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SAN JCACUIN COL ?UBL:C HEALTH SERVICSS/EWIRCNMENTAL HEAL; VTS:CN <br /> I• u,%w rausHuT F✓CR/SIITEE CLOSURE EVALUATICIN �� OATE� il�iV /C.Ll <br /> (NAME OF FACILITY .-.rO.'� ISLE-PS Cx(i <br /> ADDRESSI �FSS � � , �1 '�i� �G (� <br /> (TANK !D 3l 3Ci ' 1 �J - L• <br /> TANK GI2£IwGC-, FUEL <br /> II. GEMERAL SITE HISTCRY <br /> Is permit currenttl Yes No Permit YI 00 15sc'�. Facility Status Cedel U I Occ.Soi L/CV Contl-fesl No�' <br /> INhnEer of Tanks at fuiliryl IAge of Tanks(it available) ?p,r Type of TanklStott JA Fbrgl( ISNLI,/Duel1� <br /> Ii:. TANK HISTORY <br /> Yea Tank tested?l Yesl J 190 (Failed precision test 7 Yea INoI V Iif yes, give date(s)I <br /> IVaa a repair made co the conk system?lYes l No lit yea, what was rep.i redl <br /> (Vas -eoeir done ender inspection? TesI INo1 Wrs soil samples aralytedil Yeal INoI 8TXE1 TPH-G 74-01 IPb/EDB <br /> Type of failure/discharge) catastrophic) Ilcm-care Leakage) �overfiLLl Iuntrrosnl other: <br /> IV. REMCVAL HISTORY (ATTACH INSPECTION W"T FOR SITE DETAILS/CLLECT DATA FCR LEACHING POTENTIAL ANALYSIS) <br /> ISoil Samples Received Yes) NoI 0epth to Grand VeterhL Aef/Yea (d Average Annum PrecipitationIAs114 110-25 <br /> On-Site 'Jell(s)IYes I Noi INumoer A Typal I Irrl Dam (Pub <br /> 5 Beare S Beare 5 Sacra <br /> Oirtarce to Well(s) from Tankl ft; ft; ft C 10 pts C 9 pts C 5 Pts <br /> 0 if 0 if 0 if <br /> R condi cion R condition R Condition <br /> IV. Site Featurs Leaching Potential Atlalysis _ is met E is met c is mt <br /> !Mini" Oepch to groundwater frcm the Soil Sampte (feec) 1 >100 151-100 1 7 25-50\1 <br /> Fractures in subsurface (applies to foothills or montsin areas) 1 Nora I Unknown (Present <br /> Average AcnueL Precipitation (inchaa) :oOOLuI <10 I 9 110-Z5 Ix=o= 25-40\2 <br /> Merr4ade Conduits which inereese vertical signtim <br /> I <br /> of :emchate (1.e., septic systema, water wells, ponds) I Mme I UrlOhawn 5- <br /> Unique <br /> Unique site features: Recharge area, crone soil, nearby rolls. ( AL lent) Mora than <br /> ha 11 <br /> X)C= Nora �� aon, <br /> I <br /> C.00LDOs TOTALA»TOTAL POINTS V �- � \� • 1.,(� s ��� <br /> Sample Result: (H T X OR E) RANCC Of TOTAL POINTS 49 pts or mre 1 41 - 4a pts 1 40 pts or less <br /> 3 T X I E 3 T X - <br /> \�Zl MAXI" ALLOWABLE 3-T-X-E LEVELS (PPM) it M 501 So 3 .3 1. 1. NA\3 <br /> Sample Result; GASOLINE 1000 100 1 10 <br /> MAXIMUM ALLLVABI_ TPN LEVELS (PPM) <br /> Ty WN OfESEt 10,000 I 1000 100 1 <br /> FCOTNOTES: —if documented soil and/or grand winter Cmtaminatim is present, do rot cemolete the leaching potential <br /> analysis. (La., site is currently an UGT Cmtaminatim List for soil or grand water) <br /> \1 if depth is > S ft. xd < ZS ft-, scan 0 Points. If depth a5 ft-, do not use table. <br /> \Z :f precipitation is > 40 inches, scone 0 Points. <br /> 13 levels for 3TXAE an not applicable at a TPN concentration of 10 ppm (amotim) or 100 Ppm (diesel). <br /> '11. STAFF ZS=WEN)AT:ON/CNC-USICN <br /> 1. Are 3TX 3 E or TPN Cancmtratiaim > AllanbLe Levels 'Yesl.71mal <br /> Z. Raeammesn0 Sits C:osurai Tnl INoi 110if Tn, Refer ca Site Mitigation far Evaluation) ' -` <br /> VII. RNTEV EVALUATION • TO 3E cWt.447 3T A sswelviscR/SEYICR <br /> CNGR 'JITH STAFF RECChaEIMATICN FCR LC=xEITES) �90I REFERRED TO SITE MITIGATICH FCR -VALUATICNITESI (NCI <br /> i <br /> 'DATE IES-eRREDI / / (DATE ==ME -ZTTER MALUD1 / / 1 <br /> 1NAME CF <br /> I%VALCATCR <br /> EH Z3 30 (UG7LKSHT)A5/90 <br />