Laserfiche WebLink
SAN .:OACl7IR CXNT ISLIC HEALTH SERVICES/E4VIRCNMENTAL HEALTe- ON <br /> UGS�:RXSHEET FOR SITE CLOSURE EVALUATION ATE I� 9/(fZNAME OF FACILITY IG�w„ Ln'--'7Ct *;I ,.� <br /> "ORESS I C.SOO <br /> MANX SIZE UEL TYPE <br /> GE4ERAL SITE HISTORY <br /> Is permit curremt? es o ermit p acility S[a tus Code cc.Soil/GW Cont es o <br /> �vuxer of Tanks a[ (acility ge of Tanks(It available) ype of tank teal brgl I Dual <br /> ng <br /> I. TANK HISTORY <br /> lens Tank tested? es o ailed precision test 7 es o if yes, give date(s) <br /> .:as a repair made to the tank system? es No 11f yes, what was repaired? <br /> -'as repair done under inspection7 as o ere soil samples anatyzed7 1Y <br /> es o TXE PH-G PN-0 b/EDS <br /> 'ype of failure/discharge acastrophic long-term leakage verfilt mown lo <br /> cher: <br /> . REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> >oil Same Les Received les o epth to Ground Vater of/Year I verage Annual Precipitation = C 0.25 <br /> Dn-Site VeLL(s) es I a umber d Type frr I as I ub <br /> S care 5 care S core <br /> 7istance to Welt(s) frac Tank ft; ft; ft C 10 pts C 9 Pts C i pts <br /> 0 if 0 if 0 it <br /> R onditicn R condition R ondition <br /> V• Site Feature - Leaching Potential Analysis E is met E is met E s mac <br /> iinimum Depth to groundwater from the Soil Sample (feet) >100 I 1.100 25-50\1 <br /> -ractures in subsurface (app(ies to foothills or mountain areas) ,' None Unknown resent <br /> .vcrage Annual Precipitation (inches) zxxz <10 I 9 10.25 XZXXsz 26•4O\2 <br /> 'an-Made conduits which increase vertical migration <br /> :f leachate (i.e., septic system , water welts, pords7 None Unknown resent <br /> s <br /> nit};e site features: Recharge area, coarse soil, nearby welts. At least ) ore than <br /> XXAa None one one <br /> CCLLRBH TOTALS»>TOTAL POINTS 3 J7 <br /> :ample Result: IS T X OR E)O)*l RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts AO pts ss <br /> v <br /> _ S T X E B T X E i� <br /> iy L' MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. j 4A\3 <br /> ;ample Result: ASOIINE 1000 100 10 <br /> AXIHM ALLOWABLE TPX LEVELS (PPM) <br /> J 71,E Tpg IESEL 10,000 1000 100 <br /> -COINOTES: ...if documented soil and/or ground water contamination is present, do not complete the teach Tlg potential <br /> amiysfs. (i.e., site is currently on UOT Contamination list for soil or ground 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 BTXdE are not applicable at a TPH concentration of 10 ppm (gasoline) at 100 ppm (diesel). <br /> STAFF RECCFMENDATICN/CCNCLUSION <br /> i <br /> 1• Are BTX i E or TPH Concentratioru > Allowable Levels Yes <br /> 2. Rec-- n rd Site Closure ITes o P Yes, Refer to Site gation for Evaluation <br /> REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISCR/SENIOR - <br /> GOHCJR 'JITH STAFF RECCHMENDATION FOR CLOSURE ES 0 Ef ERRED TO SITE HITIOATICN FOR EVALUATION )LIES <br /> BATE REFERRED ATE CLOSURE LETTER HAILED y / <br /> rIAME Of <br /> ':VALUATOR <br /> -H 23 80 (UCTU'KSHT)\5/90 <br />