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SAN XACUNI CCUNTT P( HEALTH SERVICES/ENVIRC4MENTAL HEALTH OIVf _..., 1 <br /> UOST :L _..HEFT FCR SITE CLOSURE EVALUATION ATE - <br /> .E OF FACtLITT I .'EFPS '_,/E <br /> TRESS 4ANK ID s + _ <br /> tX SIZE UEL TYPE <br /> :ENE.RAL SITE HISTCRT <br /> permit currenC7 des o ermit 3 stili Cy Status Code oc.Sail/GV Cont ez � <br /> rxer of Tanks at facility �1ge of Tanks(if available) ype of tank Meet brgl ngl Oual <br /> TANX HISTCRT <br /> t Tank tested? des o ailed precision test t es o If yes, give dace(s) <br /> t a repair .made to the tank system? as Ho f yes, what was repaired? <br /> i repair dove under inspection} Yes o Mere soil sanples analysed? lyas o777P 4-G PX•0 b/EDO I- <br /> :e of failure/discharge acaserarhic I long-tern leakage verfill n Cher: <br /> !<_90VAL HISTCRT (ATTACH INSPECTION REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALTSIS) <br /> L Samples Received es o epch to Gretnd 'later I ,� of/Tear Average Arnuat Precipitation = h4 0-25 <br /> Si to HeIL(s) 11" ( o Leber S Type ter n>m <br /> S care S core S core <br /> tante to Welt(s) from tank ft; ft; ft C 0 pts C PCs C pts <br /> 0 f 0 if 0 f <br /> R odition R cod!cion R andicion <br /> Site Feature - Leaching Potential Analysis E �s met E is met E 's met <br /> :im m Oepth to graurdvater tram the Sail Seep(* (feet) >100 I - 1-100 i 125-50\1 <br /> ,c-ures in subsurface (applies to foothills or moCncain areas) I None ( Unknown present <br /> -rage Arnual Precipitation (inches) <t0 I 9 10-25 ants 26.40\2 <br /> t-Made canduits which increase vertical migration <br /> leachate (i.e., septic systems, water wells, pwxs) None Unknotat resent <br /> we site features: Recharge area, coarse sail, nearby wells. ( l At teasel are than <br /> sza None one one <br /> CCL" TOTALS»>TOTAL POIRTS + <br /> pie .Resut t: (3 T X CR E) RANGE Of TOTAL POINTS 9 pts or more ( 41 - 4a pts 40 pts ar less <br /> 3 T X E d T X E <br /> XAXIMIat ALLRlA3LE g-i•X•E LEVELS (PPM) 1 SO 150 150 1 .3 .3 ). t. NA\3 <br /> pie Result: CUM 1(100 I 100 10 <br /> AXIfI))1 ALL CUASCE TPN LEVELS (PPM) <br /> TPN IES'eL 10,000 1000 - 100 <br /> LROTES: •'•(f documented soil and/or ground water contamination is Present, do not caaplece the leaching potential <br /> analysis. (i.e., site is currently on UOT Contamination List for soil or grctnd water.) <br /> \1 If depth is > 5 ft, and < 25 ft., score 0 points. If depth <=5 ft., do roc use cable. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXLE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> TAFF RECC)ME40ATICH/CCNCLUSICM <br /> Are SIX 1. E or TP4 Concentrations > Allowable Levels Tes o <br /> Rr-ommerd Si cc Closure' es o I _ If Yes, Refer to Sic* Mitigation for Evaluation <br /> TEVIN FVALUATICH . 10 3E CCNPLFTED 3T A SLVERVISCR/SENICR <br /> RC'R WITH STAFF AMP.M.ENOATICH FCR CLOSLRE 1!r E31 O I I EFE.RREO TO SITE MITICATICH FOR FVALUATICH <br /> .F REFCRAEO I ATE CLOS'RE LETTER MAILFO <br /> .e CF <br /> IL UATCR <br /> 23 d0 (UGT:zSHT)\5/90 <br />