITI.OI.GUSTODY BTGOIBPage I of 1TEL:FAX:ProjectNo:PO:925-288-2190(925) 827-2029#838819; PB-SLO6tr8t036n8103dlvaozrelaotsd sw826oBsw8015cTestsE200_9Sample lDCllentSamplDMatrixCollectlon Date HoldcABDLI611710312:38:00 PMWaterw-1(131/2',))306368-001Prepared by: Maria VenegasComments: 24brNOTE: Samples are discarded 60 days afer results are reported unless other arrangements are made. Hazardous samples will be retumed to client or disposed of at client expense'
Shaw Environmental
4005 Port Chicago Hwy
Concor4 CA 94520
ClientProject ID: #838819; PB-SLO Date Sampled: 06117103
DateReceived: 06118/03
Client Contact Rob Delnagro DateReported: 06/19/03
ClientP.O.:Date Corrpleted: 06119103I
I
gP vr"Campbell Analytical Inc.
I l0 2nd Avenire Soudl #D7, Pacheco, CA 94551-5560
Telephone : 925-?98-1620 Fil : 92 5-798-1622
h@://www.rnccarpbell.com E-mail: nrain@rrccanpbell.com
Workorder: 0306367
June 19,2003
DearRob:
Enclosed are:
1). the results of 2 analyzed sanples from your #838819; PB-SLO project,
2). a QC report for the above samples
3). a copy ofthe chain ofcustody, and
4). a bill for analytical services.
All analyses were completed satisfactorily and all QC samples were found to be within our control limits.
If you have any questions please contact me. McCarrpbell Analytical Laboratories strives for excellence
in quality, service and cost. Thank you for your business and I look forward to working with you again.
Yours Y,
I
I
_l
Angela Rydelius, Lab Manager
g$ t""u-Obell Analytical Inc.Avenue Sout[ #D7, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax : 925 -798-1622
1 lO 2nd
E-mil:
Date Sampled: 06117103Client Project ID: #838819; PB-SLO
Date Received: 06/18/03
Client Contact Rob Delnagro Date Extracted: 06118/03
Shaw Environmental
4005 Port Chicago Hwy
Concord, CA94520
Client P.O Date Analyzed: 06/18/03
Gasoline Range (C6-Cl2) Volatite Hydrocarbons as Gasoline with BTEX and MTBE*
Wort Order: O3O6367Extraction nrethod: SW50I0B Analytical rcthods: SW8O2lB/80l5Cm
tab ID Client ID Matrix TPH(g)MTBE Benzene Toluene Ethylbenzene Xylenes DF %ss
00lA TP-oE-02(13)S ND ND ND ND ND 79.2
002A TP4E4r(13)S ND ND ND ND ND 88.9
w NA NA NA NA NA NA I uglLRe?orting Limit for DF =l;
ND nram notdetected ator
above the reporting limit S 1.0 0.05 0.005 0.005 0.005 0.005 I
and vapor samples are reported in pgfi soil and sludge samples in mg/kg,wipe samples in pglwipe, and TCLP extracts in pgll.
+The
gasoline?;not appear to be derived
diesel range compounds
theoffollowing TPH aredescriptions natureln andchromatogramcufsory ls notMcCampbell theirforAnalyticalresponsible a)interpretation:unmodified or modified ts heavierweaklygasolineb)significant;gasoline arecompoundsrange significant(aged c)gasoline?);gasolinelighter rangemobilemost(the afefraction)d)significant;rangegasoline broadhavingcompounds irleihromatographicpeaks biologicallysignificant;TPH doesthate)pa$em from solvent mineral(stoddardgasoline one to isolatedfewspirit?);0 non-targetpresent;orc)agedstrongly gasoline are waterthan immisciblesignificant;lighterh)lssheen/product present;liquid0containsthat-2than vol./ogreater sediment;raisedlimit toduereporting,MTBE TPHhighcontent;doesthat not tok)pattem beappearfromgasolinenocas).(aviation m)pattem.recognizable
cluttered chromatogram; sample peak coelutes with surrogate peak.
I
j
DHS Certihcation No. 1644 Rydelius, Lab Manager
I
I d McCampbell Analytical Inc Telephone : 925 -798-t6ZO Fax : 925-798-1622
I l0 2nd Avenue South #D7 Pacheco, CA 94553-5560
Date Sampled: 06/17/03ClientProject ID: #838819; pB-SLO
Date Received: 06/18/03
Client Contact Rob Delnagro Date Extracted: 06/18/03
Shaw Environmental
4005 Port Chicago Hwy
Concord CA94520
ClientP.O.:Date Analyzed: 06/18/03
Diesel Range (C10-C23) Extractable Hydrocarbons as Diesel*
npthod: SW3550C Arplyticalmethods: SW80I5C WorkOrder: O306367
I.ab ID Client ID Matrix rPH(d)DF %ss
0306367401A TP{E-02(13)S 4-5'g 2 98.1
0306367402A rP4E-0t(13)s 1.4,b 94.7
w NA NA
Reporting Limit for DF =l;
ND means not det€cted at or
above the reporting limit S 1,0 mg/Kg
samples in mg/kg,product/oi l/non -aqu@us liquid samples in
of the TPHfollowingdescriptions are lnchromatogram andnatur€cursory notlsAnalyticalMcCampbell for theirresponsible interpretation a)or modifiedweakly diesel ls dieselsigrificant;b)arerange nocompoundssignificant;recognizable diesel?lsc)pattem;aged significant);d)aferangecompounds significant;unknown mediume)boiling doesthat notpattefnpoint beto derivedappear from onediesel;to fewa0oilpresent;peala afee)range compounds significant;waterthanlighterh)immiscitrle lssheen/product present;i)that containsliquidsamplethan1%vol.kerosene/kerosene bunker fuel stoddard solvent
water and vapor :re msamplesreported ItgL,lnwlpesamples ug/wipe,
and TCLPall STrc SPLP extracts ln ILgL
or;or;
cluttered ln coelutedchromatogramresulting andsurrogate sample peaks,ts onsurrogate elevatedpeak baseline,beenhassurrogate diminishedofdilutionextract.original
DHS Certification No. 1644 Rydelius, Lab Manager
d McCampbell Analytical Inc.Telephone : 925-798-162O Fax : 925-798-1622
I l0 2nd Avmu Sou0r,#D7, Pacheco, CA 94553-5560
E-mil:
Shaw Environmental
4005 Port Chicago Hwy
Concord, CA94520
Client Project ID: #838819; pB-SLO Date Sampled: 06/17/03
Date Received 06/18/03
Client Contact Rob Delnagro Date Extracted: 06/18/03
Client P.O.Date Analyzed: 06/1 8/03-06/ t9 103
ixtraction ncthod: SW3O50B
Lead by ICP*
Analytical nrcthoG: 6010C Work Orden 0306367
tab ID Client ID Matrix Extraction kad DF %SS
0306367401A TP-0E42(13')s TTrc 5.6 106
0306367-002A TP-0E-0 r(13)S TTrc 4.0 I t04
w TTLC NA m9lL
Reporting Limit for DF =l;
ND means not detected at or
above the reporting limit S TTLC 3.0 mg/Kg
for allelements excepr 200.9 (water/liquid- Sb, As, pb, Se, Tl);245.1(Hg); 7010
- As, Se, Tl); 74718 (Hg).
EPAcontainsthatsamplethanvol.4liquidgreater o/thissediment;sediment ls extracted thewith m withaccordanceliquid,and canmethodologieseffectmetalreportedconcentrations;limiti)raised toduereporting insufticient amount;areresultssamplek)byreported dry weight;v)duevalues lowto surrogate limitrecovery;z)raised todue matrixreporting interference.
alland TCLPsamples STLCliquid DISTLC SP
msamples filter tntrrg/wipe,ItersamplespC/fi
extracts are reported in mg/L,soi[/sludge/solid samples in mg/kg,
means surrogate outside ofrecovery due toacceptance matrixrange NDinterference;notmeans abovedetected the N/Areportinglimit;means notto this sample or instrument.
Mehods: EPA 6010C/200.7
DHS Certification No. 1644 Angela Rydelius, Lab Manager
&McCampbell Analytical Inc.South, #D7, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax : 925-jgg-1622
I 10 Znd Avenue
E-rmil:
Date Sampled: 06/17/03Client Project ID: #838819; PB-SLO
Date Received: 06/18/03
Client Contact Rob Delnagro Date Exfracted: 06/18/03
Shaw Environmental
4005 Port Chicago Hwy
Concord, CA94520
ClientP.O.Date Analyzed: 06/18/03
Oxygenated Volatile Organics by p&T and GC/IVIS*
Exhaction Mettnd: SW5030B Analytical Method: SW8260B Work Orden 0306367
Lab ID 0306367-001A 0306367-002A
Client ID TP-08-02(13)TP-0E-01(13)
Matrix s s
Reporting Limit for
DF =l
DF s w
Compound Concentration FclKc ttg/L
Diisopropyl ether (DIPE)ND ND J.0 NA
Ethyl tert-butyl ether (ETBE)ND ND 5.0 NA
Methyl-t-butyl ether (MTB E)ND ND 5.0 NA
tert-Amyl methyl ether (TAME)ND ND 5.0 NA
t-Butyl alcohol (TBA)ND ND 25 NA
Surrogate Recoveries (7o)
%SS:99.7 97.7
Comments
means not detected above the reporting limit; N/A means analyte not applicable to this analysis.
waterthanlighter immiscible lssheen/product that containspresent;liquidi)*7than vol.sample greater sediment;diluted due toi)sample highcontent.
soiUsludge/solidandwaterallandvapor&TCLP SPLPsamples extracts are lnreported pgL,samples lnwipeIrElkC,samples 1tg/wipe,lnsamples mdL.liquid
l
i
l
DHS Certification No. 1644 Rydelius, Lab Manager
gP t "cu*obell Analytical Inc.
I l0 2nd Avenue South, #D7, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax : 925-79E-1622
htto://wwrf,.mccamptlell-com E-mail: main@lnccampbell.com
QC SUMMARY REPORT F',OR SW8021B/8015Cm
Matrix: S WorkOrder: 0306367
EPAMethod: SW8021B/8015Cm Extraction: SW5030B BatchlD:7402 Spiked Sample lD: 0306351-010A
Sample Spiked MS*MSD-[/ts-MsD LCS LCSD rcs-LcsD Acceptance Criteria (%)
mg/Kg mg/Kg % Rec.% Rec.% RPD % Rec.% Rec.% RPD Low High
TPH(btex)e ND 0.60 109 106 3.03 lt4 ll5 0.734 70 130
MTBE ND 0. t0 84.5 83.6 L.l7 94.2 95.4 1.25 70 r30
Benzene ND 0.10 t12 109 2.9r ll0 113 3.26 70 130
Toluene ND 0.10 llt 109 2,03 ll0 t14 3.17 70 130
Ethylbenzene ND 0.10 lll 107 3.45 109 n3 3.78 70 r30
Xylenes ND 0.30 113 ll0 2.99 113 1t3 0 70 130
%SS 88.3 100 106 104 1.90 95.1 98.6 3.61 70 130
All target compounds in the Metftod Blank of this exhaction batch were ND less than the method RL with the following exceptions:
NONE
[,lS = Mahix Spike; MSD = Matrix Spike Duplicate; LCS = Laboratory Control Sample; LCSD = Laboratory Control Sample Duplicate; RPD = Relative Percent
Deviation.
%Recovery=100'(MS-Sample)/(AmountSpiked); RPD=100-(MS-MSD)/(MS+MSD)t2.
' MS and / or MSD spike recoveries may not be near 100% or lhe RPDS near 0% it a) the sample is inhomogenous AND contains signilicant concentrations of
analyte relative to the amount spiked, or b) if that specific sample matrix interferes with spike recovery.
e TPH{btex) = sum ofBTEX areas ftom the FlD.
# cluttered dlromatogram; sample peak coelutes with sunogate peak.
N/A = not enough sample to p€rform malrix spike and matrix spike duplicate.
NR = analyte concentration in sample exceeds spike amount for soil matrix or exceeds 2x spike amount for water matrix or sample diluted due to high matrix or
g$ t"au*nbetl Anatytical Inc.
I l0 2nd Avenue South, #D7, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax : 925-798'1622
http://www.mccampbell.com Lmail: main@nccampbell.com
QC SUMMARY REPORT X'OR SW8015C
Matrix: S WorkOrder: 0306367
EPAMethod: SW8015C Extraction: SW3550C BatchlD:7406 Spiked Sample lD: 0306356-005A
Sample Spiked MS-MSD-MS-MSD LCS LCSD -cs-LcsD Acceptance Criteria (%)
mg/Kg mg/Kg % Rec.% Rec.o/o RPD % Rec.o/o Rec.% RPD Low HiSh
TPH(d)ND 150 88.4 90.7 2.49 83.8 85.8 2.32 70 130
%SS:l0t 100 102 103 1.32 90.3 92.2 2.10 70 t30
All target compounds in the Method Blank of this extraction batch were ND less than the method RL with the following exceptions:
NONE
= Matrix Spike; MSD = Matrix Spike Duplicate; LCS = Laboratory Control Sample; LCSD = l-aboratory Control Sample Duplicate; RPD = Relative Percent
Deviation.
ToRecovery=100-(Ms-Sample)/(AmountSpiked); RPD=100*(MS-MSD)/(MS+MSD)-2.
MS and / or MSD spike recoveries may not be near 100% or he RPDS near 0% if: a) lhe sample is inhomogenous AND contiains significant concenkations of
relative to the amount spiked, or b) if that specific sample mabix interferes with spike recovery
= not enough sample to perform makix spike and matrix spike duplicate.
= analyte concentration in sample exceeds spike amount for soil matrix or exceeds 2x spike amount for water matrix or sample diluted due to high matrix or
ij
-t
d McCampbell Analytical Inc.
t l0 2nd Avenue South, #D7, Pacheco, CA 94553-5560
Telephone : 925-798-1620 Fax : 925-798-1622
h@://www.mccampbell.com Bmail:
QC SUMMARY REPORT FOR SW8260B
Matrix: S WorkOrder: 0306367
EPA Method: SW8260B Extraction: SW5030B BatchlD:7393 Spiked Sample lD: 0306340-001A
Sample Spiked MS-MSD*MS-MSD LCS LCSD -cs-LcsD Acceptance Criteria (%)
us/Kg ug/Ks 7o Rec.7o Rec.% RPD % Rec.% Rec.% RPD Low High
tert-Amyl methyl ether (TAME)ND 50 8r.2 82.6 1.66 84,2 84.1 0.0629 70 130
Diisopropyl ether @IPE)ND 50 96.5 99.9 3.47 97.7 100 2.74 70 130
Ethyl tert-butyl ether (ETBE)ND 50 82.2 87 5.76 85.1 85.5 0_461 70 130
Methyl-t-butyl ether (MTBE)ND 50 88 90.4 2.68 89. I 92.3 3.57 70 130
%ssl l0s 100 106 105 0;7f5 106 106 0 70 130
All target compounds in the Method Blank of this extraction batch were ND less than the method RL with the following exceptions:
NONE
%Recovery=100*(Ms-sample)/(AmountSpiked); Rpo=100"(MS-MSD)/(MS+MSD)'i.
MS and / or MSD spike recoveries may not be near 100% or the RPDS near 0% it a) the sample is inhomogenous AND contains significant concentrations of
relative to the amount spiked, or b) if that specific sample matrix interferes with spike recovery.
= not enough sample to perform matrix spike and matrk spike duplicate.
= analyte concentration in sample exceeds spike amount for soil matrix or exceeds 2x spike amount for water matrix or sample diluted due lo high matrix or
in the method blank at low levels.such as chloride and acetone
MSD = Matrix Spike Duplicate: LCS = Laboratory Control Sample;
content.
extraction
l
l
g$ *"Cutttnbell AnalYtical Inc.
I l0 2nd Avenue South, #D7, Pacheco, CA 94553-5560
Telephone : 925-7 9&.1620 Fax : 925-798-1622
htq://www.mccampbell.com E-mail: main@,mccampbell.com
QC SUMMARY REPORT FOR 6010C
Matrix: S WorkOrder: 0306367
EPAMethod: 6010C Extraclion: SW3050B BatchlD:7412 Spiked Sample lD: N/A
Sample Spiked MS*MSD-MS-MSD LCS LCSD LCS.LCSD Acceptance Criteria (%)
mg/Kg mg/Kg % Rec.7o Rec.% RPD % Rec.% Rec.% RPD Low High
Lead N/A 500 N/A N/A N/A 101 96.7 4.7 L 70 130
%SS:N/A 100 N/A N/A N/A t00 t02 t.32 70 130
All target compounds in the Method Blank of this extraction batch were ND less than the method RL with the following exceptions:
NONE
= Matix Spike; MSD = Matrix Spike Duplicate; LCS = Laboratory Control Sample; LCSD = Laboratory Conkol Sample Duplicate; RPD = Relative Percent
Recovery = 100' (Ms-Sample) / (Amount spiked): RPD = 100 - (MS - MSD) / (MS + MSD) . 2.
MS and / or MSD spike recoveries may not be near 100% or the RPDs near 0% it a) he sample is inhomogenous AND contains signincant concentrations of
relative to the amount spiked, or b) if that specific sample matrix interferes with spike recovery
= not applicable to this method-
= analyte concentration in sample exceeds spike amount for soil matrix or excreds 2x spike amount for water matdx or sample diluted due to high matrix or
content.
tiMcCampbell Analytical Inc.I 10 Second Avenue South, #D?Pacheco, CA 94553-5560(925) 198:1620ClientrShaw Environmental4005 Port Chicago HwYConcord, CA 94520Sample lDCllentSamplDcHff ll-0f-G1l,$T00Y n $0n DPage I of 1WorkOrderz 0306367TEL:FAX:ProjectNo:PO:925-288-2190(925) 827-2029#838819; PB-SLODate Recelved:Date Printed:6/18/036n8t03MatrlxCollection Date Hold&sw8260BB/801sw80l5cTests6010cAAAAAAAt_in611710311:47:00 AM611710312:04:00 PMSoilSoilTP.0E-03(13')TP-0E-01(13'))306367-0010306367-002Prepared by: Maria VenegasComments: 24br RushNOTE: Samples are discarded 60 days after results are reported unless other anangements are made. Hazardous samples will be retumed to client or disposed of at client expense.