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SAN .ICACUtxC?. PUBLIC :HEALTH S-"cRVIC_S/ENV12CNMEXTAL NEALT&ISiCX qA <br /> . . UGST IX9R-;HF-E FCR SITE CLOSURE VIALUATICH OAT'c �2, eb /` 1 <br /> INANE 3F FACILITY I ISLESPS CODEI <br /> ADDRESSI ITAX% ID 41 I „0y <br /> TAMK SIZEIa� IFUEL TYPEI 1 <br /> (I. C'c4ERAL SITE HI CRY _ <br /> FIs permit currentllYesl INoI �IPerait ii - Facility Stals CO-del IDoc.Soil/G� Cant lyes x INoI <br /> Nun er Of Tanks at facility -/ IAge of Tanks(if available) (Type of TankI Steel�' Fbrgll ISngII Duall <br /> ' <br /> t(I. TANK 41STCRY <br /> leas TWK tested7lYesl INoI IFai led pmcisim :est 7 Yes INoI IIf yes, live date(s)I <br /> :Was a repair made to the tank sys"aff? yesNa IIf yes, what vas repaired?) <br /> I <br /> IVas repair done under iropeotim7l7esl INoI IVere soil satples aralyteo?IY"I ITXEI Fps-GI I <br /> No STPH-OI IPb/pal I <br /> Type of Failure/discharge) Catastrophic Itorq-Lara Leakage) awrfilll IU*ra I other: <br /> Y. 2E4CVAL HISTORY (ATTACH IXSPECTICH 2EPCRT FOR SITE DETAILS/CLLECT DATA FCR LEACHING POT1,ATIAL AXALTSIS) <br /> Soil Smotes ieesived Tal MoI Depth to Grau1d VaterI-11ARefivos �n Avenge Arcual PrecipitatimlA•I14 110-25 <br /> ICn-Size Vet L(s)IYes1 INoI INutber L Typal IIrr1 Dam Publ <br /> 5 Score S Seare S Score <br /> 10i3tarct to VeLL(s) frm T4nkl_52r_ft; f-; ft C 10 pts C 9 PCs C 5 PCs <br /> 0 if 0 if 0 if <br /> R Condition x corditim R eendi tion <br /> IV. Sita Featur • Leaching Potential Aratysia is net E is met _ is met <br /> INinim Depth to groeter frthe Soil Saaote (feet) (�G yr I >100 I51-100 I 5' 1 ?5-50\t <br /> uwdwom <br /> (Frac-urs in subsurface (applies to foothills or axntain are") 1 I Nora 1 I Unkrw I (Present <br /> IAverage Arvasl Precipitatim (inches) xxxsxxl <10 I 9 1 10-25 lx==l 25-40\2 <br /> lMan-lade conduits vhich increase vertical migration \ �7J <br /> of :eachate (I.e., septic systams, nater watts, pones) J`J' ( Nae I I Urlawovn Present <br /> Unique site 'features: Recharge aro, coarse soil, nearby walls. I At least) More than <br /> av xxxxxs Neta ane as <br /> 1 tU =L701 TOTALS»>TCTAL POINTS �� I + I + I = <br /> a .les �• (S T X RANCc Of TOTAL ?LINTS 49 pcs or are 47 43 Pts I 40 pts or less <br /> 9� A i <br /> FO <br /> -r-SA <br /> � �• �' (MAXI" ALLOAUL_ 3-T-X-<_ LEVELS (PPM) ;I TO SOI SO .3 I.3 i.I 7. NA\3 <br /> GASOLINE lace I l00 I IO <br /> MAXI" ALLCYARLE TPH LEVELS (m) <br /> -J-{IO �1� iPlC,O� DIESEL 10,000 7000 100 <br /> IF` TNOTES: —If doecmented soil rd/or grand Water contamination is present, do metato eta the teaehirg potential <br /> ` ane Lysis. (I.a., site is currently m UGT Cmtaminatim List for soil or grand voter.) <br /> 6� \1 If depth is > 5 ft, arid < 25 ft., scare 0 points. If depth a'S ft., do roc =e ;able. <br /> \Z If pmcipitatim is > 40 inches, scop 0 points. <br /> \3 Levels for 3TXSE am not atpticable at a TPN cancentratim of 10 .'Fa (gasalina) r Ica ppm (diesel). <br /> Vt. STAFF .2EC=4HE4DATICX/=C!."SICX / <br /> t. Are 3TX .1 E or TP traticns > Allowable Levels I-Yesl INo <br /> _. .2 --ld Sita C(osumI Yes INoI If Its, Refer ;o Sita Nf tugatim for Evatustim <br /> TO 3E L:IED 3T A SUP<_4Y1 SCRITZRICt <br /> CZHCR 'VITH STAFF ZECOWE40ATICX FCR 'LCSUREIYESI �NOI IR£rr-3..RE] TO SITE NITIGATICH FC2 __VAL'1,tTI01 YES (NCI <br /> IOATE 3E?aRRflI ) / S / qS' <br /> IDA TZ CLOSURE L_Ti ER AAI LEDI / / <br /> INA.'(E, OF <br /> EVALUATCR <br /> E:'. ? as (UG,.XSHT)\7/90 <br />