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SAN XACU N '=NTT X 3EALTH Sc2VICES/ENVIXCNY.ENTAL HE.;LTH OIV% i <br /> � <br /> UGST ;� .,,aE-1i FCR SITE CLOSttRE IALUATICH AIe <br /> E CF :AC:LI T � <br /> T I / I K <br /> RESS I .Z 4ANz IO r _�v LCj�FJ �►� <br /> X S I ZE I CCCS FUEL rTPE I /✓l[ I _ 3 y- 00 z01`�7y -C 2- <br /> EX EU L <br /> EXEUL SITE HISTCRT <br /> Terric current? I(es o emit 3 - aeiLicy Status Cote Poe.SaWTJ C:nc i es �10 <br /> r of Tanks at facility I ge of Tanks(if 3vailabte) 1 I ype of rank �teeL prgl mgt Oval <br /> TANX HISTCRT <br /> Tank tested? yes o ailed precision test ? yes o [f yes, give date(s) <br /> a repair .node :a the :ark system? ` es 1 NO f yes, what was repaired? I <br /> repair .one txr inspection? Yes �1a1 ere sail samptes analy:ed7 est �ta 1 TXE 4?4-G1 PH•0 1 b/E08 <br /> of failureldischarge 1 ratascrophie (tong-term leakage pverfilt ( nl cher: <br /> .OVAL 9tSTCAT (ATTACH INSPECT ICN XE?CRT FCR SITE DETAILS/COLLECT OATH FCR LEACHING ?OTENTIAL ANALTS(S) <br /> L Samples .2eceived es o 1 Peach :o Grocrd 'lacer I2 of/Year 1 average Annual Precipitation = 114 110-25 <br /> VSicelett(s) 'Yes 0 umber S Type 12rr ao �-bS care S care S ecare <br /> :a ':eMz) from Tank ft; ft; ft C 1.0 pts C Pts C P pts <br /> 0 tf 0 if 0 1f <br /> ondition R ondicion X ondicion <br /> Feature - Leaching Potential Analysis s net E is net E s net <br /> ian.rm Ouch to grourdvater from :he Sail Sample (fee:) I >100 1 �i-100 1 25-10\1 C1 <br /> tures in sucsurface (applies to foothills or notncain areas) b I Yore 1 I Unkno,.n I present <br /> age ArnuaL Precipitation (inches) 1 <10 1 9 1 10-25 Ixzxzxxz 126-40%2 <br /> Made :ordtlits .hich increase vertical migration <br /> tescha:e (i.e., septic systems. water wells, ponds) None I ! Unknown resent . <br />[te,l,e'. <br /> te features: Recharge area, coarse sail, nearby wells. I At Least are than <br /> gone We one <br /> CCCL'1OV TOTALS»>TOTAL POINTS <br /> 4 <br /> sul;: (3 T X CR UXGc OF TOTAL POINTS 9 Pts or more T - 4a acs I 40 pts or tess <br /> f'' 33 T X50 150 . <br /> O<it) )1AXI.!l21 ALLCUAaL_ 3-T-X-? LEVELS (PPM) 1 I So 13 I.T 3 IX. 1. NA\3 <br /> to Xesu(•• CLINE 1COO I 100 1 10 <br /> I, /Y' I" ALLCI:ABLE TPN LEVELS (PPM) <br /> py IESc'L SO,OCO SCO lO0 <br /> VWTES: •"If documented soil and/or ground water contamination is Present, do not complete the teaching ,potential <br /> eralysis. (i.e., site is currently on UGT Coneamination List for soil or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., scare 0 points. If depth `5 ft., do noc use :able. <br /> \2 If precipitation is > 40 inches, score 0 points. : <br /> \3 Levels tar 3TXjE are not applicable at a TP4 concentration of 10 ;pa (gasoline) or 100 rpm (diesel). <br />[W! ECUMENCATICN/CCUCLUSICU 3TX L : or TAY Concentrations > tovabte Levels Tesrtmer+d Site Closure YesIf Tes, Refer to Site Mitigation for Evaluation:YALUATICN - TO 39 CCNPtETEO 3T A SL9E2YiSCR/ 'MICR 4;f- ��y <br /> MR VITH STAFF XECCMKNOATICH FCR CLOSURE YES 1 �E!"c2RE0 TO SITE 41TICATICH FCR ;VALUAIICN Y=31 <br /> 2EF°XRE0 I / / PAT: :LCSUL ETTER a ILEO � f / <br /> c <br /> CF � Z <br /> LUAiCR J <br /> 23 d0 <UGT:�CS�1T)\5/40 <br />