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SAN JCAOUIMCOIi PUBLIC 4EALrH ScRVIC_S/ENVIRCHNENTAL :4EALT*!S:cH <br /> uG5 XUSHEET FCR SITE CLOSURE EVALUATICH <br /> INANE IF FAC: ITY I y P <br /> LLJ (SLEEPS =EI <br /> (ADDRESS( (TANK 10 =I <br /> TAM% SLZEI (FUEL TYPE( zZL <br /> It. G<NE.¢AL SITE HIS GRT _ <br /> IIs ;emit current?I Yes INS IPerait YI - IFaei Lity Status cadel Occ....IIISeiL/GV Cont Tea INal <br /> eucber of ranks at facility) �J (Age of Tanks(if available) (Type of Tarrk l Steell ;t�FbrgL) ISngl Duell <br /> :It. ?ANX 'd ISTCRT ••c , `I <br /> )Vas Tank tested7lTesl INaI (Failed precision ;est 7 Yes) INoI Iif yes, give dota(s)I / / / / <br /> Was a repair mode ;a the tank systam7lYes I No IIf yes, +diet was repaired? <br /> was repair done '.rider inspection? Yes INoI (Vere soiL saepies analyxec(7 Tes INoI 3T%EI ITPB-GI ITPH-DI Pb/OBI <br /> Type ai failure/discharge) Catastrophic hang-ten leakage) overfill) lunknaunl other- <br /> :V. BEN VAL HISTCRY (ATTAC3 INSPECrICR REPCRT FOR SITE OETAILS/CCLLEC OATA FCR LE.(CNING POTENTIAL ANALTsis) <br /> Soil Saanles Recaivedlyesl NaI Depth to Gro,nd Vater n01/ �Ref/Tear b.3Avers9e Atrusl PreeipitsifonlAa114 I10-25 <br /> ICn-Site VeLL(s)ITesl No IMudxr 6 Typal IIrrI JOaa Pub <br /> S $Core S Scars S Scare <br /> Oistame ca VeIL(s) from Tank) 48n_ft., , 3?,10 ft; ft c 10 PCs C 9 pts C 5 pts <br /> 0 if 0 if 0 it <br /> R eondf tion R Condition R tradition <br /> 11. Sita Feature . Leaching Pocand4L Analysis _ is met E is met Z is sec <br /> Minims Oepth ;a grourduater from the SoiL Sacple (feet) y7 Jr- I I >100 151-100 <br /> 1.ractures in subsurface (applies to ,foothills or aancain areas) I I None I I jr*- v I (Present <br /> i <br /> )Average Annuat Precipitation (inches) zzzcctl <10 I 9 110-Z5 lx=c=l Z5-40\2 <br /> INan-Nsde cancuits which increase ver.f"L aigrstion 7 <br /> of .aschace (I.a.. septic systems, water volts, ponds) / � I Mone I unla *at Presme <br /> Unique s xe features: Recharge area, coarse sail, nearby .%L.. //wry At least ,\ /" More than <br /> \` z:;Vj�L = 7cc= Nora _/ I one ,(�' one <br /> =LM TOTALS»TOTAL POINTS « + I' <br /> la Result. (3 T X CR Q=3 pJn' UMM Of TOTAL POINTS 49 pas or acre I 41 I 40 pts or less <br /> r— PAM <br /> 6_ :oro 6 NAxIML71 ALLLLA8L5 3-r-X-c LEVELS (PPM) iI ial s0` 50 .3 .3 i. <br /> 14 e Rn L I GASCL.INE 1000 I tea I 10 <br /> MAXIML01 ALLCYARLE TPN LEVELS (PPM) <br /> TPN DIESEL 10,000 I 10CaXK 100 <br /> rCOTNOTESt a—If dcanted soil and/or ground watsr contamination is present, do t combat he Lesczing ?otenciaL <br /> analysis. (I.a., site is currently on UGT Contamination List f r ground "Car.) <br /> `` \1 If depth is > 5 ft. and < 25 ft., sco" 0 points. If depth Qi ft., do not ue table. <br /> \2 If precipitation is > 40 inches, scop O ?pints. <br /> \3 L_wels for 3T)ISE art roc applicable at a TPM concmcration of 10 ppn (gascUne) or IaO .xm (diesal). <br /> VI. STAFF .ZECCMEY0ATICH/CCHGUSICM <br /> 1. Ara 3TX 3 E or TPN C.oncmt.^atiors > Atlarable LaveLs I-Tesl/� INoI ed j Z. Recamaerd Sita Clasun{Teal IAo{X I If It Rsfer ;a Site Mitigation for Evaluation) �� <br /> '111. IFITEW VIALUATICM - TO 3E (ICHPLETZ-3 3T A SUPERVISCR/SEXICR <br /> CHCR VITA STAFF RECCMIENOATICN FCR LCSUREfYES!j OoO IRErcRRJ Ta SITE MITIOATICM FCR EVALLATTCHIYES{ ! OI I <br /> OATS IEFERREOI / / � / ���� /fIODATTS = E �'Z7ZR AALL�I / / <br /> INAME .F <br /> {a/AIUATCR <br /> _H Z3 80 (UG XSHT)\S/90 <br />