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SAH 'CACUIN CaMTT Pf 4EALTH S'c2VICES/£4VIRCe.4i HEALTH OIV{ ) ATE <br /> UGST :t Ei FOR SITE CLOSLRE -VALVATICH I Z`Z — <br />.E OF FACILITY I EPS <br />)RESS I 4203 c/,. •I��GDi•'7 �� AHK 10 <br /> RK SIZE 0 UEL TYPE <br /> GENERAL SITE 4ISTCRY - <br /> Permit current7 def a ermit 3 • <br /> acility Status Code «.Soi i Cent es o <br /> r of Tanks at facility g, of ranks(if available) ype of rank teal brgl rql Oual <br /> TANX HISTORY <br /> rank tested? es o ailed precision test 7 4es o If yes, give dates) <br /> a repair .made to the tank system? es Ho f yea, vhat vas repaired? <br /> ,r epa Ir date under inpeetion7 4es o Mere soil samples an4ly:ed7 es o TXE PH-G PH•0 b/E08 <br />.e of failure/discharge racastrophie long-term leakage Iverfill n cher: <br /> EY.OVAL Hi STORY (AtTAC4 INSPECTION REPORT FOR SITE DETAILS/COLLECT OATH FCR LEACHING POTENTIAL ARALTSIS) <br /> I Samples Received es o ep th co Grand 'Ja car �� eF/Year <br /> 6 verage Arnual Precipitation n4 0-ZS <br /> Site 'Jett(s) 4ft es I o umber i Type Ire um 'b <br /> 5 core S core S core <br /> C 0 pts C pts C PCs <br /> tante to 'Jell(s) from Tank ft; ft; 0 •f O if 0 if <br /> R ondition R ad)ti cn R :ondi tion <br /> Site Feature - leaching Potential Analysis <br /> is met E is mec E s met <br /> imam Oep[h Co graurdwater from the Soil Sanpte tfeeU <br /> >I00 1.100 �j25-50V1 <br /> aures in subsurface (applies to foothills or mountain areas) <br /> None I Unknown resent <br /> p <br /> rage Arnual Precipitation (inches) <IO I 9 10-25 xxxxxx 25•GO\2 <br /> -Made Conduits t.hich increase vertical migration - Rone I Unknown resent <br /> leachate (i.e., septic System, water veils, Ponds) <br /> A[ leas: 4or* than <br /> c}:e site features: Recharge area, coarse soil, nearby wells. Kxxxxx Vone one one <br /> * 3� <br /> CCCLgd tOTAlS»>TOtAL POINTS _ <br /> Itjewtt: (3 T X CR E) RAHC'c OF TOTAL POIHTS 9 ;its or more 41 • 48 PCs I 40 pts or less <br /> X 3 1 X E d T X E <br /> / HAXi)!I..N ALLLVA3lE 3-T•X-E LEVELS (PPM) 1 50 50 SO .3 .3 1. 1. NA\3 <br /> pie Result. /Pq II FASCLINE 1000 100 10 / <br /> Ap pAXIM.'M ALLCVASU TPN LEVELS (DPM) fE5'cl 10,000 I 1000 - 100 <br /> iPH I( <br /> FRECCWEUDAT <br /> •'•If d«tmenced soil and/or ground water eontami[tation is present, do not Complete the leaching pot tel <br /> J aralysis. (i.e., site is currently on UG <br /> Contamination Lise for Bait or grovtd "ter-) <br /> \1 It depth is > 5 ft. and 4 25 ft., score 0 points. If depth <=5 ft., da not use cable. . <br /> / \2 If precipitation is > 40 inches, sears 0 points. <br /> q' \3 Levels for 3TXEE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 n (diesel). <br /> ICN/CCHCLUSION <br /> PneroAre SIX LE or HCcnin > Allowable levels Yes o . <br /> Recommend Site Closure es �!o If Yes, Refer to Site Hi ligation for Eralwtion <br /> REVIEW EVALUATION - TO 3E COMPLETED 3Y A SUPERVISOR/SENICR <br /> 9C'R 'JITN STAFF RECCf!MEVOAT ICN FOR CLOSLRE SES OI �tEFERREO TO SITE HITICATICN FOR EVALUATICH CIES I 0 <br /> E .REFERRED ATE CLORIR£ -STTER MAILED } / <br /> E IF <br /> tLUATCR $5 <br /> 23 30 (UGT:%S3T)\5/90 • • <br />