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SAN JCACUIH alar PUNL:C 4EAL-q S'ZV C:3/ERV[RCNNE47AL HEA -N 3VICS:CN <br />i • a"JCRKSNE-r :•CR SITE CLC'S19E =/ALUA7ICN � Inarcl <br />!MANE r:F FAC:L:T. -] ) r l war w <br />IS----- 1 Ep�J IJ !J <br />IACCRESSI �'11 T �. xl 9 C /O�(,�/�• TANK co of <br />IiANK SIZ-I (FUEL TrPEI <br />[!. C-eAEiAI SITe 4I S7CRT <br />Is oenait �•rrent?I Yes NCI Perrot �� ' <br />I I =I - Iraeility Stirs Codel©/ IOee_Sai l/CV Cacl Tesl INO <br />NLorcer or Lancs ac ,aetLlyl IAge of 7aa:s(ir avar laale)l� L IType of rakes-ceel IF tI ISngII OuaLI <br />::t. TANK HIS -.CRT <br />Was rank ceseed7l Yes X , NCI IFailed precision :est ?1Tes lx IMaI IIf yes, give Cace(s)I <br />.:as a reaair :made :o +re :artk SystewlTesl 401 IIf yes, vnat was :mai reC7l a, <br />;'Jas -sir ccre oxer inspeetimi l Yesl INa; Vere sail saeles atalyt"-Cures) INC; IBTXEj ITPN ;I I7PR 7 q/O8 <br />Type of iai lur_ldiseia l I P <br />rgel IdataStraQllCl (Lang -fella Leekagel Iaverfi LLl Iumima�nl IaCert P I %2 p 0 Z' '4 <br />:V. REMOVAL HISTCRY (A77AC3 71SPE-,:CN IC -M7 .--OR SITE OE-,AILS/C^ ' =L" 2A7A ;Og 'LS01MG POTE-RTUL ANALYSIS) <br />SoiL Sa Las iecaiveciyas b -room 'Jaterl/ / Ref/Year: Av <br />I Na00= :o bl � <br />I <br />! I I ( enge Ar!%!aL 7rs:pi;ac:aniA-1 <br />tb I110 -25I <br />jCn-Seca Vet L(s)IYesI INaI lAlu=er i TYPeI I[: rj ia�I jP�I <br />S I Score S Sere 13 <br />0is:ance :o ''et L(s) f� rank) f.; - <br />Scom <br />C i0 pts C 9 a; C <br />5 pts <br />a Iif 3 i? O <br />if <br />.2 caai:fen 3 code cion 3 <br />V. Site Feature - L--=ing PCc.7itiat Analysis _ Iis at I is met I <br />eandition <br />is <br />- - <br />Set <br />iMinim 0eetn :o ;raunaaatsr -.roti .re Sail Sa=te :feet)!�v-/ola 9 <br />j >toa 19 .51-ica j <br />I -5a\t I <br />IP-is-:ris In su sura= (avlies o aatnM3 or xr.-:cain artss)I <br />OI None I <br />!PrBanc <br />Average ArruL Pre:':pitattan (ir=es) <br />an -!Lade canaJi t3 "hien increase "meed! mgrovw <br />II <br />of Leacnace (i.e_, septic rrscas, Yater veils, pares) <br />' I Name I I 3nia;o�aR I <br />Present <br />unicue site features: .2ecoarge arts, coarse soil., nesry xtls_ <br />I - At tees�.j ,per <br />:.tan <br />I <br />INCm <br />I I <br />one <br />l IFYq <br />L.LIARI TarAL9»TaraL ?DINTS <br />I O <br />aaa;le .iesuL:- (3 T X CR El UN( -e OF 7DIAL POINTS <br />3 <br />�N g?=FloO <br />9 <br />pts ar ,mre <br />I 44 - :3 �c I ^cs ar <br />I t*i x S'J oo <br />a-3 <br />I <br />yAXINAAI ALLCUAMZ 3 -r -x•? LEVELS CP?M), <br />iai sae is <br />I 3 1.i <br />f :.1 1_ NAV <br />.r�KI e/V�t- 17Or�� AIL�M1Bt c iPM I_"VE'S <br />GuaLIAE <br />1000 <br />Ica 10 <br />I C?PM) <br />TO, OOO I <br />taxa )00 <br />PxTitOT'c5: "'!f GaamsrCed sail and/or ;round Yater :anramimatfat is present, do not csplate the LeearingPo a <br />afaLysis_ 0-e_, site is=1rr-1CtY an UGT Cam amination List 'Cr Spit Y 3rmg-d Yatar_) <br />\t [f -meft- ares t is > 5 es e g ft_, score 0 Paints- If 4m= =5 f,., do not use axle. <br />\Z [f precipitation is > :a metes, sore 0 ,points_ <br />\3 Levels far 3TUE we not aeplicmLe at a -PR �Leenc-acfan of is .3m (SawLim) or ta0 = ,dj ej)_ <br />VI. STAFF 3ECZMMENOATTCN/=CWSICM -- <br />Are 3TX i E or TPM CanCana'atiCns > Al latiecte Levels I"'es7INS} <br />i?_ 3ecamKra Site C:asuml Yesl INe j+!f Ya. ierer co Site Mitigation far <br />VII. REVIEW EVALUATi CN - 7C 3E =MPUTEa 3Y A SUP<ZVISCR/SEMICR <br />ICCVGR 'JI A STAFr iE 7MN@IDATiCM AM neroF;YE3j 401 IREZRS) 1-0 S:ic 41TICATICN .zCR <br />CA -.0 3E. =igSD / 7 / jaArc ^....^SURE _Tr Et .wi=- <br />NAME IF I /� ' <br />E/ALJA7CR I V� J1 <br />E:1 Z3 30 (UGiVKSHT)\5/90 <br />