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SAN :CAaJ:N CCt)NTT P( C HEALTH SFIVIC55/EHVIRCHAENTAL HEALTH OIVI I <br /> UGST .,HEEL FOR SITE CLOSURE EVALuATICR ATE <br /> .E CF FACIL(TT II4.'EEPT',COE <br /> TRESS I AHK f0 .1 ._ Q <br /> 4X SIZE UEL TYPE <br /> GENERAL SLE NISrCRT <br /> Permit current? des oerm�t 3 acilicy Status Cade pae.Sdil/GU Cant es o <br /> `ter of Tanks at facility ge of ranks(if available) ype of rank Leel begl rql Oual <br /> TARX HISTCRT <br /> S Tank tested? as o ailed precision test t es o if yes, give dates) <br /> s a repair .made to the tank system? es Na f yes, what was repaired? <br /> s repair done tsder inspectlon7 Les a �ere soil samples analysed? es a TXE PH•G I PH•0 b/EOR <br /> :e of failure/discharge I,acaserophie long-term leakage verfill n I cher: <br /> tEMOVAL HISTORY CATTACH INSPECT ICN REPORT FOR SITE OETA(LS/COLLECr DATA FCR LEACHING POTENTIAL ANALYSIS) <br /> it Samples .Received esa epth to Grand 'later of/TearIA- rverage Amual Precipitation a h< a•25 <br /> Si to VeMs) 11 as I o umber i Type I Irr pea 'b <br /> S core S cora S etore <br /> :Cance to Vell(s) from Tank ft; fr ft C 0 pts C pts C 6 pts <br /> O if 0 if 0 f <br /> R ondi;ion R x+dition R ordi cion <br /> Site Feature - Leaching Potential Analysis "e is net E is met E •s .net <br /> :imum Oepth to groundwater frau the Sail Sample (feet) I >100 I ISI-Ica I _f 125-50\1 <br /> ietures in subsurface (applies to faachi[is or mountain areas) I None I Unknown present <br /> :rage Annual Precipitation (inches) zzzx 410 I 9 10-25 �..=z 26-40\2 <br /> -Made conduits shish increase vertical migration <br /> Leachate (i.e., septic systems, water wells, ponds) I Hone I I Unknown resent <br /> que site features: Rechar;e area, coarse sail, nearby wells. ` At leas; dare than <br /> sass None one one <br /> CCLLIM TOTALS»>TOTAL POINTS * I 3 • I U� �/ <br /> cte Result: (3 T X CR U RANC'c OF TOTAL POINTS 49 pts or more <t - 48 pts JN 40 pts or less <br /> 49 3 1 T ( X "e 13 T X E <br /> d%��+ MAXI.". ALLCVARLE 3-T•x-E LEVELS (PPM) I 50 50 5 .3 .3 t. 1. AA\3 <br /> plc Result: <br /> CLINE 1000 100 I 10 <br /> SZ <br /> �AXIMN ALLCVARIE TPH LEVELS (PPM) <br /> n TPHIES'el 10,OGO 1000 100 <br /> (NOTES: ...if dccemenced soil and/or ground water contamination is present, do c complete c leaching potential <br /> analysis. (i.e., site is currently on UGT Contamination List fo sail mor ound water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <a5 ft., do no a table. <br /> \2 If precipitation is > GO inches, score 0 points. : <br /> \3 levels for 3TXEc are roe applicable at a TPH concentration of 10 ppa (gasoline) ar 100 ppm (diesel). <br /> TAFF RECCMIENOATICH/CCUMSIOH <br /> Are 3TX L E or TPH Concentrations > Allowable e!s Tn o <br /> Rr_oatnend Site Closure es �lo I if Yes, Refer to Sita Mitigation for Evaluation <br /> REVIEW EVALUATICH - To 3E CCMPLETEO 3T A SWERVISCR/SENICR <br /> 4C;R 'JITH STAFF RECCMMENOATICH FCR CLOSURE 1YES I �2EF-ARED TO SITE MITIGATICN FOR E'/ALL'ATICH '�SS I O <br /> .E 1<_FERREO I / / ArE CLOSURE LETTER MAILED I Y / <br /> IF <br /> ll'JA TCR <br /> 23 30 (UG1.1 Yiar)\5190 <br />