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SAN(I+OAGUIN C"%T PUBLIC <br /> RKSXEETALTH FOR SITE(C'_SOSAIREI EV-A/L-U'ATI}ON4-yet-....rtIVISICN DATE( 7- 1 J 1 <br /> : OF FACILITY f f�T., ✓' S L�YL `��i 0 / d/r 7r-=---. <br /> /7;i c/ ISE°S CCOEI 3 I /_ I <br /> .i+ r . A (TANK ID =139 .,-)fiW tf�Q 0 I <br /> .00RESSI 766D �J/)_A/]CL�CJ <br /> { JJJ I I SToC- r�/ /e <br /> (TANK SIZE( FUEL TYPE <br /> 11. GENERAL SITE HISTORY <br /> ermit current?1Yes 1 NoI Permit � - <br /> Facility Status Cade) G IOoe.SaiL/GW Cant l Yes INoI <br /> [N��er of Tanks at facility) 1Age of Tanks(if available)( Type of ranklStmL Ftrrgll 15nxll Dual) <br /> III. TANK HISTORY <br /> Vas Tank tested?IYes 1No (failed precision test 71 Yes1 INaI, If yes, give date($)( <br /> Was a repair made to the tank systeatl Yesl Not if yes, what was repaired7l <br /> Was repair done under inspection?)Yesl INaI Were sail saactes aalyzee?IYesl INoI BTXEI TPX-GI TPN-O IPb/FORT <br /> Type of failure/discharge) (catastrophicI ILang-Ters Leakagel IeveHilll IunknonI Iocner: <br /> IV. ; OVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OEiA1LS/COLLECT DATA FOR LEACHING POT,,NT I <br /> EfAL ANALYSIS) <br /> SolL Samptes Received Yes1X No IDepth to Ground Waterlf 0 IRef/Yearl ?(- ; IAverage Am L Precipitation A-114 110-251 <br /> Ion-Size WeLL(s)IYes Na Nuater 3 Type IrrI Iowl,, IPunl <br /> g Scare -a Scare S scare <br /> Distance :a Wet L(s) from ft; ft; C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> t condition 3 condition R condition <br /> V. Site Feature - Leaching Pate Bial Analysis E is met 9its net - is mea <br /> Minix Depth to groundwater from the Sail Sample Cfeet) C I I >100 I i51-100 e/ 25-50\1 <br /> (Fractures fn subsurface (applies cc foothills or muntain areas) I ( j 1 None I Unknown (Present <br /> (Average Annual Precipitation (ivies) (X=X j <10 I 9 1 t0-ZS XXXXXXX) 25-60\2 <br /> Man-lade canauitS which increase vertiraL migration <br /> .of leachate (i.e., septic systems, water wells, bonds) None I Unknown Presort <br /> Unique size features: Recharge area, coarse sail, nearby wells. I - I At LeastMore than <br /> None, on <br /> xXrxx<x None 1 one <br /> COLUMN TOTALS>»TOTAL POINTS <br /> Saomle Result-. (3 T X OR -c) .RANGE OF TOTAL POINTS 49 pts or mare I 4.1 - 48 pts I 40 or lass <br /> MAXIMUM ALLOWABLE 3-1-X-E LEVELS (PPM) tI SOI 50 50 .3 .3 I 1.I 1. NA\3 <br /> Sava is Result: GASOLINE 1000 1 lea 10 <br /> MAXIMUM ALLOWABLE TPX LEVELS (PPM) <br /> TPH DIESEL 10,000 1000 100 <br /> FOOTNOTES: "'If docuatnted soil and/or ground water contamination is present, do nor —Late the L <br /> analysis. (i.e., site is currently an LAST Cottanrinetion List far soil or ground waiter.) <br /> \1 If depth is > 5 ft. and < 25 ft., scare 0 Points. If depth e5 ft., do rat Use table. <br /> \2 If precipitation is > 40 inches, scare 0 points. <br /> \3 Levels for BTXSE are not applicable at a TPN concentration of 10 ppa (gaasolins) or 100 ppm CdieseL). . <br /> VI. STAFF RECCMMENDATION/CONCLUSICN (f X f t cZi(iC-G�' r�_� zn ' ..ft 6"ti <br /> 1. Are 3TX 3 E or TPN Concentrations > Allowable Levels I-Yes) INoI <br /> 2. .Recommend Size Closurel Yesl 1Nol �'tt Yas, Refer to Site Mitigation for -valuation <br /> VII. REVIEW VALUATION - TO 3E CCMPLETED BY A SUPERVISOR/SENIOR 1 <br /> �C_MQ)R WITH STAFF RECOMMENDATION FOR CLOSUREJYESI INaI (REFERRED TO SITE 19ITIGATION FOR EVALLATIONIYESI NOI I <br /> 'OA7E REFERRED / / '(DATE CLOSURE LETTER MAILED( <br /> NAME OF <br /> E`/ALUATCR I <br /> 2H 23 30 (UGTWKSHT)\5/90 <br />