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mFNTAL ATE <br /> HEALTH SET/ICES/E)IVl�'IALUATICNHE•ALTH DIV <br /> SAN :CACUIN CCUHTT i EST FOR SITE CLOSu'RE <br /> UGST :EEPS CODE "'x 21"- � <br /> � AHX f0 <br /> C' ! <br /> L.:L! <br /> UEL TYPE LMFL` <br /> .,. SITE HISTORY ,silt ty Status C,Ce <br /> o,,SoiL/Gu ConC as ° <br /> ermit ( Dual <br /> s permit curren[7 les o ype of tank reel br3l � <br /> ge of Ianks(lf available) <br /> unser of tanks at facility <br /> TANX HISTCRY <br /> as o ailed precision fes: 7 es <br /> o if yes, give date(s) <br /> Tank tested? as / <br /> � to � F yes, what was repo ired7 PN-0 b/E73 <br /> as a repair Wade to the tank system. as ° TXE PH-G <br /> o are soil samples analY=edT as <br /> as repair done under inspeccion7es cher: <br /> acastrophic Long-ce nn leakage <br /> vert ill ^Ow^ <br /> ype of failure/discharge <br /> RE4pvAL 91 STORY (ATTACH 14SPECTICH REPORT FOR SITE DETAIL/COLLECT DATA 4FOR LEACHiNCvPO e9NeT ArnualA Pree i p itation I = 4 0-25 <br /> o epth co Grou:d 'later <br /> of/Year p 7 <br /> oil Samples deceived des S core <br /> lrr an ub S core <br /> o um)xr 3 type 5 core C pts C pas <br /> .Site wells) as ft C 0 pts 0 F <br /> ft; ft% 0 if 0 if kondition <br /> istance to Vell(s) from Tank R ondition R snondiCion R <br /> / E is net <br /> E is net E s `net <br /> Site Feature - Leaching Pocentlal Analysts 3 �O >100 11.100 I 25-50\1 <br /> inlmua Depch to gr ,ter from the Soil Saaple (feet) present <br /> None � Unknown <br /> -,,tures in subsurface (applies to foothills or wt,ncain areas) 10 25 zXzzzz 26.40\2 <br /> zxxX I <l0 g . <br /> ,rage Annual Precipitation (inches) <br /> �n•Hads cCrxYjits which increase vertical migration None Unknown ratans <br /> F leachate (i.e., septic SYst las, water wells, per'-s) I I At least ) , �7ore than <br /> i n,,•e site features: Recharge area, Coarse soil, nearby wells. zzzz `L,ne <br /> we I one <br /> . r <br /> CCLLMN TOTALS>>>TOTAL P014T5 41 48 pts I 40 pts or less <br /> RANG", Of TOTAL POINTS 9 pts or more <br /> -mole Result: (3 T X OR E) 3 E <br /> T % 8 7 X E <br /> ..(3/'= , 5 eIK3 Ec.00rjr� •3 1. 1. <br /> (PNA\3 <br /> �_ • p I,{ '• <br /> MAXI-LM ALLOWABLE 3•T-X-E LEVELS P4) 1 50 50 50 •3 10 <br /> Le Result: <br /> ASOLINE 1C00 100 <br /> 1000 - 100 <br /> 14UH ALLOWABLE TPH LEVELS (PPM) [EBEL 10,000 <br /> �g P�TPR'6- tencial <br /> .OTNOTES; <br /> ...If docunen sed soil and/or ground <br /> water con rami nation is present, do not complete the water.) <br /> analysis. (I.e., site ft current) on ints.0 Iftdepthcic<i ft., dornot tuse r table. <br /> %I If depth is > 5 ft. and < 25 ft., score 0 po r^ (gasoline) or 1C0 ppm (diesel). <br /> \2 If precipitation is > 40 inches, score 0 points. / <br /> \3 Levels for 3TXSE are roc applicable at a TPH concentration of 10 pm (9 e� <br /> STAFF RECCMMENOATICN/CCNCLUSICN <br /> Are SIX S. E or TPH Corcentratioro > ALLowabLe levels Tes <br /> 0 <br /> d ecamnetd Site Closure es o Lf Yes, Refer to Site Mitigation for Evaluation <br /> REV:_', EVALUATION • TO 3E COMPLETED BY A SUPERVISOR/SE4(CR <br /> CHCCR 4ITH STAFF RECCYM.ENOATICH FOR CLOSURE lES <br /> EFERRED TO SITE 41TICATICH FCR VIALUATICN 4ESI O <br /> a;E IEiERREo / / PATE CLOSURE LETTER MAILED / <br /> 'E CF <br /> UATCR <br /> a0 (JOTvr SMT)\5/90 <br />