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SAN AACUIN CCU4T` C HEALTH SERVICES/E4VIHCNME4TAL HEALTH 0 Tom ID Z3 <br /> ULT FCR St TE CLOSURE EVALUATION �(• ATE G) <br /> :AME Of FACILITY .S. plum �M � 'EEPS CODE 2553 <br /> nORESS bD5 �--Y,,ewo + !7 ANK IO x 0 ' <br /> fANK SIZE G UEL TYPE <br /> GENERAL SITE HISTORY L),Av_. <br /> is permit current7 as o ermit I - aril ity Stacul Code O oc.So11/0V Canc eso <br /> ;vu�er of Tanks at facility 1 ge of Tanks(if available) I ,,L, ype of Tank teel Fbrgl ngl Oual <br /> (.t/YI an vG✓V. <br /> 11. TANK HISTORY �. <br /> :As tank tested? es o ailed precision test 7 es o If yes, give date(s) <br /> .os a repair made to the tank system? es No f yes, what was repaired? U/y\k4vvY� <br /> :as repair done under inspection7 as ere soil samples analyzed? as o TXE PH-G PH-0 b/EDB <br /> Type of failure/discharge atastrophic long-term leakage I verfill nown I cher: <br /> REMOVAL HISTORY (ATTACH INSP TION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> .ail Samples Received es c epth to Ground ''darer oc VMef/Year ; <br /> ge Annual Precipitation = 4 0-25 <br /> On-Site 4ell(s) 4es L r d Type Irr an5 care S core <br /> 7istance to Wells) from Tank (� PC ft; fq C pts C pcs <br /> O if 0 if <br /> R ondir ion R ordition <br /> Site Feature - Leaching Potential Analysts E is mer E s met <br /> ini,x Depth to grousdcater from the Soil Sample (feet) /0 ,100 1.100 O 25.50V <br /> =rac tures in subsurface (applies to foothills or mountain areas) None 9 Unknown resent <br /> ,Lvcrage Annual Precipitation (inches) =u, <10 9 10-25 KXXXXXx 26.40\2 <br /> (rIt in-Made conduits which increase vertical migration <br /> 61 leachate (i.e., septic systems, water wells, ponds) None 9 Unkncwi resent <br /> :pique site features: Recharge area, coarse soil, nearby weLLS. q At least ore than <br /> xxxx None -1 one one <br /> COLUMN TOTALS»,TOTAL POINTS + <br /> Sa.pplppe ppResult: (8 T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 PCs 40 Pts or less <br /> G <br /> i <br /> Al-D. B T X E 8 T % E <br /> MAXIMU7 ALLOWABLE g-T•X-E LEVELS (PPM) 1 SO 50 50 .3 .3 1. 1. NA\3 <br /> .ample Result: <br /> AS <br /> LINE 1000 100 10 <br /> NAXIM H ALLOWABLE TPH LEYELS (PPN) <br /> D._TPH (ESEL 10,000 1000 100 <br /> 'OTNOTES: '•If documented soil and/or ground water contamination is present, do not complete the Leaching potential <br /> analysis. (i.e., site is currently on UCT Contamination List for soil or grovel water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXEE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECOFHENOATION/CCNCLUSICN <br /> 1. Are BT% E ar TPH Concencrati0 > Allowable Levels Yes o <br /> 2. Recammud Site Closure as o If Yes, Refer to Site Hitigatim for Evaluacim OJ)� 5Tr✓ /��� ! 64'Jwv.��L <br /> ti. REVIEW EVALUATION - TO RE CCHPLETED BY A SUPERVISCR/SEN <br /> CHQ)R WITHSTAFF RECCNY.E4DATtCN FOR CLOSURE 1E5 0 EFERRED TO SITE 4ITIGATICN FOR EVALUATION 4ESI 0 <br /> )ATE REFERRED / / ATE CLOSURE LETTER MAILED ' f / <br /> FAME OF <br /> ]VALUATOR <br /> CH 23 30 (UCTWXSXT)\5/90 <br />