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SM JCACILN CSNITT ASUC 4EW4 SMICS/EHVIMPOTAL :A CTH 11VIMCN — <br /> i. U1 ST 'JORKSAE FCR Sl-1c C^..S 19 VAUUTICN GATE /a`�•^� t <br /> ;NAME CF -AC:LIi' G�b�i/�`U ` a-3 <br /> IACORESSIIT.= I0 e3 <br /> TANK SISI a5aIFUEL TYPE! to 5fe <br /> II. 62.4VAL SITE 4ISTCRY <br /> �Is Terni- clrrent?lyes! INe! (Plait Sj IFaef Li-y Saar= C.:ael IOce_Sni l/(:7 CmeIyesj INaI <br /> ,qu=er of Tanks At facility) IAge Cf Tants(if svailable)l (Type of iu>;lSteeLl I1-cr77LI SMti 0a 1.1 <br /> TANK 4ISTCRT <br /> ! ! I ! I yes. give =ts(s)I / <br /> 'Jas ionic :est sa7 yes NM Failed aree:tion :es: ?!Yes No! If <br /> .as a re-cair Croce :o :.he :Yd( systm?jyas! 40I 114 Yes, uaat vas repai real <br /> -air acne timer itsspectimZl Yes! INC; were =it samles anakneelTes! INo! I3�! !?H-5! lTPN 7I IPC/DBI <br /> ! ov ..H L L l I u irmin MCer: <br /> "yce of failurs/disczargel lcatas7'oplicl llEn9-tars eainge! I ! l <br /> IV. iE'ICVAL AISTCRT (A7TAC3 IN57DTICII ISMT iM Sf is 3ETAILS/CLL=- ]ATA R2 I..5AC(ING af)TZITTAL ANAL'SIS) <br /> I Soit Samies Redeivedj Tes! INS! l0eaet :o O.•.una 'Jatarl IRefl-ftri lAvenge AtTNit iroei piarmiA=!14 I10-25I <br /> Cn-ii 'JeU Cs)ITesI I40! !Ammer 1. Type! I Irrj i0m! (P�i <br /> ! i Serei Ser_ I S Sara <br /> �Oi stance ca vetlCs) frm TanK! C 10 ;tsy Sac; C 5 PCs <br /> ~• 0 Iif it I 0 if <br /> i emef:fm 3 cs+df cfm g crdf rim <br /> Iv. -Site Feature - Laeetting 70CMICI L AMLYsi3 lis Set I _ is •mc E is mt <br /> I4iniaam IeCl= tz grout csr Tm -Ste foil Saaele Cfr_t) ! j >100 j "t-ICO j I LE-i0\t <br /> IF-ic_'res in sidsur.'aee (aeplies :M fo0atitls or aa.-stain 3reat) I xj 4me I i s> t ;Prnsertc l <br /> j C! <br /> ' <:0 <br /> nual ! 9 I 70- IJccsooal 25":C\Z <br /> 'Aver39e AnPr-- m ipitaciOr=ms) <br /> j <br /> V-�_J��. :�e{JI CS vfll Cl inCreOe vert:eal atgraizm <br /> �a� Leacnate (i.e_ seaifc syste:. uayar •rlts, ;=vs) ' 4me I ; Unid:wt I '� iPressnc <br /> :uni Cue sire features: ReGtarge arra. parse soil, nmr'd'/ '+ei Ls_ ! I ^ I At lmt} .i (Mare yfan <br /> j �xaocal 4oe,e N1 am1 I 7m��ey <br /> j =UM i=AL9»TOTAL POINTS ! ► D I - I I � i � 1� I' � U <br /> Sa Le lesut:: (s T x CR D URGE 0f TOTu POINTS 49 pis or Sore l L: - =3 pa i <br /> Pb� IC�6q,00,,T= 76,I� EB�1) ! <br /> X= �8AI00 3 3 ` T x <br /> 4N ZML1W Atom a 3-T-x-x L<ygLS ")1 13 Sal Cal 50 I ; f� d NA\3 <br /> !Saaoto R t,I,LL• " GASx.lNE 'ID00 ! taG I to <br /> K�\ a= em0 'rr k& 4� s.t,tuat a TPR L�9 CAM) <br /> TK 'LgDO fpll otESma I to,:LG ! 1000 100 <br /> IT'eS: '.f dMaaetced soil mWw gratatd mvw C .Cm mcim is ;j C, dv me ®leu ::to meting patantial <br /> svtysfs. (I.s., site is =rratcty an UGT CataNinetim List `ar mil r gfeusd water.) <br /> \1 If death is > 5 fC- snd a :S ft., score a ;Mina- If depa =j ft., do nM :se aole_ <br /> i \Z If ;r=ipia[fm is > 40 ir=nes, son 0 Points_ <br /> j \3 Lavets for 3TUE are nae aapt geode ac a TPM cm=ma-Mcfm 0f 10 ppe (93soL tics) or 100 ppa (_diesel),_—�( <br /> VI. STAFF AECCMME40ATICN/CMAC%=C11 aArt a -gsess Y�Lfiyt�v/t <br /> Are 37X Z ° ar TPH Csaatt."aiiom > Allarots L ovals I^esj ( � �• I <br /> ?. getattoena site C:C.aJTMI INej I>If Yes, ;oder m Site Mitfgac:m for EvaLwem! <br /> VII. 2EVIEW VALUATICH - TO 3E C71PL.5M 3T A SUPc-%VISOR/SBICR <br /> C=C:R WITH STAFF .AE=WeMTTCN FOR .^=IREIYES! I IRS:Eno m SIi< HITIGAT-mm Z-.L 'eVAL::A7TCNITES INOI <br /> I <br /> OAT_ dEF�RE71 / / IDA < .^.."-SI1RE LM-TER; MAIL71 <br /> NAME CIF i <br /> EVALLIA i CII I <br /> 3H M 30 (UG,.'KSHT)\5/90 <br />