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SAN 'CACUIH COUNTY N HEALTH SERVICES/E4VUCMME4TAL HEALTH Olv1 I AIE <br /> UGST HEFT FCR SITE CLOSLIZE EVALVAMN Z <br /> .E OF FACILITY I S E / <br /> DRESS I y/ AX l0 Y <br /> NX SIZE L TYPE C <br /> GENERAL SITE 'HISTORY - <br /> permit current? eso ermit 3 aeitity Status Cafe ae.Soil/Gu Conc es o <br /> rcer of Tanks at facility g' of Tanks(if availab(e) Iype of Tank teal brgl ngl Oual <br /> TANK HISTORY <br /> Tank tested? des I o ailed precision test 7 4es o (( yes, give date(s) <br /> a repair made to the lark system? as No E yes, what was repaired? <br /> repair done under inspeccion7 �Ies o ere soil sams alysed? 'Yes o TXE PH•G I PN•D b/EDB <br /> plean <br /> e of failure/discharge atastrophic Long-term leakage verfill own cher: <br /> EMOVAL 3ISTCRY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> it Samples Received as oa <br /> I epth to Grand 'later of/Tear iXb average Arnual Precipitation v (iG 0-25 <br /> Si to 'Wett(s) 'Yes I a lumber i Type Irr Cf° to S core S Scare S ecoro <br /> tante to ',telt(s) from tank f ft; ft; ft C pts C Pcs C Pcs <br /> O if 0 if 0 f <br /> R endicion Rmdition R ordition <br /> Site Feature - Leaching Potential Analysis "c is met E is met E s met <br /> ims m Death to groutdvacer fr xn the Soil Sample fleet) 1.lQ�1'$:� I >100 I - 1.100 I ,'I�25-50%1ctures in subsurface (applies to foothills or movitain areas) None Unknown <br /> :rage Arnual Precipitation (inches) zxxx I <10 I 9 10-25 zszzxx 26-40\2 <br /> -Rade conduits which increase vertical migrationresent <br /> leac4a;e (i.e., septic systems, water wells, ponds) None 17 Unknown <br /> At least ) are than <br /> q:e site features: Recharge area, coarse soil, nearly wells. zzzx None one oone <br /> CCLLVN TOTALS»>TOTAL POINTS <br /> le 3esulc: (3 T X CR E) RANGE OF TOTAL POINTS 9 PCs or more 41 • 48 Pts I 40 pts or less <br /> 3T X d T X E <br /> MAXIALLCUABLE 3-T•X-t LEVELS (PPM) 1 SO 150 I S I .3 .3 1. 11. F NA'3 �w <br /> le Result:/ 7 CLINE 1060 100 I 10 <br /> 7-P (J"TPH �Ax IlUM ALLCI:ABLE TPH LEVELS (PPM) i I 1 100 <br /> fESEI 10,OCO 1000 <br /> IND t£S: ••'1f documented sail and/or grovel water contamination is Present, da c template he .-aching potential <br /> analysis. (i.e., site is currently on UGT Contamination List fo ground water.) <br /> \1 If depth is > 5 ft. and < 25 Et., score 0 points. If depth <=5 it., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXSE are not applicable at a TPH concentration of 10 Ppm (gasoline) or 100 r"p*m (diesel). <br /> TAFF RECCWMENOATICH/CUCLUSIOH <br /> Are 3TX L. E or TP4 Concentrations > Allowab Levels Yes o <br /> Recommend Site Closure as � if Tes, Refer to Site Mitigation for Evaluation <br /> REVIEW EVALVATICH • TO 3E COMPLETED 3Y A SUPEAVISCR/SENICR <br /> HCR WITH STAFF AECCNMENOAIICN FCR CLOSURE i4 ES 0 I � EFERREO TO SITE 91TICATICH FOR EVA LUATICH ETES I 0 <br /> E 3e_FERRE] I / / ATE CLOSURE LETTER YAllEO 1 / <br /> IUAiCR <br /> 23 d0 (Ucc:xSHry\5/90 <br />