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SAN XACUM CQ:NTT X C HEALTH SZRVICES/ENVIACAMEHTAL HEALTH OIV{ I <br />UGST :t 'IEET FOR SITE CLOSRE EVALUATION ATE I T, — <br />:E CF FAC I L I T Yk• E-? S V E <br />0 <br />DREss I MANX 10 r j R lt84-63 <br />NX SIZE I SOoo I FUEL TYPE _ <br />SEHERAL SITE NISTCRT <br />permit current? es a ermit -4 - aeility status Cade oc.Sail/Gu Cant !z I H <br />tuber of ranks at facility ge of ranks( If available) Irype of Tank Cee( I rb,gt I ngl a..I <br />TAN% HISTORY <br />s Tank tested7 les <br />o ailed precision test 7 es o <br />epth Co Crural 'facer of/Tear <br />If yes, give date(s) <br />s a repair .made to <br />the Cank system? Ifes <br />No f yes, what was repaired? <br />0-25 <br />s repair done under <br />inspection?Yeso <br />ere soil saooles analyted7 es X <br />a TXE <br />PH -G <br />I PX -0 <br />b/EDS <br />:e of failure/discharge <br />acts tro¢[ic <br />long-term leakage <br />verf i[l own <br />Cher: <br />tS4CVAL XISTCRY (ATTAC3 INSPECTION .REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br />it Samples Received i es X o <br />epth Co Crural 'facer of/Tear <br />q�t I <br />verage Arnual Precipitation <br />o <br />hG <br />0-25 <br />-Site Uel l(s) IYas I <br />o umber S Type I Ilrr <br />I aia <br />lub <br />i <br />S <br />C <br />core <br />0 pts <br />S <br />C <br />care <br />pts <br />S <br />C <br />core <br />pas <br />;tante to Vell(s) from Tank ft; ft; ft <br />0 <br />R <br />E <br />if <br />arditim <br />is net <br />0 <br />R <br />E <br />it <br />ondition <br />is met <br />0 <br />R <br />E <br />a( <br />ordition <br />•s met <br />Site Feature - Leaching Potential Analysis <br />iinun Oepch to groundwater train the Sail Staple (feet) <br />>t00 <br />I - <br />)-100 <br />I <br />I ZS -i0\1 <br />utures in subsurface (applies to foochitls or mountain areas) <br />(a <br />I None <br />I le <br />Unknown <br />It resent <br />:rage Annual Precipitation (inches) <br />zCXX <br /><10 <br />I 9 <br />10-25 <br />xxxsxz <br />26-40\2 <br />rXade conduits which increase vertical migration <br />I <br />I <br />leachate (i.e., septic systems, water wells, ponds) <br />More <br />q <br />Unknown <br />resent <br />Cue site features: Recharge area, coarse soil, nearby welts. <br />None <br />At least <br />one <br />I I <br />Aare than <br />one <br />xxxx <br />CCLL77) TOTALS>WOTAL POINTS <br />-� <br />,ole Iesu(,: (3 T X OR S) <br />BARGEE OF TOTAL POINTS <br />9 pts <br />or more <br />1.1 - <br />1.8 pts <br />r GO pts air less <br />S <br />-fixai- , OZ,�/9�/✓t <br />MAXN"L ALLCUASLE 3•i•%•E LEVELS (PPM) <br />1 <br />50 <br />50 <br />50 <br />.3I. <br />AA\3 <br />'Pte Result -p <br />100 I <br />10 <br />�AXIMNALLCc:ABLE TPX LEYELS (PPM) <br />(Esti <br />t0, 000 <br />1000 <br />100 <br />:rNOTES: eeelf documented sail and/or ground water eoneaoination is present, do roc cemptete ane ieacn'ng pwe c+.. ..• <br />analysis. (i.e., site is currently on UGt Contamination List for soil or ground water.) <br />\1 If depth is > 5 ft. and < Z5 ft., scare 0 points. If depth <a5 ft., do not use table. <br />%2 If precipitation is > GO inches, score 0 points. <br />t3 Levels for 3TXEE are roc applicable ac a TPX concentracian of 10 ppm (gasoline) or 100 ppm (diesel). <br />TAFF REC^.MIENOATICN/CCNCLUSION <br />Are 3TX L E or TPX Concentratierer > Allowable Levels Yes I NoI <br />Recommend Site Closure l7 es �!o /\ If Yes, Refer Site Mitigation for Evaluation <br />1EVIEV EVALUATICN . TO 3E CQ4PLETED 3Y A SL7SAVTSC2/SEHICR <br />RC.'R 'VITR STAFF RECCMMENOATICN FCR CLOSER£ LLYES �O I REFERRED TO SITE ..41Tt GAT1CH FOR EVALUATICH <br />.E 1EFERRED I / / yArE CLOS'RE LETTER MAILED <br />• I <br />•E CF /✓/ // /S ILL�f / <br />kwzrca�'�- <br />