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SAN :CACUM CQNTT PfHEALTH SERVICES/ENVIRCNMEVTAL 4EALr3 OIVt I qq <br /> UGST 4T- ET FCR SITE CLOSURE EVALUATICH 1 Atc I Iz ��y3 <br /> I.E CF FACILITY I �f-w i +EEPS Z Z-70 <br /> RESS I z(,rey, � '42e/ ANX 10 Y - <br /> x SIZE I jQQ UEL TTPE / <br /> G<-NE.RAL SITE HISTORY - <br /> permit current? des o ermit 1 aeility Status Code ee.so II/Gu Cana es o <br /> Fr of Tanks at facility ge of Tanks(if available) ype of tank reel brgl rql Oual <br /> TANK HISTCRY <br /> Tank tested? des a ailed Precision test 7 et o if yes, give date(s) / / <br /> a repair .made Co the clank syscees .3 Ha Ff yes, what was repaired? <br /> repair done :-der inspecaion7 lyes o dere soil samples analyxed7 es X o TXE PH-G IXI PH•0 b/EOB <br /> e of failure/discharge atascrophie (long-term leakage verfilt I n Cher: <br /> EMCVAL HISTORY CATTACH INSPECTION REPCRf FOR SITE OETAILS/COLLECT DATA FCR LEACHING POTENTIAL ANALTSIS) <br /> I Samples Received es o epth to Grcurd Vater Il✓S' ef/7ear ;g'6 verage Annual Precipitation = hG 0-25 <br /> Site Vett(s) 11 as o urber i TypeIrr paa ,b <br /> S core S core S care <br /> tante to Wells) frau Tank ft; ft; ft C 0 Pts C pts C PCs <br /> 0 if C <br /> i onditIon R cndition R ondi Cion <br /> Site Feature • Leaching Pocenclal Analysis "c is met E is met E $ met <br /> i,wa Oepch to groLTewater frau the Soil Saaple (feet) I >100 I I-= I 25•i0\) <br /> ctures in subsurface (applies to foothills or mountain areas) I None ( Unknown present <br /> rage Am at Precipitation (inches) xxzx ( <l0 I 9 10-25 xxxxxx 25-40\2 <br /> -Made conduits whi eti increase vertical migration <br /> Leschace (i.e., septic systems, water wells, Ponds) None 9 Unknown resent <br /> Ge site features: Recharge area, coarse soil, nearby wells. At leas: lace than <br /> sxxx None one I oy/nee <br /> CCLL'PN TOTALS>>>TOTAL POINTS . / <br /> le Result: (a T X CR E) RANGE OF TOTAL POINTS 9 PCs or .more Gt G8 Pts <0 pts or less <br /> 3 L X E a T X E <br /> MAXIALLCUARLE 3-T•X•E LEVELS (PPM) 1 50 50 5 .3 .3 1. I. NA\3 <br /> 'Pte Result: <br /> GASOLINE 1000 I 100 LO <br /> �AXIMM ALLOWABLE TPH LEVELS (PPM) <br /> TPH IESFL 10,000 1W0 100 <br /> INDIES: ...if dxueenced soil and/or ground water contamination is Present, do roe a the leaching Potential <br /> analysis. (f.e., site is currently on UGT Contamiracton List for sail or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., scare 0 points. if depth <=5 fc., do not use table. <br /> \2 If precipitation is > 40 inches, scar 0 points. <br /> \3 Levels for 3TXdE are roc applicable at a TPH concencraticn of 10 PPM (gasoline) or 100 ppm (diesel). <br /> TAFF RECCM•IENOATICH/CCHCLUSIO)1 E �O5p 1�� <br /> Are 3TX 4 or TPH Concentrations > Allowable Levels yes o / <br /> Recomnerd Site Closure ty <br /> es Ito If Yes, Refer to Site Mitigation for _valuation <br /> REVIE'V EVALUATICH • To 3E CCMPLe.TED 3Y A SL4E3VISCR/SENICR <br /> NC'R 'VITA STAFF RECCMMENOATICH FCR CLOSURE lyESI 0 i pEFERRED TO SITE..4ITIGAT(CM FOR EVALUATICH IVES I 0 <br /> E .RET ERRED / / PATE CLOSURE LETTER MAILED <br /> i <br /> EF <br /> UIATCR <br /> Z3 d0 (uGT:xSHr)\5/g0 <br /> r <br />