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SAN AOA( COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTA 4EALTH DIVISION <br /> •pow UCSF WORYSHE=, FOR SITE CLOSURE EVALUAT IDAi <br /> ''NAME OF "AC:L'-" ^ S ISWEEPS CODEI <br /> ADDRESS( ��, A �J(. ` (TANK ID dI 3R 17/'/!22 5 _ <br /> 'TANK SIZE r;:) I --- TYPE( <br /> I:. GENERAL SITE HISTORY <br /> jis Permit current? Yes INoI (Permit ZI - <br /> Facility Status Codel IDoc.Sai L/GU Cant Yesl No <br /> INuroer of Tanks at facili-yl (Age of Tanla(if available)( IIS yIType of Tank)SteelI A Fbrgl ISngII Dual <br /> 1:I. TANK HISTORY <br /> )Was Tank test INoI (Failed precision test ?ITm INoI If yes. 4ive dates) / / <br /> Was a repair maae to the tank systeafllYes No If yes, that "-' repaired?( �`,,II <br /> ;Was repair cone under inspection?IYesl INoI Were soil Samples analysed?IYMI� INoI IBTXEI YITPH-GI �H-OI �Pb/ED81r. <br /> jType of failure/discharge) (catastrophic) (long-term leakage) Ioverftll Munk o n lather- <br /> Type <br /> ��l <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ;Soil Saaoles Received IWest INoI (Death to Grou'+d Yater) iRef/1'mr =PR 9 Average Annual Prr_ipitaiionlA= 14 I10-Z: <br /> Ion-Site Wei L(s)IYes No INumoer L Type ImI (Dam IPual S Score S Scare S Scare <br /> '.Distance to WeLL(s) from Tankl IT; ft; C 10 pts C 9 pts C 5 Pts <br /> 0 f 0 it 0 if <br /> R cardi <br /> an R condi ti and R condi ti an j <br /> E is met is met <br /> 'V. Site Feature - Leaching Potential Ana Lysis "c i5 amt E <br /> Minimum Depth to groundwater from the Soil Sample (feet) II >100 I I51-700 I I 8-50\1 <br /> Fractures in stssur=ace (applies to foothills or mountain areas) None I R I UnKnorn I IPresent <br /> Average Annual Precipitation (inanes) ISzzxXXl <10 9 10-8 IXzcnuxl 26-Z-0\2 <br /> j <br /> Man-Made candwits which increase vertical migration <br /> of leachate (i.e., septic systems Yater wells, ponds) "we � Unknown Present <br /> j UnipUe site features: Recharge area, coarsew soil, neartry Lls- AL least) More than <br /> JXXX:GV None "I onell one , <br /> - 3 = 3(0 <br /> j COLLM » <br /> N TOTALS >TDTAL POINTS ' <br /> Sample Result: (8 T XOR E) RANGE OF TOTAL POINTS 49 Pts or more I 41 - 48 Pts 40 pts or Less <br /> $—NDS- rOFpn <br /> B T X I E 6 T X "e <br /> MAXIMUM ALLOWABL B-T-X-E LEVELS (PPM) 1 50 50 50 3 3 1. 1. NA\3 <br /> �sainpLe Resutt: f..tSOLINEI 1000 I 100 - I 10 <br /> 7,100 PPA) MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> zytYy� hyo Tpp�d� DIESEL 10,000 l 1000 I 100 <br /> (FOOTNOTES: "'If docencontamination,soil and/or gL= water rttamination, is presort, do not ®tete the leaching potential <br /> analysis. (i.e., site is currently an UGT Cmsaeination List for sail or ground water.) <br /> \1 It depth is > 5 ft. and < 8 Y.., spore C points. If death <---� ft., do not use able. <br /> \2 If precipitation is ) 40 inches, spore 0 points. <br /> \3 Levels for BTXEE arc not applicable at a TPH concentration of 10 ppm (gasotine) or 100 pam (diesel). <br /> VI_ STAFF RE=MMEMDATION/CONCLUSION <br /> j 1. Are BTX 3 E or TPH Cancerrtrations > Allowable Levels I'yes l X INoI <br /> I <br /> 2. Recenmetre Site CloeurelYesl INoI I If Yes, Refer to Site Mitigation for Evaluation <br /> JI1_ REVIEW EVALUATION - TO HE COMPLL�IDi 8Y A $11PERVISOR/5-e)lIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSUREI YES INoI IReFE RED TO SITE MITIrATION FOR EVALUATION IYESI`,117pI <br /> DATE REFERRED / 2 / (DATE C.OSURE LEER MAILED <br /> NAME OF <br /> EVALUATOR rte+ <br /> EH Zi 80 (UG7=HT)\5/90 <br />